29112 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO ' BUILDING-ELECTRICAL. PERMITSI
BUI7�IHNG DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 1
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARYNO. APPLICATION SU13MMAL DAT
10 5M
1 X�/
OWNER' NAivlli: t) r CO " CT 'SNA :: I�yQ:
G� Q N/C CONTRO1.1
RCHI Cf NHNEER: LIC NO: ADDRESS: ❑
CONTACT: PHONE: BUILDING PF,RMIT INFO
�_ ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLLUMMB MECH
le
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEF,
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
OW=Z [h SeeddimWl00)of Division Sof the Bresiocxsmld Porfessions Cale.rad my license is RESIDENTIAL
Op with PERMIT ISSUANCE E
Fly in full Tome an sn,rr I. ❑SFDWL ❑KITCHEN REMODEL
4 V U License Class d Lic.X APPLIANCES—RESIDENTIAL ❑ADDITION ❑PLUMBING RE PIPE
N 6 w Date Cootracmr
ARCHITECT'S UIiChARATION D MULTI-UNIT D STRUCNRAI,
p.7 car PANELS
Zpnn ZZ l understand my plan.cshal be ns ed as p.hlle record. MODIFICATION
OZ—Q UP TO 300 AMPS [D INTERIOR ❑CHIMNEY REPAIR
F 14FW Licensed Pmfir.imul 201-1000AMPS IMPROVEMENT
9y2; OWNER-BUILDER DECLARATION OVER 1000AMY5 ❑BATH REMODEUREPAIR [I DEMOLITION
a 6 1 hereby affiral I stn exempt form the Contractors License Law for the
X 3 a m N
U following reason.(Section 7031.5,Business and Professions Cale:Any city or county SIGNS ELECTRICAL. ❑OTHER
Y1 4 which requires a permit to congmc4 site,improve,demolish,or repair any u actarc
prior to its issuance,also requires the applicant lit such permit In rile a signed x1roment SPECIAL CIRCUITIMISC.
Obit he is liccrwdpur.until o the provisions oldie Contractor's License Un.(ChuprrY
apo (commencing wi[hffivtiist7000)of Ddidon 3of the Birunes,ted Pr�fc,uor,Code)or TEMP.METER OR POLE INST. COMMERCIAL:
tL a o LL that he is exempt therefrom and the basis for the alleged exemption.Any violation of D NEW BLDG/ADDITION D D13MOhITION
5
�m Section 7031.5 by any applicant for a Permit subjects the applicant to a civil pewlty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
not more than five hundred dollars(8500). IMPROVEMENT
D
F Z}
_Ql.as owner of me propcny,or my employees with wagcsas theirsnle rnmpensauon. SWIMMING P(R)LELECTRIC
0 will do thework,erd lhempremre is net intended mof(ered forsale(Sec.9(/1J,Business ❑OTHER
tail and Professions Code:The Contractor's License Law does not apply to an owner of OUTLETS—SWITCHES—FIXTD
d
property who build,,,,hnpnwcs thereon,and who Jncv such work hlnnsdl car trough
his own employees,provided that such Itnprovenunts are not intended or offered for NBW RESIDENTIAL I?I.ECI'R SQ PI'.
side.If,however.the huddingor improvement is sold within oneycurofcnmpleion,the00, SQ.FT.FLOOR AREA VSQ.FT
owner-builder will have the burden of pmving that he did not build or improve for par
puseofsale.L
D L as owner of the property,am exclusively contracting with licensed comm atersm !!k
AL
project(Sec.9014.Business and Professions Code:)The Contmem's Li- Q y�
ase law does not apply to an owner of property who builds or improves thereon,add QTY. PLUMBING PERMIT ,
who umwtta for such pmjmts with v mm�wun(s)licensed puntup,m the Comracmr's es
License Law. PI7RMIT ISSUANCE (\ n�/ 'I�QXX
D l am excnn,t Boder See. ,B&PC far lbla revsen C (� 1 I 95
ALTER-DRAIN&VENT-WATER(EA) VALUATION
Owner WORKER:SCOMPENSATIONDECLARATION HACK FLOW PROTECT.DEVICE (��I Vr \Xu�dIN( I
1 hereby rizo umlcr penaM1y of perjury one of me following Jeclumtions: IIIYY005 WO
I have and will maintain aCenlfcate of Conscnuoxelf-insure for Worker's Compen- DRAINS—FLOOR,ROOF AREA,CON❑.
STORIES TYPE CONSTRUCf10!
cation,as provided for by Section 370E of the Labor Code,for the prof anor of the
work for which this pennit In issued, FIXTURES—PFR TRAY
1 have and will n orionm Workcr's Cn..re...lion loomanec,as requited by Section
3700.fthe Lala,Code.for lhepcommmot oflhe work for which[bis pennit is issued. GAS—EA.SYSTEM-1 INC.4 OUTLETS OCC.GROUP APN
My Worker',*, pc tion u c and Policy no he re: 21 GAS—EA.SYS'IEM.OVER 4(EA)
Carrie P Policy No.:
CF.RfIFl ATEOP SEMINION FROM WORKERS' Iia GREASFANDUSTRh WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(This section need not he completed if[he permit is forunc hundred dollars(SOW) GREASE TRAP
car Icss.) PLANCHECK FET,
I ecoifymnt In the pe,furponerf in,work fnrwhlchthi.apennitln is,avd,[,half SEWER—SANITARY—S'IURM EA.200 FT.
not employ any perom in any manner so as to hecome.snna
hjeco the Wders'Compen. ENERGY 17EE
� sZ sation laws of Calibroa.Dare WATER HEATER W/VESFUELECTIt GRADING FEE
Z 2 Applicant
aNOTICE TO APPLICANT.If.after making(his Certificate of Exemption,You should WATER SYSTEMODIDGING SUITS FEE,r, became subject to the Workers Compensation provisions of the Labor Code,you must
forthwith comply with such provisions or This permit shall be,deemed revoked. WATER SERVICE
Q
:Dz CONSTRUCTION LENDING AGENCY NEW RESIDENTIALPI,MB. SQ IT. PAID p
I hereby affirm that there is a conatmction lending agency for the performance of
V U. the work for which[],is per mit is issued(Sec.3097,Civ.C)
lenders Name
TOTAL.:
{Uil Lenders Address TOTAL:
1 I certify that 1 have revel Nis application and state that the above information is BUILDING FEI
h correct.l agree to comply with all city and county ordinances and state laws relating to QT'y, MECHANICAL PERMIT FEE
V z building constip ,and hereby authorize representatives of this city to enter upon the SEISMI , \
.Nop-nenumad!property for inspection purposes. PERMIT ISSUANCE
(We)agree m save,indemnify and ke,bunoless the City ol'Cupenino against F?hECfRIG FEE
Inddities,judgmem vac t%.and expenses which may in any way accrue against said City ALTER OR ADD TO MECH.
nscqucncc of Nc grani of lhi permit. PLUMBING FP;
APPLICANT UNDEN S AN)S DWITO( , OMPLY WITH ALL NON-POINT AIR HANDLING UNIT O10.000 CFM) MECHANICA
nN
S) RCE REGULATE S.
AIR HANDLING UNIT(OVER IR00 CFM) CONSTRUCTIONTAX
Si namrt ofApplicvnUComra or ate EXHAUST HOOD DYMUCT) HOUSING MITIGATION F E
HA7.AR US MATERIALS DISCLOSURE
Will lheapplicanl ort core building txeupuntamrc nr handle htrzarJon,material I(BATING UNIT(TO 100,000 BTU)
as defined by the Cupenino Munidpal Code,Chapter 9.12,and[be Health and Safe,,
Codes Sectinn 25532(07 HEATING UNIT(OVER 100,000 BTU)
❑Yes ❑No VENTILATION PAN(SINGLE RES ID) PAID
�\
Dam Receipt X
Will he a lcant nr future building occupant use equipment nt or devices which
hsaNus it cnmaminvnts as defined by the Bay Area Air Quality Management BOILER—COMP(31111 OR 100.000 BTU) TO
TAL:
Tmstnd1
BOILER—COMP(OVEN 100,000 BTU)
Fl Yes D No
(have mad theoreticians materials requirements under Chapter e.95 of she Cali- AIR CONDITIONER ISSUANCE DATE
fmnia HeaIN&Safety Cute.Sectiotss:S505,25533 mrd 25534.1 undersand that if Nc NEW RESIDENTIAL MECH. SQ.FT.
building does not currently have a tenant.that it is my responsibility m unify the occupant
of the requirements which all be con prior a issuatee of a Cmificara of Occupancy
X
(Owner or uuthorizvJ agcm Doc TOTAI; ISSUED BY:
OFFICE
si
TEL Dec 20'95 11 :42 No .003 P.01
BERG C.UO Int.
Wednesday, December 20, 1995 11:41
IC
From: - To: U
I
Name: Cindy Wong Name: Kevin Antonelli
Company: Berg C.I.H. Inc. Company: Turner Construction Company
Phones (415) 291-8700 Phone: (408) 295-7598
Fax: (415) 291-9433 Fax: (408) 295-7698
Total number of pages, including cover: 3
Message: -- ------�
Bulk sample results for 10500 Ridgeview Court, Cupertino. Please call if you have any
questions.
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MAP in hWa,(OfiraM g41o4•i114 Phone w4lao 40104"
%I TEL ; Dec 20'95 11 :42 No .003 P.02
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