28704 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-,USE BALL POINT PEN ONLY '
CITY OF CUPERTINO RUMBI�NG.MECHANICAL � _ PERMIT NO. 28704^ �O w
BUILDING DIVISION , APPLICATIONIPERMIT PING PROJECT
Lt8J 4
BUILDING PRf1JF.CT IDBNTEMICATION
BUILDING ADDRESS: SANITARY NO, APPLICATION SUBMITTAL DATE
OWNER'S NA E: PONE: CON'RACTOR'S NAME: 'LIC NO:
xj7FXLP••`w_1 I . NBC CONTROL If
ARCHITECTIENGINEER: LIC NO: ADDRESS:
CONTACT: _ PHONE: - - BUILDING PERMIT INFO
❑ Consultant Fees.Paid by Applicant(Initial) BLDG EnT PLUMB MECI;
LICENSED CONTRACTOR'S DECLARATION Qq`Y ELECTRIC PERMIT FEE 'A7�T•`
I heFebr
y affia aunt 1 am licensed ander.pnrvislnns of chaplet 9(xmnmeedng - JOB DESCRIPTION
�,-O='R win Section 7000)of Division 3 ofthe Business and Pnd'essionx Cade,and my license is RESIDENTIAL: -
in full force and effect. - ,. PERMIT ISSUANCE
V License Class Lie. OSFDWI. O KITCHEN REMODEL
Q U .
a Uma r APPLIANCES-RESIDENTIAL [71 ADDITION [_1 PLUMBING R&PIPE
.� - ' '
p.Dm
ARCHITECTS DDECECLARATIONPANELS OMULTI-UNIT OSTRUCTURAL
y O w 7a drnmnd my plans nhall us d as publico curds MODIFICATION
p',�'3 UP T0200AMP5 ❑INTERIOR ❑CHIMNEY REPAIR'
u1 Licensed Professional 201-1000AMPS .IMPROVEMENT
OWNER-BUILDER DECLARATION
t-1'PC a I hereby anion mal 1 am exempt from the Clmranor',License Law fomhe OVER-HROAMPS ❑BATH REMODELREPAIR 0 DEMOLITION
X05
0,L) following reason.(Section 90315,Business and Professions Code:Any city or county gIGNS ELECTRICAL OOTHER
sw 1.D I which reyuirec a permit to construed,utter;improve,demolish,or repair any suucture
pCzy g pnmmidai......clod,requires lheapplicam for auto permit la file a aigeed almmenl SPECIAL CiRCUIT/MISC.
W Gds that he is licensed pursuanrto the provisions of the Contractor's License Law(Chapter 9 '
i4tll QO (aommencng with Section 9000)of Division 9 offine BusiressaindP fe dans Cale)or TEMP,METER OR POLE INST. COMMERCIAL:
a y m rG
that he is exempt therefrom and the basis for the alleged exemption Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
i IL
Section 7031,5 by any applicant fpermit subjects the applicant to ac it penalty of POWER DEVICES [-]TENANT OFOOD SERVICE
not mare man five hundredr' II ($5W). - IMPROVEM
,
r'C I es owner of me pr p ny y ploy m gas as tb' I pensaeoq SWIMMING POOL ELECTRIC O 1
X64! wdldo the work,andthe. t lime dr' fd dfrr. l (S ']044 Bnsunees
El HE R
and Pacfessmns Code ThmCcurifirsavols License Law does not apply to an owner of OUTLET'S-SWITCHES-FIXTURES �(-RJ' \ISE alk
n' r propeny who builds or improves thereon,and who does such work hi mself orthrough VF" V� '
his own employees,provided mat such improvements are not intended or offered for NEW RESIDENTIAL ELECTR SQ FT. - N
aide.If,however;me building or improvement is sold within one year ofcomple.ion,the SQ.IT.FLOOR AREA S/SQ.ET.
owner,builder will have the burden of proving that he did nm build or improve for pur-
pose of sale.). -
Ol,as owner or the property,am exclusively commaing with licensed contractors to -
- construct the project(Sec.9044,Business and Professions Code:)The Contractor's Li-
censsLawdoesnotapplyto an owner of property who builds of improves thereon,and QTY PLUMBING PERMIT FEE .
who maintains for such projects with a emolumrts)licensed pursuant o me Contractors
License law PERMIT ISSUANCE `
O l am exempt under Sec., ,B&PCf�:tl a reason ALTER=DRAIN&VENT-WATER(EA) EVALUATION
owner Dam •..
WORKERS COMPENSATION❑F,CLARATIO� BACK FLOW PROTEC f.DEVICE,
I bcrcby e[finn under penalty of perjury ono of me fnlln deeluindir s
I heveand will uoalnmin aCeni[Ic..e of Corrsenl to self-I refer Workers mpen- DRAINS-'FLOOR,ROOF,AREA.GOND. STORIES TYPE CONSTRUCTION
m,as provided for by Section 3]00 of the Labor ,for the peRonrua of the -
w irk for which this permit is issued. FIXTURES PER TRAP .t
1 have and will maintain Warkers Co millennia as required by S lien -
00ofineLabor Code,for the per a ofthewmkfoi which this permi[is iss ed. GAS-EA.SYSTEM-II1,7.4OUTLETS OCC.GROUP a ANN_
Worker's Compensatin m - tamer and Policy ra mbar are:
C i Policy No.: GAS-EA.SYSTEM-OVER 4(EA)
RT TE OF EXEMPTION FROM WOR KERS'
COMPENSATION INSURANCE GREASUINDUSTRL WASTE INTERCEPTOR ,
G section need not he armplend ifthe permit is source handred dollars($IW) BUILDING DIVISION PBBS
or less.) GREASE TRAP PLANCHECK FEE^
leenif hat in the performance lithe work for whit pe lis issrwl,l shell SEWER-SANITARY-STORM EA,200 FT.
not employ any n in any manner sr ae m he .rot nrken'Cnmpem ENERGY FEE
O,Z smirntawsof C..,a---Dade a ATER HEATER W/VENT/ELECTR -
7 C Applicant_ GRADING PEE
G f�q NOTICE TO APPL1 NT:if,after kin 1 ode of Exemption,you should gTER SYSTEM/1'REATING
abecome subject to me orkers Qumpc a nor .tons ol'the Ludo'Code,you t SOILS FEE
W fonhwim comply with s ch pace' 'ua o In it shall be deemed revoked, TBR SERVICE -
Q
CO STRUCTION -NDINGAGENCY N. RESIDENTIAL PLM.. SQ.FT. PAID
U O Thereby affirm that aronslruc'onlendingtgencyforthe rioters of u - Data Recei 4
t••t the work for which this per 'tis issued(Sec: 197,Civ,C.) ,
ct C•t Lenders Name TOTAL:
4UkI Le 1-1 Address TOTAL:
LI...tt " I eerily that I have can his apdo stem and state that a no a information is BUILDING FEE
fr clon canga.I agree do comply with I city and county million and ate laws relating to QTY. MECHANICAL PERMIT FEE
Uz hui4dics conshuc.iogand hamb eumorizerepreaemmm So fdaisek,tainarupnnth, SEISMIC FEE
above-mentioned propeny for in coon purposes PERMIT.ISSUANCE -
(We)agate m save,Indemn y ead keep hn ass lh'e Cly of Cupertino....... '9 ELECTRIC FEE
liubilidies,judgments,costs and expe seswhichm in any way same against said City ALTERORADDTOMECH.
inconsequenceoflhegrantinpofdhis act PLUMBINGFEE
APPLICANT UNDERSTANDS AN WIT, COMPLY WITH ALL NON-POTNT AIR HANDLING UNIT(TO Itri CPM) MECHANICA E
SOURCEREGULAT NS. _
'i/ ow AIR HANDLING UNIT(OVER 10,000 CFM), - CONSTRU PENTAX
ign neo ApplicanUCrml o - Data EXHAUST HOOD DOIDUCT)
HAZARDOUS MA ERIALS DISCLOSURE BOOSTMITIGATION FEE
Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(TO 100,000 BTU)as defined by the Cupertino Municipal Code,Chapter 912,and due Health and Safety
Code,Section 25532(a)9 HEATING UNIT(OVER 100,001)BTU)
❑Yu ONr,. _ VENTILATION FAN(SINGLE RESID) EA
Will.he applicant or future build ing occupant use equipment or devices which
- Data Receipt#
it hazardous air aootamments as defined hy,lhe Bay Area Air Quality Managemenl
:m0BOILER-COMP(JHP OR IOO,OlO BTU) -
istrid? 1 00(1
'O Yos r, ,0No BOILER-COMP(OVER 100, BTU) TOTAL:
' I have read the hrandous nnmials requirements under Chapter 6.95 of the Cal i- AIR CONDITIONER - ISSUANCE DATE
soman Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if.he NEW RESIDENTIAL MECH. SQFT. '
building does not currently have Tenant,that it is my respcmihility m narify the excellent . -
of me requirements which must h met prior to issuance of a Certificate of Occupancy.
Owner.,authorized agent Date - TOTAL: ISSUED BY:
OFFICE
• Inspection Query for a Specfic Permit 10/15/96
• PERMIT# SITUS ST SITUS STREET Lot# INSDESCRIPT InsType DATEDESIRED
28704 21975 SAN FERNANDO PLMBG 12/1/95
28704 21975 SAN FERNANDO PLBG/POOL 12/7/95
28704 21975 SAN FERNANDO ELECT/BONDING/ 12/11/95
28704 21975 SAN FERNANDO ELECT 12/18/95
28704 21975 SAN FERNANDO STEEL PLACEMEN 12/18/95
28704 21975 SAN FERNANDO BONDING/POOL 12/20/95
28704 21975 SAN FERNANDO REBAR/STEEL 12/20/95
28704 21975 SAN FERNANDO BONDING &STEE 1/2/96
28704 21975 SAN FERNANDO R PLBG 1/2/96
28704 21975 SAN FERNANDO PLMBG 2/2/96
28704 21975 SAN FERNANDO REBAR 2/2/96
28704 21975 SAN FERNANDO REBAR/BLKBRY P 2/12/96
28704 21975 SAN FERNANDO BONDING/POOL/S 2/27/96
28704 21975 SAN FERNANDO REBAR/POOL/BLA 2/27/96
28704 21975 SAN FERNANDO SLAB BONDING 3/5/96
28704 21975 SAN FERNANDO UNDG ELE/BLKBE 3/27/96
28704 21975 SAN FERNANDO SEWER 3/29/96
28704 21975 SAN FERNANDO POOL INSPECTIO 4/12/96
26704 21975 SAN FERNANDO GAS TEST BLACK 5/9/96
28704 21975 SAN FERNANDO GS TEST/BLACKB 5/10/96
•
Page 1
Inspection Query for a Specfic Permit 10/15/96
• DeteDone Inspector Units Pass/Feil Code
12/1/95 CC 2 P
12/7/95 JS 3 P
12/11/95 JB 2 N
12/18/95 JB 1
12/18/95 JB 1
12/20/95 AD 2 P
12/20/95 AD 2 P
1/2196 AD 2 F
1/2/96 AD 2P
2/2/96 JB 2 P
2/2/96 JB 3 P
2/12/96 AD 2 P
2/27/96 JB 2 P
2/27/96 JB 2 P
3/5/96 AD 3 P
3/27/96 AD 2,P
3/29/96 JB 3 P ,
4/11/96 JB 3P
JB T
5/10/96 AD 21F
•
•
Page 2