30852APPLICANTTO FILL IN INFORMATION WITHIN RED LINES • USE BALL POINT PEN ONLY.
•
CITY OF CUPERTINO BUILDING - ELECTRICAL
BUILDING DIVISION APPIACATION/PERMIT PLUMBING - MECHANICAL
BUILDING PROJECT IIIENTIFICA'TION
PERMITNO. /� O O � !�
J O L
BUILDING ADDRESS:
09 s.
r SANITARYNO.
APPLICATION SUBMITTAL DATE
4 3-9'7
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❑ Consultant Fees Paid by Applicant (Initial)
-
BUILDING PERMIT INFO
BLDG ELECT PLUMB
tfhK Jp�(`. ,S7p�,
LICENSED CONTRACfUR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section of Dlvisina 3 arthc lusiness and Professions Clue. and mylinam"is
in full force and effect.
License Class Lic.# Z"I
Dam Comrunor
QTY
ELECTRIC PERMIT
FEE
JOB DESCRIPTION
RRSIDENTI JO
❑SPDWI. ❑ KITCHEN REMODEL
❑ADDITION ❑PLUMBING RE -PIPE
�,
❑MULTI -UNIT .�$TRGCfORAI.
MODIFICA'T'ION
[I INTERIOR El CHIMNEY REPAIR
IMPROVEMENT
❑ BATH REMODEUREPAIR ❑ DEMOLITION
❑OTHER
'
PERMIT ISSUANCE
-
APPLIANCES - RESIDENTIAL.
AR ITECI'S DECLARATIO
'�
- y�1—.� Jcjj��IN`T Xd my plans shall he u,wd as public mcordfs
A�J�lll.� �.�
PANELS'
UPT021HIAMI'S "
Licensed se siona
Oat I an exempt f DECLARATION the Commoto
1 hereby affirm that I am exempt from the Cnmmmors License law for the
following reason. (Section ]03L5,Bu. sines% and Professions Code: Any city m cony
which requires a #,unlit to construct, alter, improve, demolish, or repair any soucmrc
prior to its issuance, alsorequi¢sthe applicant for such pemrino fdevsigned suromem
tom he is licensed po ati n to the provisions of the Contractor's License law(Chapter9
(commencing with Section against Division 3 ofNe BUSinesand Pmfcxsions Cede)nr
thin he is axempt therefrom and the basis for the alleged exemption. Any sminisn of
Section 7111 IS by.ny applicant for u..milt subjects the upplicnm to a civil pemJly of
ma am hum five hundreddollars (3500).
❑1, as owner ofthe property. or my employees with wages a their sole compensation,
will dodo, work, and the structure is not intended mourned forsake (See aW, Business
and Professions Code: 'Me Contractor's License Law does not apply m an owner of
property who holds or improves there..., and who does such work himsdf or through
his own employees, provided that such improvements are and intended sr offered for
sale. If, however, the building orimpmvenent is sold within one year ofcompletion, the
owner - builder will have the burden of proving that he did not build or improve for pur-
pose of sale.).
1, ar owner of the pndpery, am axelusivcly wnweting wiN licensul cmttuttnrs m
(See onse Law notlpply]044,Businessandrty who huilds Cs or i The Cs thereon. Li
Law Jcesnnapplyean with a connotations) wonbuildsorimprovea thereon. and
who 1. Law. for wchp jee¢wiNacnmmcorts) licensed pursuannolhe Contractor
Lic<nse Law.
❑taro exempt under SCC. ,N &PC for this rectum
201.1"AMPS
OVER ["AMPS
SIGNS ELECTRICAL.
SPECIAL CIRCUIT/MISC.
TEMP. METER OR POLE INST.
❑ %W BLDG 1' 0 HMOLITION
TENA,{p�T��TH'.gr /tp�RVICE
PR§ /1Dpr' C. tV
❑OTHC•R t�
NO
POWER DF.VICHS
SWIMMING POOL ELECTRIC
Ofr11LTS - SWITCHES- FIXTURES
NEW RESIDENTIAL. F,LECTR SQ Pr.
SQ. FT. FLOOR AREA
I/� -ate /� /�
v ✓2-9 [�'l /)
$/SQ. n..
IS I,
N�"Mll Td
QTY. PL MI
FEE
PERMI NCE
ALTIiOf DRAT ENT- WATER(EA
Owner' Dale
VALUATION
�
.J WORKER'S COMPENSATION DECLARATION
I hereby walumunder Penalty eoe perjuryoneof doefollowing decimations
powidilmaitny eCen3700of the Lab mCone, far the Worker's Cooper.
Work us provided for by Ss issued. 3]00 of the Lvhnr Cude, for the perforrnnnce of th,
work for which this permit is issued.
1 have and will muimain Worker's Compensation Insurance, m required by Section
l]OOn ,tabor Cale. Bee the perfurmance of Ne w�rkforpwbh�ichatryhispermit is issued
M arker" rMetFadUN 1pcuranC`C'✓me vol cy NtiYH_
orfa: /VI-G Lr /N7
CER'1'IINCA'fF:OF HX1iMPTION PROM WORKfat s'
COMPENSATION INSURANCE
(This section need not be completed if the permit, is forms, hundred dsllarspinso
or less.)
Toy any that in in any manner tworkfor which this the W rkers sampan.
not employ any person In any manner sss us m beconm subject m the Workers Compem
sourer Laws of California. Date
hcanl
BACK FLOW PR r. D'V10E
DRAINS - OR, ROO ;A,COND.
STORIES
TYPE CONSTRUCTION
�1
Y�r
FIX '1'UR
GAS -t?A. SYSTIi C. IITI. S
OCC. GROUP
APN
GAS -EA. SYSTEM -OVER
G1t1iASFJINDUS'1'RL WASTE INAWEPFOR
BUILDING DIVISION FEES
GREASE TRAP
PLANCHECK FEE
sr
SEWER- SANITARY -STORM I7A. 200 FT
ENERGY FEE
a..+
WA'T'ER HEATER WNENT/ELIi TH?
GRADING FE
NOTICE TO APPLICANT. IL alter making this Certificate of Exemption. you should
become subject to the Worker's Compensation provisions of the Labor Cole, you must
forthwith comply With such provisions or this permit shall be deemed revoked.
P P
CONSTRUCTION LENDING AGENCY
thereby affirm that there isaconhwmiun lending agency fonhe performance of
the work for which this permit is issued (Sce. 309], ON C.)
Lender's Nnne
WATER SYSTF.MAREATING
SOILS TEE
WAIT ?R SERVICE
JV
PAID
ate Receipt#
NEW RESIDENTIAL PLMB. SQ. Fr.
OTAL:
Lender's Address
1 certify that I have read this application and slam that the above information is
Imal tagrcc to comply with all city end county ordinances an d rum la., relating do
building construction, and hereby nomadic representatives of this city to enter upon the above -mentioned property for inspection purposes.
(Wu) vgrea ro auv,, inJOmni[y unit keep harnJchs the Ciry'sf Cupertino agvinet
Ilabilities,judgii cashoul expenses which may funny way accrue against said City
in ..sequence of the granting of this Permit. A cPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
S URCE RE LATIONS.
QTY MECHANICAL PERMIT
PERMIT ISSUANCE ..
R_CONsFRU�
$NTAX
A] ITR OR ADD TO
p1µ HANDLING UNIT (TO 1(1,(#X1 CFM)
AIR HANDLING UNIT (OVER Ig1XX) CFM)
Sawn of pp fear 'nnoscon D e
HAZARDOUS MATERIALS DISCLOSURE
Will thcepplicum or future building occupant store or handle hazardous material
as definul by the Cupeninn Municipal Cnde, Chapter 9,12, and the Dream and Safety
Code. SCLllon 25532(%)'!
❑Yes ❑No
Will the li licam or future building t use a
pp dby the Area equipment devices
mid hazardous air mnmminams as delineJ by the Buy Area Air Quality Management
Ulsrtict'!
Fl Yes (]N,
1 have ad the ho m leas materials reyuirentcnds under Chapter fi.95 of the Cali
Tanta Heahh re & Study Code. Sections 25505, 25533 unit 25534. 1 undeismnd Nat if the
building costs 'lot racially have a Mount. that it is my responsibility to loudly the occupant
of flue requirements which must be met prior o issuance ids Certificate of Occupancy.
EXHAUST HOOD (W /DUCT)
HOUSING MITI TION FEE
HEATING UNIT (TO 100,000 BTU)
DEALING UNIT (OVER 10g0fX) BTU)
_
'
PAID
VENTILATION PAN (SINGLE RESIO)
Dare eceipt#
BOILER - COMP OR I ol.WO B "fU
( )
TOTAL:
BOILER - COMP (OVER I Milks) li'1'U7
AIR CONDITIONER
ISSUANCE DATE
ISSUEDBY:
NEW RESIDENTIAL MECH. SQ. Fr.
Owneroramhorzed a gem Date
T�A
OFFICE, - — \���— — —
1-10
Inspection Query for a Speck Permit 10/20/97
RERMIT #,'
SITUSISM
SIT OS;T;REET
Loot#
INSDESCRIP,�T
Ins, ""
DAyTEDESIRE�
Da %D "one
30852
19286
STEVENS CRE
DRYWALL SCREW
6/10/97
6/10/97
30852
19286
STEVENS CRE
DRYWALL
6/12/97
6/12/97
30852
19286
STEVENS CRE
SCREW
6/12/97
6/12/97
30852
19286
STEVENS CRE
SHEETRK
6/11/97
6/11/97
30852
19286
STEVENS CRE
ABV CEIL T -BAR
6/24/97
6/24/97
30852
19286
STEVENS CRE
ABV CEIL MECH
6/24/97
6/24/97
30652
19286
STEVENS CRE
ABV CEIL ELECT
6/24/97
6/24/97
30852
19286
STEVENS CRE
STUCCO SCRATCH
717/97
7/7/97
30852
19286
ISTEVENS CRE
30852
19286
ISTEVENS CRE
BLDG -F
7/9/97
7/9/97
30852
19286
ISTEVENS CRE
PLBG -F
7/9/97
7/9/97
30852
19286
STEVENS CRE
BLDG ENRGY -F
7/9/97
7/9/97
30852
19286
STEVENS CRE
MECH -F
7/9/97
7/9/97
30852
19286
STEVENS CRE
ELEC -F
7/9/97
7/9/97
30852
19286
STEVENS CRE
FRAME
7/29/97
7/28/97
30852
19286
STEVENS CRE
ELEC -R
1 7/29/97
7/28/97
30852
19286
STEVENS CRE
PLBG -R
7/29/97
7/28/97
30852
19286
STEVENS CRE
SCREW
7/31/97
7/31/97
30852
19286
STEVENS CRE
DRYWALL NAIL
7/31/97
7/31/97
30852
19286
STEVENS CRE
UNDR SLB /PLBG
7/24/97
30852
19286
STEVENS CRE
UNDRSLB ELECT
7/24/97
7/24/97
30852
19286
STEVENS CRE
ABV CEIL MECH
8/12/97
8/12/97
30852
19286
STEVENS CRE
ABV T -BAR
8/11/97
8/11/97
30852
19286
STEVENS CRE
IFINAL
8/27/97
8127/97
30852
19286
STEVENS CRE
ELECT -F
8/28/97
8/28197
30852
19286
STEVENS CRE
PLBG -F
8/28/97
8/28/97
30852
19286
STEVENS CRE
MECH -F
8/28/97
8/28/97
30852
19286
STEVENS CRE
BLDG FINAL
8/28/97
8/28/97
30852
19286
STEVENS CRE
FINAL "ATTN: CHUC
8/28/97
8/28/97
30852
19286
STEVENS CRE
BLDQ FINAL
/29/97
8/29/ 7
30852
6
STEVENS CRE
ELECT -F
8/29/97
8129/97
30852
19286
STEVENS CRE
PLBG -F
8129/97
8/29/97
30852
19286
STEVENS RE
MECH -F
8/29/97
8/29/97
30852 119286
ISTEVENS
CRE IF
FIRE FINAL
9/2197
9/2/97
Page 1
Inspection Query for a Specfic Permit 10120/97
Ins ecto
,Units
Pass /F,aII
Wdel
D
2F
D
2P
P
D
2P
P
D
2F
cc
2P
cc
2P
cc
2P
JB
3P
JB
4F
B
1F
B
1F
B
1F
B
2
N
JS
31P
S
3P
S
2P
cc
2P
cc
1P
O
1P
O
2P
cc
3P
JB
2
N
cc
1P
cc
2
P
cc
1F
cc
2F
cc
2F
cc
2P
cc
2P
cc
2
P
cc
2P
WE V I
IP
Page 2