31172 - permit APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO B HIDING-ELECTRICAL PERMIT NO. 7
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROTECT'IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
OWNERS NAME: P NE: C 'IBACI'ON'9 NAA1}y LIC NO'.
59'0 -a//'C//1 NIC CONIROLia
CHITECT/IiNGINEER: LIC NO: AD ESS: J ❑
etl
CONTACT PHONE: It .t Fc BUILDING PERM( Ih-O
jr, Qpp�
IyGI Consultant cs Paid by Applicant(Initial) .DG E iCT P UMn
LICENSED CONTRACTOR'S DECLARAi'ION QT'Y ELECTRIC PERMIT FEEI hereby aRrm dhm I em li<enuJ under provixions dChapter 9(commencing JOB DESCRIPTION
WOO with Section 70(10)of Division 3 ofthe Business and Professions Code,and my license In PERMIT ISSUANCE RESIDENTIAL:
Fly. in fallcand effect. ❑SI'UWh ❑ IT
KH REMODELREMODELFa.Vr~j Licami,enurelas Lie.x' APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBINGRE-PIPE
+n 6 4 Date Comercin' _
ARCHIMICu DECLA ❑MULTI-UNIT [ STRUCTURAL
Z~OvZ I understand my plans shall be,used as public records (ANUS MODIFICATION
OZ-N+M UPT0200AMPS E3 INTERIOR El CHIMNEY REPAIR
F4LW LiOc.,d Pamc,,rad 201-1AX)AMPS IMPROVEMENT
�y E; - OWNER-BUILDER DECLARATION OVER I(Nq AMPS ❑BATH REMODELIREPAIR El DEMOLITION
a W Q I hereby amp
ffirm that 1 am exet Iranian,Cmartaam's License Law for the
V following retoon.(Seldom 7031.5,Bonino,,and Pri,fessions Code:Any city or enunly SIGNS EL,GC'1'RICAL ❑OTHER
Yl3 LL N which requires a permit to control,alter,improve,demolish,or repair any structure
C=O� prior wits issuance.at.,requlrcltheapplicant for such pc.it,to Glc asigned statement SPECIAL CIRCUITAI1SC.
Hy that
he is liccnxJ pursuant to the provisions of @e Cnmacinr's License Law lChapar9
MO (oommenedgwith Section 7WB)of Division 3ofmc Businea and Profusions Codgor TEMP.METER OR POLI:INST. I '
a q o that he is exempt therefrom and the basis for the alleged exemption.Any violation of W BLDG/ADDITION ❑DEMOLITION
x m Section 7031 S by any aFplicam for a permit subjects the applicant m a civil penally of POWER DEVICES
W^w ' ❑TIiNANf ❑FOOD SERVICE
F+Z> mol mote Ivan live hundred dollam(S500t
Q IMPROVEMENT
[3 1,a owner ofthc ppr srty.or myemployecs with wages as motivate compensation, SWIMMING POOL ELE IC
O will do the work,and the structure isnot intended or offered for.sale(See,7014,Business ❑OTHER
THER
and Professions Cody.The Contractors License law dtcs not apply n'an owner of GUTLE'I:S-SWH' -PIXTU 13S
a 3 property who builds or improves thctron,and who does such work himself or 1ltrough
his own employees,provided that such improvements are not intended.,,Offered for NEW RESIDF.NTI EL. SQ
sale.If.however.the building or lmprovemcm issnld within one year lr coatplelion,the SQ.FL I7LOOR AREA $ISQ.17L
owner-builder will have the burden of proving that he did not build or improve for pur- ' !'�� �• Di.I•
pottuf salt.), J l !/�
1,as owner of the pntperY,um exclusively comuacting wdo li.....I comrnemc.m 'TOTAL: f
onsauct the proper,(Sec.704L.Business and Professions Ctdu)'fhe Contfacmrs Li. �f
ase Law does no,apply to an owner of property who builds or improves thrown.and QTY. PLUMBING MIT' FEE
wbo conamors tot such prudecb will a u,mmctm(3)licensed punt ant to the Condmmdor x /^
License Law. PERMIT ISSUANCE
1 am exempt under Sec. .B&P C for this reason
ALTER-DRAIN&VENT- ' (EA)
Date VALl1ATl N
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
pen �_ '
I hembrydrum under alty of psparyoncof the following dcclwns
utio : - J VVV
I have and will mainline Cenificateol Consen 1.self-insure far Worker's Camper, DRAINS-FLOOR,ROOF AREA,CON ST ORIF TYPE CONSTRUCT ION
sation,as providW for by Section 37W of the labor Cale,for are perform...,of a
work]or which this pemtil is issued. FIXTURES-PER TRAP
❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section
370dofthe NmrC q4n the perfomtunce of the work fur which this permit is issued. GAS-EA.SYSTENIAINC.a OUTLETS OCC.GROUP µN
My Work Pito tiw Ensuante carrier and Policy yynyefjac[//�q 3 (p Gy
Curti L(7 Policy No.:(aZ((J-((F�� GAS-PA.SYS'1'EM-OVIiR4(EA)
CERTIFICATE OF EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE GREASEIINDUSTR.WASTE INTERCEPTOR
BUILDING DIVISION FEES
(This.scGion...dnmheenmpleicd if theperrnit is for arc hundred doBaa(SI(gp GRF.ASETRAP
or les,) PW NCHECK IEE
I cOmytha mine pedormmixoofthe work for which this permit is i...ad.lsbell SEWER-SANITARY-STORM EA.200 FT.
not employ any person in any mmmcr sr,as m b Cama.xoldoso B,the Workers'Compen. ENERGY FEE
OZ Indian Iawsmf California.Date WATER HEATERWNENTELECfR GRADING FEE
Z O Applicant
F-'? NO TICE TO APPLICANT:IL alter making this Ccaificac of Exemption,you should WATER SYSTEM/I'REATINO
become subjud w the Waders Compensation provisions of the Labasr Cade,you must SOUS FEE
forthwith comply with such provisions orchis permit shall be deemed revoked WAT17R SERVICE
aQ
5Z CONhemis.RUCTION LENDING AGENCY NEW BESIDEN'1'[AL PLMB. SQ.1+[ PATH Dae Receipt Or
L) p k for
nis permit
isuco (Set,30 len ding agency for performance of
F' Le wad for which lhln limit is issued(Sec.3097,Co,CJ
P" Lender's Name 0 'TU'I'AL
L) Lena4 Address TOTAL:
I
cmify the 1 bout mad this application and sunt ihm the uMwe information is BUILDING FEE
correct.l agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PFRMFF FEE
buildagconswe,inn,and herehy audtnvc mpmanmtives of,hiscl,y Rsemerupon the SEISMIC jE
a o,c-or miomed property for inspection ImPowl. PERMIT ISSUANCE
(WO)agree to save,indemnify and keep harmless the City of Cupeninm again.. ELECTRIC 'E
hold itics.judgmenvs,costs and expenses which may in any way accrue against said City ALTER OR ADD TO MECH.
incoma, cof, ranting of this permit. PLUMBING
APPLE :RS'TANDS AND WILL COMPLY W ITH ALL NON-POINT AIR HANDLING UNI'I'CFO 10.000 CFM)
MECI(ANI 'L;
SOU F' TIONS.
AIR HANDLING UNIT(OVER 10.000 CFM) CONSTRUCION
pplicamUCon tar /�i�yOpy EXHAUST HOOD(WIDUC) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSUREI//-1]l�J 1
Il the upplicuor or Name maliingoccupant 4oreor handle hueaedouxmarenui HEAT]NG UNIT(TO 100JON)B'IU)
as defined by,he Cupertino Municipal Code.Chapter 9.12,and the Heath and Safety
Cade,Section 25532(.07 HEATING UNIT(OVER 100,0011 BTU)
C3 Ycs ❑No PAID
VENTILATION FAN(SINGLE RT;SID) Dam Receiptx
Will the applicant or future building occupant use equipment or devices which
hazardous air c somminoms as ddincd h the Ba Arco Air Qtml'ny Manogmncnt BOILER-COMP UHP OR lK000 BTU)
TOTAL
n :
0District I BOILER-COMP(OVER 1 W.IXp BTU)
E]Yet ❑No
1 ve t hmmdousmatenals AIR CONDI'1'IONER
m]uimmann under Cl1 uncepast of Ne Calm ISSUANCE DAI'F�
foddi all eyll, Sections 25ra it N533old SS3q.I undersand that trthe ,yF.W RFSIUCMIAL MECH. SQ.Ff.
M1ui]di umnlly ma tenant,Ihm id isnry resrymsihility est notify the rccupant COY'
of Iw ' and he to IATA.Ccnilic teof u
nu nv IhurlreJ ngrnt Umc TOTAL: ISSUED BY: ��
OFFICE
Ptgil< UFFICE • / P.al '�3e
31172
LG,E,:,yv -:4COr
• INC.
BUILDING CONTRACTORS S • 4�f" ,
October 30, 2000
CITY OF CUPERfINO
City Planr:ing Department
10300 Torre Avanue
Cupertino CA 95014-3255
ATTENTION: Ciddy Wonleil, AICP
REGARDING: Projec!- Cupertino Pire Station �(
20.'5 Stev3ns Creek Blvd.
Owner - Fire Department Santa Clara County
147W Winchoster Blvd., Los Gatos CA 95032
Attn: Hal Rooney - 408'378-4010 Fax 408/378-9342
APN #
Penult # 31 172
REQUEST FOR OCCUPANCY IN PHASE I
• Dear Ivls. Wardell,
As per your conversation with Steve Jacobson on 10/27/00, attached you will
find a schedule o+events requested by your office for the Santa Clara County
Fire De:par.me!ii to take occupancy of their new building as Phase 1 work is in
progress.
The move in date is scheduled for Wednesday, November 1", with the
completion of Phase li no later than February 28, 2001. All construction shall be
competed in accordance the plans and the City of Cuper?1ro's standards.
Very tn3iy yours,
Ben Ortiz
Project Manager
BO:phm
• 800 C,Uflvb L"c Campbt0,CA 45008-5406 • (608)879-1660 • Fax(408)879.16s6
Wane 1,53348
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