29959 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO I BUILDING.ELECTRICAL PERMIT NO.
BUILDING DIVISIONAPPLICATIONIPERMIT PLUMBING-MECHANICAL. n G
RUII.IIINGPROJI?CTIIIBNFIFICA9'IDN G J
BU DING ADDRESS: ������ BLUE. �� � SANITARY NO. APPLICATION SUBMI'1'fAL OAT
7 L.�a h Itjo 6-MrqK PHONE: C 'RA N 'S NAM LIC NO:
Y A). L1w B ��C NIC CO OL p
RCHITEC]/ENGINtan
snritf /I{ C. LIC NO: VV AORENS(8O �� �GfASA�Te�J
'GNTACT. /V PHONE: BUILDING PERMITINFO
30W
I,Ad .3/.7-41(3'�Z2 ❑ Consultant Fees Paid by Applicant(Initial) BLD eO PLUMB ME❑CH
LICENSED CONTRACTOR'S DECLARATION (JTY ELECTRIC PERMIT FEE %
I hereby affirm that 1 am licensed malar provisions of Chapter 9(commencing JOB DESCRIPTION
E`IWZ with Section of Division 3 ofthe Business and Professions Cale,and my license is RESIDENTIAL:
DO i PERMIT ISSUANCE ❑SFDWL ❑KITCHEN REMODEL
n full force unJfF c d.
�af UU License ` Contract
30
APPLIANCES-RESIDHN'I'IAL [-]ADDITION El PLUMBING RE-PIPE
zt i Dam conuuctm
F=y ARCHITECTS DIiC1.ARATION PANELS ❑MULTI-UNIT ❑STRULTURAL
zone Iundersttand myplom shall bamedwfablic records MODIFICATION
CZ IJP TO 200 AMPS
Licensed Professional ❑IMPROVR ❑CIiIMNEY REPAIR,
3 201-1000AMPS IMPROVEMENT
Oat I am exeLDERmpt
DECLARATION OVIiR["AMPS ❑BATH REMOQEUREP111R El DEMOLITION
yy W,Q 1 hereby affirm Net 1 1. exempt from the Contractor's License Law far to r'rtyC'
)d r og F following reason(Section]011.5,Business and Prnfexsions Cade:Any city at county SIGNS ELECTRICAL ❑OTHER
RMYY17 LLLLO which its isssapermit requires to alter impmvgdemolish,ae a sig anyswemre 11+:
pour to is issuance,also requires applicant for such perninofikasignN statement SPECIAL CIRCUIT/MISC. JM
�y that hers licensed pursuant to the provisions ofthe Comanm'sLicense Law(Chapter 9 _
�'p0 (commencing with Section 701)(0)of Doislnn3 ofthe Business and Professions C,de)or TEMP.METER OR POLE INS]'. M1 -OMM� PRCIAAL
a a n et. that he is exempt Nereftnm and the basis for the alleged exemption.Any vinWtion of ❑NEW BLDG/ADDITION ❑DIWOLITION
Y• Senion]0ll.llyaoy4pplicaatfnrapemtitmbilc'l Neop,licantmucililpenol'y'I POWERDEVICIS ❑TENANT ❑FOOD SERVICE
{{.. nm marc than fisc hundred dollars(85(10).
q Q F7Las owncrofthe pmpeny,orn,employees wit wages ns their sole compensation, SWIMMING POOL ELECT RIC IMPROVEMENT
2575' will do the work,and the structure is not intended,.offered formle(Sec.]O......--- ❑OTHER
ul a$ and Nor..loss Code:The Cummchnes License Law dooe not apply to an owner of OUTLETS—SWITCHES—FIXTURES
as .. prnpeny who build¢or improves thereon,.,,it who docs such work himself or through
his own employees,pmsided that such improvements un rot intended or offered for NEW RESIDENTIAL ELEC'I'R SQ IT.
sale.If,however,the building or improvement isoAd within one year ofcampledion,the SQ:FI'. RARIiA $tip.Ff.
owner-builder will have the burden of proving Nat he did not build or improve for par- -
poseofsule,).
01,as owner of the property.am exclusively contracting with licensed contract...to1SecUWTOTAL. JUN 3 1996
construct the project .] ,Business and Professions Code,Thm
The Coremor's Li�
cense Law does not apply to an(wnerofpropeny who builds or improves Human,and QTY PLUMBING PERMIT FEE ,
who contracts for such pr jects with a commetobs)Iicemed pursuant to thecontractoea
License Law. PERMIT ISSUANCE. O CITY Ut UUI-LKI axi ,
❑Iamaemptundcr Sec. ,B&PCfmtisreason
ALTER—DRAIN&.VENT—WATER(EA) VALUATION
13700.17thel-almaCow.
wner Uum
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Cenilicate ofComant m self-insure for Workers Compete DRAINS—FLOOR,ROOF.AREA,COND. STORIES 'I'YPECONSTRUCTION
lion,as provided for by Sect an 3710 of the Labor Code,for the parformume of the
'mk for which this permit is issued. FIXTURES—PER TRAP
1 have and will maintain Workds Compensation Insurance,as required by Section
fnnhe performance orthe work for which this permit is issued GAS—EA.SYSTEM-I INC.4OUTLETS �� OCC.GROUP AIN
y Wmk]ry Ct peyytiny,Jnia-nc'e��eapp'or and Policyarrier /7 StlP Pnlic GAS—EA.SYSTGMOVGR4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASEANDUSTRL WASTE.INTERCEPTOR
(This section mud not be mmpletal it the permit is for one hundreddoilars($Hab HUI 1 )IV(ION FEES
nr less) GREASE TRAP PLANCHECK FF
I certify Nat in the pertorrouceofthe work forwhichthis permit is issued,l shall SI7WER—SANITARY—STURM EA.2W FT
not ampt.y any permanners,son in any anns,ass m becoma.nbjcome
eorWmkers'Couraff ENERGY FEE
C)Z indoor Lows of Cnlifomia.Data _ WATER HEAT/
TER WNENELECTH -
Z O Applicant GRADING E
N NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should WATER SYSTESU TRGTING E
f'+ become snhject to the Worker's Compensation pnwLabor of the Code,you must SOILS
forthwith comply with such provisions or this permit shall he dernmd revoked WATER SERVICE
CONSTRUCTION LENDING AGENCY NEW RESIDIiNT1A1.PhMD. SQ.FT. PAID
V12 koro4urbthi t pearm,i Tissued cr.30lending agevay fartheperfitmtamenl' 'Dom RemiptM
'he week for which this Mnnit is issued lSec.31W9.Civ.CJ
CrQ'•U Lewers Name TOTAL:
14J 1<ndefs Address T
1 ecraify thm I hove real tis upplicwlnn unJ state thm the shove inlitrmmi,n is BUILDING F '
CO) correct.l agree to comply with all city and county ordinances and state laws relatingt. QTY. MECHANICAL PERMIT FEE
U Z building construction,and hereby authorize representatives of tis city to enter upon the SEISMIC
above mentioned prepeny for inter i,n purposes.
(We)agree to save,indemnify and keep harmless the City u1'Cupertino ugcu m PERMIT ISSUANCE ELP.CTRI PEE
liabilities,judgments.cons anlosionses shichmay,inany wayaccmeagaima and Cityin ALTER OR ADD DD MECH.asequence of the Emitting of this permit. PLUMBI GFEE
APPLICANT UNDERSTANDS AND WILL .OMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.00)CFM)
SOURCE NS. A MOCHA ICTI
AIR HANDLING UNIT LOVER 10,N)0 CFM) - CONSTR CTION'TAX
Signaw fApplicam/Cmi mnnr ate EXHAUST HOOD(W/DUCT) HOUSING MI' 'ATION FEE
RDOUSI TERIALSDISCLOSURE
Will the applicant orfuntre building occupant More orhandle hazsNous material HEATING ONE f(T0100.0ria BTU)
as defined by the Cupertino Municipal Core.Chapter 9.12,and the Health and Safety t IT
Code,Section 25532(a)] HHA'I'ING UNIT'(OVER 100,000 BTU)
❑Yes Elba - - PAID
VENTILATION PAN(SINGLE RESIDE Data Recelpl 11
Will the air coinntor(ware building mcheBuseea Air uterdeviceswhich BOILER—COMP(3HP OR 100,000 BTU)
nit hazardous air nnuuminams as defined by the Bay Area Air Quality Management TOTAL.
nric?
C3 Yes ❑No BOILER—COMP(OVIiH 100,t]MI BTU)
I have read the hmz.do.,aratenid,o ruirements under Chapter 6.95 of the Cull- AIR CUNDI'fIONER
u ISSUAN DA'fF:
forma Heaths ar Safety Code,Sections,thm i,25533 and 25534.1 understand rhos if the NEW RESIDENTIAL MECH. SQ.PT.
ofthe requirements
encs hickaid,have aanent. or it qua ce'of aC difitominifythe
laticy d
of Ne requirements which mart be met prior to issuance ofu Cenificam of Occupancy.
Owner or euthorixcJ agent Date TOTAL: ISSUED BY:
OFFICE
I I Consolidated Engineering Laboratories Report I I
June 20, 1996
City of Cupertino
Building Inspection Dept.
10300 Torre Avenue
Cupertino, CA 95014
RE: Mervyn's Dept. Store Inspection Date: 06/10-13/96
20730 Stevens Creek Blvd. Location: Jobsite
Cupertino, CA Inspector: & Sitt
Permit #29959/P.O. #620671 Report # 01
t CEL #10288
STI, A1?13 W11? 2SfXTS 'wC TI1�1 TT'( 'I
On the above dates, our representative inspected the referenced project as reported below:
Checked welder and procedure qualification papers.
Visually inspected the in progress welding performed by two qualified welders using SMAW
process with E6010 electrodes.
Weldments consist of complete penetration groove welds on 6" and 4" diameter schedule 40
piping and fittings at gas piping for chillers from main supply valve at building seat up to
roof and horizontal runs to first threaded connections.
Work inspected was in compliance with approved plans and specifications.
REVIEWING ENGINEER: JAMES M. POWERS, R.C.E. QP°F po��
cc: City of Cupertino 6 z
York International 5 g�-99
* s
All reports an submitted as the confidential property of clients. Publication of statements,conclusions or a our
written approval. SOF CAS
1
P.O. Box 9131, Pleasanton, CA 94566, Phone 510/460-5100 Fax 5 10/460-51 18