30025 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY DP CUPERTINO DL.
BUILDING-ELECTRICAL. - PERMITNO. 30025 00
BUDDING DIVISION APPLICATIONIPERMIT PLUMBING•MECHANICAL
BUILDING PROJEC T IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
NL PHONE: CO NAME:
NIC - CONTROLN
A INE LIC NO: p
CONTACT. PI}�ry.�_ �.jA/I BUILDING PERMIT INFO
t,
Paz—
I
❑ Consultant Fees Paid by Applicant(initial) BLDG ELECT PLUMB MECH
LICENSED C NTR CTOR'S DEOLARATION QTY. ELECTRIC PERMIT FEE a�
neo.nr arum mil 1 am Iia <ed sneer pnmsinnx ter cnapmr 9(,nmmen,mg ' JOB DESCRIPTION
�y with Semlan 90pD)of Uivision3of tho siness ane l'nd'w.ions coda vntl mY lieenmis
WO PERMIT ISSUANCE RESIDENTIAL'
aUVinfula rcerh and treed.
Licence Cla Urar ❑SFDWL ❑KITCHEN REMODEL
�•TaW Date Contract APPLIANCES-RESIDENTIAL ❑ADDITION El PLUMBING RE-PIPE
be
ARCHITECTS DECLA TION PANELS s, ❑MULTI-UNIT ❑STRUCTURAL
I undasmnJ my plvns shall he umd as public r nils MODIFICATION
OZ—q lIP T0200AMPS ❑INTERIOR L1 CHIMNEY REPAIR
r�tW Licensed Professional 2041000AMPS IMPROVEMENT '
�G qq OWNER-BUILDER DF.CLARATIO
a 6 I hereby afBmo that 1 am exempt from the Contractor's 'cause Law for the OVE AMPS ❑BATH REMODEUREPAIR ❑DEMOLITION
3O y U 1'olWwing reason.(Section 7031.5,Badness ane Prufu,,imw C,mr: pity or conmy ION ,U?CTRTCAL - - - - OTHER -
,Fa which requires u permit m cannmct,.her.improve,demolish,or rep. soy strocwre
��h.] primmits issuance.uleooeptirestheapplicam mrsnch pcmtiun fleusig amennern SPECT IRCUITIMISC.
y
that he is licensed pursuantto the provisions of due Commences Licenm Law mia9
<0 (commencing with Sectam70a)of Division Sof the Bmstreasend Professions lehu TEMP.ME POLCINST. COMMERCIAL
:
4 p, tY
that he i.s manner therefrom add the 1, is for the alleged exemption.Any vianni of ❑NEW BLDG/ADDHHON ❑DEMOLIT[ON
i� ISN, Section101 IS byany applicunr fm a Permit subjects the upplicunnn acivil penahy POWER DEVI P �FNANT ❑FOODSERVICE
nm more than five hundred dollars(S500).
G ❑1,as owns(rhe property,or my employees with wages as their sole compensation. SWIMMINGI'001. FC IMPROVEMENT
will do the work,and the structure is not intended oroffered forsale(Sec.70a,I.Business ❑OTHER
m and Rofessioos Wea:The Contmcnn's License haw does oto i,pplyp)ren no of OUTLETS-SWITCHES- RES
propeny who builds or improves thereon,and who docs,such work himself m Inrough
his awn employees,provided that such improvement-are not intended or offered for 'W RESIDENTIAL ELECTR - ED sa B rT.
sale.IL however,the building or improvement is sold within one year ofcomplerion,the SQ.FT.FLOORARRA $/SQ.Fr.
owner-builder will have the burden of proving that be did not build or improve for pur-
pnmmmde.). ,
❑ has owner of the See Try,um exclusively comrai9ns wire licensed cursors i- t TOTAL: JUN 10 1996
conswct the project(Sec. 046,Business and Professions Coen.)The Contractor's Li- ys -
uLawdoesnotapplytoanownerofpropenywhobuildsorimpomslhereon.and QTY. UMBING PERMIT FEE L'��}
whocontmcs forsuchprojecswiNamr
cosctor(s)Iicensedpursven,lorhe Contractor's LII- LUr-Ch11 INV
License Law. 't PBRMITI
❑I am exempt under Sae.' SSB&P C far this reason -
Owner Dem ALTER F letion VALUATION
WORKER'SCOMPCNSATIONDECLARATION BACK FL : I
thereby affirm underpenalty or perjury one of the following Jedamtium: tcom I
ete
I have and will maintain a Certificate ofConat (X1 miu to self-insure for Workers Compen- DRAINS 11
sation,as nonred fm by Section 39of the List, Cade,for the perfnmmnce of the lions
work for which this permit is issued. FIXTURE g5TORIP1 TYPE CONSTRUCTION
❑1 have and will mairt air Workees Compensation Insurance,as required by Section ei
3900of the LbcfCude.for the perafLorrnameau�of tbeeYp'su,'sr fr M1ich rhospermilrsis... GAS- T$ OCC,CROUP APN
'db
Ca Wr* :RT�PE1.0 I'RrONt OR iR5' GAS- '
COMPENSATION INSURANCE 0RFASEBN56STRL SI INT CE
(This section neeAm h
ne completed ifthe permit is forma,hundred dollars($100) BUILDING DIVISION FEES
erles"). GRHASE 'LANCHECK R31i
I certify that in the perrnrnanee of the work l'or which this permit is issuce,lshall SEWER-SANITARY-STO 001 '.
not employ any person in soy manner so as to become subject 1.the Workers Compen-
Q z sation laws of California.Dare WATER .1 ENERGY FE
77 Applimm 8 yE
w� NOTICE TO APPLICANT.If,after making this Cenificme of Esemption,you should WATER SYSI'FM/TREAT G -
a , become subject to the Workers Compensation provisions of the Labra Cade,you must a SOILS FELs
W fonhwim comply with such previsions or Nis Tenon shall be`deemed revoked. WATER
as ;
D zCONSTRUCTION LENDING AGENCY NEN'REMDENHAL PCMB. SQ.Fr. PAID
Ll0 Thereby afttnn Nal there isaeonstmcoion lenAing agency for the pedmovid,rof Date Receipt#
e
LLwork for which This peronit is Issued(Sec.3399,Civ.C.) -
Q C-' eader's Name
Leaders JJrcss /TOTAL:
0.L 1 certify that 1 have read this application and nate that Ne above information is GILDING FEE
Vi carred.l agree to comply with all city and county ordinances and some laws relating to. QTY. M IiCHANICAL PERMIT FEE
(.) 7y buildingcon.ntuctionvnd hereby muniniec repnv,cmntivesof Niscily m mor,mion Om. SI? ' IC FEE
above-menriuned Property for inspection pinfusesPERMIT ISSUANCE
(We)agree m save,indemnify and keep hrnmess the City of Cupertinoagainm CLC CPER
liabilioies.judgmems,costs and expo c which may in anyway accmc against said City ALTER OR AUD'TO MECH, t
ICZin consequc enf the gr.miag of
il. PLUMBIN sC "
SINLICAN UNDCRS'f S 1' WILL COM PLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 1(1,0(10 CFM)
R'.IULATI - MECHANICAL. •CC -
AIR HANDLING UNIT(OVER I0,001)CFM) CONSTRUCTION TAX
So mm of pica /Commem Dare EX HA UST HOOD(W/DUCT) HOUSING MITIGATION F[h
fIA 'DO ATERIALS U. .OSURB
Will theappiicamorfutnrcbuildingmeupano sto orhandlelraaardousmmmrial HHATING UNI'FTFO EXI,IMXI BTU)
as defined by Ne Cupertino Murdcipol Cndc.CM1apur 9. .ane Ne Healthand Safety
Code,Section 85326d?. HEATING UNIT(OVER 1IXk000 BTU)
❑Yes ❑No VEINnt-NnON I-AN(SINGLE RRSID) 'n PAID
Will the applicim or future building occupant use equipment or devices which Data Recoils If
emir hazardous air conuminans as defined by the Bay Area Air Quality Management BOILER-COMP QHP OR IW,OOD BTU)
District! TOTAL:
❑Yes ❑No BOILER-COMP(OVER 100.00013TIE -
I have read the haanrdous matcriab requimmenu under Chaser 6,95 of Ne Cali. AIR CONDITIONER _ ISSUANCE DATE
fomite Healthg does&Safdy Code,u.nemo 8509.25533 and 25534.I undesmnd Nm if the NEW RESIDENTIAL MECH, SQ.Fr.
buildingpeesnotes which have th tenant,Nal it ismyce of. ertificae.1fytheoccupant
of the requirements which muse be met poor,to issuance ofa Certificate of Occupancy. {�w•�.I}��/
Owner or authorise agent - Date TOTAL: ISSUED BY:
OFFICE
Inspection Query for a Specfic Permit Print 10/23/96
PERMIT# SITUS ST SITUS STREET AVE,CT,ST,RD Lot# INSDESCRIPT InsType
30025 10600 TANTAU RGH FRAME
30025 10600 TANTAU RGH ELEC
30025 10600 TANTAU UNDRGRD PLMBG
30025 10600 TANTAU RGH MECH
30025 - 10600 TANTAU PLBG-R
30025 10600 TANTAU SHEETRK SCREW
30025 10600 TANTAU PLBG-R
30025 10600 TANTAU SHTRK SCREW
30025 10600 TANTAU METAL STUD FRA
30025 10600 TANTAU RGH ELEC
30025 10600 ITANTAU FRAME
30025 10600 TANTAU ELECT-R
30025 10600 TANTAU PLBG-R
30025 10600 TANTAU
30025 10600 TANTAU METAL STUD FRA
30025 10600 TANTAU _ RGH ELEC
30025 10600 TANTAU RGH PLMBG
30025 10600 TANTAU SHEET ROCK
30025 10600 TANTAU REBAR
30025 10600 ITANTAU JELEC
30025 10600 TANTAU MECH
30025 10600 TANTAU T BAR
30025 10600 TANTAU ABOVE CIELING
30025 10600 TANTAU T BARS
30025 10600 TANTAU ELEC
30025 10600 TANTAU T BAR
30025 10600 TANTAU —T-BAR
Page 1
Inspection Query for a Specfic Permit Print 10/23/96
. DATEDESIRED DateDona I Inspector Units Pass/Fail
6/13/96 6/13/96 CC 2F
6/14/96 6/14/96 CC 2 P
6/13/96_ 6/13/96 CC _ 2 P
6/17/96 CC 2 P
6/19/96 6/19/96 CC 2 F
6/19/96 6/19/96 CC 2 P
6/20/96 6/20/96 CC 2 P
6/20/96 6/20/96 CC 2 P
6/20/96 6/20/96 CC 2 P
6/20/96 6/20/96 CC 2 P
6/24/96 CC 2 P
6/24/96 CC 2 P
6/24/96 CC 2 P
6/26/96
6/26/96
6/26/96
6/27/96 6/27/96 CC 2,P -
7/2/96 7/2/96 CC 2 P
7/3/96
7/3/96
7/3/96
7/8/96 7/6/96 CC 2
7/16/96 7/16/96 CC 2 P
7/16/96 7/16/96 CC 2 P
7/18/96 7/18/96 CC 2 F
7/25/96
Page 2