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S 1452I Den I lelee _ nCC PAI 1 DnINT PFM nKRY AYYLAdAIV11V CITY OF CUPERTINO BUILDING - ELECTRICAL BUILDING DIVISION APPLICATIONXERMIT PLUMBING - MECHANICAL BUILDING PROJECT IDENTIFICATION PF.tI'1' NO 1452 SANITARY NO. APPLICATION SUBMITTAL BATT BUILDING AI)DDRESS: OW E SNAMO: PIIONE: CO TRACTOR'S NAME: LIC NO: u NIC ❑ -CONT�hN CHITECT/F.NGIN HER: AU )KESS: CONTACT: PHONE: :5i;/J9 p I ps pp }` - ❑ Consultant Fees Paid by Applicant (Initial) G .EUILDINPERMIT INFO FLECT PLUMB MECH LICENSED CON' A DECLARATION 1 hereby fir n n p I I d d tpr i of Chapter 9 (commencing witM1Si 9006)fD'vikan3ofNe Bu rnAPnRss'oms Codeardmylcnsels in full force and elffid. \ ��! License Class E�� Lic.M t - g Date Cnn QTY ELECTRIC PERMIT FEE 1 JOB DESCRIPTION RESIDENTIAL ,❑SPDWL ❑KI'TCHEN REMODEL ❑ADDITION El PLUMBING RC -PIPE MUl:fi-UNIT El STRUCTURAL MODIPICA""PION ❑INTER[OR ❑CIIIMNEYREPAIR IMPROVEMENTE]SWIMMING POOLS BATH REMODELIREPAIR El DEMOLITION ❑ OTHER - PERM]] ISSUANCE 'APPLIANCES - RESIDENTIAL ARCHITECTDEET 'S UF.CI-ARATIO❑ I understood my plans shall be used as public records \ PANELS - UP TO 200 AMPS Licensed Prefersional \� OwNGx-BUILDER DECLARATION I hereby sharp that 1 ton exempt front the Co micmis ltcense,Law for the 1 folkw ng reaenn. (Section 9031.5, Beeinesv, and Professions Cade: Any oiy or county iwhich requires a permit to corearra, alter, improve, demolish, or repaiT any s metene I prior n) its assnanw, also requires the applicant for such permit to File a signed statarrom That he is licensed pursuant the provisions of the Convectors License Law (Chapmz gv mompronc ing with Section 9(0ID) of Division 3 of the Business and Pro - k[tat Ins is exempt therefrom and the basis for the alleged enempdon. Section 7031.5 by tory applicant for a permit subparts malipplicunt to aeivil penally of co, more then five hundred dollars ($500) (�� y� ❑1,a, ownuof the property, ormye.Pl,c" with wegesns their eo1$549dorr will do Ne work, ped Nestmdum isnotimendal nrofiereA fur sole (Se(..VV�yy i Embalmers : C 1' T1 Centel n Fs L La J not applyN�bl� 20 1 -1000 AMPS OVER 1000 AMPS SIGNS ELECTRICAL. SPECI AL CIRCU IT/MISC. rsl 'E�NIHtyTBIIIg20R POLE INST.OD COMMERCIAL: BLDG/AUDITION ❑ DEMOLITION q ANT ❑ FOOD SERVICE. 1 PROVP•MENT POWER DEVICES -\ c, Or K5 ANT KI PtOOEELI3CTRICt1 l❑OTHE t'It0 ETS S�YlfHF`S FIX9VRE.' end hupwn euployees, p ov ded that such o mild, or improvec improvements a, and who does m tots intuch work ho nJsada If, however We befliingordmprovemcm isnold w ihirnne year d(y�ryjltre+ll hove Ne burden of proving that he did not huild or /M��/Q/t��}AmmVL„(I�li1ppG♦♦Ftpp )-fth lye t 1 't11' MYthA/lR19I(i}d' D � SQ. FT. PL(l(HZ Eohuilderwill •• �.. �(� - 9EL. J�•I)II �TOTAL'P s pmpeny, an excln g cc eLconstruct the p j t PP y t 044 Billions, I property T 1 builds Code) pufffi iii'.tKL wh t 1'f nuuhp jeepsw nh ac m mor(s)I'wnvedp t,, the Cnnvernal Li L n/�en Q 1 pm ex pp underSed. B ffi P�fti+tW �1'fR .�, •^"-� ii ♦ „ h, riV P�d / I IT Vc�l y� 1'f>P� RA 9N SER (EA) n17y IAATION Dmer- wt er COMPENSATION DECLAkATIOltNd'Q(Iatul' P (YI' ns„\ 11 by fWORKEkP he one (if rise a new 1x11 r!! ❑Ih d II t Cnf p fC elf' f W k :Cnmpcn set provided f by Section 3700offlam LaboaCcole,f thpyGyyIM111f Ne AI - -O ,ARCA, CONI_['( -t VA STORIES TYPECONSTRUCf101 week far which this tiscould. {/Ol0 ' ❑ 1 have aid will mimes n Workers Cmarclarese Fenimore as replied by Sat r p 3900of the Labor Code to, he performanmofthe work for whdehthis permit ie issued. 1� GAS-EA.SYSTFM-I INQ40UHTFS \� 4 OCC.GROUP APN 'L, GA -4 -OVER OVBR4(BA) ss" My Worker's C firm f d Policy nu rr m¢ pry�yg ler and I Cazrin: ” �war;a Policy No.:�iiL CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This smtienneulnot he completed if Ne permit is fulcra hundred dollars ($ IIID) less) Iwrtify that in the performance of the work fur which this pernphisisxneA,[shall not employ any petxon in any interracial as to become subject to the Workers Crimper- ' sotion Laws of California. Date Applicam is DI IVIS[ON FEES - GREASEIINDUS'PRI. WAS E INTFRCF.PTOk �\ GREASE IRAP N\ ,is'" PLANCHECK F135 SEWER -SANITARY- STORM F.A. 200FT, � �� dNERGYF• WATER HEATER WNENTIELECTR � pGRADIN FEE 3 NOXICE TO APPLICAN'F. If, after making this Cerci ^rate of P,xanptlon, you should Labor Gide, you mull' ser he be became snourttothe Worker's Compensation this permit „ forthwith comply with such pmvisiona or this permit shall he decreed revoked. WATER SYSTEMOREADNG SOILS FE ,av WATER SERVICE NEW RESIDENTIAL PUSH. SQ. FT CONSTRUCTION LENDING AGENCY T I hereby affirm that them I,. construction Icndmg agency for performance of PAID\ I A Date Reeelpt p - -\ V: TOTAL '. s the work for which this permit is issued(Sca309], Civ. C.) lender's Name "TOTAL: _ QTY. MF.HHAMCAL PERMIT FEE -' lad . Add BUILDING IIiE � rely that Ih 'd misapplicationand state thtth'b f 'I career .Ir, no ply with affl,in,and cournoaudionoureas and:n covellans,t building construction, dfarcby author lresematisesordls�ty m enter user the above-mentioned property for inspection purposes. (We) agree to save, index mify and keep harmless the City of Cupertino against Iiabllities,judgntants, costs andexpnses which may in any way accrue against said CityALTER in nsequure, It he gractirigof this permit. APPLICANT UNDERSTANDS ANTI WILL COMPLY WITH ALL NON -POINT SEISMIC FEE �\ PERMIT' ISSUANCE\ ELECTRIC FEE. OR ADD TO MECII. - PLUMRINO FEE �\ ' AIR HANDLING UNIT (TO I0h010 CFM) MECHANICAL FEE \\ SOURCE RFOULATIO�`C,. AIR HANDLING UNIT (OVER 10,000 CFM) CONSTRUCTION TAX � \\ Signet t Applirme/Commdor em EXI IAUST HOOD(WIDUCT) HOUSING MITIGATION FEE \\ HAZARDOUS MATERIALS DISCLOSURE Will Neapplieamerr fuwfe building occupantsav or handle hazardous mmerial HEATING UNI T('10100,011) BTU) A\ as defined by the Cupertino Municipal Code, Chapter 9, 12, and the Heahh and Safety Coda Section 25532(x)? HEATING ON[ 'P(OVER 00,000BTO) , VENT ILATION PAN (SINGLE RESID) ❑ Was ❑ No PAID Dam Receipt 4 Will the amemert orantra building occupant aremAir Quality emit hnzardnus air nnmminonts as defined by the Bay Area Air Quality Msmgemnt BOILER-COMP(3HPOR 100AIX1 pTU) TOTAL: 5 Dial I ❑Yes ❑NU BOILER -COMP (OVER 100,000 BTU) AIR CONDITIONER I have real the hazardous materials requiremnvs under Chapter 6.95 of the Cali- ISSUANCE DATE - NEW RESIDENTIAL MECH. SQ EL frome Heallb A, Safety Coda Sections 25505, 25533 and 25534. I understand that if the building docs concurrently have a person, that it is my responsibility to rotil'yrho occupant ' of the requiremnls which n no lance, prionn i -serines nfe Cwlificmc of Qcupmmy. ISSUED BY: TOTAL] Owner or authorized agent Date OFFICE Inspection Query for a Specfic Permit PEt2MIT IIISST Skis S EREfT Lat# NSDESGFfIPI = nsTyp DIk-T,EDESIRE ,aie€JQne E�spec#a Unrfs PI cr S1452 19333 VALLCO PLBG-R 4/13/98 4/13/981AD 1 I E 51452 19333 VALLCO WALK THRU 4/9/98 4/9/98 CC 1 2 1 O S1452 19333 VALLCO WALKTHRU 4/10/98 4/10198 CC 41 O S1452 19333 VALLCO REBAR 4/14/98 4/14/98 CC 2P P S1452 19333 VALLCO PLBG-R 4/14/98 4/14/98 CC 2 P P §1452 19333 VALLCO FRAMING 4/14/98 4/14/98 CC 2P P S1452 19333 VALLCO ELECT 4/15/98 4/15/98 S1452 19333 VALLCO FRAME 4/16/98 4/16/98 CC 2P P 51452 19333 VALLCO ELECT 4/16/98 4/16/98 CC 2P P S1452 19333 VALLCO FRAMING 4/20/98 4/20/98CC 2P P S1452 19333 VALLCO ELECT 4/20/98 4/20/98CC 1 P P S1452 19333 VALLCO SCREW 4/20/98 4120198CC 1 P P §1452 19333 VALLCO SCREW 4/22/98 4/22/98JS 3P §1452 19333 VALLCO FRAME 4/22/98 4/22/98 JS 2 N 51452 19333 VALLCO ELECT -R 4/22/98 4/22/98 JS 2 N 51452 19M VALLCO IFRAME 4/23/98 4/23/98JS 3P S1452 19333 VALLCO ELECT -R 4/23/98 4/23/98JS 3P S1452 19333 VALLCO SCREW 4/27/98 4/27/98 S1452 19333 VALLCO FRAME 4/27/98 4/27/98 S1452 19333 VALLCO ELECT -R 4/27/98 4/27/98 S1452 19333 VALLCO SCREW 4/28/98 4/28/98 CC 1 P S1452 19333 VALLCO FRAME 4/28/98 4/28/98 CC IP S1452 19333 VALLCO ELECT -R 4/28/98 4/28/98 CC 1 P S1452 19333 VALLCO SCREW/CORR.#1082 4/29/98 4/30/98 CC 3P P S1452 19333 VALLCO FRAME, RMS 4/20/98 51452 19333 VALLCO FRAME 4/30/98 4/30/98 CC 2P P §1452 19333 VALLCO ELECT -R 4/30/98 4/30/98 CC 2P P S1452 19333 VALLCO SCREWING 4/30/98 4/30/98 CC 2 P P ,:ICILY.? •