S 1525 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.ELECTRICAL PEgqIT NO. �I r/�
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL J _ 1 5 2 5
BUILDING PROJECT IDEN'T'IFICATION .•LL VV �J
UILDING ADDRESS:' SANITARY NO. APPLICATION SUBMI'TI'AL DATE
lU7Y/ /V, Wore 20G �.1, . �, �, Qsory �A-A6-AzI
OWN 'S A? PHONE:PHONE: C 'IRAC'FOR SNAME: LIC NO:571
W t ($'F( CcsNS'TK✓cTInN l0 NtC CONTROLN
I2CHITECT/ENGINEER: LIC No All BSS ❑
2.il-
CONTACT. \ PHONE: BUILDI NO PERMITINFO, -
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB NHICII
LICENSED CONTRACTORS DE LARATION { ILC 1'-►f(�
QTY . ELECTRIC PERMIT FEC
I hereby n7000)frm this l sed de er on. r,Crpter 9 e.all iomm g -. - .. JOB DESCRIPTION
OCz with Scetion]WO)ofD"sion3ofthe Bus sand4mfesoons G,de,and my license is RESIDENTIAL,
WOO PERMIT ISSUANCE
�
F W F In full and effect. \� ❑SFDWL El KITCHEN REMODEL
U License
Class
e Cloys oK APPLIANCES-IIHSIDP.NTIAI. ❑ADI119'ION ❑PLUMBING RH-PIPE
Dole—C
Daal
Zpyyy ARCI II1'BC'IrS'S DECL UECLAI2ATION ❑MULTI-UNIT ❑STRUCTURAL
Z Tendersard my porus shill be used mpublnean , PANELS MODIFICATION
pyC90 "I UP TO 21()AMPS El INTERIOR El CHIMNEY REPAIR
F,bn,E'tW Licensed Professional 201-1500AMPS IMPROVEMENT SWIMMING POOLS
OWNER-BUILDER BUILDER DE CLARATION OVER 101NIAMPS ❑BATH REMODELSEPAIR ❑DEMOLITION
J ❑
0.z I naso affirm that I am exempt from the Cssions r s:Any e Law for the
O0.U fallowing reason.(Section 9,0315.Business and Professions Cris:Any city n'bu u re SIGNS ELECTRICAL El OTHER
W�WOywhich requiresape t tall p d I'.h p ya=etdre
poo t tis 1 q th ppl tf I person.file a t aNT1 SPHSO AL CIRCUIT/MISC.
y that h .I' d p u th p fah Contract L Lt (Ch pl kx` .
COO (m n b with Seen—91100) f0 n3 fit BusinesssuitProgressions Cod)o,js TEMP.MP.IL'R OR POLL'I NST. COMMERCIAL:
d c C The,l empt Wen.l rte and the basis f da allegro exempt n Any v oluC f ,N ❑NEW BLDG/ADDITION ❑DEMOLITION
IL
Section 7031,5 by any applicantfrs perrnl bj elheappl' II it penalty(d '+"�4 POWER DEVICES
^'rn ti NAST ❑FOODSERVICE
=
not more than rive hundred dollsWIFE -
;S� ❑ I,axowner of Chep pdy yemply lh gex r.Ih' Icompensation, 'SWIMMING POOL ELECTRIC IMPROVEMENT
Cjd py will do the warkatd th tucl esnal int dJ uttered for:'1 (Sea 7044,Bromu, ❑OTHER
and erry asn.b clipCcalea,i he Connaeomi Gcerse Law does Mol apply m an owner of OUTLETS-SWITCHES-PIXTIIRE$
rt ho bnildt or vi thereon,tme who foes a air,
work himself or through
x
a 3- pmpe r w Troves g
his own omployeas,provided that such improvenmms are nq intended or altered for NE W'RE$IDENTIAL EEEC?'R1�1". SQ FT.
sale,If,however,The buildingor improvement itself within one yeaofeompletiti The SQ.FT.FLOOR AREA $ISQ.PT.
owneuroulder will hove the burden of proving that nc did not build or improve for pun- ,
p Ee cf sale). - y�
[_] 1,as awnerof the pm ,pen nm exclusively ommmirg with licensed eommemn w � � �TOij LU P A
consumer thToopert(S 70act.nosiness adP T.! .Code,)ThCoraborma,
- Li- yy �'cx ERM�IT .
Ee r L d not apply p p Ir n h '1ds rimproves m e d QTY. PMRI
who t hf hpP� 16
Rce❑ ldnexe npluncleSec ,B&PCCorthixrwxn PERMIT ISSUANCHX\
Owner Dnle ALTER-DRAIN&VE WATER(HA), \ _� r��r.I�,V/d DATION
WORKER'S COMPENSATION DBCI.ARATION vino IM
-
BACK PLOW PROTECT.DBVICEIc
1 hereby affirm ender penalty of p jury one of the following declarations:
Ibrvc and will fee
eCrnl3700 of Ca,Laba to scif Code sure for Workefsce mpen- DRAT F R PARR��OND. STORIES 'TYPE CONSTRUCTION
work os provided for a Sector 3]l10 0(Jm Lnbnr CnJe,for the perfnrmnnce of the
work fa e and this permit is issued. FIXT - ,R i
❑ 1 have and will mnlnlnln Worker's Compensation Insurance,as required by Section s
39UU of the Lobar Code fonhe perPormrnce of the work for which this permit is usual. GAS 'l orl OCC.GROUP APN
My Worked's Compcyy inion ace carriervmd Policy number are:
Carrier IQ-SDtlQ EXEMPTION I'ROM WORKERS OAS I2
Mowat .K Policy Nn: Omwft
1m'� CRB C Ov Nq1�
nor yx�M N1rvS�Av,fi q + seU #'i pIV1910NWRES `
( Mored act bac pa T oprmnisl"cashunJred�lnra($I W) GRP
orlesc) r ia� sS PLA NC HECK FBx
I cavity that in the performance ofthe work for which this permit is issued,Ishallp -G
non empley any person in any murder its to reduce subject the Workers'Comport- SEW
tt Ilk ENERGY FEE
z Bober Law,ofCaliumn.Dale \NAP \ -
z 2 Applicant 1 " GRADING FEE
F-t % NOTICE TO APPLICANT,IL after making this Certificate of Exemption,you should WATER SYSTP.M?REATING
a become subject to the Worker's Compensation provisions of the Labor Code,you must Y� SOILS FEE
forthwith comply with such provisions or this permit shoot be decntearcyoked. t WAT E i �
a o V�
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL YLMB. S NIAID°
U C I hereby affirm that There is a construction lending agencyfortheperfarromme f '\� Umc - Receipt
W
'he work for which this permit is issued(See 3097,Cie,C.)
Lender's Name TOTAL:
Ixcces Address
G1 certify Ind 1 have rend this application and state that the abase information is - - BUILDING PCE/
h correct 1 agree to comply with all city red county ordinances and state laws relaing In QTY., t
U building construction,and hereby authorize representatives ofthisedy to enter upon the
ab ce-necntioncB propmy for In,wctinn purposes.
inner,save,incemnif dkee harmleatmc Cit fCu rtinon l PERMIT ISSUANCE
(We) yen p yo pr gairu' BLHC'I'RIC PHP:
IiaM1ilitiev,judgmena,ca,is and expenses which mvy many way sameagainntsaid City
m gL'fER OR ADD TO MHCIL
in
constructive of the imnling of Ir
bis Pot,. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT'(1010,0000 M) -
sOUIICHk50' ❑( MECHANICAL FEE
�- t6v�� AIR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTION TAX -
// Signa of ApplicanUCommemrDote EXHAUST HOOD(WMUCT) HOUSING MIT IGA'I'ION FEE
HAZARDOUS MATERIALS DISCLOSURE
'l Will the applicant or Future building occupant store or handle hazardous material HEATING UNIT(TO 100,000 BTU)
us choral by the Cupertino Municipal Code,Chapter 9.12,mrd the Health and Safety
Lodq Section 25532(r)P HEATING UNIT(OVER 100,000 BTU)
[:]Ym 0N - PAID
VENTILATION FAN(SINGLE kES1D) Data - Receipt#
Will the applmmoa or ops auture bandingby the a use equipment or Mrio s which BOILER-COMP(3HPOR 100,000 BTU)
'n hazrMous Mir wmantinants as de0ncd by the day Area Air Quality Management TOTAL
R
I ❑Yes ON. BOILER-COMP(OVER 101,001 PTU)
I have read The hrxardous matrndsrc is under Chr to 6.95 of the Cult- AIR CONDITIONER requirements p ISSUANCE.DATE
fomlu Health&Safetytcurre Code,Seamon ,that i 25533 dad 25534.I understand Thai if the NEW RESIDENTIAL MECH. 9Q.FT.
building does not currently have a lemma iort o is ua ce of a ibiliq ca enotify lheacccy.
of the regnircmena which most he mw prior to issuance oris Certlhcme of Oecnpvncy.
Owner or authorized agent Date TOTAL: ISSUED BY:
OFFICE
Inspection Query for a Specfic Permit 6/4198
P IML ik
_]"TEQkSIREll0�#eQ,b� 116 e—c 1
S1525 10741 WOLFE IBOARDING INSPECTI 4/20/98 4/20/981CC 21F
S1525 10741 WOLFE CORBOARD/1ST,2ND 4/17/98 4/17/98 AD 41P P
S1525 10741 WOLFE DRYWALL SHAFTS 4/21/98 4/21/98 CC 41P IP
S1525 10741 WOLFE FRAME/4TH FL/ALL 4/22/98 4/22198 AD 3P P
S1525 10741 WOLFE FRAMING 516198 5/6/98 CC 4P P
FE
S1525 10741 WOLFE -FRAME 5/8/98 5/8/98 CC 2P IP
51525 10741 WOLFE PLBG 5/8/98 5/8/98 CC 1 P P
S1525 10741 WOLFE R - ELECT 5/8/98 5/8/98 2P IP
S1525 10741 WOLFE FRAME 5/11/98 5/11/98CC 14P
S1525 10741 WOLFE ELECT 5/13/98 5/13/98CC 3P IP
§1525 10741 WOLFE CHAULKING(?) 5/13198 5/13/98 CC 2P IP
51525 10741 IWOLFE PLBG-R 5/15/98 5115198AD 3P IP
S1525 10741 IWOLFE ELECT 5/18/98 5/18198 CC 2P IP
S1525 10741 WOLFE PLBG 5/18/98 5/18/98CC IP P
S1525 10741 WOLFE SHEETING 5/19/98 5/19/981CC 6P I
S1525 10741 WOLFE PLYWOOD NAIL 5/20/98 5/201981CC 3P IP
S1525 10741 WOLFE SHEETING 5/21/98 5/21/981CC 4F
S1525 10741 WOLFE PLUMBING 5/21/98 5/21/981CC 2P
S1525 10741 WOLFE PLUMBING 5/22/98 5/22/981CC 4P
S1525 10741 WOLFE PLBG-R 5/26/98 5/26/981CC 6P P
S1525 10741 WOLFE PLBG/CHILLED WTR 5/27/98 5/27/98 CC 3P
S1525 10741 WOLFE NN S U L 5/27/98 5/2_7/98 CC 4P P
S1525 10741 WOLFE PLBG-R 5/28/98 CC 3F
S1525 10741 WOLFE PLBG-R 5/29/98 5/29198JS 9P P
S1525 10741 WOLFE PLBG 6/1/98 6/1/98AD 6P P
5-1-5-25 10741 WOLFE PLBG-R 6/2/98 6/2/98CC 5P _P
S1525 10741 WOLFE _FRAME 6/4/98 CC
P 1