29145 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO auu.DINU-eLecralcAh PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECIIANICAL ' /' S
BUIL INGPROJECTIDPNTIFICATION 2914
BUILDING AODRL3S: SANITARY NO. APPEICATIONSUBMI'1'1'ALDATti
�
Lo�1,It
OWNER'S NAME: PHONE: CONTRACTOR'S NAME NO:
NIC CONTROL#
ARCHITECTIENGINEER: LIC NO: ADDRESS: ❑
CONTACT: PHONE_- - BUILDING PERMITINFO
❑ Consultant Fees Paid by Applicant(InitlaD. rl RCT� PLUMB h>f y
- LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I bet a frnn lhm I aro Bcepned ince,pnvin'.of Chq,rom
r v(coorreing JOB DESCRIPTION
�woZ with Sauon]lKp)MDivioiaeJoftK Hosiauad lYofeuiaa Code.ed mY licrnuin RESIDENTIAL -
in full farce ud cRnp. PERMITISSUANCE
tFoZ Lieeme Clea Lie.♦ _ OSFDWL [I KITCHEN REMODEL
N61 We - Conserv APPLIANCES-RESIDENTIAL DDITION ❑PLUMBING RE-PIPIT
SmDviARCHITECTS DECLARATIONIULTI-UNIT DSTRUCRIRAL
Zcp T4 I undeatmd my plans ahall4 uved as Public ncm-dN PANELS MODIFICATION
'0Z UP TO 2W AMPS OINTERIOR OCHIMNEYREPAIR
ta1 Licrnd professional ,201-I(IOOAMPS IMPROVEMENT
y C I,"3 OWNER-HU1LDER DECLARATION OVER Iqp AAtPs ❑BATH REMODEUREPAIR [I DEMOLITION
6 1 hcrtM1Y Win^dw I em caemp from the Contramofs Licenu Lew for the
x a O following ow w.(,Sapion 7031.5,Business and Po,eniau Code:Any city a coomy SIGNS PU,ECI'RICAL El OTHER
n1 LL LLO{': which requires a peanut o,rnnanuct,at improve,dampish,a repair any sommore
a'3} priam its ivuanes.den teyuim the applicant faeuch permit to file a agrcd deterrent SPECIAL CIRCUIT(MISC.
jlot heis licence pn.I mer poviaipra of dr Comtrsmh Dame low(Chapter 9 COMMERCIAL:
E'00 (emaneteingwiW Section 7")of DiOdon Sof the Be,inouvW PmfcaiensCJs)a TEMP.METER OR POLE INSP. �I
6 �C that he I.caemp therefrom arta the huia for the allege exemption.Any violmovas of D NEW BLDG/ADDITIO.S'� tY DEMOLMON
��os Smim]OJI.S by any applinnt faeprrmit whjcctsrk applicant toanvil prneltY of POWER DEVICES OTENANT it,
SERVICE
�z6tut note Wes five howit dd,11—(55110).
O L,uowaref the popenY•amY employees wish wagesvthir ale romprnwiun. SWIMMING POOL ELECTRIC rkIMPROVEMENT, n
CI ill do the wo ,.rd the amucmrt it not inJcd a
lennffeted for eale(Sec.]014,Husinev, - ❑OTHER
W 3 a"d Prof.Code:Inc Cnmraem;s Lane I�w deex net apply to am cow m of ovn.ers-swrzeHEs-P%Tuaec (y, (�
ptM¢rY who builds a impr ,oves there and who dv such*(Ahimvlr or through `•,'
has own employc<s,povio1d that ouch improvements em rot intended a offered fa NEW RESIDENTIAL ELECIR SO FT.
sale.If.however,the holding or impnvement iv sold within ne yearef completion,live SQ.FT FLOOR AREA r'm L TI F IjVL5/SQ.EL
owner-Ivilder will have the bec le.Npmviog that he av build or impovc for pea- Z It � yl/�
pose of We). I" V V� �• -Al
I.....of bee proary,am nclusivelY tolmetin,with liamud tearoom ad `te �YY11����
wa rhe pmjen(Sec.]061,Buvms Ord rty whoowC.chane n, L-
«ts,Co deem apply rein owarofmaeme.wewridoo imoo,IN,Wemm,.rd QTY. PLUMBING PERMIT FEE
Licer,-Law.fa wch projxa withacmractm(a)Iittvd pursuant to Ore Cauncol.
0Iturlaw. - • PERMIT ISSUANCE
❑1 am caemp odea Ser. .B&P C fm Jus roan
Taw
ALTER-DRAIN&VENT-WATER FA) VALUATION
WORKERS COMPENSATION DECLARATION HACK PLOW PROTE .DE CE ^ ��
I hereby.ffom under petulty of perjury one of the following decWationv:
have erewill moi by
31TO of be Lour Code
eforte W'akctaer,of He
- DRAINS-PLOOR,R .GOND. STORIES TYPE CONSTRUCTION
tial,r provided for it S,tapn J]ql of the ISWr Cak,for Ur pafumuaee of Jose
Werk for anal thupemdtis Issued. Fl%T1HFS-PER TR
❑ 1have andwill
dcen fon Warif Co of thion Inwmae,btm,mlt i tiowect
My ostr kIssbasCoo Codefpe 0tcpofamueer the some,Jr.m which Nis pomit is usucd. GAS-PA.SYSTEM-1 INC.30fITL
OCC.GROUP � APE
My Worker's Cmuyen minim Insumna tameroli Policy mortar we: ,
Ganite Policy No.: OAS-EA.SYSTEMOVER 6
I CERTIFICATE,OP EXEMPTION FROM WORKERS '
COMPENSATION INSURANC17 CREASP/INDUSTRL WASTE I
(This section recd rot of ronrplctN if the permit is fa cone toothed!dollen(3100) BUILDING DIVISION PEES
or less) GREASE TRAP PLANCHY.CK PEE �+
IecifYJat nin the perfeameree Mthe wprkfor who,hffik permit is issued,10.11 SEWER-SANITARY-SBORM EA.2W
'
not employ any person in any morn en v to Ince.abject I.the Worker'Canpen- - ENERGY FEE 111 0
Zzastiat".of CaOfania Dose WATER NEATEN WN II /ELECIR
— Applicant m GRADING FELE
h NOTICE TO APPLICANT:If after mutiny this Ceadacate of Exemption.you should WATER SYSTE.M?REVDNG
a ; become.ubjm to the Wprori Canlrneadpn prpviaiona of tie luNn Code,you must SOTS FEE 1 a.
r forthwith comply vich Loch provioars or this permit shall he dame revoked WATER SFR VICE R
� z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SO.FT. PAID '
u0 1thereby affirm thea there is a conmmOien lending ageaY for the performance of Date Reccifo0
pthe work for which thio pcmmit x,,iod(Se,,TAG.Civ,C.)
U lcdea's Name TOTAL:
V IcMcr'.i Adlm'.s '
L9 I cert that,lave read due application ad uea that the.M1ove inf.ion is BUILDING ITE
h cmnn.l ngremcnmpy with all city and county orJinunccs and stmt Wws miming u' QTY. MECHANICAL PERMIT FEE rg�
U Z banding omuruniara ad M1vebyaerhave repe.wmatives ofrhu city tuemmupan the SEISMIC FEE LL
aMve-rrntiarrd propcny for irepc'ctian paras PERMIT ISSUANCE.
(We)ogre I.sees,infirmity end kap hemi the City m Caped.against ELECTRIC FEE O
barilitia,judgmenta,mus ad expenses whieh may in any way acme against a'xl City
m coma snoi nee of he gandng of this permit. ALTER OR ADD TO MECH. PLUMBING FFE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IO,"CFM) - MECHANICAL fFE
SOURCE REGULATIONS. I
AIR HANDLING UNIT(OVER IO,OOIICFM)
CONSTRUCTION TAX" -
SignattveofApplicar/Cmwna D.re EXHAUST HOOD(W/UUC1) HOUSING MITIGATION FliIi
HAZARDOUS MATERIALS DISCLOSURE
Will Ne applium orbome building occupant sore or handle haaardaas material HEATING UNIT 0101 WJIW BTU)
is defined by the Cupmiro Maniclpal Gde,Chapter 9.IZ and de,Health and Safely _
Cale,Section 26532(e)'I HIATI NO UNIT IOVER IW.000 BTU)
❑Yes F1 No m. VfMILiTION FAN(SINGLE RFSIDI PAID Dae . Roti N
.Win Je applicant a future Wildin - p
g aaeBayAeat Air mluy Meev which BOILER OR IW.gXI BTU)
l hm.wJmms nim eonamiwna v defined by the Bey Arm Air Quaky Maeagcment . J/`
aurtl BOILER-COMP(OVER NTNEBTU) -/•/
LM�ildi,
- Otho �
AIR CONDITIONERouISSUANCE DATE
&Safety Code.Selena 25505,255]1 ed 25511.I wdvsurvl dot if UrNE,I'RESIDBNTAL MECH. SQ.FT.erewrtnJY have ateaunt.thato iemyre.of.Cmiry Ipe ofytheacvponlena which none be mn print to iuuurc M'e Cmifcmtc Of Occtµmrcy.orircd eg<nt Dare TA ' \ ISSUED Pv
OFFICE
Inspection Query for a Specfic Permit 9/15/97
PERMIT#; I,T,US1STtSITiUSISTREET Lot# INSDESCRIPT IVsT" DATEDESIREP.DaCeDone
9145 HOMESTEAD BDG FLOOR NAIL 7/30/96 7/30/96
9145 HOMESTEAD BDG FLOOR NAIL 7/31/96
29145 HOMESTEAD BDG SILL PLATE 7/31/96
9145 HOMESTEAD BDG FLOOR NAIL 7/30/96 7/30/96
29145 HOMESTEAD BDG STEEL PLATE 8/1196 8/1/96
9145 20661 FORGE BD 1 ROOF NAIL 9/20/96 9/20/96
9145 20661 FORGE BD 1 elec 10/16/96
9145 61 FORGE BD 1 PLMBG 10/16/96
9145 20661 FORGE BD 1 MECH 10/16/96
9145 20661 FORGE BD 1 FRAME 10/16/96
145 20661 FORGE BD 1 ELEC 10/22/96 10/2219
145 20661 FORGE BD 1 PLMBG 10/22/9 10/22/96
9145 20661 FORGE BD 1 FRAME 10/22/96 10/22/96
9145 20661 FORGE BD 1 FRAME 10/24/9 1 /24/
9145 20661 FORGE BD 1 ELECT-R 10114/9
9145 20661 FORGE BD 1 MECH-R 10/24/96 10/24/96
9145 20661 FORGE BD 1 PLBG-R 10/24/96 10/24/
9145 20661FORGE BD 1 FRAME 10/30196 10/30/96
29145 20661 FORGE BID 1 IELECT 10/30/96 10/30/96
9145 20661 IFORGE BD 1 IPLBG 10/30/96 10/30/9
9145 20661 IFORGE BID 1 IMECH 10/30/9 6 10/30/96
29145 20661 IFORGE BD 1 INSUL 11/5/96 11/5/96
9145 20661 IFORGE BD 1 FRAME 11/5/ 11/5/96
9145 20661 IFORGE BD 1 PLBG 11/7/96 11/7/96
9145 20661 IFORGE BD 1 FRAME 11/7/96 11/7/96
29145 20661 IFORGE BD 1 ELEC 11/7/ 11/7/96
29145 20661 FORGE 13D 1 MECH 11f7l96 11/7/96
9145 20661 FORGE BD 1 GAS TEST 2/11/97 2/11/97
9145 20661 FORGE BD 1 ELE 2/20/97 2/20/97
291 45 20661 FORGE BD 1 BLD -F 2J27/97 2/27/97
9145 20661 FORGE BD 1 BLDG ENRGY-F 2/27/97 2/27/97
29145 20661 FORGE BD 1 L 2/27/97 2/27/97
29145 20661 FORGE B 1 PLBG-F 2/27/97 2/2719
9145 20661 FORGE BD 1 MECH-F 2/27/97 2/27/97
9145 20661 FORGE BD 1 BLDG=F 2/28/97 2/28/97
9145 2 61 FORGE BD 1 BLDG ENERGY F 2/28/97 2/28/97
9145 20661 FORGE BD 1 ELECT=F 2/28/97 2/28/97
9145 20 61 FR E BD 1 PLB -F 2/28/97 2128/9
145 20661 FORGE D M C - 2/28197 2/28/97
Page 1
Inspection Query for a Specfic Permit 9/15/97
Ins ecto Un`Its Pa"ss/Fail jCode`{
J 12P
C 2P P
J 18P
S 1 N
is 4F
is 4
S 4P
is 8F
S 3P
S F
S P
S 3P
S 3P
S 3P
S 4P
SP
is P
S 6P
S 4P
S 6P
S 3P
_S 4 P
S 2F
is 2F
S 2F
S 2F
2P X
S 2P
S 2P
P
2
i
Page 2