30314 (3) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PF,RMITNO. 31
BURA)INC DWISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION
BUIL(IN012-15
2-15; ' ��0 0,,sb+ P� SANITARY NO. APPLICATION SUBMITTAL DATE
OWN.R'. NAME: PHONE' Cf NTR/spCTOR'S NAME: _ LIC NO [
O li �C GJ G/(W e/�" NIC CONTROL N
LC N ADDRESS: ❑
COM'A`////C'''I�'.:��.� A PHONE: BUILDING PERM INFO
�-L v J Q)Q9 —b Q /7 ❑ Consultant Fees Paid by Applicant(Initial) BLDG EL� v�B MECH
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE JOB
I hereby aRr that 1 vm licenud udtt provisions of Chapter 9(commencing JOB DESCRIPTION
th Section 7000)of Division 3 ofthe Business and Professions Cade,and my license is PERMIT ISSUANCE
U License Class a�
m fall force and elTeet.
�,C WL ❑KITCHEN REMODEL LicADDITION ❑PLUMBING R&PIPE
hG� Dmc Contractor APPLIANCES-RESIDENTIAL
p.Dm ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL.
Z 0 n 3 I understand my plans shall be used a5 public ccmds 'MODIFICATION
OZ-0 UP TO 200 AMPS
El INTERIOR ❑CHIMNEY REPAIR
ty Leenscd Profcssinnul 201-1000AMPS IMPROVEMENT
k:aaaCCC -aj OWNER-BUILDER DECLARATION
I hereby affirm that f um exempt Irom Om Gmtmctor's License Lew for the OVER IINIf1AMPS [I BATH ftEMOOEL/REPAIR (]DEMOLITION
pe0i u Infiniti,reason.(Section 2031.5,Buei.ctx.and Professions Code:Any city car county SIGNS ELECTRICAL []OTHER
aall a. which cultures v pemtit to construct.alter,improve,demolish,or repair any swemrc
��°� prinnnits issuance,N-a requires the applicant for such Permit file a signed statement SPECIAL CIRCUITMISC.
y that he is licensed Provisions (Chapter
} purmanno the ns a(Ihe Conuacmrs License law9
W SCC (commencing with Scene.7001B.TDivision 3ofthe Business and Professions Cde)or TEMP.METER OR POLE,INS'E y}a
6 a n Y that he is exempt therefrom and Ne basis for the alleged exemption.Any violation of ❑NEW BLDG/AD IT AL TION
•-,y
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of POWER DEVICES �TFNANeLr•si .,r ❑FO RVICE
t mare than five hundred dollars($5010. 0
I.
CI I,as owner afthepropenY.ormyemployees with wages astheir sole compensation, SWIMMING POOL ELECTRIC IMPROVE. WrCr
will dothewofk.and the structure is not intended oruffercd for sale(Sec.J044,Business ❑OTHER )fHvLr
and Professions Code:The Contractor's License low does not apply to an owner(il' OUTLETS-SWITCHES-FIXTURES
property who builds or improves thereon,mul who docs such work himself or thrntgh
his own employee's,provided that sued improvements me not intended or offered for NEW RESIDENTIAL HLECIR SQ PI'.
sole.IL however.the building or imprzrven¢m iv solJ within ane yearof romplminn,the SR FT.FLOO [A VSQ.FT.
owner will have the burden of proving that he did not build or improve for pun �
pose of,aa). - (�
I,as owner of the property,am exclusively contracting with licensed conuumnrs to
construct Bae project(Sec.7614,Business and Professions CWC:)The Committers Li- ^ ah
cense law does not apply to an owner of prolixity who builds or improves thereon,and QTY. PLUMBING PERMIT FEE (/ `/`r A
who contracts for such projeces with a cit mneme(s)licensed indicators tothe Cement
License law. PERMIT ISSUANCE
[Dm I aexemptinder Sec. ,B&P C for this rcemn
ALTER-DRAIN&VENA IT- ER BEA)
Owner Date �!\a VA♦LUAfTI�ON
WORKER'S COMPENSATION DECLARATION RACK FLOW PROTECI. E J� 11 �f
Ihxchy affirm undo penalty of perjury ono of Wofollowing declarations: 7 7 b
I huvc anJ will maimaina Cenificote mf Cnnsem to eelbinsurc for Worker's Congam. DRAINS-FLOOR,ROOF,AREA,CO STORIES TYPE CONSTRUCTION
nation,as provided for by Section 37M of the labor Code,for the performance of the
work for which this perit is issued. FIXTURES-PER TRAP
1 have and will maintain Workers Compnsmren
eion Insuec,as required by Section
T/alof the LaborCds,for the perfonnuncam'he work forwhich Nis permit is issued. GAS-PA.SYSTEMd INC.4 OCC.GROUP APN
My Workers Compensation Insurance carrier and Policy number are:
Cartier. Policy No.: OAS-B.SYSTEM OVER 4(IIA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GRT:ASERNDUSTRL WASTE INTERCEPTOR
(This section need not becourn d fthe permit is fornne hundreddollars($)BB) B D G [VISION FEES
or Icss.) GREASE TRAP
PLANCHECK ��
Icenify that imtheperf..acccofthe work for subjectch i. he Wosinsued,I shallCm,pr. SEWER-SANITARY-STORM V.A.200 FT.
not employ any person in any manner en a m hcutme subject m the Workers'Cnmpcm ENERGY FE
Zz ptmnwsof Califnmia.Date
Applicant WATER HEATER WNENTIELECTR GRADING AJ
Q A licant
tr 4 NOTICE TO APPLICANT:IL after making this Cenificam of Exemption,you should a � WATER SYSTFM,TRIlA3'INO became subject m the Worker
Worker's Compensation provisions of the labor Code,you must SOILS FEE
4i1 forthwith comply with such Provisions or this permit shall be deemed revoked. WATER SERVICE
0
z CONSTRUCTION LENDING AGENCY NEW RESIDENTIALPLhfll. SQ ET. PAID
L)O (hereby affirm that there is a commction lending agency for Ne performance of Data c
Br F"ti the work for which this permit is issued(Sec.309),Civ.C.)
Lenders N..
� TOTAL:
{UEl Lenders Address b
1 certify that 1 have read this application and state Nat the above information is BUILDING O �•
l/1 toren.l agree to comply with all city and county ordinances and stare laws relating to QTY. MECHANICAL PERMIT FEE
V building construction,and hereby andmim representatives of thiscity toemer upon the SF.ISMI F60
oMwwnenum d progeny for inspection purposes.
(We)ugres to save,indemnify and keep hornless the City of C.Penino ugvimt PERMIT ISSUANCE ELE I'CPWU
Iinhilities,judgments,costs and expenses which may in any way accmx against said City ALTER OR ADD TO MECH.
in consequence of the granting of Nis peril. PLUMB G FEE
APPLICANT UNDERSTAND' AND WIL COMPLY WITH ALL NON POINT AIR HANDLING UNIT LTO 10.000 CFM) 0
SOURCr REGULAT10Ng. / MECHANICAL
p Ay
N- - J Q 6 AIR HANDLING UNIT 10,000 CFM)
p L / CONSTRUCTION TAX
Si etc f pp canVConmc r Dom EXHAUSTHOOD(W/DUCp HOUSING MITIGATION FEE
H="MUSM TRIALS DISCLOSURE
Will the applicant or(uwre bui goccupamsmreor handle haardots material HEATING UNIT TO 100,000 BTU)
as defined by the Cupenim Munici I Code.Chapter 9.12,and the HmIda and Safety
Cdc,Section 25532(a)P HEATING UNIT(OVER 100,000 B-I U) st
❑Yes []No PAID
VENTILATION FAN(SINGLE RESLD) gem RcaiplM
Will the applicant or future building occupant use equipment or devices which BOILER-COMP(311POR 1(NI,(MN BTU)
Pit hmardous air mmaminants ns defici by the Bay Area Air Quality Manogement TOTAL:
District?
❑Yes ❑Ne BOILER-COME(OVER 100,0110 BTU)
I have rend the haaardous mmerials cl.itnmcncs antler Chapter 6x95 ofthe Cali- AIR CONDITIONER ISSUANCE DATE
forme Health&Safety Code,Sections 25505,23533 and 25534.1 understand den if the NEW RESIDENTIAL MECH. SQ.ET.
bailding does.umcummly have a tenant,thin it is my responsibility to costly the occupant u
of the requirements which must be met prior to issuance of a Certificate of Occupancy.
Owner or mttharitd agent Data ISSUED BY:
OFFICE
Inspection Query for a Specliic Permit 1/13/98
• PERM_ITf ITU$STI SITOS STREET Lot# INSDESCRIP.T @j 'D'A'TEDESIREJ DateDone'
30314 10251 PRADO VISTA —FOUNDATION 11/1/96 11/1/96
0314 10251 PRADO VISTA —FOUNDATION FOR 11/4/ 11/4/9
0314 10251 P D VISTA F 11/4/96 11/4/9
30314 10251 PRADO VISTA CONCR SLAB 11/12/96 11/12/96
303 14 10251 PRADO VISTA —UNDIRFL PILBG 11/25/96 11/25/96
30314 10251 PRADO VISTA MECH 11/25/96 11/25/96
30314 10251 PRADO VISTA INSULATION UNDERF 11/27/96 11/27/96
30314 10251 PRADO VISTA UNDRFL PLBG 11/27/9 1/27/96
30314 1 251 PRADO VISTA UNDIRFLIFIRAME 12/2/96 12/2/96
30314 10251 PRADO VISTA IUNDRFL MECH 1 12/2/96 12/2/96
30314 10251 PRADO VISTA IUNDRFLPLBG 12/2/9 12/2/ 6
30314 10251 PRADO VISA UNDRFL INS 12/3/96 12/3/96
30314 10251 PRADO VISTA U/F FRAME 11/25/96 11/25/96
30314 10251 PIR DO VISTA —ROOF 2/5/97
30314 10251 RA VISTA EXT SHTIRIK NAIL 2/5/97
30314 10251 PRADO VISTA R FRAME 3/7/97 3/7/97
3 314 10251 PRADO VISTA R PILBG 3/7/97 3/7/97
0314 10251 PRADO VISTA R ELECT 3/7/97 /7/97
30314 10251 PRADO VISTA R MECH 3/7/97 3/7/97
30314 10251 PRADO VISTA SEWER WATER 3/7/ 7 /7/ 7
30314 10251 RAD VISTA UND .EL T 3/10/ 3/10197
30314 10251 PRADO VISTA INSULATION 3/13/97 3/13/97
303 14 10251 P A VISTA U / HWR PAN 3/19/9 3/19/97
30314 10251 PRADO VISTA SHTIRK NAI 3/24/97 3/24/97
30314 10251 PRADO VISTA EXT LATH 3/24/97 3/24/97
30314 10251 PRADOVISTA GAST 1 3/27/97 3/27/97
• 3 314 10251 PRADO VISTA —SHOWER LATH 4/30/97
30314 10251 PRADO VISTA ELEC.REL 8/18/97 8/18/97
30314 10251 PRADO VISTA —GAS TEST 9/9/97 9/9/97
30314 10251 PRADO VISTA CT=F 9/15/ /15/97
30314 110251 PRADO VISTA PLBG-F 9/15/97 9/15/97
30314 10251 PRADO VISTA MECH-F 9/15/ 7 9/15/97
30314 1 251 PRADO VISTA BLDG FINAL9/15/ 7 9/15197
30314 10251 PRADO VISTA BLDG ENERGY FINAL 9/15/97 9/15/97
30314 10251 PRADO VISTA 9/18/97 9/18/97
30314 RAD VISTA PLBG-F 9/18/97 9/18/97
30314 10251 PRADO VISTA BLDG-F 9/18/97 9/18/97
30314 102 1 PRADO VISA ELE -F 9/18/97 9/ /97
30314 10251 PRADO VISTA B D -F 9/26/97 9/26/97
30314 10251 PRADO VISTA ELECT-F 9/26/97 9/26/97
14 10 5 PRADO VISTA P BG-F 9/26/ 7 9/26/97
0314 10 51 PRADO I A ME H-F 9/26/9 9/26/97
30314 10251 PRADO VISTA BLDG ENERGY FINAL 9/26/97 9/26/97
•
Pagel
I
Inspection Query for a Specfic Permit 1/13/98
Ina ec`"o`. RIM,061fyall Code
• D 2F
S P
B
S 3P
B 2F
B N
D 2F
D 2P
CC 1P
CC 1P
CC 1 P
D
B 2F
D 2P
D 2P
D P
D 2P
D 2P
D
O 2P
O 2P
S 2P
S 2P
O 2
• D 2P
S 3P
O
D 2F
D 2F
D
D
D 2F
D
D
D 2F
D 2F
D 2F
D 2P
D 2 ---
D 21P
D 2P
•
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