S 2174 (2) S'Ig WPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTTNO BUILTNG-ELECTRICAL PEg`X,1IT NO.
BUILDING DIVISION APPLICATION/PIERMIT PLUMB NC-MECHANICAL V ' 2174
BUILDING PROJECT IDENTIFICATION i
BUILDING ADDRESS: SANITARY NO, APPLICATION/SUBMITTAL DATE
/ - r
OWN 'S NAME: PHONE: CONTRACIOR'S NAME LIC NO:
N/C CONTROLX
C ITBC'I'IIiNOINET:E; IAC NO ADDRESS ❑
f-nese$ d FA(.
CONTACT: PHONE. BUILDING PERMIT 1 O
1¢/5) El Consultant Fees Paid By Applicant(Initial) BLDG IP.EC'T PLO ld:
A✓ A� /' 8&,Po ❑ ❑
LICIiNSEDCONCRACIOR'SDECI.ARATION QTY. ELECTRIC PERMIT FEE
I hcmhy affirm that 1 am hc,nsed mor pmvisim,x PIChnpfer 9(....... •nning J0I3 DESCR TION
O O'Z with Section700f.f Divisiom3ofthe RLLGnCss.md Professions Cmnimd my license is RF.SIDENTIA),
Fwp in rail force and effect. PEHMI'1'ISSUANCE
W� , ❑SFDWI. ❑KITCHEN REMODEL
�UU Dun Class Lich APPLIANCES-RES IDEN'I'I At. ❑ADUI PION ❑PLUMPING RE.PIPF.
Nva Ua1C Con DELL
,mon AkCHI'1'IiCI'S DECLARATION PANELS ❑MUCI'LUNI'I' [I STRUCTURAL
ZpyZ I understand my plans shall be used as public records MODIFICATION
UPTO 20f1 AMPS
OZ^p ❑INTIikIOR El CHIMNEY REPAIR
CM7.Wa Lirenxal l'n,fcsaionul 201-1000AMPS IMPROVEM' 'I' E]SWIMMING POOLS
OWNERdf MILDER IIECLARAI'[ON
C��-a OVER I"AMPS ❑BATHRE• D: EPAIR ❑DEMOLITION
d' 1 hereby af0mt That 1 am caempt from he Connanmr's License Law far the
iq5 a.U following reason.(Section 7031 s,Business and Professions Cale:Any city ter county SIGNS ELECTRICAL ❑MHII
uta 4 y Which royuims a pmndt n.ame,hael,otter,Iei,rcva,then mh,h,or repair any aR u, R,
u p
priorto itsissuance,als q .toe applicant lsuch pc not tofile a signedantcmenl SPECIAL CIRCUPPOMISC.
hot he licensed psoot to thepn n fth to
C mo L La (Chipmr9
On
¢C) lent 6 tit Scct 70001 fD ioi 1 fth B .' c.n dP f ::- nx Gtd,)or TEMP METER OR POLE INST.
a o Y
that he Is,tempt darct.nm and the hails Jnr the ulleged'e aRpnolr Any violation of NHW ULDG/AIJUITION El UEMOhI'fION
em
Section mJ 1.5 by any upplic II'm,.permit othFev the upplicanun aclvil,samt,of POWER DEVICES ❑TENANT 0 TOO[)SERVICE
n more than rive hundred dollars 15500). IMPROVEMENT
S� ❑I,as thowneraofthc properly.ter is myempinycu with wage.as their snlecompenxmion, SWIMMING POOL ELECT RIC
F+ wllldmewk,and th,,umnie natintendcdoroffcred forsule(See.70W1,lousiness OTHER
m and Poetwoions Calc:The CmIculm's License Law dies not apply m an Per of OU'T'LETS-SWIICIIES-10XTUH13KFF
❑
property who builds or improves thereat and who does such work himself or through
his awn employees,provided ohm such haprove nents arc not intended or offcrcd for NEW RESIDENTIAL ELECT SQ ET.
sale.If,hasever,the building or improvement ix cold within one year o[cnmpletinn,theSQ.FI'.FLOON AREA $/SQ.IT.
1+�n -builder will moo,the buNen of proving tbut he did not build ter improve far pur-
%,rof svlcJ.
1,vs owner of the pPt,wny,ata exchtsivcly ennneeli ng with hocrvsal IRrune cors I. TUT
consume,the pngect(Sec.7(144.Business and Professions Codc:)the Contmcmr's Li-
u Law does not apply to an owner of property who build.or impnwes themtm,and
s,no contracts for such projects with a contructur(s)licensed puraatto the Contractor v 7
Lirenre Law. FERMI'f ISSUANCE
❑I am emmpl under Sec ,O R I'C for this mason
AI: iR-DRAT At VENT 'H(EA) VALUATION
Date
wn
WORKER'SCOMPF,NSA'I']ON DECLARATIC F W R .LT ICE — 9 4
I hereby affirm under Penalty of perjury one of the following declarations: o
I have and will initiation a Certificate of Comenuo sell-insure for Workers Compen- DRAINS-FLOOR.RO �,AREA,COND. STORIFist_ 'IYI'ii CONSTRUCTIONsatien,av provided for by Section 37M of the LabCode Labor Ce,home pefonn.ne,i,Frhe
ark for which this pcnnit is ie,ord, FIXTURES-VER" AI'
❑ I hove and will nraimnln Workers Cnmpi nsmlmn heamor ce,as eipm ed by Section
3710 of the Labor Cole.forme performance ofthe work for which this permit is issued. GAS-EA.SY.' rM-1 INC.4 OUTIJ- DEC.GROUP APN
My Wnrker's Compri lionln.sursncecaricr and Policy number are:
Currier: Polity No OAS-BA. S'I'EM OV ER 4(EA)
CP.R' ATE OF P.XEM 11 ION FROM WORK17RS'
COMPENSATION INSURANCE GRE.A. INDUSTRL WASTE INTERCEPTOR
CI'hismnian mccdnol be completed Una,permit is forma,hendredd.R.,(SIM) BI1L1 'G DIVISION PI:ES
r rlcvs) GH SE TRAP PLANCHECKFEE
I cenily mm in the any manner o as t become
for which This thePerini,Wo s issued,Co I shall :WER-SANITARY-STORM EA.2n)IT.
no,employ any person in any manner so as m hcome suhjea m the Workers Compen- ENERGY IgiE
Z vision Laws or C.RIPRoa.Dam WATER HEATER WNENT/HLECTR
O Q Applicant - GRAVING FEF.
77 NOTICE B'O APPLICANT.If,alter making this Ccnificum of Exent ishould
F N 6 P coq You WATER SYSTIiM EATING
a ; become suhjea m the Workers Cnmpensatinn provision:of the IrMn Cale,you mus' SOUS FEE
W hinhwirh comply with such provisions or this permit snail he deemed revoked. WAI EH SERVICE.
Q
Z) z CONSTRUC'PION LIiNDING AGENCY NEW RESIT "ALPL { SQ. PAID
I hereby affimuhat there is a consnuction lending agency for the peRn neeof HcttiptN
the work for which this permit is issued(See,3097,Civ,C.)
Lender's N:une TOTAL
U :
Wlender's Address cav, T(l'IAL:
1 certify that 1 have read this uppliculias/theyRf
at the aM, information is BUILDING FE O
rn7/1t correct.l agree to comply with all city and counts and sC LastmLtingto QTY. MSCI [CAL PERMIT FEE
V ❑ buildingcmmxlmcliam,nndhembyauWorizeicprcfthis ytnemerupnnlhe SEISMIC FEE
aMrvcmemimned propsny for inspersion PI7RMIT ISSUANC
(Wel agree a,save,indemnify and keep y mf Cupeninmagaintliabiliticsludgments,cnxm and cap,nscs wl,icM1 t .sero,agviaslsvid City AI:1'hR OR ADIl TO Iin m..ynencrid litegmnlin• I'Ihis p, I PLUMIIING PEE
APPLICANT UNDERST D. AND WILL ITH AI.1,NON-POINT AIR HANDLING UNITUD Ig0(MCPM)
SOURC RE ILATIO':. MECHANICAL 103E
11-1 `it a' AIR HANDLING UNIT(OVER High CFM) CONST RUCT1ONTAX
Signal -4 in V in a nr Date EXHAUST HOOD(W/DUCT)
1 AR )US MATF.I LS DISCLOSURE HOUSING MITIGATION FEE
Ica if nt ter future buildin roupan,
score attend huzallou"onomal HEATING UNIT(TO 11Xk000 BTU)
,is de ed by Ih, uI orlon Municipal Jnr,Chapter 9.12,arl the Health and Safe,,
Code.Section 25532()^. HEATING UNIT(OVER HORFOH11{'I V)
El Yes N
o PAID
VIINTILA'1'ION PAN(SINGLE HHSID) Dam Rca,fsX
Will the applicant ing occupant use equipment or devices which
it harurdaos airconmmed by the Bay Area Air Quality Management BOILER-COMPOHPOR IW,0MITIO)
strict?
❑Ye, BOILER-COMP(OVER W,"Hol)
AIR CONDI'T'IONER
I have mad he It mryirtmems udder Chute,6.95 it Bis Coli- ISSUANCE DATE
!corm.H ahhhSafety Cale, 5(15.25533 and 255J4.1 unJermnJ Thal if the NEWRESIDEN'1IALMECIL SQ.FRhuildin a cmtmuly hae ryis nos which ternnn miancenf u Cenilicu,t 0,/.,aaP'Y�.
Own o ,coed gen - lbar TOTAL: ISSUEIIBY'
OFFICE
•
Inspection Query%Oppecfic Permit 2/40
PER nVp, ,—e
,MIT ffu 51 TOK T IN MDEStIME jfn��T�-Vji6IESIP -EW017 ct—pAOffifi§1
S2174 I RESULTS BG6 UNDG PLBG 9/14/981 9/14/98 DS 21P I-
52174 1 RESULTS BG6 ROOF FRAME 9/14/981 9/14/98 DS 2F
S2174 1 RESULTS----dG6 FRAME-R 9/17198 9117/98 DS 3F
52174 1 RESULTS BG6 ELECT-R 9/17/98 9/17/98 DS 1
S2174 1 RESULTS BG6 PLBG-R 9/17/98 9/17/98 DS 2F
S2174 1 RESULTS BG6 PLBG-R 9118/98 9/18/98 JS 2P
S2174 1 RESULTS BG6 MECH-R 9/18/98 9/18/98 JS 2P
---
S2174 1 RESULTS BG6-[SHTRK NAIL 9/23/98 9123/98 IDS 2P
S2174 1 RESULTS BG6 ICEILING GRID 10/5/98 10/5/98 CC T
52174 1 RESULTS BG61MECH 1 1015/98 10/5/98 CC T
S2174 1 RESULTS BG6 ELECT 10/5/98 10/5/98 CC T
S2174 1 RESULTS BG6 ABOVE CHING 10/5/98 10/5198 CC T
S2174 1 RESULTS BG6 ABV GRID ELECT 10/6198 10/6/98 CC 2P
S2174 1 RESULTS BG6 ABV GRID MECH 10/6/98 10/6/98 CC 2P
S2174 1 RESULTS BG6 ABV GRID/MECH 10/6198 10/6198 DS 2P
S2174 1 RESULTS---BG6 ABV GRID/ELECT - 10/6/9.8 10/6/98 DS 2F
Pagel