S 1477 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY qF CUPERTINO BUILDING-ELEcI'RICAL Pe1Irgppl F NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL V 1477
BUILDING PROJECT IDENTIFICATION
BUINGADDRESS`. � �� - SANITARY NO. APPLICATION SUBMITTAL DATE
O PI ICING: TRA ORS NAME,: C
2/1l' ZO•� N/C CONTROL#
C .CT N GH // L T_IC NO (I VV A R SS t ❑
CONTACT: (' PHON '
g (� �r /� 11 BUILDING PERMIT INFO '
J97fAA V(r1JJ\)I )W lj SD) 47fr Z5'P1 L-1Consultant Feei Paid by Applicant(Initial) ELECT PLUMB MECH
LICENSED CON'I'R , ARS DECLARATION -
l QTY ELECTRIC PERMIT.' FEE
1 horehy nfr m tot 1 T nr d oda p ,P Chapter 9(common,,g JOB DESCRIPTION
FOCy with Schico 9(g0)ofD 3 fticEus abYnnJ Pn fe vinm Qule mJ nyl cense is
W0W�u infaus"Cle ttnJ eR t \ PERMIT ISSUANCE RESIDENTIA11'
Dart cClass Lia# \\ 019 ❑SFDWL El KITCHEN RL'MOfll?I.
yW�
Dart- Commmne APPLIANCES-RESIDENTIAL ❑ADDITION El PLUMBING RE-PIPE
ARCHITECT'S DECLARATlON ❑MUUFLUNIT El STRUCTURAL
PANELS
ypy Inndersmne my Oleos,hall ne usraWs politic tecordl MODIFICA'T'ION
__4) �1 UP TO 200 AMPS
F14 Licensed Professional El INTERIOR ❑CHIMNEY RP,PAIft
x � - 201-1000AMPS IMPROVEMENTO SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER 1000 AMPS ❑OATH REMODEL/REPAIR ❑DN�MOLITION
y w¢ 1 hereny arrm,thatI ant oxennpt cont me cemmrar,pro
„e Law for me
a
DC O G O following mama(Sermon"IBJ LS,Bucmcs vnd Pmfexsinnn Code Any city er cetmty SIGNS HI.HC TRICAL ❑OTHER
Ey' which requires a permit to construct,alter,improve,demnlieh,or apair�any tantalum
F.. 6 prior to its iauance,also requires the epplicralfor such pennlno file osignca ktromcnt
ComA�Chupler9 SPECIALCIRCUI'TIMISC.
nt
that he is licensed pursua1.We pmvislnromde,Cnnoa,a',License
(commencing with Sconam 700(BofDiOdon3nflhe Husines,and Prefesdens CMv )or TEMP.METER OR POLE INS'1'. COMMERCIAL'
P.F c rG that he is exempl Iherefmm and the basis fon the alleged exemption.Any vioalpt of El NEW BLDG/ADDITION Q DEMOLITION
"y Section 701.5 by any applicant for a permit subjects the applicant to a civil penalty'Ilf POWER DEVICES
Fq
material Iran five handreJdclbtrs($SW). A El TENANT [I FOOD SERVICE2C ❑1,as owner of the property,or my employees with wagesas their sole contprneml\\ SWIMMING POOL ELECTRIC IMPROVEMENT
C^2 will do the work.and thenmcmre a hotWandler,offered fee .to(See 9044,Business ❑OTHER
4 a ti and Professions Code:The G urprele,'a License Law does not apply m an owner of \\ OUTLETS-SWITCHES-FIXTURES
property Jr.wbolds m improves thereoe,and who docs such work himself or Through
his own employee,,provided Jit coch improvements are not intended or offered for \NEW RESIDENTIAL ELECT SQ FT.
safe.IL hewcva,IhchuilJingnrimprovemcm is sold within one yearnfcomplctionthe SQ.I7 FLDUR AREA. $/SQ,FT. .
owner-bapider will have tburden f losingthat hdid Poth 'IJ or improve[rpur 1
p xe )
C] Is
the property 1 1Y contracting with licensed compactors to \s h
constructit prime,(Sao 9044 R . d P( C d C l: i*k T09-AL' :
cruiseI e not apply fp p IYwh builip or
imp tit mrtd QTY. IT, 4t-
' ,
Z
s �i P,P
whocontractsfon,Iehprojcue with awno cmrs)I'ennseddpursuant the Cmmnmrors
Liwne Law. PERMIT ISSUANCE
❑ I m,exempt under Sec. ,R&PC fanhis rmson
ALTER-DRAIN&VENT-WATER(EA)\
wear Date VALUATION l
WORKER'S COMPENSATION DECLARATION \ I✓
BACK FLOW PROTECT,UP.VICB rO V� V
1 hereby affirm under penalty is perjury one of the following d arkerti Co "\
(have mdwill maintain uCenifiule of C'ansent to self-in,nrefor Worked Cnmpen- DRAINS-FLOOR,BOOP,ARRA,GOND. .STORIES I YPEGDNSTRGGTIGN
,ant provided f by Scamp 3981 f the Labor Code,f the pe f hence of the - _
work Ihwhichill.pc t d. � PIX MRCS-PCR TRAP
Otvave and will
Pvatioh
ti
00[Ili Luhnr Code maintain
C IM1 p fanuttm�in
flh xork fm
which
Ihpe'm ' J r A.SYSTEM-I INC 40UTHEfS r�i OCC GROUP APN
M)Wo rs Cpmttenr �nl�nrance ca' Policy bm: S-F.ASYSTEM-OVER4(EA)
Ca L��CERTI ON FROM pI1 p O
CERTIFfCCOMPEN A'TIONATE OF EX IINSURA CC{I � `r g'
'gyp 2CF,PTOR U N# LLIvVISIONIFF.F.S, �ti
rule”)(Tits f readtot bemunpleted Policy
p t' t .192¢Jcu ildo L
n �� r: i x '� ANCfIGCKPEEI cerllfy that's the performance ofthe work for wit c j��r,,n umnpley any person in anymunner s.mtobecomemjel�fl\l- - ENERGY FEE
�. soden Lows ofCnlifomia.Dam AAn �
MIOfOJ�Q# R W/VENT/ELEC \\\ GRADING I EE
'z NOTICPPI t L �f1' \\
h NOTICETOAPPLICAoakeIf,
Ccan making this Cenifiuf QR SVSTEMITRP.ATINO
a ; becomes e,,.pm the Wonke..Compem thin pmvisjons \ SOILS PCE
� fonhwilM1 u�mply with such provisions nr this pvmit shall he deemed ra d, �\\
a q
z y20NSTRIsCT10N L Tina. Ott (�j� tSIUENTIAL TIME. $Q.FT A PAID
I hereby atfinn shat there is.ammnnaion lending ugeney oe \�� Date Receipt#
W the work for
which thl,pemtil is,,red Pre,3097.Ci,..&)
O LULender's Name - \ 'TOTAL',
Lender's Address - TOTAL:
I comfy that l little read this applicatio d site that the above nfor 9UILIlING FEE
ra/] correct.I agree m comply with all Sity and coil y co delatel' ,lath In Q M[T i PEE'
C.) Z buil,ingconsleuation,and hereby awhoriev rcP at citym t t SEISMIC FHP
aheve-mentioned me'u,for inspection purpU44444I a'. a 1, ANTE x ee /0
(We)agree to save,Indemnify and keep uninless the City of Cupert' a agalne ELE�Pv cvF.. 4J
Iiahi lilies,judgments.cants and expanses which may in any way accrue against said City gL'I'ER OR ADDTO
far a..amence of the gornong of this permit. - PLUMH 'E
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIN HANDLING IINI'T(TO IB,B00CFM)
SOURCE RFA LATI( MECHANICAL
/! AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION
Signature of gpplicnn0Contractor Data EXHAUST HOOD(W/DUCT) HOUSING MITIOATIONPE
HAZARDOUS MAALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous intranet HEATING UNIT(TO 100,000 BTU)
as defined by theCuperuno Municipal Cale,Chapter 9.12,and the Health and Safety -
Code.Sermon 25532(.)? HEATING UNIT(OVER 103,000 BTU)
I]Yes E:lNn
VENTILATION PAN(SINGLP.RESID) PAID _
Will the ap,herinl nr future building eccupur use equipment or devices which Data Receipt#�
dt hazardous air can rnurents as defined by the Bay Area Air Quality Man agrncnt BOILER-COMP(3HP OR 100,000 RTU) - .,v A
District? 'TOTAL:
❑yes 7]she BOILER-COMP(OVER 100,000 RTU)
'k
1 have mad the M1azaede111 materials as uimments under Chapter 6.95 of the Cali- AIR CONDITIONER TE
�
fornix Health&Salary Code,Sections 45,105.25533.,to 25534,1 undeoand IIr,if the NEW RFSIDFN'I JAL MOCK
building does not currently have a tenant,that it is Pry re,pensbility to Pell ry the occupant
01 tile mquieements which rutin be ma prior to issuance of a Ccnificale of occupancy. -
Owner on aothonzed agent Dote TOTAL:
ISSU9r PV:
OFFICE �
Inspection Query for a Specfic Permit 6/4/98
PERMIT�E IFUS 8j S1Tf1SsSTL2EET Lot# INSDESGRIPF InsTyp ATJ DESIRE DateDo�e rtsp tt? }rnfs'Pass/Faj� Godes
S1477 10555 RIDGEVIEW 100 JELECT 5/7/98 5/7/98 CC 2F
51477 10555 RIDGEVIEW 100 UNDRSLAB 5/7/98 5/7/98 CC 3P
S1477 10555 RIDGEVIEW 100 FRAME 5/12/98 5/12/98 CC 3V—P
S1477 10555 RIDGEVIEW 100 ELECT-R 5/12/98 5/12/98CC 5P P
S1477 10555 RIDGEVIEW 100 FRAME 5/15/98 5/15/98 JS 30
S1477 10555 RIDGEVIEW 100 ELECT 5/15/98 5/15/98JS 3P
S1477 10555 RIDGEVIEW 100 SHTRK—SCREW 5/18/98 5/18/98 CC 3P
S1477 10555 RIDGEVIEW 100 HVAC 5/27/98 5/27/98 CC 5P P
S1477 10555 RIDGEVIEW 100 REBAR —5/28/981 CC 3p
S1477 10555 RIDGEVIEW 100 ELECT/UNDGRND 6/4/98 CC
t • � 1 •