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31156 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALLPOINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. /� r BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL J V1 ` BUILDING PROJECT IDENTIF'ICAI'[ON - BUILDING ARFSS: Q � � ��� � 1� l�� ^ .• /� SANITARY NO. APPLICATION SUBMITTAL DATE LG /��` 6 , �3 0 -q�7 OWNERS NA ME: A / PHONE: CO TRACTf 'SNA ., J e IC ©O ; N/C I /CONTROL# RCHITE HN i" 1•••L' LIC NO: ApURCSS: F ❑ y CONTA(M. - PHONE: Q1 p BUILDING PERMIT INFO Dp_t '/I e ,1 1 ~C,t ! ❑ Consultant Fees Fald y App icant(Initial) B1LLENG \ELLE ICT PLUMB _VIIWH T1('(' (`LICGENv5GD C0 CFOR'S CLARAOT N v k - Y� )n f4� /11fJ� I herebyfirm that I um licensed tinder ions of Cha ter 9 QTY. ELECTRIC PERMIT FEE WCC a provisions p (commencing JOB DESCRIPPION SOL with Section]000)of Uivision3ofthe Business and Professions Code.and licence is RESIDENTIAL' FU_ in full fade aadeffec PERMIT ISSUANCE �U License Clas—� Lit,Of loeoo ❑SFDWL ❑KITCHEN REMODEL Z Date Contracmr +r APPLIANCES-RESIDENTIAL y<� ❑ADDITION - ❑PLUMBING RF:-PIPE. 1„p to e Alt TI CTS DECLARAT ) PANELS ❑MULTI-UNIT ❑STRUCTURAL O ZtnZ ILEUM my ass Il he usW nspublic rdcoNs MODIFICATION h UP TO 200 AMPS F�F"W I-karred Prasdonal n - C1 INTERIOR El CHIMNEY REPAIR 2014000AMPS IMPROVEMENT Gyg� OWNER-BUILDER DECLARATION CCC6 I hereby affirm tbut I am exempt from the Commences License Law for the OVER 1000 AMPS [I#ATH REMODF,L/REPAIR (]DEMOLITION pee,3aU fallowing reason.(Section 7031.5,Business and Professions Cade:Any city or countySIGNS ELECTRICAL ❑OTHER W My mit J:hich acclaims a perm common,alter,improve,demolish,or repair any,manure ` F �NOa pit Or its i,.munce,al.n rcyuims the apph,co,for.wch permit m lileasigtmdnamment SPECIAL CIRCUIT/MISC. X W y J that he is licensed pursuant o the provisions of the Conuacmfs License Law(Chapter 9 I�i1 at C) (commencing with Scoma70(1 of Divr.inn3 of the Brs,masend Professions Cootie)or TEMP.METER OR PO NST, COMMERCIAL: d d e C that he is exvnhpt therefrom and the basis toss the alleged exemption.Any violation til ❑NEW BLDG/ADDITION ❑DEMOLITION E� a Section]031.5 by any applicom far a permit subjects Ne applicam m a civil penalty of POWER DEVICES u7—yl ❑TF,NANT " - ❑FOOD SERVICE fS� not more than Eve hundred dollars;(ESW). IMPROVEMENT [1 1.as owner of the propeny,or my employees with wages as their sole compensation, SWIMMING POOL N Ila thek and the structure not intended ooffe df I (See90L1 l ess ❑OTHER mdProfessions Cd Th Contractors Lc L does tapply i rot OUTLETS-SWIT - T . impart who builds p themon.ami who J catch work h malt or though his own employees,provided that such i nprove ncrts are not intended or offeral for NBW 'SIDE LF 'R sale.If.however,the building or improvement is sold within one year ofcompletion,Ne SQ.FT.FLOOR AREA VSQ.FT. iter builder will have the burden of proving that he did not build or improve for pur- ,,e of'.1c.). ❑ 1 fdue prop losis ly t ting with)en.ed contractors to T Dost t The projes,(Sec ](001 Basin...and P f :bar Cash:)no C bucmr s Li- cense i- cense) d of apply to fpr pert h builds or impr e'thereon and QTY. PLUMBING ,#MIT FEE r ( (J who contracts for such pm/eats with a contracmt(s)licensed Innocent to the Commences Ln,rw Law. PERMITISSUANCES El I am exempt under Sec. ,B&PC for Nis... Owner Date ALTER-DRAIN&VENT-WATER(FAT VALUATIOZ, WORKERS COMPENSATION DECLARATION ' BACK FLOW PROTECT.DEVICE Zy' O(OD Q � hereby aft under Penalty ofperjury one of the following doctormions: / have and will maintain a Cerilicane mConani to self-insure for Worker's Co.,.- DRAINS-FLOOR.ROOF.AREA.COND. S RIES TYPE CONSTRUCTION lion,as provided for by Section 3700 of the Labor Cole,for Ne performance of the work for which;his permit is ia,red. FIXTURES-1.17R TRAP E3 1 have and will maintain Worker's Compensation Insurance,as required by Section 3]IX)nf Nye Latin,Carle,Ifor the perfnnnance of the work for which this pennon i�sJi'sued. GAS-IiA.SYSTEM-1INC.gOUTLETS OCC.GROUT' APN Carrier.My W Cy#ihlAn /ye In "mIA PoBdcy No. Tlafl a2' GAS-EA.SYSTEMOVER J(EA) �� 110EERIITIFICGATEOF EXEMPTION FROM WORKERS' L/ COMPENSATION INSURANCE GREASEIINDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FEES (This%action need not be completed if the permit is for one hundred dollar, $1001) _ or less.) - GRF.ASIi TkAI' PLANCHECK FEE I certify that in the perforromweofthe work br ich this permit is is,:ump.Ishall SEWER-SANITARY-STORM EA.200 FT. t employany persorm any manner so asw n n nese Atom; ma", ENERGY FEE' ation taws of Califomiu.Dune WATER HEATER WNENT/ELECTR Applicant GRADING FEE NOTICE TO APPLICANT:If aRe lc t Is C. ' cats 'ecce prion,you s nu Id WATER SYS'I ENE TRF,ATING Ca become subject to the WorkeisC ipensaion previsions of Ne Labor Cafe,you must SOILS PTE ltd forthwith comply with such provisions or this permit shall Far deemed revoked. WATER SERVICE y A 77` CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ,FT. PAID Date mit# U Q 7 kfiar hichouthanheac is acnnsaunion lending agency for the penimnanec of P the work for which this permit is issued(Sec.309].Cie C.) � F. funders Name _ TOTAL: U lenders Address 'TOTAL: I certify Nat 1 have real This application ani.late Nat the vbiwe infommninn is BUILDING FEE uF" tn cored.l agree to comply with all city and county ordinances and state laws relating to QTY MECHANICAL PERMIT FEE Z building construction,and hereby authorize representatives of this city to enter upon the SEISM IC FEE above-mendoned property for inspersion purports, PERMIT ISSUANCE (We)agree to nave,indemnify and krep hannlcss the City of Cupcnino ogulnm ELECTRIC FEE liabilitics.judgments.costs and expenses which may in any wayaceme against said City ALTER OR ADD TO MECH. ' consequencein of Ne grinning ofthis Permit, PLUMBING FEE �J APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINTAIR HANDLING UNI"I(TO 10,000 CFM) SOURCE REGULATIONS. MECHANICAL FEE ! /Mev � AIR HANDLING UNIT(OVER 10.000 CONSTRUCTION TAX coremmA/Apppphhc/%nom for ��TTEXHAUST HOOD(WIDUCT) - HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE / Will the applicant or future building occupant or handle hazardoustmmmial HEATING UNIT(TO TOO."RTU) as defirud by the Cupcnino Municipal Cole,Chapter 9.12,and Ne Health end Safety Code,Section 25532(m7 HEATING UNIT(OVER 100,0010 TO —APR 2 9 REN ❑Yes C]No PAID VIiNTI1ATION PAN(SINGLERESID) Dune Reccip,# / iWill The is or future building occupant use equipment or devices which I I t ( r mam coinants as deOnel by the Bay Arta Air Quality Management BOILER-GQMP(311P OR 100.000 BTU) TOTAL c3Yes MNo BOILER-COMP(OVER TOO."BTU) I have real the hmallous materialsrequiremems under Chapter CONDITIONERr 6.95 of the Cali- ISSUANCE DATE forma Health&Safety Code,Senions 25505.3533 and 2553q.1 understand that if the NEW RESIDENTIAL SUCH. SQ.FL 1 budding dons not cutremly have a an ant that it is any mspnn.ihifdy To notify The mcupunt of the requirements-which must be met prior to issuance of a Certificate of Occupancy. - J Owner ar amhorired agent Data TOTAL: ISSUED BY: OFFICE Inspection Query for a Specfic Permit 3/24/98 PERMIT#ISITUS ST ISITUS STREETILot#1 INSDESCRIPT jInsTypjDATE5E,9IRE DateDone 31156 10921 IWOLFE IFRAME 1 5/12/971 5/12/97 31156 10921 WOLFE JUNDG PLBG 5/12/97 5/12/97 31156 10921 WOLFE ELECT-R 5/12/97 5/12/97 31156 10921 WOLFE Sp C MECH-R 5/23/97 5/23/97 31156 10921 WOLFE C-60 ELEC-R 5/23/97 5/23/97 31156 10921 WOLFE C-60 T-BAR 5/23/97 5/23/97 31156 10921 WOLFE C-601NSULATION 5/23/97 5/23/97 31156 110921 WOLFE Sp C ELEC-R 6/2/97 6/2/97 31156 110921 WOLFE Sp C T-BAR CEIL 6/2/97 6/2/97 G� CA- c( • Page 1 Inspection Query for a Specfic Permit 3/24/98 Irispectb Units Pa's's/Frail Code;; cc 2P cc 2P cc 1P cc 2F cc 2F cc 2F cc 1P cc 1P _ cc 2P • ,Page 2