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28682 APPLICANTTO FILL iN INFORMATION WITHIN RED LINES-.USE BALL POINT PEN ONLY CITY OF CUPEWTINO t BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 28602 BUILDING PROJECTIDENTIFICATION BUILDING ADDRESS. SANITARY NO " APPLICATION SUBMITTAL DTE �V � " 1Sic� � D R k, -0WNER'SN MF;: — 4ic' 1 PHONE: CONTRACTOR'S NAME: LIC NO: NIC CONTROL ARCHITE /ENGI PER LIC NO: a, I�&S5: u. 5•�a ❑ CONTACT: 6 PHONE: ^L BUILDING PERRMIT INFO 6kKil /��.f_ n '4-�k� ❑ Consultant Fees Paid by Applicant BLDG PLUMB MECH LICENSED CONTRACTORS DECLARATION y QTY ELECTRIC PERMIT FEE tic 1 hereby affirm that Iran licensed under provisions of Chapter 9(commencing JOB DESCRIPTION DaZ with Svvlims70(Tuf Dme.r3 of the Busi2e.,sand Profv,o6ns Cnde.indmylicensc is 1 {c1Op in lull force and effect. PERMIT ISSUANCE. C Ur'' WL El KITCHEN REMODEL I-GU Date Class Llc.M U - APPLIANCES-RESIDENTIAL ADDITION ❑PLUMBING REPIPE a Dae Contractor Fah ARCHITECT'S tePANELS DECLARATION ❑MULTI-UNIT ❑STRUCTURAL � Z O y Z I understand my plain shall he used as public vernal MODIFICATION OZ— - UP TO 21p AMPS p ❑INTERIOR ❑CHIMNEY REPAIR Fag7~ Licensed Professional RATION _ 201-1(XX)AMPS IMPROVEMENT CL a� OWNER-BUILDER rma the mtmcm , � OVER 1081 AMPS - ❑BATH REMODEL/REPAIR O DEMOLITION C G 1 hereby offrm that 1 am exempt from the Contracmr'x License Low for the K3 a FU- following reason.(Section 7031.5,Business and Professions Code:Any city or county SIGNS ELECTRICAL' ❑OTHER !T W t m which requires a permit to construct,alter,improve,demolish,or repair any structure 4; 1 p• F� Q to,buffs issuancga6o requires the applicant forsoch pemtitm flea signednaremem SPECIAL CIRCUITMISC. Eay•J that he is licensed pursuamvo the provisions ofthe Contractors License Law(Chapter 9 �a MC) (commencing ithS to NW) fD' :io J oftheBusiness and l f Codc)or - TEMP METER OR POLE INST. I '? a q C f that h is a rept th r fir n and the basis bur the alleged exentpti n Any Taboo of Elk%`BLDG/ADI�(rl 1f�1 ❑DEMOLITION iG 4. Sectio 9(1915 by Y VPI t1 up int: b) t.tM1 ppli 1t 1pcnalty of POWCR IIEVICNS 199j ., ul�y ' ❑TENANT, v(dJ FOOD SERVICE " net more than Five hundred dollars(551X0. IMPROVEA1FM. F. ❑ Las owner of Ne propny.or my cmploytts wiN wagesmtheir sole compensation. SWIMMING POOL ELECTRIC �KJd pgF willd.flewurk,amith swcwrertnntimenJM aroffemJfor sale(Sec.]B14,Bu inns ❑OTHER W �_ mad Professions Code:The Contractor's License law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES d 3 pm,rt,who builds or mrfna,es thereon and who does such work himself or through his own employees,provided that such improvements an not intended or offered for NEW RESIDENTIAL ELECTR• SQ FL sale.If,howeveq the building or improvenrent is sold within one year of con"'Eiou,the SQ.FL FLOORAREA VSQ.PT. owner-builder willhave the burden of proving that he did not hail)or improve for pear. OIo� paw asacted. • JD 1 wine prnpnY ry IY c Irzcf Com., ,,ed tracts:t copse I th p note(Seco an Business a d Professions Cal ) p C to t r.L whee a d t hplYt fpmpny who licensed a mpm e. Contractors rem a J QTY. PLUMBING MIT FEE who5 Lat.f hpnJ t '� IretrO1" dpun n th �� License La PERMIT ISSUANCE - ❑la iupt .B A PC for this n i '15senter `4' ALTER—GRAIN&VENT—WATER(EA) VALUATION Date WOR 'S COMPENSATION DECLARATION BACK FLOW PROTECT/DEVICE 1 hereby eBimt Jer penalty of perjury one of me following dcelmations: J ❑ Ihave end will mainmin aCenificam of ConscmmsdLinsure for Warker'n Compal DRAINS—FLOOR. F,AREA,COND. cation,as provided for by Section 3700of the Labor Cade,liar 11hyprforman5e of the STORIES TYPECONSTRUCTION work for whichtbix perant k,,,aed. FIXTURES—PERT A - 1 have and will maintain Worker's Compensation Iwumnce,as required by Section - 37W ofthe Labor Code,for the performance ofnc,work for which this permit is issued. GAS—EA.SYS -1 INC. S OCC.GROUP APN My Worker's Conipnsation Insurance carrier coal Policy number me: Caniec Policy No.: CAS—EA.Sy V 41EA CERTIFICATE OF EXEMPTION FROM WORKERN 'COMPENSATION INSURANCE GREASEANDUSTILAn :I 'RC LDIN IVISION FEES - This section need net be completed it the is fomne hundred dollars($IIXB GREASE'TRAP m trace.) - Lman +E 2 O Toy any thin int he performance of the work for w lej.tnch ..the WmlLaw'Crd.1pca- SEWER-SANITARY-S'IY)HM EA.2 not employ any prwn in any manner so as m become subjecuo the Workers'Compo- ENER TE zZ settom laws of Calif arm Dau - WATER HEATER WNENTAU ELTR Applicant GRADING FEE t �� y NOTICE TO APPLICANT:If,afar making this Ceniricau of Exemption,you should WATER SYSTENUTREATING SOILS FEE � � becomesubjen to the Workers Compensation provisions of the Labor Code,you must 'lianhwith comply with suchp mmnnnx ur ih spermit shall 6edecmW revoked WATER SERVICE a A 7 Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB, SQ.PT PAID R U O Thereby anion that them is a conswDau th etion lending agency for e performance of etptM she work for which this Permit is issued(See.J(19].Civ.C.) LLF-' als� U171 lender',Name QTAL: Leader Address T k 1 certify that I have read This application and nu¢that the nberve infnrmmion is BUILDING FEE `l acorrect.)vgme u,comply wish all city and eoumy ordinances and state laws relating In QTY. - MECHANICAL PERMIT FEE V Z building consnuctem,rid hereby2muniet representmlve,ol this city tnenscrupe.the SI71SMUFEE al ave-mentioned pmpny for inspection puryers«. PERMIT ISSUANCE (We)agree to save,indemnify and keep harmless the City of Cupertino against ELECTRIC FF. Iiabilides,judgments.costs and expenses which may in a my way accrue against said City ALTERORADDTOMECH, in consequence ofthe gmining ofthi,prmil. PLUMB E APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIH HANDLING UNIT M)lo,orx)CFM) MECH. hFEF SOURCE REGULATIONS. I. AIR HANDLING UNIT(OVER 10,WO CFM) CONST ' ('IOWA% Signature o'ApplicanVComuctio Time EXHAUST HOOD(W/DUC) HOUSING MITIGTION FEE �O HAZARDOUS MATERIALS DISCLOSURE Will the applicant or fuwre building occupant store or handle Emanations material HEATING UNIT(TO IW,000 BTU) as definal by the Copnino Municipal Cale.Chapter 9.12,and the Health and Safely Code,Section 255320)'?. HEATING UNIT(OVER 100010 BTU) ' YesNo. � � �� � VENTILnTION PAN(SINGLE RCSID) _ PAID pate eeeiptN Will the applicant or future building occupant use equipment or devices which t barou ands air contaminants a defined by the Bay Area Air Quality Management BOILER—COMP pHP OR 100.000 BTU) •it TOTAL: teener? (]yes ON. BOILER—COMP(OVER IM."BTU) AIR CONDITIONER I have read the hazardous materials I t 2553 ,1 Pel 695 of that Cali ?SSUANjEL ---✓ TE foredog does m,rimaral ale S te 2:25505 is an, d25534.Iunderstand that 1'Ihc NEW RESIDENTIAL MHCII. SQ.FT. building whichral,have.be met t.pintoat it is y responsibility eeanufylbupamwam of the requirements which man be met prior to once Certificate of Occupancy. " Owner or auNorieW agent Date ✓A ISSUED BY: OFFICE �. . Inspection Query for a Specfic Permit 4/22/97 • PERMIT#,:SITUS;,SITUS;STREET ;L'ot#„ „{INSDESCRIPTR InsTDATEDESIREI3 WteDone 28682 11571 JUPLAND COU FNDTN PIER HOLE 5/28/96 5/28/96 28682 11571 JUPLAND COU FOUNDATION FOR 6/6/96 6/6/96 8682 11571 JUPLAND COU UNDFLR PLBG 6/12/96 6/12/96 8682 11571 JUPLAND COU UNDRFLR FRAME 6/14/96 6/14/96 28682 11571 JUPLAND COU IUNDRFLR PLMBG 6/14/96 6/14/96 28682 11571 JUPLAND COU IUNDRFLR MECH 6/14/961 6/14/96 28682 11571 IUPLAND COU IINSULATION 6/14/96 6/14/96 28682 11571 IUPLAND COU IGARAGE SLAB 1 6/28/96 6/28/96 28682 11571 IUPLAND COU IUNDERFLR MECH 6/28/96 6/28/96 28682 11571 IUPLAND COU JUNDRFLR PLMBG 1 6/28/96 6/28/96 8682 11571 JUPLAND COU UNDRFLR FRAMIN 6/28/96 6/28/96 8682 11571 UPLAND COU EXT SHEARNAIL 8/29/96 8/29/96 8682 11571 UPLAND COU ROOF NAIL 9/3/96 9/3/96 8682 11571 UPLAND COU ROOF NAIL 9/5/96 9/5/96 8682 11571 UPLAND COU INT. SHEAR 10/1/96 28682 11571 UPLAND COU FRAME 10/1/96 28682 11571 UPLAND COU ELECT-R 10/1/96 28682 11571 UPLAND COU PLBG-R 10/1/96 8682 11571 UPLAND COU MECH-R 10/1/96 8682 11571 1UPLAND COU ELEC 10/3/96 8682 11571 JUPLAND COU FRAME 10/3/96 28682 11571 IUPLAND COU RGH MECH 10/3/96 8682 11571 UPLAND COU RGH PLMBG 10/3/96 8682 11571 UPLAND COU INSUL 10/4/96 • 28682 11571 UPLAND COU INSULATION 10/7/96 28682 11571 UPLAND COU FRAME 10/3/96 10/3/96 28682 11571 UPLAND COU CERT 10/3/96 10/3/96 28682 11571 UPLAND COU 28682 11571 UPLAND COU TUB/SHOWER 10/9/96 28682 11571 UPLAND COU EXT LATH 10/10/96 10/10/96 28682 11571 UPLAND COU INT LATH/SHWR 10/28/96 10/28/96 28682 11571 UPLAND COU INSULATION 11/15/96 11/15/96 28682 11571 UPLAND COU FRAME REINSPECT 11/15/96 11/15/96 28682 11571 UPLAND COU MECH-R/REINSPEC 11/15/96 11/15/96 28682 11571 UPLAND COU TUB-SHWR 11/15/96 11/15/96 28682 11571 UPLAND COU IINTER SHR 11/15/96 11/15/96 8682 11571 UPLAND COU JELEC MTR RELEAS 3/27/97 3/27/97 28682 11571 UPLAND COU BLDG-F 3/27/97 3/27/97 28682 11571 UPLAND COU BLDG ENRGY-F 3/27/97 3/27/97 28682 11571 UPLAND COU MECH-F 3/27/97 3/27/97 28682 11571 JUPLAND COU PLBG-F 3/27/97 3/27/97 28682 11571 JUPLAND COU ELEC-F 3/27/97 3/27/97 8682 11571 UPLAND COU ELEC MTR RELEAS 3/28/97 3/28/97 8682 11571 UPLAND COU BLDG -F 4/2/97 4/2/97 28682 11571 UPLAND COU BLDG ENRGY-F 4/2/97 4/2/97 28682 11571 UPLAND COU ELEC-F 4/2/97 4/2/97 28682 11571UPLAND COU MECH-F 4/2/97 4/2/97 28682 11571 UPLAND COU PLBG-F 4/2/97 4/2/97 8682 11571 UPLAND COU GAST 4/2/97 4/2/97 8682 11571 UPLAND COU BLDG-F 4/7/97 4/7/97 • 8682 11571 UPLAND COUELECT-F 4/7/97 4/7/97 28682 11571 UPLAND COU PLBG-F 4/7/971 4/7/97 Page 1 Inspection Query for a Speck Permit 4/22/97 • InsPecto ,Units Pass/Fail'Code'. D 2P CC 2P JB 3P CC 2P CC 2P CC 2P CC 2 P D 1F D 1F D 1P D 1F D 2P CC 1F D 2F CC 1F CC 1F Cc 1F cc 1P CC 1F D 1P D 1P D 1P D 1P CC 1 N • CC 1P D 1P D 1P JB d,2 P JS P CC P D P D P P p P D P O 2F O 2F O 2F TO 2F O 2F O 2F CC 2P D 2F D 2F D 2V -- AD 2F -- AD 2F D 2P CC 2F • CC 2P CC 2P Page 2 Inspection Query for a Specfic Permit 4/22/97 • °PERMIT# ITjUS`,ISITUS STREET,Lot#,' "`.ANSDESCRIPT"r" InsT DATEDESIRE�jWfii66h6 8682 11571 UPLAND COU IMECH-F 4/7/97 4/7/97 8682 11571 UPLAND COU BLDG ENERGY FIN 1 1 4/7/97 4/7/97 • • Page 3 Inspection Query for a Specfic Permit 4/22/97 Inspecto',Units'Pa§s/Fail 'Code,`, CC I 21P • • Page 4