29140 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO - BUILDING-KLECTRICAL PERMIT N'O. ^^29 O
BUILDINGDIVISION APPLICATIOWPERMIT PLUMBING-MECHANICAL
_ le UILDING PROJECT'IDENTIFICATION
BUILLDDINGADD�RFSS:,�. SANITARY NO. APPLICATION SUBMITTAL DATE
OWNER'S NAME: PHONE CONTRACTOR'S NAME: .O'.
-
NIC CONTROL»
III NKCHI I Euu NGLNEFR LIC NO: ADDRESS: ❑
CONTACT: PHONE RU ILDING PERMOIT INFO
' ❑ CongWlBnt Fees Paid by Applicant(Initial) - LI'� PLUMB
ME
LICENSED CONRACIOR:S DECLARATION [--L)
ELECTRIC PERMIT FEE y*
I hereby aR thin I inn licensor]umer rovi,imss a Llup[r 9([��.ncing JOB DESCRIPTION
�0CCZ thSint70X1)of Division 3 ofthe Buslrcevad ProfeavoN Cola'snd my liamein RFCID NTIA
0 with PERMIT ISSUANCE F
in full fare sed effm.
QUj Liam[Clms Fic.N ❑SFDWL ❑KITCHEN REMODEL
APPLIANCES-RPS IDPNTIAL
W
Dire-Comeaeex - ADDITION ❑PLUh1BING RE-PIPE
F-0y ARCHITECTS DECLARATION PANELS •LTI-UNIT ❑STRUCTURAL
Z 0 b I umdenland my plans shall W useJ as panic mxxds MODIFICATION
OZ�O UP10200AMPS []INTERIOR []CHIMNEY REPAIR'
Ir,4���51 Licensed Dofex.imul 301-100 AMPS - LSIPROVEMFNT
BX .] , OWNBR-BUILDER DECLARATION VIiR IgX1AMPS - [I BATH REMODFJJREPAIR ❑DEMOLITION
4 d - 1 hatnby effmt Ohm I em csemp boom tut Ctmmor,Liccroa Lw for the
x 3 L F µvlbwing raven.ISa'tion]0313,Butiocu era Rofcaiotn Calc:Any city m county SIGNS ELECTRICAL
[1 OTHER � AI 0 -�
Is1 4 h ch rt9mv a pcmN to cm+uuc6 filar,impav[,tkmolid,a tcpoir wy urucwm f�
F�'O`3 rtyuhea the apdi[+n,fa such pvnti,fo 0leasignd we a SPECIALCIRCUITNISC. _
,7 peer tong Wathta,asa ''
<m /eth[i.lianseJ puauam to the pmviniom of do CmtranWS Lkmu law(Chapc9
W - COMMERCIAL:i6
fGO (annmecncing wi,h 5atim]000O ofDivisim 3ofpe Buuau ad Rofcuiom Ctdc)m TEMP,METEOR POLE INST. 7 ^
a e c thv M is exemd Neeefmm mJ the basic Fort the alleg[J eaemptiun.AnY viaWion of ❑NEW BLDG/ADDITION ZI)FMOLMON
x It !kyypn7031.5 by eery applicant fm a Permit subjects the aMlicenl to a civil Penalty of POWER DEVICES V/-
Yl—r/i ❑TENANT ('Ij/- ❑FOODSERVICE
1- y ma mart t„"ave hmnJtm wlWma(tsu]). r
�¢0 �1,uwvm of,tK Pea)er,y,a Ott mwhh wa IAIPROVPMP,NT r(!JlY(� ,
my amp Y gc«anh[irsdc 0,14.BLwian, SWIMMING POOL EI.LCfRIC
,ill wthework,adthewncwrtis meths Licadoochafastk(Sec.h,am .,Z,of OTHER
63, $ sedany w1h oma'Cod[:Th[mcs treats L sit law docsintaPdrmarowtNr li OUTI.I;IS=SWI'rCIfES-IIXTURFS
- his..who ayis,, Iaylc,lb,hsach ad wW das such watt himself or thrtugh ,
his own employett pmvidd tall such imPn is sold thin no.intcndeJ apf don-for NEW RESIDEMIAL EI,ECfR SQ FT.
talc.If.Mwev a ill aethisngmin of Main,issold did nt ywofmproveor Fut, 50,FT Fl.(XORAR rA $5Q.FT.
m-W ildm will Wvc the burden efpoving thin he did inset Wild a improve for par-
you ofsat.). t LOC \��
1,as owner ofthe Sac.70,innexulusi valy nmlraeting with:)Ths,sl conln " I- T
c the pojact(See.]0H,tlesiw arV Pmfeaaims Code:)The C,avxta'n Li-
nt Law does mat apply To an owner of prnpany wW buihIs or improves hatchet.wJ QTY. /U IT FEE
who comacts for such rojcm with a contract licemsd punuaa to Jin Cmtnctafs - -
License Ww.
Ia icionvinarli . ,BRPCfa th;s mason PERMIT LSS A
O ALTER-DRAIN&VENT-W _ VALUATION
WORKER'S COMPENSAMON DECIARATION BACK FLOW PROTECT DEVICE 5,98
I hcrtby eRirm uNcr penmlry of p:r)mY err of Dec following Jecluvtimns: v
❑IWveeM will mneinwin aCenificthe ofCmunuu ulr-insurt for Waka's Cwnpen- DRAINS-FLOOR.R(bF,'AREA,GOND. STORIES TYPECONSIRUCI'ION
samon,in pravHed fox by Section 3](10 a the U Cda,for the Twfor.... a of the
work fin which this pcmm is iirucJ. FIXTURES-PER TRAP
❑ I nave anal will manition Wahera Compenodiun homontt,as riyuired by Seen.. '
3700ofdte labvrCale.far the ptianwrce of the woK!«which Wspennil it usuad. GAS-EA.SYSEN[-I INC 4 OUTLETS -
MyWmrkm's Compensation Insurance carrier ad Policy numbm me: OCC.GROUP .DPN
Cover: Policy No.: GAS-FA.SYSTEM-0VER S(EA)
CERTIFICATE OF EMUiIPTION FROM W ORKIBOY '
COMPENSATION INSURANCE GREASFl18DU.S1'RI.WASTE INTERCEPTOR
(Thio rection rcd nm be,mingled Pth[Terma is foeone htmdtd dollars ISIIXB BUILDING DIVISION FEES
m ksvf GREASE TRAP PLANCHECK FEE assess
Icenify patintW perfomnntt of the watlix which this permit is iiru C.,dI SEWER-SANITARY-STORM EA.200 FT.
r:Z ��%s nk Cabfimmi,.Datto any��ncea to bcaxoe aubjcnmthe Warten'Canpen- ENERGY FEL;
zO NOTICN EA
WATER HTER WNENT/F.LEC R GRADING FEF.
OnC
y NE TO APPLICANT,1f,Co muking Thr.❑emacsa of Esa or Codyaw sWnld WATER SY.cfEM?REATING
fccNvc w,,m,to the Womkera Centp[ this povisihal M th[labor Cada,You mtut SOILS FEE
ftmhwith comply with.ah pravisimr nr this permit shall be dantN rt,akcd. WATER SERVICE
Q
CONSTRUCTION LENDING AGENCY NEW RFSIDFNTIAL PLAIB. SQ.FT PAID
UO I her bhlch rhe barmnit is iaed(Sactiml[NBag agency fm the Perfonnarvx of Date RttcipN
� the work for which this pcemmJf is issued(Sac.109].Civ.C.) ,
p U fended Name TOTAL
Cil bcdaei Adolness
I minty thbm I have head this apPlicaisn and some that the allow information is BUILDING FEB
L 10./1 comx.l agrtzmmmdy wish all city ed camty adivrcn Nd swelawa muting to QTy, MECHANICAL PERMIT FEE
V Wilding amYmVim,and hereby authorise rrPmenlatives of this city to enter upon the SEISMIC FEE
aWv[.nrNicad popany ra inspactiom purloae.
I W[)«gra to saw,iNnnnifY ad kcal hannlc.0 tM C'ny of CUPmino against PERMIT ISSUANCE ELEC`LR1C FEE
IiabJltin,jwgvems,aws and expeasa whicb may in any way eccrm[againu said City ALTER OR ADO TO MECH.
In conseqgmmi
uence of me nling of Ihh po v PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNITI TO 10,001 CFM) MECHANICAL FEC
SOURCE REGULATIONS,
AIR HANDLING UNIT(OVER 10.000 CFM) CONSTRUCTION TAX
Signwurevf ApplirthwCmtnclm Dau EXHAUST'HOOD(W/DUCI} HOUSING MITIGATION FEF,
HAZARDOUS MATERIALS DISCLOSURE I
Will,leapplicint or I.Wiklingo .No,nae or bthtdle haavdw.malariaHEATING UNIT TO 100,000 BN)
an okfa d by the Cupcnino Municipal Code,Chapter 9,13,and the HaIN and Sohn,
Code,Section 255320)] HEATING UNIT(OVER 10,00)BTU)
❑Ya ❑No
' VfIl1IlAT10N PAN(SINGLE RES ID) PAID
WII thin Ream or furor,Wilding eccup.W us Data Receipt Y
app a[pAir Q,loy Mar whkh BOILER-COMP(3HPOR 100,000BTU) `
nit hmm6rts air ttnlvninanu as dRnd by tire Bay A.Air Quality Managancnt _ TO J
Nnidf
Cl Yea ❑Nn BOILER-COMP(OVER 100,000 BTU)
I have and flee ho orhus matcn,1smyuimnams motor Chapter 695o lie Cllr AIR CONDITIONER
ISSUANCE DATE
hands{IWth& conmCat.ti.im25585.isZ5533
to, eN25531.I uMcumth dmf Bthe NEW RCSIDGNIIALM1;Cfl, SQ.FT.
Wtha docs txaf ev"ich have newtshor if Ismytnpaulbllitynt ,ofYcc ircupent
of de nequ'vvrcnu which be mat pater fr idtthlr[ofeCcnifcatc of(kvvparcy. `
Owes crainforn d agar, Detc tIT& ISSUED BY:
OFFICE
Inspection Query for a Specfic Permit 9/15/97
• PERMIT#. ITUS:,ST SITUS".STREETC6t# .INSDESCRIPT EInsTWO DATEDESIRE#Dat6Done
9140 HOMESTEAD BDG FLOOR NAIL 7/25/96
29140 20637 FORGE BD 1 RGH ELEC 8/14/96 8/14/96
9140 20637 FORGE BD 1 ROOF NAIL 8/20/96
9140 20637 FORGE BD 1 RGH ELEC 9/10/96
9140 20637 FORGE BD 1 RGH MECH 9/10/96
9140 20637 FORGE BD 1 RGH PLMBG 9/10/96
9140 20637 FORGE BD 1 FRAME 9/10/96
9140 20637 FORGE BD 1 RGH P MBG 9/10/96
29140 20637 FORGE BD 1 ELEC9/10/96
9140 20637 FORGE BD 1 HVAC 9/10/96
9140 2 637 FORGE BD 1 FRAME 9/12/96 9/12/
9140 20637 FORGE BD 1 FRAME 9/16/96 9/16/9
9140 20637 FORGE BD 1 RC CHANNEL 9/17/96 9/17/96
29140 20637 FORGE BD 1 INSULATION 9/17/96 9/17/9
9140 20637 FORGE BD 1 IN UL 9/18/96 /18/96
9140 20637 FORGE BD 1 RC CHANNEL 9/18/96 9/18/96
140 20637 FORGE BID 1 SCRATCHCOAT 10/3/96
9140 20637 FORGE BID 1 ELECT REL 12/9/96 12/9/ 6
9140 20637 FORGE BD 1 BLDG-F 1/27/ 7 1/27/97
2914Q 20637 FORGE BID 1 BLDG ENRGY-F 1/27/97 1/27/97
29,14020637 FORGE BID 1 PLBG-F /27/97 1/27/97
9140 20637 FORGE BD 1 MECH-F 1/27/97 1/27/97
9140 120637 FORGE BD 1 ELEC-F 1127/971 1/27/97
Page 1
Inspection Query for a Specfic Permit 9/15/97
166—p—e&—bd Unks Pass/Fill#Cotle?i
J
J 112 P
I
I
J 4P
J 8P
J 4P
cc I N
S I 81P
S 11 N
S 1 N
S 2 P
is 2P
2-
4 P
4P X
S 2P
2P
Page 2