313320
W
I
0.
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES- USE BALL POINT PEN ONLY
CITY OF CUPERTINO - - BUILDING-ELECrR
CONTACI':PHUNe:
?1Z 6,
LICP,Id ') CONTRACTOR'S DECLARATION
1 herchy offinn Nm I s Ilcenved under provixiovs of Cloudier 9
with Section 7(th offovislon Ne Business and Professions Code. an
in fall fame and effm.
License Class de. R
Data acetol
ARCHITEC . ECLARATION
I understand my plana shall be us ublia records
g, 'OWNER -BUILDER DE RATION •,
a a 1 hereby affirm thin I em exempt from the nsracmr's Locus�.�lg(p the
G d V fall.mng reason. (Section ]031.5, Business and Profe. 'ons CW e: Any f I�,�(i5E
LL I"' which requires a permit m cunswe, utter, improve, de ish, or repair cry stmcture
prior to its issuance. also requires the applicant for such pe mfleas1lty��yfLp��IilI(�j�p��'1�
} that he is licensed pursuant to the previsions of the Conaacm icense'^Oa�W
Y00(commencing with Section 9000) of Division 3 of the Business a Profcssine, CodO r,
d1 of
that he is exempt therefrom and the M1uxls for the alleged exenlp A Inlalion of
ti•
Section 7031.5 by any applicant fora permit suhjcesNe applicant Ry of
ZN not more Nan five hundred dollar ($5001. YYYYYY{WWV a
Oa ❑ 1, as owner of the property, or my employees with wages as their sale mplamar on,
will dothe work, andthe stmcmreisnormendeq or offered lbrsale Ilea.] ,Business
and Professions Code: The Conlo cmr'x License Law dces nm apply m a wner, nl'
L a progeny who builds or improves thereon, end who it such work himself o rough
his own employees, provided that such improvemnm are not intended or .
sale. IL however, the building or improvement mould within one year of ro
owner-INAIderwill have the burden of proving that he did nm build arintpurve torp
"pose of sale.).
❑ 1, u owner of the property, am exclusively contracting with licensed dMniCbrsto
eanvbuet Nc project (Sec. 9BM1. Business and Professions Code) The Cao//Rrtga��WtRda1J.,
- e not se Law doapply m un owner ofpropeny who builds or improves iNbrHirIUd Q
who cardinals for such projects with a contractors) licensed pumuanrto the ,oWpGgrS
License law. I CJ'1�'J.
El I am'exempt under Sec. , B & P C f eamq `
of9'fiS:•r.• r.
Owner - Date '
WORKER'S COMPENSATION DECLARATION I I'•
I hereby affirm under Penalty of perjury one ofthe following neal��'y{Wyrpp��'I�� (y,
❑ I haveund will institution Certiheneof Consent mself-in"uro l'm WorlfeAfbM1gnm-i
urian, os provided far by Section 3701 of the Lal or Cale, for the perforearce of the
walk for which this gem n is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as ra,mfrewhoar
390() of the Labor Code, for the el-firroulares, ofthe work for which this pertni(is issair
My Worker's Compensation Insurance currier and Policy number are:
Cartier. Policy
CERTIFICATE OF EXEMPTION MOMKERS WOR------
COMPENSATION INSURANCE
or less.)lll�•,•''
(This section need not b<completed if the permit is for one handleobriB IDB)
1 certify that in Ne nmmnce of the wmk far which his permit is issued,
any l she
not employ any person in any an in vu oil ;is mM1eenvm subject to rhe,Wurkecr'Cnmpem
Q Z sation Laws of California. Date
Z Applicant "
pl NOTICE TO APPLICANT: If, after making this Cenificate of Exemption, you should
F became subject m the Worker's Compens:nioa Novi"ivus of Nc Labra Gde, you mu.a
Wforthwith comply with such provisions or his permit shall be donned revoked
Q '
CONSTRUCTION LENDING AGENCY
U O l hereby affirm that is a construction lending agency for the performance of
F the walk for which this permit is issued (Sec. 3099, Civ, Cd
O U Lenders Name
Lender's Addrexs -
p. 1 certify that I have read this appl icatian and stem Nat the above information is
V] correct. I agree to comply with all city and county ordionnces and state laws relating to QTY,
U z building construction, and hereby authorize representatives of this tidy to enter upon Ne
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cvpertim, against
habil ities, judgments, costs and expenses which may in any way uccroe against said City
in consequence of the Rumors of Nis pen -rad.
APPLICANT UNDER ANDS WILL COMPLY WITH ALL NON -POINT
SOUR(. .IILATI NS - I 0 / Z•.; /01z'
Will Neapp pertmPoswcMlNng occupantstereor and tehazardousd Safety as defined by Ne Cupertino Municipal Code, Chapter 9.12, and the Health end Safety
Code, Section 25532(e))
❑Yes K.
Will the applicant or future building cecupent use equipment or devices which
emir, haaerdous air contaminants as defined by the Bay Area Air Quality Management
nixbmn
El year
1 have read the mccom us mmerivls requirernams under Chapter 695 of the Calm
fomla Oro & Safn Sections 2$by5, 25533 and 25534. 1 underemnA shot if the
nvildingpwrpat currently ht itthlx ter raaryrnainuitr to notify me naaapont
LL—❑
NF, LIC NO:
'NIC COMROLM
❑ Qas�� .
BUILDING PERMIT INFO
Applicant
OUTLETS - SWITCHES - FIXTURES
NEW RESIDENTIAL ELECTR SQ FT.
�'• `• PLUMBING PERMIT
,SET ISSUANCE
1. DRAIN &VENT( WATER (HA)
kApW7Ywoly= DEVICE
FIXTURES
GAS-
.BLDG ELECT
BUILDING DIVISION
APPLICA•FION/1'ERMIT
❑ ❑
BUILDING ADDRESS:
'
❑ KITCHEN REMODEL
I `3`ba
N4 ES`PE
❑MULTI -UNIT
OWNEj'•.,�jJAML:w. a
"N IC'A9 ort
a. PHOov
CONTACI':PHUNe:
?1Z 6,
LICP,Id ') CONTRACTOR'S DECLARATION
1 herchy offinn Nm I s Ilcenved under provixiovs of Cloudier 9
with Section 7(th offovislon Ne Business and Professions Code. an
in fall fame and effm.
License Class de. R
Data acetol
ARCHITEC . ECLARATION
I understand my plana shall be us ublia records
g, 'OWNER -BUILDER DE RATION •,
a a 1 hereby affirm thin I em exempt from the nsracmr's Locus�.�lg(p the
G d V fall.mng reason. (Section ]031.5, Business and Profe. 'ons CW e: Any f I�,�(i5E
LL I"' which requires a permit m cunswe, utter, improve, de ish, or repair cry stmcture
prior to its issuance. also requires the applicant for such pe mfleas1lty��yfLp��IilI(�j�p��'1�
} that he is licensed pursuant to the previsions of the Conaacm icense'^Oa�W
Y00(commencing with Section 9000) of Division 3 of the Business a Profcssine, CodO r,
d1 of
that he is exempt therefrom and the M1uxls for the alleged exenlp A Inlalion of
ti•
Section 7031.5 by any applicant fora permit suhjcesNe applicant Ry of
ZN not more Nan five hundred dollar ($5001. YYYYYY{WWV a
Oa ❑ 1, as owner of the property, or my employees with wages as their sale mplamar on,
will dothe work, andthe stmcmreisnormendeq or offered lbrsale Ilea.] ,Business
and Professions Code: The Conlo cmr'x License Law dces nm apply m a wner, nl'
L a progeny who builds or improves thereon, end who it such work himself o rough
his own employees, provided that such improvemnm are not intended or .
sale. IL however, the building or improvement mould within one year of ro
owner-INAIderwill have the burden of proving that he did nm build arintpurve torp
"pose of sale.).
❑ 1, u owner of the property, am exclusively contracting with licensed dMniCbrsto
eanvbuet Nc project (Sec. 9BM1. Business and Professions Code) The Cao//Rrtga��WtRda1J.,
- e not se Law doapply m un owner ofpropeny who builds or improves iNbrHirIUd Q
who cardinals for such projects with a contractors) licensed pumuanrto the ,oWpGgrS
License law. I CJ'1�'J.
El I am'exempt under Sec. , B & P C f eamq `
of9'fiS:•r.• r.
Owner - Date '
WORKER'S COMPENSATION DECLARATION I I'•
I hereby affirm under Penalty of perjury one ofthe following neal��'y{Wyrpp��'I�� (y,
❑ I haveund will institution Certiheneof Consent mself-in"uro l'm WorlfeAfbM1gnm-i
urian, os provided far by Section 3701 of the Lal or Cale, for the perforearce of the
walk for which this gem n is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as ra,mfrewhoar
390() of the Labor Code, for the el-firroulares, ofthe work for which this pertni(is issair
My Worker's Compensation Insurance currier and Policy number are:
Cartier. Policy
CERTIFICATE OF EXEMPTION MOMKERS WOR------
COMPENSATION INSURANCE
or less.)lll�•,•''
(This section need not b<completed if the permit is for one handleobriB IDB)
1 certify that in Ne nmmnce of the wmk far which his permit is issued,
any l she
not employ any person in any an in vu oil ;is mM1eenvm subject to rhe,Wurkecr'Cnmpem
Q Z sation Laws of California. Date
Z Applicant "
pl NOTICE TO APPLICANT: If, after making this Cenificate of Exemption, you should
F became subject m the Worker's Compens:nioa Novi"ivus of Nc Labra Gde, you mu.a
Wforthwith comply with such provisions or his permit shall be donned revoked
Q '
CONSTRUCTION LENDING AGENCY
U O l hereby affirm that is a construction lending agency for the performance of
F the walk for which this permit is issued (Sec. 3099, Civ, Cd
O U Lenders Name
Lender's Addrexs -
p. 1 certify that I have read this appl icatian and stem Nat the above information is
V] correct. I agree to comply with all city and county ordionnces and state laws relating to QTY,
U z building construction, and hereby authorize representatives of this tidy to enter upon Ne
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cvpertim, against
habil ities, judgments, costs and expenses which may in any way uccroe against said City
in consequence of the Rumors of Nis pen -rad.
APPLICANT UNDER ANDS WILL COMPLY WITH ALL NON -POINT
SOUR(. .IILATI NS - I 0 / Z•.; /01z'
Will Neapp pertmPoswcMlNng occupantstereor and tehazardousd Safety as defined by Ne Cupertino Municipal Code, Chapter 9.12, and the Health end Safety
Code, Section 25532(e))
❑Yes K.
Will the applicant or future building cecupent use equipment or devices which
emir, haaerdous air contaminants as defined by the Bay Area Air Quality Management
nixbmn
El year
1 have read the mccom us mmerivls requirernams under Chapter 695 of the Calm
fomla Oro & Safn Sections 2$by5, 25533 and 25534. 1 underemnA shot if the
nvildingpwrpat currently ht itthlx ter raaryrnainuitr to notify me naaapont
LL—❑
NF, LIC NO:
'NIC COMROLM
❑ Qas�� .
BUILDING PERMIT INFO
Applicant
OUTLETS - SWITCHES - FIXTURES
NEW RESIDENTIAL ELECTR SQ FT.
�'• `• PLUMBING PERMIT
,SET ISSUANCE
1. DRAIN &VENT( WATER (HA)
kApW7Ywoly= DEVICE
FIXTURES
GAS-
.BLDG ELECT
PLUMB MECH
❑ ❑
❑ ❑
JOB DESCRIPTION
RESIDENTIAL:
O SFDWL
❑ KITCHEN REMODEL
[]ADDITION
❑ PLUMBING RE PIPE
❑MULTI -UNIT
C] STRUCTURAL
•
MODIFICATION
EI INTERIOR
❑CHIMNEY REPAIR
IMPROVEMENT
❑ BATH REMODEUREPAIR D DEMOLITION
❑ OTIII7R
IME
❑ DEMOLITION
--
G . ETRAP
•BUILDING DIVISION FEES
PLANCHECK FEE
SEWE A ITAR
ENERGY FRE
WATER IT ENT/ELECTR
GRADING FEE ,
WATER SYSTIi AT NG
SOILS FEL'
WATER SERVICE
PAID
NEW RE 1( fST1AL PL . I SQ.
TOTAL:
MECH. s
IT fro 10,010 CI -M)
11F(OVER IQ13ial CPM)
HEATING UNIT (TO IN
HEATING UNIT (OVER
BOILER- COMP QHP OR 10),000 BTU) Oi
BOILER -COMP (OVER 100.0010 B'Tlp
AIR CONDITIONER
NEWRESIDENTIALMECH. SQ. I'r.
OFFICE
PLUMB( "FEE
ANICAL FEE P A IV
C STRUCTION TAX
HOU GMITIG E
PAID
DiN Receipt It
TOTAL
ISSUANCE DATE
ISSUED BY:
1
•
•
Inspection Query for a Specfic Permit 1/16/97
PERMIT#
SITUS ST
SITUS STREET
Lot# FINSDESCRIPT -.Type I
DATEDESIRED
DateDone
31332
18880
HOMESTEAD
BLDG -R
11/4/96
11/4/96
31332
18880
HOMESTEAD
BLDG -2ND
11/4/96
11/4196
31332
18880
HOMESTEAD
WALLS -R
11/7/96
11/7/96
31332
18880
HOMESTEAD
FRAME
11/5/96
11/5/96
31332
16880
HOMESTEAD
FRAME
11/14/96
11/14/96
31332
18880
HOMESTEAD
SHEETRK SCREW
11/14/96
11/14/96
31332
18880
HOMESTEAD
ELEC
11/14/96
11/14/96
31332
18880
HOMESTEAD
FRAME
11/12/96
11/12/96
31332
18880
HOMESTEAD
ELECT
11/12/96
11/12/96
37332
18880
HOMESTEAD
SHEETRK SCREW
11/18/96
11/18/96
31332
18880
HOMESTEAD
FRAME
11/18/96
11/18/96
31332
16880
HOMESTEAD
ELECT -R
11/18/96
11/18/96
31332
18880
HOMESTEAD
SHEETRK
11/19/96
11/19/96
31332
18880
HOMESTEAD
FRAME -R
11/19/96
11/19/96
31332
18880
HOMESTEAD
ELEC-R
11/19/96
11/19/96
37332
18880
HOMESTEAD
SHEETRK SCREW
11/25/96
11/25/96
31332
18880
HOMESTEAD
FRAME -R
11/25/96
11/25/96
31332
18880
HOMESTEAD
ELECT
11/25/96
11/25/96
31332
18880
HOMESTEAD
sheetrock screw
11/26/96
11/26/96
31332
18880
HOMESTEAD
R -Frame
11/26/96
11/26/96
37332
18880
HOMESTEAD
R -elect
11/26/96
11/26/96
31332
18880
HOMESTEAD
SHOWER PAN
11/27/96
11/27/96
31332
18880
HOMESTEAD
SHTRK
11/21/96
11/21/96
31332
18880
HOMESTEAD
FRAME
11/21/96
11/21/96
31332
18880
HOMESTEAD
ELEC
11/21/96
11/21/96
31332
16880
HOMESTEAD
SHEETRK SCREW
12/3/96
12/3/96
31332
18880
HOMESTEAD
SHEETRK
11/21/96
11/21/96
37332
18880
HOMESTEAD
IFRAME
11/21/96
11/21/96
31332
18880
HOMESTEAD
JELECT
11/21/96
11/21/96
31332
18880
HOMESTEAD
TOP OUT
11/25/96
11/25/96
31332
18880
HOMESTEAD
DUCKSHAFT
12/4/96
12/4/96
31332
18880
HOMESTEAD
FRAME
12/3/96
12/3/96
31332
18880
HOMESTEAD
SHWR PAN
12/5/96
12/5/96
31332
18880
HOMESTEAD
SHEETRK SCREW
12/11/96
12/11/96
31332
18880
HOMESTEAD
SUSP.CEILING
12/12/96
12/12/96
31332
18880
HOMESTEAD
SUSPENDED CEIL
12/16/96
12/16/96
31332
18880
HOMESTEAD
SHOWER PAN
12/16/96
12/16/96
31332
18880
HOMESTEAD
SUSPENDED CEIL
12/18/96
12/18/96
31332
18880
HOMESTEAD
SHOWER PAN
12/18/96
12/18/96
31332
18880
HOMESTEAD
31332
18880
HOMESTEAD
GAST
12/19/96
12/19/96
31332
18880
HOMESTEAD
FRAME
12/19/96
12/19/96
31332
18880
HOMESTEAD
31332
18880
HOMESTEAD
ELECT
12/19/96
12/19/96
31332
18880
HOMESTEAD
SUSPND CEILING
12/23/96
12/23/96
31332
18880
HOMESTEAD
SUSPND CEIL
12/26/96
12/26/96
31332
78880
HOMESTEAD
BALANCE OF SUSP
12/27/96
12/27/96
31332
18880
HOMESTEAD
SPNDED CEIL
12/30/96
12/30/96
Page 1
•
11
•
Inspector
Units Pass/Fail
Code
CC
6F
CC
6
CC
3P
P
CC
6P
P
CC
6P
P
CC
4P
P
CC
6P
P
CC
3P
P
CC
2P
P
CC
4P
CC
4P
CC
4P
CC
2P
CC
4P
CC
3 P
CC
1P
CC
1P
CC
2P
CC
4P
CC
2P
CC
2P
CC
2F
CC
2 P
CC
2 P
CC
2 P
CC
2P
CC
2 P
CC
2P
CC
2P
CC
2P
CC
2P
CC
2P
CC
2 F
CC
4P
CC
3 P
CC
2 P
P
CC
2 P
CC
3P
P
CC
1P
CC
2 P
CC
2P
CC
2P
CC
2F
CC
6P
P
CC
6 P
P
CC
6P
P
Inspection Query for a Specfic Permit 1/16/97
Page 2