30991APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE SALL POINT PEN ONLY; _
CITY OF COPERTINO BUILDING - ELECTRICAL PERMIT NO.
BUILUINC. DIv1, N APPLICATION/PFRMIT x.,.r;'IwuM 11— olN(.L 't—.1mcn� ��9 91
LIC NO: I ADDRESS:
a'/yTPH NL �7U0
��K �'✓ • � � El Consultant Fees Paid by Applicant (Initial)
1 hereby aRrrn not 1 am licensed under provisions of Chapter 9 (commencing
CZp with Seaiun](MXB of Divisinn3of Ne Business end Profasinnr Cnde.aWmylicense is
CWF in full force and effect. .
Q U U License Class Lia R
I Z 6 Date Commctor
ARCHUECTS (DEECLLA�RATIOIN/
lhlicr ad,
F? W LtcLh—S2cuxvd u �ftl�It [-AiJL4{76
s OWNER-BUILDERDECIARATION
p, I herchy .firm tat I um uempt from the Gmimmor's License Luw fur the
x o d F following reason. (Section 9031.5, Business and Professions Code: Any dly or county
F = C) h which requires .permit m caf aracl, aUnr, improve, demolish, t,repair any swcmrc
its
yQ 11{g�ionn issuance, also requires the applicantfar such permtuo file a signed statement
iy `I that he is licensed ppmuant mine provisions of the Commearox Licence Law (Chapter 9
(commencing with Secuim7k)(d) of Division 3 of the Business and Professions Code).,
that he is exempt Nerefmm and the basis for the alleged exemption. Any violation of
uXl I+y Section 703 L5 by any appli add for a permit subjects the applicant to a civil penalty of
0 not more than five hundred dollars (5500).
F-1Las owner of the property, or my employees with wages ax their sole compensation,
Kee willdothework,ondthestrucmreisnot intended orufferW forsale (Sec. ]06q, Business
6 3 ^ and Pmfessioma Code: The Contrnclnrs License Low dues not apply to on owner of
property who builds or improves thereon, and who does suet wmk himself or through
his own employees. Parsoal that such Improvements am not intended or offered for
sale. IL however, the building or improvement is sold within one year of completion, the
owner- builder will have the burden of proving that he did not build or improve for pur-
ofsns'
sl, as owner of the property, am exclusively contracting with licensed contractors m
canm the project (Sec. 904, Business and Professions CodcJ The Contractor's Li.
cense Law does net .rely to an owner ofpmpcny who hnilds or improves therm., end
who Sorntraps[ur such" jack wit nen ,cmr(s) licensed Pennant to the Countesses
Lice. L,,'',,11FFbb PP1111
❑tut under' ,It% P q forth# reason
IMI hereby affirm tinder permh,al''perjury ncof the following dednrminns:'
❑ I have it will mnimnin. Cerlifcum of Co em mslf-insure lit Workers Cc
cation, as provided for by Section 3700 of the Libor Cede, for the performance e
work for which this permit is issued,
❑ I have and wit l*mnintin Worker Compensation himmuce, as requite
3700 of to Labor Code, for the perform a of die work for which ti 1 v ted,
My Workers Compensation Insurance tamer and Policy number
Cartier. Policy He,:
CERTIFICATE OF EXEMPTION FROM WORK
COMPENSATION INSURANCE
fibieseeionneed not beccutdred iflGe permit is for in oil SIM)
or less.)
I certify that in the performance of Ne work for wht if ardiv' led, l shall
notmpl
eoy any prs
eon in any manner en an m hennne su it We n' Compete
0 z ..tion Laws of Coliform.. Date
0 Applicant 1W IF
q fA NOTICE TO APPLICANT. If, after making tis Ceni'c o' of Ex 'tion, yon should
7 become subject m the Worker's Compensminn'rnvisians of the J or Code, you must
Q funhwit comply with such provisions or this permit smgcy
fined revoked
z CONSTRUCTION LENDING
'U � •Ih rchy affirm that there ispmnxiructlnn lcndi for the performance of
W F the work for which this permit is issual (SecJW]Ci
0 U Lenders Name
W LcndaAAidreax Air
ELECTRIC PERMIT
PERMIT ISSUANCE
APPLIANCES - RESIDENTIAL
PANELS
UPT02W AMPS
OVER 1000 AMPS
SIGNS ELECTRICAL
SPECIAL CIRCUIT/MISC:
TEMP. METER OR POLE INST.
POWER DEVICES
SWIMMING POOL
OUTLETS -SWIT
NEW REsB)pj&IfLbl
WATER SERVICE
NEW RESIDENTIAL
OFFICE
I celLly that I have rad This application a stale that the shove infuriated Is
_❑KITCHEN
Z]
U Z
correct. I agree m comply with all city and coup tdmances and stale laws relating m
buildingconawclipn.and hereby autonxere motives of thiscilytoemeuponte
vbnvo-mrntiuned property for inspection pu es.
(We) agree m cove, indemnify and p hunnleas the City of Cupenlnn ngainvl
QTY. MECHANICAL PERMIT
PERMIT ISSUANCE
AIA ER OR ADD TO MECH.
CON, ROLat
liabilities, judgments. costs and expenses ch may in any way accrue against said City
in consequence of to gnoting of Nis it.
APPLICANT UNDERSTANDS AN ILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS,
AIR HANDLING UNIT (TO 10,000 CPM)
AIR HANDLING UNIT (OVER 10,(010 CF
BLDG
❑
ELECT'
❑
Signanre ofApticanl/Cmare Dam
HAZARD S MATERIALS DISCLOSURE
EXHAUST HOOD(W/DUCq
HEATING UNI'f(TO 100AX) BTU)
HEATING UNIT (OVER 100,000 BTU)
'
Will thc.pplianl in future huildin...... art stere or handle latitudinal material
as defined by the CupeninnMunicipal Code, Chapter 9.12, and the Health and Safety
Cale, Section 25532(a)7 _
El Yell EjNo
VENTILATION PAN (SINGLE RES ID)
Will llm replicate or for.. building occulting use equipment or devices which
ami( hazardous sir contaminants as defined by the Bay Area Air Quality Management
District" ,
BOILER-COMP(JHP OR 100,000 BTU)
BOILER- COMP (OVER HANX BTU)
i Fl Yes ❑No
AIR CONDITIONER ')-
1 have reed Ne hazardous rourri h, `
t5, 2553 enw, ualer Chapter oma d t to Calm
that if to
forma doesHealth & Safety Cale. Sections 75505, 25533 and nsS34. 1 to notify the
building dmsnmeunen0y must IV metn,thato ismytesponsicolycausofy,pupoa �y't
fthtl�ir�s�ssy)hich lnnst bn mel prior la ixguunce nlaCenilicete of Ocyupnnr/.
NEW RESIDENTIAL MECH.
'
OFFICE
"
JOB DES&OOTION
''
REMODEL
7DITION❑PLUMBING RE -PIPE
❑STRUCTURAL
MODIFICATION
❑CHIMNEY REPAIR
TFUREPAIR ❑ DEMOLITION
❑ OTHER
_❑KITCHEN
NIC
CON, ROLat
BUILDING PERMIT INFO
BLDG
❑
ELECT'
❑
PLUMB MECH
❑ ❑
FEE
"
JOB DES&OOTION
''
REMODEL
7DITION❑PLUMBING RE -PIPE
❑STRUCTURAL
MODIFICATION
❑CHIMNEY REPAIR
TFUREPAIR ❑ DEMOLITION
❑ OTHER
_❑KITCHEN
SQ PT.
SQ. FT.
SQ. FT.
TOTAL:
or COMMERCIAL,
❑NEWBLDG/ADDITION ❑DEMOLITION
❑TENANT ❑FOOOSERVICE
IMPROV17MENT
❑ OTHER
SQ. FC FLOOR
AREAp� SISQ. Fr.
P F?' Ff .
�FQEB 21 RECD
11 Qr vuf Cr51114U
y. )
OCC. GROUP
BUILDING DIVISION FEES
PIANCHECK FEE
ENERGY FEE -
GRADING HE
SOILS FEE'
FBI;
PAID
Dm. Receipt It
TOTAL:
BUILDING FEE
SEISMIC FEE'
ELECTRIC FEE
PLUMBING FEE
MF,CHANICALFEE
CONSTRUCTION I'A% '
HOUSING MITIGATION FEE
PAID `
Date Receipt#
2- Z �
SUED BY:
Inspection Query for a Specfic Permit
0991
110440
IBUBB
IPLBG I I
3/4/971
3/4/971
I
0991
(10440
BUBB
U/G LATH
3/4/971
3/4/971AD
21P
0991
110440
BUBB
IU/G PLBG I
3/4/971
3/4/971CC
21P
0991
110440
IBUBB
IMETAL STUD I I
3/13/971
3/13/971AD
I 21P I
0991
10440
IBUBB
]DRYWALL I
3/13/971-3/13/971AD
I 21P
0991
10440
IBUBB
(FIRE CORRIDOR 1
3/13/971
3/13/971AD
I 2 F
0991
10440
BUBB
(DRAFT STOP I
3/13/97
3/13/971AD
I 21F
0991
110440
IBUBB
i !EL IN LOBBY I
3/13/971
3/13/971AD
2P
0991
110440
IBUBB
I (DRYWALL SCREW
3/18/971
3/18/971AD
I 31P
099110440
BUBB
I ELEC
3/18/97
3/18/971AD
31P 1
0991
10440
]BUBB
IPLBG I I
3/18/9
3/18/971AD
3 P
0991
110440
IBUBB
1DRYWL$CREW
3/19/971
3/19197CC
11F
0991
110440
IBUBB
;T -BAR 1
3/18/971
3/181971AD
I 31F i
0991
110440
IBUBB
(DRYWALL SCREW 1
3/24/971
3/24/971AD
1 21P
0991
110440
IBUBB
!FRAME i
3/24/9
3/24/971AD
I 21P
0991
110440
IBUBB
IELEC I
3/24/971
3/24/971AD
21P I
0991
110440
IBUBB
IELECT 2ND I
3/24/971
3/24/971AD
I 21P I
0991
110440
IBUBB
(FRAME 2ND 1 I
3/24/971
3/24/971AD
I 2 P
0991
10440
IBUBB
(DRYWALL SCREW
3/24/971
324/97iAD
2IP I
Page 1
4/7/97