25118 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO H . IJifU nu-bI,b(JRI AL PERN,ITNG. 2 5118
APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING DIVISION BUILDING PROJECT IHFIKI'IFICAI]ON
BUILDING ADDRESS. ��� SANITARY NO. APPLICA'110Ng'SUBIMIUTTAL DATE
^^��//''t�AAJJ UNITp LOTH S
OWNERS NAMs=.0 OS
PHONE: CO ACTOR'S AME: LIC NO:
COKTROL#
'1 1 /L
0 FITfI�CJ'1i Is�'F.ER: INOS II 1+LIC NO: �� ADDNIg �1 �t I, ❑ 171 AI-V
CONTACT:
C C-1
_d 11 LWu,'VI`
/VLLOp QTY. ELECTRIC PERMIT ITS BUILDING�PERMIT INFO
M94110ZS! TAS 6
,� •� BLDG E! — P UM MECH
PERMIT ISSUANCE
LICENSED CONT'RACTOR'S DECLARATION APPLIANCES-RESIDENTIAL TOB DESCRIPf10N
pay Ihereby ulfDivisin 3 ofthnsedinss and missions Cote,and mmmerse with �� ���
Ri100C fulloeand1of Division3of the Business and Professions Code,and mylicense is PANELS
a+t l U fall force and effect. 2 3^ .
Fyty Licen ass Contractor
� UP T0200 AMP'
m?y ate Contractor WO AM
Fye ARCIIItTLTS DEC RATION OVER OVERiAMS SQ.PT.FLOCIft AREA f/SQ.17.
ZOsa I er. d p s 'd use IiCrccnds. /
oy-G
p=,4 ,j S Ng he ICAI.
J sed Prnlcsslon
can WNER.BUILDF.R DECLARATION
KO F 1 hereby effi that 1 ver aminpt from the Contractor Licen w or In
W3 .rQn following reason.(Seaion 7031.5.Rosins aandP ficseim. :M cit or o TEMP. INST. `V UVI
Iz.�rnJ which requirea a permit to construct,alter,improve,demolish rep or
ar Po DE C $
prior to its iammoc,ulsorcyuirei0m.pplicant fnr such permi0 filen Isiah t
that he is licensed putsuam 1. he prnvidons or the Cnntrecuse.; s aw ICE spier
d�j ca 9homandencing with Section 7000)of Division 3 of the Business it Pro scions Code) SWIM 1 POOL EL IC I L1 VALUATION
pj_y orthat heixaempuherefrom and the basisfonhe allegW exemptioa. violation of UIL S-S CHES-FIX'NRPS vT1y �LG7
F_Za Section 7031.5 by any applicant for n permit subjects the epplicanuoacivilpcnalry of b_` `., {�
Kzz not mom than Eve handrail dollam($500). NE SIDFiNTIAL ELECIR S �Ff.
0 ❑ I,asowncroftheMopeny,mmyemploymswithwa$csastheirsolecotncnsation, Q STORIESTYPE CONSTRUCTION
pW, will du thework,und the structure is not intended uroffcrcd forsale(Sea 704,f,Business
and Profaasions Code:The Contractor's License Law does not apply to an owner of
property who buildsorimproves themomand alodme such wmkhimselforthrough hi
own employees,pravidedthat such lmprramontsare not inenlmoraffered formic.If, OCC.GROUP RES.UNITS
however,the building or improvement is sold within one year
buewillhavetheburdenofpvin6thvthdiJntildofcompl /n,
morimprovt m
sale.). QTY. PLUMBING PERMIT F17E FLoaDZONE APN
❑ I,its owner nfthe property,am exduxivelYmmmming with li sW cConamoto's
ooswm the project(Sec.7044.Bananas and Promasian e0 The
Contractor's
License lawdoesnm apply to an ownerofpmpeny whn builds m improves thereon,and PERMITISSUANCE a
who contracts forsuch projects with a contracmt(s)licensed pursuavuo the Common's V
gLTER-DRAIN& ENT-
WATER
Licenm Law. (EA) FEE SUMMARY
❑ I am exempt under Sec. ,B&P C for this mason BACK FLOW PROTECT.DEVICE D
SANITARY Y Nom_
Owner Dole RECEIPT#
�— DRAINS-FLOOR,ROOF,AREA,CONU.
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
hereby affmn that 1 have a ceniftcale ofc..t 10 self-insum.or o eenificate of RECEIPT p
mkcis'Compcnsetionlmurance oraemifiW ropy thcrca((Sm.3800,Lair C.)which IIXTURES-1'ER TRAP PARK FEE VN
coversall employ�s�de �pwe7tit. GAS-EA.SYSTEM-I INC.a OUTLETS ECEIPTN
Policy# [l fL —1 I ISION FEES
Co any GAS-EA.$YsPEM-OVER 4(P.A) PLANCHECKI :1
Ctrl fed copy is hereby famished.
CenifiW copy is filed with the city inspection division. GRPASFJINDUSI'RL WASTE IMI CEPT GRADIN
CERTIFICATE.OP EXEMPTION FROM WORKERS' OEE.7 TRAP $OII O
COMPENSATION INSURANCE
Mi.aecti....dnosIse completed ifthe permit is forum hundred dollars(1100) SEWER-SANITARY-ST 20(th ENERGYO
or less.) ,
I certify that in theperformunceof the work fnr which thixpemrit isisxuaJ,lshall WATER HEATER W/V- 'C'IR
am employ any person in any manner m m to become subject to the WorkenPAID IJ 71
Com,mationlawsof California. Dam WATER SYSTEM/IRFATING Data R 1/`/tel
Z Applicant k
z O NOMCETO APPLICANT,ILeftermaking this Certificate of Exemption,you should NEW RESIDENTIAL PLMIL SQ. TOTAL:
V] became subject to the Workers Compensation provisions of the Labor Code,you must
a17�i j forthwith comply with such provisions or permit shall he deemed revoked BUILDINGFEif
F
CONSTRUCTION LENDING AGENCY Sf?ISMIC
I herehy affirm that
here is is a construction lending agency for the perfomrrtence of
V O�+ the work for which this permit is issued(Sec.3007,Civ.C.) L GLF.
Lks t•^ leaders Name PL M GfEF.
Lenders Address QTY. MECHANICAL PERMIT IEE
V 1 certify that 1 have mail this application and state that the above infourcomf is
>1a correct I agree to comply with all city and county ordinances and state Iowa minting to 1 PERMIT ISSUANCE HANICAL PT:
Imo. V) building construction,and hereby audience representatives of Nis city incineration the 'ONS UCTIO TAX
L) Z above-mentioned properly for inspection purposes. tZ.ALTER OR ADD TO MECH. !�
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities judgments,touts and expenses which may inany way come,against said City AIR HANDLING UNIT TO Iff"CFM)
'n nseq nee of the ' gat this permit.
9 �a� AIR HANDLING UNIT(OVER I0,0f10 CPM)
Uapumof Applice/y .onvanor ,(Date EXHAUST HOOD(W/DUCT) PAID
D RDOUS MATERIALS DISCLOSURE IIPTING UNIT(TO IW."BTU) Dam iptg
Will the applicant or future building uccapa it store or handle hvaardons material HEATING UNIT(DYER 1 W,(kq BTU) TOTAL:
as defined by the Cupertino Municipal Code,Chpmr 9.12,mount[learn and Safety
Code,Section 25572(.)4 VENTILATION PAN(SINGLE RBS1D)
❑Ves El No
eO1LER-COMP OHP OR I OQ000 Bol) ISSUANCE DATE
Will air commutation as
building by the
nBay equipment Quality Managhemit SEP a 2 ISE
tloux air contaminanu ns defined by the Bay Area Air Qualify Managelrlenf BOILER-COME(OVER 1g1,tXp BTII) �` (g I��y
a4
�p r ❑Yes ❑No s NEW RP,SIDENTIAL MECI1. SQ.FT.
CIIYUr viYtYI I INU
1 have read the hazardous mations requirements under N.Chaptertun understood
of the ws�J
1
California doesita coy Coda have
Sections 25505,25533 try re5530.1i,yu,notify
Nn
if the building Joea not currently have a mttant that it is my maponsibiliry to naify Ne
occupant of the requirements which must he met prior m issuance of a Cenificam o5'
Occupancy.
Owner or autboriul agent pule ISSUED BY:
Nil() VHRRLAF
DATE DONE TYPE OF INSPECTION Inspector Cade PASS/FAIL COM
- ------ ---- ----- ----- ---
INSPECTION CATEGORY 101
° ;x,9/13/43 "JO UNDAT•ION ,a' " 44 JJ ,x' "P'
A
° INSPECTION CATEGORY 202 .Q \{'S.
4/22/93, PLEB U/FLR s JB F
v� n
° 9/22/9.3 �MECH U/FLR fl JB P
" 9/21193 MECH U/FLR JB H
" I,NSPECT-ION"CATEGORY =205
" "9/22143 FRAME U(FLRJB F'
GAMING _ =dB H '
" INSPECTION CATEGORY 206
M4i P-
" INSPECTION CATEGORY 301
e, + f9.3 P6B6R ..
0 " INSPECTION CATEGORY 302
iiiie�9 SHOWER ii) P --
a.
INSPECTION CATEGORY 303
el
" INSPECTION CATEGORY 304
er9� eE;_s � as P
" INSPECTION CATEGORY 305
FRAME dB 9
" INSPECTION CATEGORY 306
iiii2i9l; ;NS LAT;GN dB -P ,
x,
' INSPECTION CATEGORY 309
R-016
0 " INSPECTION CATEGORY 311
ArH N
A.
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ax
11/16/95 PERMIT INSPECTION ACTIVITY FOR PERMIT # 25118 Paae
xa a
n
• DATE DONE TYPE OF INSPECTION Inspector Code PASS/FAIL COMI
INSPECTION CATEGORY 312 - -
11 93 JB P
• 11/10/93 EXT LATH JB N
pp INSPECTION CATEGORY 315
10/14/93 FIREPLACE JJ F
INSPECTION CATEGORY 316
' 10108/93 ROOF NAIL J8 P
. ' INSPECTION CATEGORY 601
' 11/23/93 SCRATCH J6 P
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