19821 ,APPLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
Building Proed Identification PERMIT NO,
BuBding Ado _ Goacae�
19821
/..-
ners aces: Phone.
aL, 71 CITY OF CUPERTINOLBUILDING DIVISION ♦� _11 0
r bactor's aces:
APPLICATION /PERMIT -J
. �i BUILDINE OF TRICAL-PLUMBINC-MECHAMCAL CATECARY CONTROL
Architect/Engineer. Lic.No:
I�/ QTY ELECTRIC PERMIT. "' FEE. 'BUILDING PERMIT INFO
Add poo IPFRh4TI55UANCE ❑ ❑
LICENSED CONT ACTOR'S Dr.cIAXATION a
I hereby aBlrm that l am hcensed under provhd. of Chapter9(comrece APPLIANCESRFADENTIAL I JOB DESCRIPTION
Ingwlth5 ion7000)of Di gm3ofthe Businemand ProfmionsCode,and my
)IreneieInfun and effect. / PANELS
License 2 J Lice S a 1
Date �J ContraInC`r
Z ARCHITECTSDECLARA ION OVER
AM `F
q 4SQ. .FLOOR AREA f/FQ.FT.
q��++Oa O I understand my plan shall be used u public recomde. OVER 1000 AMP'
Fe o Licensed Professional SIGNS ELECTRICAL
<<'a- OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/Mi
I hembyaffiCommencesthat l am exempt from the Commences License Law for the
QQ qqqqqq following reason.(Section 7031.5,Business and Professions Code:Any city or
1"f'Iy county which requires a pernottorovtruc1,alley,Improve,denvolah,or repair TbTOP.METER OR L I
SSI 3 anystructure pdorto its bsuance,also requimatheappbunt forsuch permit to
(g
file a signed statement that M Is licensed pursuant to IM provisions of the TOWER DEVICES
30 Contractor's License haw(Chapter 9(cemnientlng with Section 7000)of Diel- SWI MING POOL ECTRIC
skn3ofthe Businessand Profemi mCW,)orthat he I,exempt therefromandii
VALUATION
the Weis for the alleged exemption. Any vlolalon of Stolon 70315 by any off
J v 5^
71 ❑ applicant fora permit subjects the applicant to a civil penalty of net more than 8 Ws QQ
fl6dmd dollars($5(10). VVV
Too a9 owner of the NEW RF9DEMTALELECTR sQ,FT. STORIES TYPECONSTRUCTION
property,or my employees with wages r their sok
compensation,wiltdothework desaloed esC durehnoomma ? Line Linv
q d for
sale(Sec. ppy to atr owner
property who
Wilds or improves
License Law
5S
who ddoes oes
apply work owner ofproughhisonem oyees,povide that
OCC.GROUP RIS.UNI'IS
whodoementsa not
tinten intor ended
owns.If,ho however,
building
goruch ' ��
Improvements arenotintended earofred pletioor e.ILhmner-b deer ldingve TOTAL;
Improvementiesoldwithln oneyearofcomplMlon,rise mvner-bullderwill have
t ,den of paving that he did not bund or Improve for purpose ofsale.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
LL as owner of the property,am exclusively contracting with limmed PERMRISBUANCE
conmadoma to construct the project(Sec.7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who ALTER-DRAW&VENT-WATER(EA) -
Wilds or Improves thereon, and who contracts for such ptojeds with a 5
c'lp(Iactor(e)Iloreed pursuantse FEE SUMMARY
to the Contmdoes LicenLaw. BACK FLOW PROTECT.DEVICE.
LJ I am exempt under Sec. B&P C for this reasonOUTSIDE rITS
4 Owvr Data DRAINS FLUOR,ROOF,AREA,COND. SANITARY Y N
WORKMAN COMPENSATION DECLARATION RECEIPT If
FIXTURES-PER TRAP SCIdOOL TAX Y_ N
❑1 hereby affirm that I have a tInsunar of consent to epythereo ora RECEPT p
u800rllab C.)Workems'Compensallonl�ranreera certified copylhemof(Sec. GAS EA.SYSTEM-]INCA OUTLETS is PSA Y N
I�!ljjrrZZ
Policy p
Co , GAS F.A.SYSTEM-OV 4(EA)
x1 RING DIVISION
I Vx ISIONiTfS�Certifeaco hhto 1a11
f
GREASE/WDUSIRL WASTE INTERCEPTOR CH EE
25C.ertl0ed copy h filed with the city Inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID fit] [� •{J
COMPENSATIONWSURAI9CE SEWER-SANITARY-STORM EA.81OF1'. Date
Recei [H
Qhla eectbn need not beeompld IO the INSURpermit Islorons hundred dollars $ 1
($100)orlessd WATER HEATER W/VENT/[LECTR ENERGYFEE Y N
I certify that N the performance ofthe work forwhich this permit is Issued, —
I shall not employ any person In any manner so a to become subject to the WATER SYSTEM/TREATING
'Workers'Compensation Laws of California.Dale PAID -t
.7 Z Applicant NEW RESIDENTIAL PLMB. SQFF. Date Recel tH
z O NOTICE TO APPLICANT:If,after making l his Certificate of Ban
should
should become subject to the Workers'Compensation provhiov ofthe Labor - - TOTAL:
Ly Code,you most forthwith comply with such proWbns orthIs permit shall be BUILDING FEE 1. s00
> dencnd revoked. .
1 CONSTRUCTION LENDING AGENCY SEISMIC FEE
1 hereby affirm that there Is a construction lending agency for the perform ELECTRIC FEE
2O once ofrhe work for which this permit G heued(Sec.3097,Civ.C.) TOTAL:
I— lamder's Addree; QTY. MECHANICAL PERMIT FEE PLUMBING FEE
IU Icedifylhat]have readthhappBretlon and etatethattheabovein(ormatlon MECHANICAL FEE
Iscormat.I agree to complywlth all city and county ordlnanresa to lave PFRMITISSUANCE FEES PAID:
► N relating rob Tiding mnstactlon,end hereby authorize repress tl es ofthh
z city to cote upong once ve-men-b dproperty for Ins ed p sn. AL71IItOR ADD TO MECH. Date Reaelpt#
(We) res to uvc,indemnify an d keep ha,mle i f Cupertino
-aga¢Fvt bllitles,itull; enb,roeta end expen h y acvwsyaccae AIR IiANDLINC UNIT(TO]0,000 CPM) SUBTOTAL:
ag Ity In coneequen !rise gr g t it AIR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTION TAX
sgnah, onhador EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATF.RI SUISCLOS E
Will the applicant or future buildingpant store or handle hazardous HEATING UNIT(TO 100,000 BTI))
nntDate Receiytk
oterlal as deed u I
by the Cupertino Mcipal Code,Chapter 9.17,and the
1❑Yred Safety Code,Secttiion 2553I(a)t HEATING UNIT(OVER IW,=BTI)) TOTAL: L 5
Will the applies of or❑forum building..poor use equipment or d evices VENTILATION FAN(SINGLE RFSID) ISSUANCE DATE
which a hazardous air mntaknanta as defined by the Bay Area Air
Quality Mansgcmcnt District? BOILER-COMP(3HI'OR100,0001HU)
Yes Na J
ve read theh, msmateriaLsrequim=nhunder Chapter6.95of BOILER-COMP(OVER 100,000 BTU)
the California Health&Safety Coda Sections 25505,75533 and 75534. 1
I hn
._ understa nd that if the building docs not currently have a tenant,that it is my NEWRESIDENTIALMECH. SO.Ff.
responsibility to notify the occupy of of the mqu unments which most be mel -
prior to Lasuance of a Certificate of Occupa my.
Owner or authorbed agent , Data •- - ISSUED BY:�-s����4,
TOTAL
OFFICE COPY
10/20/93 PERMIT INSPECTION ACTIVITY FOR PERMIT R 14821
rr rnURT ✓ V
I 0e{ INSPECTION CATEGORY I
el
9t
si DATE DONE - TYPE OF INSPECTION INSPECTOR CODE F/F COMMENTS
.c 3/23/90 SHEETROCK(L4EONARD) LH P
El FRii o FBGRrT—D88
le 4/13/90 INSULATIONLH P
a 4/17/90 SHEETROCK (LH) LH E
e9 "F90 SH
� 1
s9 6PEG.Hv4—C-IITEGORY-30
19
t9
c9 DATE DONE TYPE OF INSPECTION INSPECTOR CODE F/F COMMENTS I
19 _EL-K4W-A
3/23/90 R—ELECTRICAL(LEONARD) LH P
as LH P
4/11/90 ROUGH ELECTRIC
95 �4r j• .
es INSPECTION CATEGORY 305
ES I
DATE DONE TYPE OF INSPECTION INSPECTOR CODE PIF COMMENTS + '
' os 3/21/40 R—FRAME LH P
----4/i-1-/90---ROUGH—FRAM
4/12/90 FRAME—R LH P
1