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31215APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY, OF CUPERTINO .• BUILDING - ELECTRICAL' - BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL ' BUILDING PROJECT IDENTIFICATION P17RMII NO . ��w 1 5 BUILIR1. DRIiSS: -. zG � � qs� SANITARY NO. - APPLICATION SUBMITTAL DATE S S�J OWNER" AM:: 1 - PHONF.'r �1h✓nT CON'1'R CI' 'S ME. - - LIC NO: G 1 U�,�`I�j r N/C ❑ CONTROL. ARCHITIUCT/EN FR:' LIC NO cCi k bA<J ADDRESS: •$,! 2 CONTACT. � PHONE: -. ��✓ �� —S 'wl/ ❑ Consultari[ Fees Paid by Applicant (Initial) BUILDING PERMIT INFO BLDG ELECT PLUMB MECI ' LICENSIiD CON'T'RA T(IR'S DECLARATION I hereby affirm mil 1 am licensed u er pmvisions of Cbapter 9 (armmenclns with Section 7gNp of DivisiunJof the Busina' nd Pmf sions Code, end mylicenee is in full f me and effect LicepmC ss Lic.p d Dute Cmdrncmr QTY ELECTRIC PERMIT FEE JOB DESCRIPTION RESIDENTIAL: ❑SF'DWL ❑ KITCHEN REMODEL ❑ADDITION ❑ PLUMBING RE-PIPE ❑MULTI -UNIT ❑STRUCTURAL, . MODIFICATION ' ❑IN'TERIOR "' ❑CHIMNEYRHPA1R IMPROVEMENT ❑ RATE REMODEUREPAIR ❑ DEMOLITION ' ❑OTHER PERMIT ISSUANCE APPLIANCES- RE5IUENTIAL PANELS UPT02WAMP5 1p ARCHITECTS DECLARATI 1 understand my plans shall he used as public occur a Li<ert used FTOfesinnal • OWNER-BUILDER I am eU rapt from m Ce Contractor's 1 hereby affirm than 1 am exempt from the Conwcnsr's e Lew for the following reason. (Section 7031.5, Business and Professions Ccry orcounty which requires a permit t0 constmm, uteq improve. demolish, r u xwc¢Trt promo its ismance,itho ca,dresthcapplicanl fortieth .,it ned. tmmert thuzheislicenxed pursunnuo oe provisions of the Cnnwcmrs Law fC ter9 (commencing with Section 7")of Division J oftAe Business ansionsC that he is exempt therefrom and the basis for The alleged exempy vinlmin i of Section] 031.5 by any applicant for a PemNt subjects the applicaivil penalty o not more than five hundred dollars (5500). ❑Lsownuor the proper(y,,,, my employ«, with wages as thdrsnle comprnxmion, will do the work, and the structure is not intended or offered Tarsals (Sw. ]fI4, Dusineaa a and Professions Code: The Contractors License Law does... apply to on owner Of proParty who had Ids or improves thereon. and who does such work himself or through his min employees, provided that such improvements are not intended or offered for sale. IL however, the building or improvement is sold within one year ofcompletion ,the ownromilder will have the burden of proving that he did not build or prove for par- im pop of odc!). ❑ 1, as owner of the pmpeny, am exclusively connecting with licensed contractors to continue, the paper (Sec. 7644, Business sad Pmfesslons Cedar) The Carnation's Li- cense Law does not apply to an owner of propery who builds or improves dercun, t nd who contmcu for such projects withawntrzctnr (s)licrnaed pursuannothc Commmnr's License Law. - ❑ I um exempt under Set. ,B& P C for Thismrnan 201- 103TAMPS - OVER IOTHI AMPS - SIGNS ELECTRICAL SPECIAL CIRCUIT /MISC _ TEMP. METER OR POLE INST - - COMMERCIALd ❑ NI7W BLDG /ADDITION ❑ DEMOLITION ❑TIiNANT ❑FOOD SERVICE -IMPROVEMENT ❑ OTHER POWER DEVICES SWIMMING POOL ELECTRIC OUTLETS — SWITCHES — FIXTURES xk W RESIDENTIAL ELECTS SQ ITT'. SQ. IT. FLUOR AREA 5/SQ. ET, l!'"' I r �� m D CV Ut `'Urk.�r ALU 'PION labs TOTAL. Q'py, 31 - FEE PER IT SSU N A Q G. (� e on ep cop nS On Sp Owner Date WORKER'S COMPENSA'T'ION DECLARATION lhemby afRmT Under penalty of perjury one ol'the following declarnlions: I Ibavc aansida far Setima.1cam of Cassaba self -in sum for WOrkehce Of th- sonars, as provided for by Sectors t]00 of The Labor Cnde, for The performance of the work for Ovachmis permit is issued. I have and will maintain Worker's Compensation Immune, as method by Section 700ofthc Labor Code, for the perfamcco.id the work for whichthis pernir is issued. My Wnrkr mnpynsminn once eerier and Polley I me: Cartier. cTt. !` _ Policy Nn.: W � !/1t'I CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE . (This section need not h, comphrod if the permit is morons hundred dollars ISIINI) outlast.) Iny any tbn in the perforfanceof the work fur which this the W is issued ,lehu0 not employ any person nt any manner s0 as in become subject m the Workers' Conpcn- Applicant n Laws of Califomiu, Data A licam Eg ,•` TYPE CONSTRUCTION _ Son .4 S GRO P APN / R I Q J ' SFIIN DUS R I ILUING DIVISION IlSBS - RI3AS PLANCHECK E ITA — TO PA. I . WAILS HEATER ENERGY FEE ING FE NCH ICH ld becamesTjecttothe APPLICANTI: es Confirmation thisvisiinsoiu Exemption,youn him become subjutto ale Wnrkcrs Compensation provisions ofthe LabarCWe, yen must forthwith comply with such provisions or permit shall he deemed revoked.., CONSTRUCTION LENDING AGENCY I hereby affirm that ahem is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Cis. C.) Lenders Name RRSYS'I' IT SOILS FEE WATER SERVICE, NEW RESIDENTIAL PLATE. SQ. FE ate Receipt0 TOTAL Ixndere Address TOTAL: 1 cerlfy that I have read this upplicatiun and state that the above information is o.not l agree hcomply with all city and county enhancers and s tale laws relating o building conswction,and herebyamhorize repmwmphves ofthiscity menrerupan the above- mentioned pm,my for inspection pur a ,ca. (We) agree h suvc, indemnify and keep harmless the City of Cupcnbo against liabilities, judgments, costs and expenses which may in any way arcmc against said City in onsequence Of the granting ofthis Parma,. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE .GULATIONS. QPy. MECHANICAL PERMIT FEE F E , EE ^ PERMIT ISSUANCE FIT ALTI ?R OR ADD TO MITCH. FE kriGAnm.H AIR HANDLING UNIT TITO 10,000 CFM) TF E AIR HANDLING UNIT(OVER la"CIM) flO X rgantim.l 'cam/Commwor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant shat or handle hazardous material as defined by the Caperino Municipal Code, Chapter 9.12, and The Health and Safety Code, Section 25532(x)? ❑Yes ❑NO r . I Will the applicant or ntsa building by the use equipmentar devices which emit hmardoun air contaminants as defined by the Bay Area Air Quality Management District? 0Yes ❑No I have read the lacummis materials mgmircmemn under Chapmr6.9.aof the Cali- forma Healm & Safety Cnwle, Sections 8505, 25533 and 25534. 1 understand that if the building does.. m randy have a mnan4 that it is my responsibility m ratify ale occupant of the calmm menu which must he at xim at issuance of a Certificate of Occupancy. EXHAUST HOLD(WMUC'q I'fIGATI FEE HEA'T'ING UNIT (TO 100.000 BTU) HEATING UNIT RIVER IOD(KKI BTU) Date Receipt VENTILATION PAN (SINGLE RHSID) BOILER —COMP (3NP Oft 100,01]0 BTU) t TOTA ' 'BOILER— COMP(OVER'IW,(NNI BTU) AIRCONDITIONER ISSUANCE DATE _ - ISSUED BY: NEW RESIDENTIAL MECI. SQ. NI', Owner or i ummized agent Data TOTAL: OFFICE Ul • • Inspection Query for a Specfic Permit 9/12/97 PERMIT #v $I,•.T,US STA SIT,USISTREET lro'f# ,INSDESCRIPT IfisT- D'A'TEDESIRE DataQone 31215 STEVENS CRE U/F PLBG 6/2/97 6/2/97 31215 STEVENS CRE PLBG -R 6/6/97 6/6/97 31215 C TEVENS CRE ELECT -R 6/6/97 6/6/97 31215 STEVENS CRE I IFRAME/SLAB 6/6/97 6/6/97 Page 1 • u • Inspection Query for a Specfic Permit . 9/12/97 Ins Otto Units Pass /Fail God" B 4P cc 2P cc 2P cc 2P Page 2