25903 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CITYOF CUPFERTINOBUD7HNC-FI.M,RICA I. PERIM T NO. ..-
APPLICATION/PERMIT
PLUMBING-Mh1CllANICAI. 25903
nuuBUILDING DIVISION BUILDING PRO.IRC'1'llskNTllrICA'1'ION -
. no.Pan SANITARY NO. APPLICATION SUBMITTAL DATE:
um �O S L G IS - UNIT# LOT# "�1 _q,_t
OB'ryNft \� PHONE: C R CfQR'Se E: l Cf��14`J/A� NIC C{ONTROL#
RCIIITF,CI'/CNGINF:E LIC NO: Lja 1 'MLawyLwol
's 7 - ' T' BUILDING PERMIT INFO
W ` QTY. 'y ELECFI PE
RRMIT FEE
// yiAlf$9n�9
11 ;x: 3 [r B eLECI' PLUM MECH
I I L�1VbWa�3�31-b aT 122 PERMIT ISSUANCEL`l_^pl/` 62 .
LIC1!NSEDCONTRACTOR'S DECLARATION APPLIANCES-RESIDEXn JOB DESCRIPTION
Q=Z Iherebyaffthat l am licensed underprovisionsofChapter9(e mmencingwith
�00 Section 7000)of Division 3 ofthe Business and Professions Code.and my licome is in PANELS
C WE. full fares,and effete. �
p6„ZW License Class Lic.# UPT0200 `1_ 1
m 6 a Date Contractor 201-1001
ZOnrni� ARCHITECTS DECLARATION OVER IIXq SQ.FT.MOOR AREA $/SQ,FT.
Z-0 I understand my plans shall be used is public records.
Fr 21= l SIGNS EL AL � �� 8q 00a LOO
ge,YQJ LicansW PmlVssional
OWNER-BUILDER DECLARATION SPECIAL 1 IT/MISC.
1 hereby nffirm the,1.exempt from the Contactors License Law far the
IB 3 a r� following reason.(Section 7031.5,Business and Professions Code:Any city or county TEMP.METER OR LE WS .
rDI which regniresap.it o construct alma improve.demolish,orrepair any smtmure
y�V prior to its fosom,,,also requires the applicant for such permit o file a signed statement POWER DEV
,=<C,p that he is licensed pursunn„o Ile provision,of Ile Commerce,License l<w(Chapter
a�0.d ez 9(commencing with Section 7003)of Division 3 ofthe Business and Professimo Code) qVIMMINOAqLFl IC VALUATION
WMoo mthatheisexempttherefromandthebasisfortheallegedexemption.Anyviolationof OUTLETS-S H -F] CS Ga
��Q Section 9071.5 by any applicant tote permit subjects the applicant to penalty of O�,
t mom than five hundred dollars(SIDE). J
a�'o m❑ 1,asowncmf,hepropM,ormyemployeeswi,hwegesutheirsolecomp adon, NEWRPSIDFNITALEL _SQ.PT. STORIES TYPE CONSTRUCTION
will Bothe work.and the swcwreisnnt intended oroffered forsnle(See.7044.Business
and Professions Code:'I'he Contractor's License Law does no,apply to an owner of
property whobuililsorimprovestherum,and whodoes such workhimselforthrough his OCC.MODE NES.UNITS
ownemployea.provideal that such imp xwemts
enare not intended!oroffered fortune.IL
however,the building.,improvemem isxxi within nney c pletion,t fawner. T `
builder face']to burderifpmvin,-lhm he Jid nn tlJ nr int ova fur porpnee of _
ole .
I,as owncr.Ohe Prope,ry,am exclui mn,aaing with Iia dmnbamorf to QTY.r;. ' , `PLUMBING PERMIT FEE FLOOD LONE APN
construct the project(Sec.9014,D and Professions Cade:) a Conuacurza
License Law does not upplyto an owner ass party whobuildsarimpr verthercmm.ned PERMITISSUANCE
whocomaasforsuch projects wi c6nmacmtls)liced"d pursuant m he Contrantim,
License Low. AI TFR-DRAIN&VENT-WATCR(EA) PGE SUMMARY
FEES
❑ lionexempt under ,B&P C ,,his mason BACK FLOW PROTECT.DEVICE SANITARY O Y I)I N
Owner IsDateN RECEIPT#
DRAINS-FLOOR.ROOF,AREA,COND.
WORKMA C ATIONU t.sel in arN SCHOOL TAX Y N
1 Eby effim,he,lhe to of consent to ul0in arc.or ace mate of RIiCE1Pfp
/ FIXTURES-PER'TItAP
/ ers'C.mpcnsationl sue rnceniFied cnpy0a�( 390(1
Lee hich PARK FEE Y_N
c vers all em loyee' Itis, it. GAS-EA.SYSTP.M-1 INC.40UTLETS RECEIPT
Poy# BUILDING DIVISION FEES
C. any / GAS-EA.SYSTEM-OVER4(FA) PLANCHECK FEE
❑ is herch famish d.✓il
❑ etilia co is filled ith Jot c y in(Irlctiondiv" n. GREASE/iNDUSTRI.WASTE INTERCEPT OR GRADING FEE
CERTIPI,Iq'11$OF EXEMPTI OM WORKERS' GREASETRAP SOILS FEE
OMPHNSATIO SURANCR
(This. idem.eadiumbecomplel the pamitlsfornaelonlrWdollsrs($100) SEWER-SANITARY-STORM[:A.200FI'. ENBROYFEE
cal, I
I cenify hmin,heperform eofthe work forwhich this permit is issued.l shall WATER HEATER W/VENT/ELECfR
of employ a y person in a manner so as m become subject t.the Worker' PAID
ZCompensation wsof Ca' mI.. Dam WATER SYSTEMURHATING 'mc t /l_7yPj
Applice t
ZO0 NO TIG ITOA L NT:If,after making this Cenificam of Exemption.you should NEW RFS]DENTIAL PLMIL SQ.FT. TOTAL:
F-t H hes, suhjea to a Workers Compensation provisions of the Labor Code,you must
fonhwith comply with such provisions or this permit shall he deemed revoked. BUILDING FEET
Ctl."
at0 CONSTRUCTION LENDING AGENCY SEISMIC FEE saaaaasa
/,z Iherchy affirm that there isoconswc,ion lending agency for the pe,formance of / ELECTRICFEE ^
U 0 ho work far which Ibis permit is issued(Sec.3099,Cis.C)
Lender's Name PLUMBING E
Lenders Ambe. QTY, .MSCI IANICAL PERMIT PGC CC
VJ 1 cerify that 1 have reed this application and Stam that she above inf orma on is - " MECHANICAL FEE /'
corect.Iagree to comply with all city and county ordinances and state laws relating m PERMIT ISSUANCE
huildingttmsbuaion,and hereby authorize representatives of,his city to iinternment the CONSTRUCTION TAX
V above-mnt
oveioned propeny far inspection purymsuTO
. ALTCRORADDMECH.
(We)agree to save,indemnify and keep harmless the City of Cupcnino against
liabilities judgments,costs and expenses which may in any way same against said CityAIR HANDLING UN IT(TO I flash CFM) �•
c of,he garting of,his,aom —1 attar,
AIR HANDLING UNIT(OVER IL.CPM)
rErnomeof AppllcxntlC.nta for Data EXHAUST HOOD(WMUC1)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,001 BTU) Data Receipt#
Will the applicant or fumre building occupant store or handle hazardous material HEATING UNIT(OVER 100,0(1(1 BTU) TOT' 1.:
ms defined by the Cupertino Municipal Cade,Chapter 9.12,and the Ifealth and Safety
Cada Section 25532(x)9 VENTILATION PAN(SINGLE RF.SID) 119�2L
❑Yes 11 No
ISSUANCE DATE
\ Will th lu Ilcamnrfntora M1uilAin assonant tordcvices which emit BOILER-COM11P(311P OR IW,IXp BTU)
joint pp g by its,
yea Air
conmmi,mnts as defined by the Bay Arca Air Quality Management BOILER-COMP(OVER IOO,fMYJ BTU) PAID
�pin1
❑Year ❑No NEW RESIDENTIAL MECII. SQ.Fp. JAN g 0 1994
I If...mail the hazurdmaterials erials on.iremm
es under Chapter 695 of the ^..a
California Health&Safety Code,Sections 25505,25533 and 25534.1 understand that b
fthe buddingdoes not currently have atenantthat it is my responsibility to notify the CII I OF l/Ur L'fll IIVIJ
iouper,of the requirements which must be met Prior to Issuance of a Cri ificum of �y� � I Hv
Occupancy. ` `/y'J(�'Y
Owner or authorized agent Date oa � ISSUED BY: V V��`s
OFFICE
Special Inspection and Materials Testing HSR Job No. P94078.6
Mervyn's Permit 025903
20730 Stevens Crack Blvd. October 25, 1994
Cupertino, California Sncl. 1, Page 1
(Period Covered: 09/23/94)
Progress Report 09
_.._..__.._.__._._.._..._. _._.._.._.._.. ..._.._STRUCTURAL STEEL WELDING REPORT
Item Inspected YES NO Item Inspected YES NO
Plans/Specs Checked X Grades Comply X
Electrode Storage Comply X Size Comply X
Material Identifiable X Fit-up Comply X
N. D.T . Required X Drawings Approved X
Welders Certified X Shop Field FIELD
Areas/Items Inspected:
Completed: Angle Iron 4 " x 4 " B-S braces (3 ) to roof support
plates between Lines 3 & 3 . 5 at Line S .
Weld Type : Fillet
PROCESS : FCAW
FILLER: NR211
WELDER: Earl Ratcliff, Jr.
SSN# : 439-72-6867
Remarks :
Approved Plans Dated: 03/31/94
The work described DOES conform to the Project Specifications.
Inspector : David Heyd !CBO# : 57430 (BSK)
Date Work Performed: Friday, 09/23 /94 Time: 9 Hours
&Associates