The URL can be used to link to this page

30852{z] O FQ U �a SwF COQ M W �Z+ Q xQ 3° .r oz z° ao UO Ha H Ln U H APPLICANTTO 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 PERMIT NO. 3 0 n r n aVl L BUILDING ADDRESS: 09 (0 SANITARY NO. APPLICATION SUBMITTAL DAT 4-3-7 OWNEU N ME: PHONE: &CMTA I CS C LIC NO: 4— > Aq N/C ❑ CONTROL # ARC O t� CONTACT: PHONE: /SA /i_ �''1 V `'S/`J ❑Consultant Fees Paid by Applicant (Initial) BUILDING PERMIT INFO BLDG EL PL MECH LICENSED CONTRACTOR'S DDECLARRATTIOON I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ^Z License Class Date Contractor ntractor ARCHITECT'S DECLARATIOr ,Jxndejst1Wd my plans shall be used as public records QTY. ELECTRIC PERMIT FEE JOB DESCRIPTION RESIDENTIAL: ❑ SFDWL ❑ KITCHEN REMODEL ❑ ADDITION PLUMBING RE -PIPE El ❑ MULTI -UNIT ❑ STRUCTURAL MODIFICATION ❑ INTERIOR ❑ CHIMNEY REPAIR IMPROVEMENT El BATH REMODEUREPAIR El DEMOLITION ❑ OTHER PERMIT ISSUANCE APPLIANCES — RESIDENTIAL PANELS UP TO 200 AMPS Licensed OWNER - BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, 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- pose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. o an Business and Professions Code:) The Contractor's and tense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. ❑ I am exempt under Sec. , B & P C for this reason 201- 100(IAMPS OVER 1000 AMPS SIGNS ELECTRICAL SPECIAL CIRCUIT/MISC. ww TEMP. METER OR POLE INST. 4 C MMER ,!f ❑ W BLD rOIQ EMOLTTION TE (I /& ~V/ �[)r�ERVICE 'Wei ❑OTHER q� Vn POWER DEVICES SWIMMING POOL ELECTRIC OUTLETS — SWITCHES — FIXTURES NEW RESIDENTIAL ELECTR SQ FT. A A- SQ" FT. FLOOR AREA 029 $ /SQ. FT. T QTy, pL MB FEE PERM NCE ALTER — DRA ENT — WATER (EA Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: u 1 have and will maintain a Certificate of Consent to self- insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section o 3700 e Labor Code, for the performance of the work for which this permit is issued. M orker' o e attgt ante carrier and Policy nu ber are' arrie�� `�.i...� Policy No.:�'d��41 ;L CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compen- sation Laws of California. Date Applicant VALUATION ,,,��^^^ ^ , ) J �,- BACK FLOW PR T. D VICE`0� DRAINS — tlw9OR, ROO A, COND. STORIES TYPE CONSTRUCTION FIXTURE - GAS — EA. SYSTE C. OUTL S OCC. GROUP APN J GAS — EA.SYSTEM -OVER GREASEANDUSTRL WASTE I EPTOR BUILDING DIVISION FEES GREASE TRAP PLANCHECK FEE r SEWER — SANITARY —STORM EA. 200 FT. ENERGY FEE nm WATER HEATER WNENT/ELECTR GRADING FE NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you.must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY- I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name WATER SYSTEM/TREATING SOILS FEE .�. WATER SERVICE PAID Date Receipt # NEW RESIDENTIAL PLMB. SQ. FT. TOTAL: Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above - mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. PLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT S URCE RE LATIONS. 4De B LD NG QTY. MECHANICAL PERMIT FE SEISMIC E PERMIT ISSUANCE ELECT FEE RP V_ ' ALTER OR ADD TO MECH. PLUM NG FEE AIR HANDLING UNIT (TO 10,000 CFM) MEC AL FEE AIR HANDLING UNIT (OVER 10,000 CFM) CONSTRUCT N TAX Signature of pp ica ontractor HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yes ❑ No Will the applicant or furore building occupant use equipment or devices which nut hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes ❑ No I have read the hazardous materials requirements under Chapter 6.95 of the Cali- q P fomia Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which must he met prior to issuance of a Certificate of Occupancy. EXHAUST HOOD (W/DUCT) HOUSING MITI ION FEE HEATING UNIT (TO 100,000 BTU) HEATING UNIT (OVER 100,000 BTU) PAID VENTILATION FAN (SINGLE RESID) Date eceipt # BOILER — COMP (3HP OR 100,000 BTU) TOTAL: BOILER — COMP (OVER 100,000 BTU) AIR CONDITIONER ISSUANCE DATE NEW RESIDENTIAL MECH. SQ. FT. Owner or authorized agent Date nrFlrF: ISSUED BY: Inspection Query for a Specfic Permit 10/20/97 Page 1 19286 STEVENS CRE DRYWALL SCREW 30852 6/10/97 6/10/97 30852 19286 STEVENS CRE DRYWALL 6/12/97 6/12/97 30852 19286 STEVENS CRE SCREW 6/12/97 6/12197 30852 19286 STEVENS CRE SHEETRK 6/11/97 6/11/97 30852 19286 STEVENS CRE lABV CEIL T -BAR 6/24/97 6/24/97 30852 19286 STEVENS CRE lABV CEIL MECH 6/24/97 6/24/97 30852 19286 STEVENS CRE IABV CEIL ELECT 6/24/97 6/24/97 30852 19286 STEVENS CRE ISTUCCO SCRATCH 7/7/97 7/7/97 30852 19286 STEVENS CRE 30852 19286 STEVENS CRE BLDG -F 7/9/97 7/9/97 30852 19286 STEVENS CRE PLBG -F 719197 7/9197 30852 19286 STEVENS CRE IBLDG ENRGY -F 719197 719197 30852 19286 STEVENS CRE MECH -F 7/9/97 7/9/97 30852 19286 STEVENS CRE ELEC -F 719/97 719197 30852 19286 STEVENS CRE IFRAME 7/29/97 7/28/97 30852 19286 STEVENS CRE ELEC -R 7/29/97 7/28/97 30852 19286 STEVENS CRE PLBG -R 7/29/97 7/28/97 30852 19286 STEVENS CRE SCREW 7/31/97 7/31/97 30852 19286 STEVENS CRE DRYWALL NAIL 7/31/97 7/31/97 30852 19286 STEVENS CRE UNDR SLB /PLBG 7/24/97 30852 19286 STEVENS CRE UNDRSLB ELECT 7/24/97 7/24/97 30852 19286 STEVENS CRE ABV CEIL MECH 8/12/97 8/12/97 30852 19286 STEVENS CRE ABV T -BAR 8/11/97 8/11/97 30852 19286 STEVENS CRE FINAL 8/27/97 8/27/97 30852 19286 STEVENS CRE ELECT -F 8/28/97 8/28/97 30852 19286 STEVENS CRE PLBG -F 8/28/97 8/28/97 30852 19286 STEVENS CRE MECH -F 8/28/97 8/28/97 30852 19286 STEVENS CRE BLDG FINAL 8/28/97 8/28/97 30852 19286 STEVENS CRE FINAL "ATTN: CHUC 8/28/97 8/28/97 30852 19286 STEVENS CRE IBLDG FINAL 8/29/97 8/29197 30852 19286 STEVENS CRE ELECT -F 8/29/97 8/29/97 30852 19286 STEVENS CRE PLBG -F 8/29/97 8/29/97 30852 19286 STEVENS CRE MECH -F 8/29/97 8/29/97 30852 19286 STEVENS CRE FIRE FINAL 9/2/97 9/2/97 Page 1 Inspection Query for a Specfic Permit 10/20/97 Page 2