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23879 (2)APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Project Identification Bulld,niL9s`4 f PERMITNO. 23879 er Qamc: on . 11 -LI -I CITYOFCUPERTINO-BUILDING DIVISION APPLICATION 1 PERMIT BUILDINCELECIMCALPLUMBINCtECHO AL A court a '.Name: Lie. No: '�`�F'�' "•t '< < g CATEGORY Architect/Englnmr. Lk. No: QTY �'E RIC - FC FEE - BUILDING PERMIT INF Add.. �- PLRMf7RISgANCEV. I I G 9 LICENSED CONTRACTOR'S DECLARATION I herebyaffurn thatlam licensed under provlsioneof Chapter9(commence Ingwith Section 7000)of Divlslon3 ofthe Bustkeaand ProfessionsOxh, and my license IB In bull glee.force and glee. APP`I4AVCE--FkS[hE�E4AL JOB DESCRIPTION RD � ���, rk LicenseClav Date Contractor ;._.Ir .�1 VV T 7111-1 PS ARCHITECTS DECLARATION I understand my plareshallbe used as public records. (� Licensed Professional rV/\7\\`1 OVER AMPS SQ. FT. FLOOR AREA 12 S� F I7 S/SQ.FT. �3ayg SIGNS EC L OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law forthe following reason.(Section 70115, Buslnnaand Professions Code: Any city orp mmuntywhich requires a permit toedruct, alter, improve, demplbh,orrepair SPECIAL CUIT/MISC O� �( Ov E(pR OR POLE INST. anystmcture pricerolb issuance, also requirestheapplicuo forsuch permit to file a signed statement that he is Bmnsed pursuant to the provlsloru of the Contractor's License Law (Chapter 9(mmeareing with Section 7000) of Divi- slon3 ofthe9ualnessand Profee iongCo,10cothat hels exempt thercfromand the Welt for the alleged exemption. Any violation of Section 70315 by anyapp fora applicant to civil penalty of not mom than DEVICES SWIMMING POOL ELECTRIC OUTLETSSWITCHFSFT%'1'URFS VALUATION mal O VV 12 �� 0 five hunt dred doerrs($50jmedhe five11,aso owner I, sa owner of the property, or my employees with wage as that r shepro NEW RESID AL ELMER SQ.FT, ` 1 STORIES TYPE CONS'TRUCT'ION compensation, will dothe wark,and esthe onsCodurche is not IntendedContactor oroffe (or B.to alnowand f property vie (Sec. apply rope ty Code: The Contractors Lkemae law and don etapply torn owner ofthroug his o nempluilds rlmproveeded that such who doeeeuNwork hlmsel(orthrough hieownemployen,provided thatwch qoI3 t 03 S OD OCC. GROUP [[l RFS. UMTS . Improvements are notlntended proffered for sale. If, however thebullding or Improvement bold wnthinoneyearofcompsdlogtheowner-bullderwill have TOTAL: 11 W. � d4C-kurden of proving that he did not build or Improve for purpose ofule.). "L as owner of the property, am exclusively contracting with licensed conrames to..trod the project (Sao 7044, Businevand Profession Code: QTY, PLUMBING PERMIT FEE ( PERMIT ISSUANCE 'UO FLOOD TONE APN The Contractors Licrase Law don not apply to an owner of property who 'Wilds or builds oImproves r thereon, and who contracts fee sock, p(ojem with a hor(s) 5licensed pursuant to the Contractor's License Law. I, am exempt under Sec. B h P'C for this reason ALTER -DRAIN k VENT - WATER FEE SUMMARY BACK FLOW PROTECT. DEVICE OUTSIDII FEES DRAINS FLOOR ROOF, AREA, COND. FIXTURES. I'FR TRAP SANITARY Y N RECEIVE If Owner Date WORKMAN COMPENSATION DECLARATION ❑I hereby affirm that 1 have a wrilli a of consent to self -Insure, ora certifl MeolWorkere Compensation lrouunce or. unified copy dhercof(Sce. '3gBf1,ab CJ SCHOOL TAX Y_ N RECEIPT M CAS EA, SYSTEM -1 INCAOUTLEI'S PARKFM Y N Policy Y RECEIVE a Com any .GAS EA. SYSTEM -OVER 6 (EA) BUILDING DIV] SION FEES Certified copy Is filed hereby the city �CedNed mpybfiled wlthtW tlty inspection division. CERTIFICATE OF EXEMPTION FROM WORKCRS' GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECIC FEE 1.! (-0 1 F I /Ystoao� GREASETRM - COMPENSATION INSURANCE (Thlsseciionneed not Wcompleted lithe permit lsforone hundreddollars •/ 4 �V 1 ate Kern( t# SEWER -R -SANITARY -STORM EA. 700FT. WATER HEATER W/VENT/ELECTR GN' GYFEE Y _ II ' �'l Z© PAID l ($1 unify N I u that certify shat the performance of thework fprwNch this permit Is stewed, I shall not employ any person In any manner so az to become who& to the Workers' Compensation Laws of California. Date - WATER SYSTEM/TREATING Applicant NOTICE TO APPLICANT: If, after making this Corti/trate of Exemption, you should bemme subject to the Workers' Compensad Ion provisions of the Labor Code, you mpstfod hwith comply with such provisions or this permit shall be deemed revoked. Dale ems tff NEW RESIDENTIAL PLMB. SQJ,7. ." V T TAL: G FEE sates SEISMIC FEE Q CONSTRUCTION LENDING AGENCY IherebyafRrm that there is a construction lending agency for the perfor anon of the work for which this permit b bored (Sec. 3097, Civ. Q TOTAL: Q ELECTRIC FEE QTY. " MECHANICAL 'PERMIT PLUMBING PEE Ienders Name Lenders Addreaa - I certify thatl have read this application and statelhattheaboveinformation Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives ofthls city to enter upon the abovcmentloned property for inspection purposes. (We) agree to save, indemnify an d keep harmless the City of Cupertino against liabilities, judgmenb, conte and expenses which may In anyway acme asq,txaid Pty In con enre of the granting of Ed permit. Si rep! ppannt Contra o at HAZARDOUS MATERIALS DISCLOSURE MECHANICAL PEG pD PERMIT ISSUANCE FEES hA(� 2— / Date Receipt ALTER OR ADD TO MECH. AIR HANDLING UNIT (TO SUBTOTAL• 17 MR HANDLING I1NTf (Ov#R tB,1D/cr•M) CONSTRUCTION TAXttht� EXHAUST HOOD EW/DUCT) GGONS'I' ION TAX /� GIG HEATING UNIT (TO 100,000BN) le hazardous Will the apnexib the futurebuildingMunicipal material as defined by the Municipal Code Chapter 9.1 7, and the a Date RCCeI tN HEATING UNIT (OVER 100 000 BTU) TOTAL: O oon25Cupertino Health and Safety Code Section 25537(a)7 ❑ Yes No VENTILATION DAN (SINGLE RESID) ISSUANCE DATE M f y fil the enat applkantor tore building as defintuu the BayequipmentArea devices which emithagem]ousa tract? contaminants as dcOnM by the Bay Arca Air ality Management DbMci7 MOILER -COMP pFI'ORt(10,1%D BTU) Y n ON. -read BOILER-COMP(OVER 100,000 BTU) ha the haaardouematerials requirements under Chapter 6,95 of h;JAILWIIRa Health k Safety Cade, Sections 25505,75533 and 75534. 1 4 A NEWRESIDENHALMECH. SQ.ET understand what lithe building does not currently have a tenant, that It b my OCT 1992 oru rapWlll to notify the occupant of the requirements which most W met ,G prior to Issuance of a Certificate of Occupancy. CII'! Ur. Ci1Ncr+l+f4u ISSUEDBY:—V-ii Owner or authorized agent Date ' M TOTAL: W OFFICE COPY I 6 ' „ P1II_!P✓SREClIDN_gGAVidX FAR-PE{iP11.7 tl '" ae T• 1318 STELLING SO. T 3 DATE DONE TYPE OF INSPECTION ' Inspector Cade PASS/FAIL COMMENT ------------------------------------ 7 INSPECTION CATESORYs ---------- ---- ----------- f2/29/92 �PL68'R' „", JVD '^ O DONE 9 °INSPECTION CATEGORY 101 10/16!92 FOUNDATION PIERS J J F ,3 131 21t8192 PIERrHOLE5(AFTR 9')%'.'JJ F 3Imunn CATEGORY 1n2 610/19/92 UFEk JV P EXPIRED v ,a iamrTTnm RY,. X201 • SUB-FLOOR 7191'2115/92 21 1PLCAlEGUR 202 73 a 12/15/92 SUB-PLUMBING JV P EXCEPT NATER 24 iNqpprlTnN rAjErflRY Z41 112/15/92 PLBB,IOP OUT JV P INSFECTION CATEGORY IpY ael 1113/93 SHOWER PAN JJ P a luSFFfTION !'GTFMRY iQg 1/06,93 `.,. MECH;; .. .." JB .. -., P 12 12/2092 MECH-R JV N 3 M-16199 MECHANICAL 1J f • OI 1/04/93 R MECH t CC F iM9192 ELECT-R JB P 39 _ „vi. All 1012129192 . 41 FRAME JV F 4'TNqPFr.TTnN UIFORY 10A ' " 1/07/93 INSULATION JB P • 45 EC,j InU fATFnnBy' irio - m 41 12/15192 SHEAR NAIL JJ P 18 iNgpFurflN t1RY i11 49 -9,111 x193 n DRYWALL,'-, w 31 ss • 53 3• 7,7 56 s'Y1'107/94 PERMIT INSPECTION ACTIVITY FGR PERMIT # 23879 Paoe 2 1 -11 R sTFII ING SM . r DATE DONE TYPE, OF INSPECTION ---------- ------------------ 6 �REC7iCN CQ r 3i 2h3A3'­' EXT STUCCO I 1/11193 STUCCO LATH Bk P2.SPECTION CATEGORY 313 /'23/93" INT LATH 16 7 INSPECTION CATEGORY 33 12/08192 ROOF NAIL 9 INSPECTION CATEGORY 318 2/26/9-N WATER SERVICE Is INSPECT 4 '3/04/93 ELECT ENERGY --ELEC:NUCAL—ENEUY- 6 ' INSPECTION CATEGORY 503 lAA 107 E 19 PS/ "PUUMBIN lNERGY 10 21 INgpErl LW=E6ORY 504' 1111/11 1111 ENERGY M r /0 B LDG/ENERGY�"', Inseector Code PASSIFAIL COMMENT - ---------- ---- ----------- ----------------------------- JD JJ P JB JB . . .... .. P F N db P Pace 3 • ji A SIELLINS SO r— JJ JB F P P uOug, P1 Ilmn1mr JR PASS/FAIL COMMENT ---------- ------------------------------ 37 �PLUMBING 7- . ". , P, ORY 511 39 7' 2/24/93 ELECT FINAL JB is P F JB JB N. P JB P . . .... .. P N db P Pace 3 • 5NSPECTION CATEGORY 509 A SIELLINS SO r— 2/24/93 PLBG FINAL JB F JB P uOug, P1 Ilmn1mr JR 1,3/05/97 ELECTRICAL JB P 3/04/91' TEST JB P NSP ION CATEGORY 507, [2/25/.94��' 'bG'TEST . . .... .. P N PERMIT INSPECTION ACTIVITY FOR PERMIT # 23870 Pace 3 • 5NSPECTION CATEGORY 509 A SIELLINS SO 2/24/93 PLBG FINAL JB F i. uOug, P1 Ilmn1mr JR PASS/FAIL COMMENT ---------- ------------------------------ 37 �PLUMBING A JB . ". , P, ORY 511 39 2/24/93 ELECT FINAL JB is P F 41 3/04/93 MECH JB N. 41 2/24/93 MECH FINAL is F 3'04'/73 GRADE is P 6 2i0S INSPECTION CATEGORY 595 , 01193 D ;FINAL /9 is 45 4 - 4--.)5/93Pl'4QAG44NAL— � 4 .1 /9-- 'l 4 93 BUILDING FINAL ALL JB F 6. 7 S61 52 5312/01/94 PERMIT INSPECTION ACTIVITY FOR PERMIT # 23870 Pace 3 m A SIELLINS SO 57 11.7 0 ATE DONE TYPE OF INSPECTION Insoector Code PASS/FAIL COMMENT ---------- ------------------------------ 60 ORY 511 2/24/93 ELECT FINAL JB is P F 2/23197 ELECT-F(PGE RELEASE) INSPECTION CATEGORY 517 3'04'/73 GRADE is P 6 2i0S INSPECTION CATEGORY 595 , 01193 D ;FINAL /9 is 3 4 - 4--.)5/93Pl'4QAG44NAL— � 4 .1 /9-- 'l 4 93 BUILDING FINAL ALL JB F 6. 7