20728 p,�SSLLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Pm od tJendfl¢tlon _ - I'E)U.RTN
BulWiAddress: OF �`, A /� `� �O
229900 Cristo Rey Drive ` ' —r (JLJ
728
nor. one:
CITY OF CUPERTINO-BUILDING DIVISION
LieNm - APPLICATION I PERMIT January 2, 1991
kin Electic Inc. 14134 BUILDINGS.ECIAICAL-PLUMBINGMECHAMCAL CATEGORY CON RO
` Arehked/Enginheer. Lle.N.
HKI6T BUILDING PERMIT INFO
Q ELECTRIC PERMIT PEE
Aaarea6535 Mission St. , San Francisco I'MMITIBSUANCE
LICENSED CONTRACTOR'S DECLARATION
I hereby affism)atlamllce uMerpro moron (:Oopter9(m c APPIIANCESRRSIDENTIAL )08 DESCIff
N
Ingwlthgealon7000)of DlvlNon3ofthe ButlmssandPro/eealoneCade,and my
♦ironic lalnfu � 4 effect. PANELS Temporary power —
–
Llae.. 1 386973
Date Comndor east of bldg. 4
ARCHITECTS DECLARATION Wl-l()d0
9z 1 understand my plero.haft be used u public records- OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT.
w Co SIGNS ELECTRICAL
tl LkumM Professional •
OWNER.BUILDER DECLARATION $PFLIAL CIRCI117'/MLSC
(heat affirm that l Amex from the Coanmrs Ll¢ame law for the �.
z P G following reason.(Semon 70315,Bu.ine,naM Pmhmbru Codr.Anydtyor
O S TEMP.M=OR POLE♦NST.
F
county rtqulrnapermit tommwd,alter,lmpmve,demotion,or repair
anymm�unpA tolb Wuame,al requimtheappH¢ntfasurhper to POWER D��
9 file a signed statement that he b licensed pursuant to the pruvisbv ed the
- � Contraet.e.Like.Law(Chapter 9(commenMg with Sedbn 7000)of Divi- SWA1 �Li _ j.—
���� sbn3 of the Business and Profession.Code)or that he b earmpt there/romssd CTIBVALUATION
S9 the basb for the Akgedexemption. Any vinlaHon of S Ybn 7mtS by my r
�^ appE.ntforape t.bice•the.pplk.tt..d iperultya .a.o tus OUTLE
five hundred dollars(fS00). NEW REMENTIAL
n1,as owner of the property,or my employees wish wages as their sole STORIES IT7'E CONSIRUCf10N
< mmpewtlon,wllldothe wakand thntmaure isnot intended or offered for DA
O .sale S,,7014,Business and Pmfubro Code:The Coemadors U..law
'$$ does not apply to an owner of property who bunds or lmprovn thereon,and
^ who does such work hlmseH,through his awn employees,provided that such OCCGROUP R6.[JM'IS
improvemcnb art rot Intended prof/end faeak.IL however,the W IWing a TOTAL
Impmvemenbsoldwhhlnomyssrofcmnpldbn,theowner-0 MerwWlove
rdeno/provingthe he did not Wild orlmprovefapurposeofde.). QTY. PLUMBING PERMIT FEE -
L_j L as owner of the property,am eschnively om4acting with Ikensed FLOOD ZONE APN
mntractma to romtmet the project(Sm 7044,Business and Professrm Code: PFR)AnI$LIANCE
The CoMndori LI¢me law don nm apply to an owner of Property who ALTER-DRAIN&VENTWATER A:NN
Wor Imroves pth. , and who mrdram for n such Miewn - -
h a FEE SUMMARY
ap�xlor(gll¢rned pursuant to the Contndora License CLaw.to - BACK FLOW PROTECT.DEVICE
LJ I am exempt under Sec B k P C for this rtuonOUTSIDE FEES
t.O Qvmr Dns DRAINS-n.00R RODE,AREA,GOND. SANITARY Y_ N_
WORMAN COMPENSATION DECLARATION
K
®I hereby affirm that I have a cenifinte of mment to self-♦sort,a a FDCNRE&PER TRAP SCHOOL TA% Y N_
¢nN¢teofWorkers'CrmpenaaHonlvunn¢aaanlfled mpythertof0ec.
RECEIPT IT
GAS FA.SYSTM-1 MC40LFREM PARKFEE Y N
'I,Ba°0ky;�SS1�50408194 RECETT 11
I ens Fw.sYsrELuovER 4(FA)
C° nY Fir eIDBn S FLLII BUILDING DIVISION FEES
�Certl/Ied ropy b
[Y]CedNed ropy b/Red withh tUhah`¢byfe eNy e lty Inspection divlalon. FrroEE GREASE/NDUSIRL WASTE INTFRCR PLANCHECK F
CERTIFICATE OF EXEMPTION FROM WORKERS' GRE`'ETILAa PAID
COMPENSATION INSURANCE SEWFhSANITARY STORM EA.XpFT. Date Repel t#
TTlhtas inn need not becomplded fithe permit bforum hundred dollar ENERGY FEE Y N
MW)ort.) WATER HEATER W/VEM/ELFLTR
I certify that In the performanceofthe week for wMch W.peruJt is bored,
1.hal net employ any person In any manner so ss to become wbjed to the WATER SYSTEM/TWn.AnNG
Workers'Cmnpensationtaw.ofCaliferso. Date PAID
0 = A TICEi • NEW you RESIDENTIAL PLMB. 3�FT. Date Recei tp
Z O NOnCETO eed,je to
after maWompeng Compensation
catepro of isonampt e'Leen
shmldoumme.ubjh to the Workers'Comperoatlenprovbbmofthe Lab or TOTAL
CC LO> Code,you nvetfathwdh comply with such provbbro or this permit slWibe
W ] deemed revoked. BUILDING FEE
CONSTRUCTION LENDING AGENCY SEISMIC FEE
d eof the work
fiat for wmembaeermwdlondi(SL, 07a,y froths perform- ELECTRIC FEE
7 Z Lender the work/orwhlch thio puMtbbwed lSct'.3097,CIv.C) TOTAL:
O O Lenders Name PLUMBING FEE
LL L) [<ndert Address, QTY. MECHANICAL PERMIT FEE.
O w artily the I agree WemdtN theloyandl atetythat the
end
MECHANICAL FEE
b mrsect.Iag¢eb Comply withel muntyord lnan¢aand statetof thin I'FRMnISAIANCE FEES PAID:
} N relating to enter
oing n theabmelloryardhenbyauthorizertptionopu fives of thin
F Z dtyW)aree to saw,
Indeansntlon d pmpvtyfmlrmpea t of Cu rpmes.
ALTER OR ADDTO MECH.
_ (We)agree to•ave,e.ts,".and keep which the City of Cupedlm Date ReO tic
ngairo[ftabBltles,j.ndgr¢nb,arebaM expenses which may Uany way acvuo AIR HANDLING UNIT(TO 10,000 CFM) 'SUBTOTAL:
agaimtsald CBylncon sae ofthegnruingofthl•permit.
AIR HAN1wNGUNn(OVER 10,MOCFM) CONSTRUCTIONTAX
s p.d A'ppurant/ tractor Ue. E Llsr HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or forum building omvpant store or heAk havnlous HEATING UNIT(TO 100,000 BTU) _ Date Recei til
material as defined by the CupeHlnn MuNdpal Cade,Chapter 9.11,and the
Flnhh aM Seutycodeon 75532.)7 HEATING UNIT(OVER 100,M BTU) TOTAL:
RYn LrN.NOt applicable
0l the applicant orfuwm Wilding occupant use equipment adevi¢s VFNIILATK)N PAN(SINGLE RE%D) ISSUANCE DATE
whicheMthavNeu.aireta as defircd by(he Bay Area Ab
Quality Mamgemen Diatrkt7rtriMILER-ODMP O2E'DR 100,0(10 BTU)
Yn ❑No
have read the havndw.mneriab rtqulrtmenb under Clupter 695 o! BOB.FRNMP(OVER 100AW Ren
the Cabfomh Health A SafetyCode,SMIom 25505,15533 and 75534.1 Qu
understand that if the building dm not mrrcntly have a tenant,that It b my NEW RMEIENIAL MECR SQ.FT 1`uQ
respomibfilty to notify the pard of the qmnt
uLeea whkh most he met ,
pari Lsmaac ♦Bate ufOccup.'y
a�U "X1794 ILL ' "
Qvn thorlred ag Dat 7 ISSUEDBY:
OTAL
OFFICE COPY
c