20829 APPLICANT TO FILL IN INFORMATION WITHIN RED LIN
SI/NES - USE BALL POINT PEN ONLY
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B �n Pru ca Identificationror{flll a ayTC/� .�T'n I1 PF72hllT NO. O
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Fp - CITY OF CUPERTINO-BUILDINGDIVISION /� J 90
c°n a o WName: Lk.No: APPLICATION / PERMIT / �3/ /
yC BUIUNNGFlECDtICA4I'LUMBINGMFSHANKAL CATEGORY CONTROL
Arta / rrer.' Llc No
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Add. PERMITISSUANCE 12�f� O PLUMB
O ❑
LICENSED CONTRACTOR'S DECLARATION
I hereby affUm,hat l am llcensedueder pro Wonsof0uper9(mrrvrtmc APPLIANCES-RESIDENTIAL Yin UP, N
Ingwlth Sect5on700Wof DivWun3ofthe BudnessiM ProfesdessCMe,and my
11¢rae la In WD form and effe [J PANELS
LILicense /��/�
License Cl.. Lc I �x•33 /4�
Date dct
Cor. or -1000 AMPS - .s//�. r ICr�yTr�P4✓�I
ARCHITECT'S DECLARATION
¢OZ IundentaM my plans slue be ural ss pubemen, OVER 1000 AMPS SQ.FT.FLOOR AREA S/SQ.FT.
d♦"j Lleenrd Professional SIGNS ELECTRICAL
<<. OWNER-BUILDER DECLARATION SPECIALCIXCUIT/MISE
,I.., Z Thereby a(flrm that lamesemptfrom the Contnctots Lfoenm law f¢the D IN.
Ogip qq folbwing¢aeon.(S<Non 70115,Budneeand Prolmbra Code:Any dry or I`v1
. men which boa malt tommhuct,alter,ban tlermW TEMP.MEIFRORPO[.E
r,� tY rtqu pe prove, h°rmutto
6 anydmcturtprkrnelbhe he
aborted bessuantthe t the forsuchpemdtte POWER DEVICES Ll E R
V 8le•dgned statement the he b Banned pursuant to the provbbns of the I
�ecContraaori License Law(Chapter 9(mmmentlng with Section 7000)of Divi- SWIIMNG POOL ELECTRIC
C3O5 don3ofthe Buslnemand Prfes'bns C°de)orth0 he b exempt therefromaMVATE- 9-0 LUATION
the basis for the alleged eaemptlon. Any Aneton of Section 90015 by any
0�5 appeesnt for.permit subjeeta the appile.n to a tivll peruhy of out mom than OVDBISSWIIC}INTrFjXITJRES
flv es
hundreddlan(5500.
b
1, owner of the property,or my employees with wages as their sole NEW RESIDENTIAL.EI.EC7R SQFr. STORIES TYPE CONSTRUCTION
oompewatl¢t,weldo the work,and the erueure b not hdeMed or offered for
psole LSec 70K BuslressaM Pmfeebro C°de:The CoMntlols U¢rae law
j$ does mtapply loan owner of property who bailee or lmpmves thereon,and OCC.GROUP RFS.IIN1'IS
whodoessuchworkhimself¢t ghhlWownemployees,providedthearch
Imprvvemenlaarcno,Intendedoroffer f¢v k.ILhowevcr,the Wilding¢ _ TOTAL:
Imp emir baddwlthinontyearofmmpletbRtht ownerbulldcrwWluve
tV-ku,dtnofp.Argthe he did nw Wua drlmp,°Ve f¢pdrpe.e of sale.). QTY. PLUMBING PERMIT FEE FlaoozoNe APN
LJ 4 act owner°f the property,am exchsh ely contracting with Ilar
nd
ronbactun to motruct the pm)ed(See-7014.BuWbum are Profcebro Code: PERMIT NUANCE
The Contneor'a License Law dm not apply to an owner of property who AL7FILDRAIN&VENT-WATER(FA)
W Lich or Improves thereon,and who mMaea f¢such p(ojects whit, a
cga4semr(s)Bcersed pursuant to the CmttnctoYs Lbrue Law. ewac ETnw PRorrrl'.DEVICE - FEE SUMMARY
LJ I am esempt under Sec. B k P C for,his reason
FEFS
DRAINSFLODILROOF,AREA,COND. SANITARY Y_ N
® Owner Date RECEIPT S
WORIOdAN Clue Fe. ini"te DECLARATION pIX.l7lI2ES PER 7AAI' SCI IDOL TAX Y N_
❑I hereby affirm toff I have•¢rtlflote of cwacn,,a rIf-insure,or• RECEIPT
Lab
C.)aof Worktn'Comperaatlmtlounn¢ara¢neled mpythermf(Sec. GAS.F.A.
.sysTe -1 INC-4 OLITIMS PARK FEE Y N
3800,l
. C�mtyl GAS PA.SYSTEM-0VFR4(EA) BUILDING DIVISION FEES
RFiF11Ra
CeY
nifled ropy b hereby furnished. GREASE/INDUSIRL WASTE INITRCEPTOR PLANCHECK FEE
JKLCert Ned ropy b(Bed with the ety,inspection dlvWm.
CERTIFICATE OF ESEMPTION FROM WORKERS GRFL TRAP PAID
COMPENSATION INSURANCE SEWERS SANITARY-MRM Esu 2001717 Date Recti t#
(IbisWeneed not le completed Bthe perMt bf¢o¢hundrcd dollars(f1o0)¢Iesss.)J wwrFR i-ffArExc w/vExr/F�,EctR ENERGY FEE Y N
]llney lost Intoe person in of the week fores
to htMs pearlle belled,
I Wore not empty ane penin in any manner at es,o become subject to the WATERSYSTEM/TRFATTNG
Worken'Compensdlon laws°!Ge(omb. Dan PAID
O Z NOT[CApplkant NEW RESIDENTIAL PILMB. SQF. Date Remi ted
Z O NOTICE TO APPLICAM:U,affrr making this Certffl¢4 of Etcmpbn,ym
should become subiedto the Workers'Compeeaatlon provblaro of the tabor - TOTAL:
N Code,yru.9fecthwXh mmply with such proWbmor this pemdt shalt be BUILDING FEE
`> deemed revoktd.
W CONSTRUCTION LENDING AGENCY 5EISMIC FE
a
Z Ihenbya(flrmthatthertba mnstmaion lendingagenncc)T''for the perform TOTAL ELECTRIC FEE ZC37
7 a n¢oftheworkbrwhkh,hbpemdtbb Tec3097,CW.C.)
U O G Ieedrr's Name PLUMBING FEE
LL F I.enderb Address QTY. MECHANICAL PERMIT' FEE MECHANICAL FEE
O W Imtlfythdlhave¢adthbapp8 tbnaMtl tethalthea esu tonrutlm ,
bmrtcct.Iagreetocomplywflh aem
cltyand unyordlnanmand statelaws PERMIT ISSUANCE FEES PAID:
NT�atingtobulldingmrotruc Jl esI henebyauthddze npresentatWesithis
I- Z cyto enter upon the abote.mentbrrd property(¢Imprctbn purpose. ALTER ORADDTO ML)ZK DafC REYCI t41
_ (We)agree to save bdemnly an d keep harmss
le ,he City of Cupertino
agabM WbWtles,jrdgrrcMe,cwtsaM es noes whkheraylneywayamrue AIRHANDIING UNIT(TOIO,ODOCFM) SUBTOTAL•
rgalw said In o(t ting d,hb permN.
AIR HANDUNG UNIT(OVER Io,000cFD CONSTRUCTION TAX
gra peon ontnetcr J Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HA RDOUS MATER LS DISCLOSURE
Wel the appB"Morfuture Wilding omvpant store or handle harandous HEATING UNIT CIO IWOD0 BTT Date RCCCI ted
materbl as defined by the Cupertino Munidpal Code,Chapter 9.1 Z and the �I
HeanhandSafeyCodeS Ie,n25531(a)1 HEATING UNIT(OVER 100,000 BITE _ TOTAL: y�
❑ Yo No '- _J
WIII,heappbaMor tune Wlldlngocupantuseeopupmenmdavim VENTILATION FAN(SINGLE RFSID) 1$$UANIL DATE
whkhemitha rdmsairmnUam n,sasdefi dbyted Bay Arca Ab
Ty
�uOxy Marugemen DWnct9 BOILER-COMP OHP OR 100,0M B]l1) JUL 311990 .
LJ, m
I have omread the havrdous matcdahrNulrcmentsunder Chapter(.95of BOILUICOMP(OVER 100,000 BTU)
I YF-1 No
the GlBla Fleaehk Safdy Code,Sectbns T55O5,Z533and25534.1
understaM that if the building does not currently,have.tenant the It b my NEW RESIDENTIAL MEIN. • SQFT ,hf Ct
roporamcc
Bity to notify the occupant of the requlmmn
eawhkh mustbernet r
prior to Layan r CertT({tate�cupanry. � �/�� '
Ownurloorriituh age%/t Mte
' TOTAL: ISSUED BY:
OFFICE COPY
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SANTA CLARA.CA.a6054
,`'i7"1 STATEN/CONSTRUCTION
LICENSESTATE
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PULL Po% 1°---PWMAFL SEIz�IGE
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LII�DEIZG�L1No I I - _WrTar
T• 2 SWITCHBOARD ELEVATION DETAIL
C-5 01 N.T.S.
mMMoN r>=aNrt-j / l / � � ,,� - r � x �-JuucnoN pox -
7-5'G 131' PegE f / ' �I 24 T1IL�jzS
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PARTLAL R CTRICAL SITE PLAN
Esq scALe u3er-ir
I< To FUTUF-F- TPaLF,2PANELS .r-1
TYP of 24 I I
I I I I I I I I I �� ��•;�'�� � :
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_ THE FORUM
- 3 #¢ ass SAN AKTQUIQ
h,Ib b,G `c,A A,0 6,G C-rA ATD 6.G je1A AJg5 i gG - a,l . . A,15 �eG, -• r
70l� IJIJDERGIZDUNt7 , J �70AA
7-F
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2P = - �- SITE
T�'P PULL h�TIol ' P. _�) `i 1
r M M M M M M M M M r-1 OP 12 `—=':, so' +w M M M M M M M M - M M 12
6W.A/sr
n �
900 a.MFr
yza �2.a' IlA 1� ✓
drawn
checked
A13P}20i/£ 1 �-S��G• job captain
III ACCORDANCE WITH THE MY � JJ GALE �Y f'U E T
WPERTINO CODES AILD aRDINANC%3 1-4' G. GAtaL Es ��' PG 9 T
DATE1 �, date;;ll (� ((� (� r
• SIGNED �— lb g A9D F 500 K'VA PG E u tL U L�
V
1.�1
PG i; PRIMARY PAD MoU"Teo TI�ANh�1zMF-iz
����1p��� h>rizvlGE — JUL � 19`3n
chis set Of pans and speca:cati�ns fv" � S�
a kept on the job at ail times and it ism y gLp�• INSPECTIOtJ R7N�Erli
lawful a make any changes or ai-erafi.-ris, i �E (r::RTlrf9 M
the
same wdhout w ;tt n pe In ssiun tn,m
the bui:din Oe t f'�t PULL tao� T PARTIAL t.ECTRICA
g P.. Cay cf Cupe t.no.
The stamping of ih;s plan nd specifications-
PLA' SHALL NOT be he d to pa mit or to be an SITE PLA
approval of the viola'wn of any provision{
If any City O,d,nance or State Law. -
3 SINGLE LINE DIAGRAM
N.T.S.
—_OPI
scale AsSHOvT►HfICE