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24446 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY a, 0 Building Proem Identification PEILMITNQ, 4446 - Building Address: n Z r'1 FS �OA^�5 ��f?� �d Owner if11P: '',^,^^ cele: Of I" EFS CITY OF CUPERTINO-BUILDING DIVISION A Auk Ggntra , Lie.No: APPLICATION / PERMIT �C^� mall 7 t, �„ c CATEGORY CONTROL It Arddt /Engineer Lic No. BUILDINGELECTRICALPLl1MBING-MFCHAMCAL Tow m yens y�(� QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO ' Add. I Tia rob 111'1 1-�AS C¢a1PERMITISSUANCE ❑ 11 ❑ LICENSED CONTRACfOR'S DECLARATION I hereby affirm that l am licensed under provisions of Chapter 9(commenc. APPLIANC2SRESIDENTIAL JOB DESCRB'ITON ingwBh Scvoon7000)of DIAslon3 ofthe BusbiasaandPmf.i...Code,and m license is in full force and effect. PANELS License Class Date —Contractor ARCHITECTS DECLARATION 201-1000 AMPS Q CZOC I understand my plans shall be used as public records OVERIOWAMPS SQ.FT.FLOOR AREA $/SQ.FT. ZU Licensed Professional SIGNS ELECTRICAL �^ �< OWNER-BUILDER DECLARATION I SPECIAL CIRC[JIT/MLSC L., 7 IhercbyafOnn that l am exempt from the Contractor's License Law for the Z O.." following reason. 7MIS,Business and ProfenWns Code:Any city or OFZt- cmntywhichmquiresapermittommtmcLalter,Impmv,demo h,orrepalr TEMP.METPR OR POLE INST. '� _¢manystm=mprlortoltslawance,aborequirestheapplimnifmr chpermitto C V file a signed statement that he V licensed pursuant to the provisions of the POWER DEVICES 3 a Contractor's License Law(Chapter 9(commencing with Section 9000)of Divi- SWIMMING POOL FLECTRIC O< Bron 3ofthe Business and ProtesnioeCode)orthat he V exempttherefromand VALUATION b,�.'•^ the W sis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora tmb' thea Bcanttoadvil al dnat mthan OITILETSSWITCHESFD(TVRES le permi M. PP R ty o. fivehundreddollarshepr. NEW RESIDENTIAL ELECTR ❑e saowner oftheeworka ormy employees with wages theresole �'ET STOWES TYI'ECONSIRICTION < c pSec.7on,wWdosWwProfesionnd s Code:The ren IntendedContractor or License d for Law 5�p sale(Sec.7044,Business and Professions Code:The ContractoYe License Law �$$ does not apply to an owner of property who builds or improves thereon,and (XC.GROUP RFS.UNIT'S who does such work NmseUarthrough hisown employees,provided that such Improvements are not intended oroffered forsale.IL however,thebuliding er Improvement issold withinoneyearofcompletion,the owner-builderwlll have tlli oden of proving that he did not bund or improve for purpose of sale.). QTY, PLUMBING PERMIT FEE ---pLOp ZONNE APN L_f L ae owner of the property,am exclusively contracting with limmed PERMIT ISSUANCE contractors to construct the project(Sec.7044,Business and Professions;Code: The Contractor's License Law does net apply to an owner of property who ALTER-DRAIN&VFM-WATER(EA) Wilds or improves thereon, and who contracts for such pWpc,,with a Off,camencense under Snt to the Contractor's License IsP Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY LI[am exempt under Sec. B &P C for this reason • Owner Date DRAINS FLOOR ROOF,AREA COND. SANITARY Y_ N_: WORKMAN COMPENSATION DECLARATION RECEE'T N ❑1 hereby affirm that I have a certificate of consent to self-room,or a FIXTURES PER Tom' S'JiOOL TA% Y N rerti(icate of Workem%Compevatlonlaurance or a remLfled ropythereof(Sec. RECEFf N MOD,Lab C.) GAS EA.SYSTEM-1 INCA OUTLETS PARK BEEF Y N Policy a RECEI"N Com any GAS FA.SYSI'FM-0VERd(EA) BUILDING DIVISION FEES 0 CemBed copy Ls hereby th the cid. ❑CertBled mpybfiled with the city Inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECIC FEE. s' CERTIFlCATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID COMPENSATION INSURANCE Rhlssection need not Wcomplded ifthe permit V(�rone hundred dollars SEWER-SANITARY-SIORM EA.200(.7. Date Remi t# ($1I comlev.) In WATER HEATER W/VENT/ELECTR ENERGY FEE Y N (certify thatothe person eny manner for hich to permit Isissued, I shall not employ any person In any manner w v to become subject to the Wormpensatlon laws of Glllornia. Date WATER SYSTEM/TREATING Q Z Applicant PAID Applicant Z O NOTICE TO APPLICANT:If,after making this Ceftin—of Ekemptlon,you NEW RESIDENTIAL PLMB.__SQFL Date Recei t# should become tubi ct to the Workers'Compereation provisions of the Labor TOTAL: W~ W Code,you most forthwith comply wlth,uch provisions orthls permit shall be > deemed revoked. BUILDING FEE 1 p CONSTRUCTION LENDING AGENCY SEISMIC FEE Z 1 herebyaffirm that there V m a construction lending agency for the perforELabra turd ofthe work which this permit R bred fSee.3097,Civ.C) TOTAL: ELECTRIC FEE U O Lenders Name LL F ' Lender's Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE O WI certitythat l have read thiapphmtbnandmatethattheabovelnformation MECHANICAL FEE 4 iscorrect.l agreeto comply withail cityand county ordinances and state laws PERMIT ISSUANCE FEES PAID: >- W relating to building construction,and hereby authorize representatives ofthls I— Z city to enter upon the above-mentiomerty d propfor inspection purposes. ALTER OR ADDTO MECH. U.— (We)agree to save,Indemnify an d keep harmless the City of Cupertino Date Receipt# agsirut llabiblies,pcigments,rom,and expenses which may lnanywayaceroe AIR HANDLING UNIT rf010,ODO CFM) ago Inst said City In ronsequenm of the gram ing a this permit SUBTOTAL: AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTIONTAX Slgnsome of AppBnnt/Contractor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX-PAID: HAZARDOUS MATERIALS DISCLOSURE Will the applicant orfunam building occupant store or handle harardom HEATING UNIT(M 100,000 BTU) materials,defined by the Cupertino Municipal Code,Chapter 9.12,and the Date RCCCI Iimllh and Safety Code Section 2S532G)7 HEATING UNIT(OVER'Wed BITn TOT ❑yes r]No Will the applicant m future Wilding ucmpant use equipment or devices VENTILATION FAN(SINGLE RFSID) ISSUANCE DATE which emit harardous air contaMa ots as defined by the Bay Area Air RR�� Quality Management District? BOILER-COMPpFB'OR 100,IXp BTU) tr �� Yes ❑No Q . d the hazardous materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,(Xp BTU) IVOV a I Iealth&SafetyCod,Sections 25505,25ST3 and 25534.I •1(1(10 hst lithe Wilding does not currently have a tenant,that it b my NEW RESDENTIAL MECH. SQ.FL 's9x7G to ndity aCertlnvtenfOccupancy. CIIY UI' CUrrnI114V OlrrA3 thorbod agent Date TOTAL: ISSUED BY: OFFICE COPY � • v ;gig rix fJ —1 m J C7 • , , Sl T q (� 3J oil o _ v = IIEIIT Nl _ FINr end — SCR :WMYA. asp +dt r RFttY�✓a'�vK�ju�i: • MF 1'� • i ttttrtrt22 f,f 4r�dur.CCY:a. SS txin +{[W,fv 1 • ter; '� �FM1 b :. �„` +,� � • :H1ttieti .3iiy.yvp:r4!+L... x - t: cnnz P& rnmCOM� O Mz CD g e - � �^� o 0 O• � � p•�V`�f a c 0 p � N Opp 6D mc0 ;,MID_ O i -- -- - - --_ -- O .. C om O �m cn cn nI ® ❑ Y i x V^l � y^l D v Y 00 �° n b N O II � 1 II � r h C) y cc O Li m 0bo ED m 'ti c 6T C4 B � n � � p C) • - Pro'ect: NEON ILLUMINATED LETTERS Client: INLINE SPORTS • ' Date: NO V. 2 1992 Pa e: I of 2 Revise: I Job: 92-5258 All Rights Reserved By Merke Mw.,Inc.No Uneuth"ad RWoduudon AllwW. / 0 ° 0 / f (D � 4 \ 00 '2 ow0wow > \ � ' � ) \ /] 2 - `x § ® ^ ` E { [ A: 2) OL 03 \ (} 0 ` ° F� 00 00 ] � " E0, �\ ® k }/m 0 E�� 00 CL / \ } § 0 g - - E moo m(nt— /( ) \3 n � (} \� /\ . Pr NEON ILLUMINATED LETTERS . . , - cam: INLINE »op 2001 TAROB COURT,MILPITAS.CA 95035 mx 2, !992 2J2 m • m . . : Revise: Job: 9Zl58 All Right,__BY--- M.-U�"t—©__m_