20014 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building project de Ifk IonN /O� PERMIT N .
Building Addaee: 1 `_`7/ /�0 O
2 OO U G
14
Phone:
CITY OF CUPERTINO-BUILDING DIVISION -� p
• c adore IX.Nu APPLICATION / PERMIT
' 3 BUfLDINI—aEC[RICA nP BINGMECHANKAL CATEGORY CONTROL e
rchltee/FsglpeF X G — - I.r.Nu
QTY - ELECTRIC PERMTT FEE BUILDING PERMIT INFO
Address 60 b S PERMITISSUANCE ❑ 1:1LICENSED CONTRACTOR'S DECLARATION
IherebygfH thatlamllee mr,derpm Wb of Chapter9(mmmei APPLIANCES-RESIDENTIAL JOB DESCN
ingwith Se tion700))of Dlvlelun3 ofthe Busireuend Pmfevlon.Code,aM my
Ir71---1✓�,/`h
11¢roe b In full o and d/ed.
Lketac s Lk.I�
Date Contactor
ARCHfEECTS DECLA A N 201'1000 AM
wp�QZ IuMentand my phroshuB be,used u public remrda OVER1000AMPS FT.FLOOR AREA S/SQ.Fr.
E (j LicensedProfmbnal SIGNSELEC-DKAL E D I IV
X 61 OWNER-BUILDER DECLARATION SPISUALCIRCUIT/M1SC V
Ihereby.fOrmtheleneaemptfromtheCnrdraaor'eLlaroelawforthe T E R
following re..(Section 7ML.b,Buslnm and Pmfmbru Code:Any dtyor
countywhlch rcepdresa permit tomrutruM alter,Improve,demolish,orrepair 7FAIP.METD20R POIR INS?.
anynmu mprmtoita amalaorequimtheappUo tfineuNpe to POWER DEVICES
r< file a aigned.statement the he b Bmroed pursuant to the provbbro of the
ww< Contractor',Lice.Law(Chapter9(mmurendng whh Section 7000)rd DM-� VALUATION�o, sbn3Ofthe Buynm,and Profmbro Cade)arthat hebeumpt there/mmaM SIVPdMING POOL ELECTRIC
< the banks for the alleged eumption. Any violation of Section 7(1115 by any OUTLETSSY.TTCHESFDMjRES
O� appUl tforaper =bjMatheappUr ttoadvllpemhy&nam mthan
(Iundyed ddhre($SM. NEW RESIDENTIAL ELFCTR SQ. .
6STORIES TYPECONSTRUCTION
I,as owner of the property,or may employeswith wage as their sole
ZQ comperwtion,willdothe wos"ndthestrudurcbnot wendedOr offend for
❑ sale(Sec 7014,Ill. a and Profmbro Code:The Cordract.e.Iuaroe Law
(ljS dos not a pply to an owner of property who build.or impwrs thereon,and OCC.GROUP RES,UNITS
EE who dohimselfro
auch work himself or through Ma own empIcyua,provided that uch
Improvetrcw are ret Intended oroHcred(orale.If,henvever,thebulMing or TOTAL:
t"i-dmemlmi wflhinorcyeard1buiId tbn,thewvner-loin..(.hove
H19„¢nnaen water of thepoeerty,a wuanrvely contracting
withliue.). QTY, PLUMBING PERMIT FEE
LJ cti Honer tr the property,.m eacK Bood eas and
who C 1 1•lOOD ZONE APN
contradmato construct the project(See 7W4,Bu,it�and Profmbro Cadr. PERMIT ISSUANCE
The Comrsdare Liceue Law don nu apply to an owner of property who ALTER-DRAIN 4 VENT-WATER(EA)
builds or Improve therron,and who md
rvna fee auch ptojeN with a
roii4et.K.)Banaed porwam to chs Coetndar.Liomae Law. BACK FLOW PROTECT'.DEVICE FEE SUMMARY
U I am eaempl umbo Sec n
B 4 P C for this teon '
® O.vner Dye DRAI NS FLOOR,ROOF,AREA,ODND. SANITARY Y_ N
WORKMAN COMPENSATION DECLARATION RECF]PTI
hereby affirm that I have a anifiate of consent to ae8-Wren,or a FIXIURF_S PER TRAP SCITOOLTAX Y_ N
ce Jloteof Workers'Carperoadonlmuranmmau"Ul mpythereof L5ec. RFX"m It
3NOO,Lb O O O If
tl/a GAS IA SYSIFAI-1 INCL OUTLETS PARK FEE REIN
Pdky. 7 GAS EA.SYSIFM-0VER4(EA)
Cam ny BUILDING DIVISION FEES
Cert m
hereby furnldad. fGREASE/INDUS[RL WASTE INTERCEPTOR PLANCHECKF'EE
enwedcopy b Hlea..ttntk dry wpedbn alvwon. .
CERTIFICATE OF E)(e PT10N FROM WORKERS' GRESSE'HLV' PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM FA 3TOFr Date Recei til
(I'hbaedbn need nor becompleted uthe permit laforomhunaad doR.n EN _
moo)or lege.) ERGY FEE YN
I unify the N the perfomanu of the work rorwhich thla permit is baued, WATER HEATER w/vwr/FdJ•rrtT
I slue not employ any person In any manner n a to bemtrc aub ret to the WATLR SYSI41/TR1:171nG'
Worken'Comperaylanrawn of Gbfomla.Date PAID
O Z Appeant NEWRF9DENTIALPLMR. SQSI. Date Repel til
Z O NOITCE TO APPLICANT:H,.flu nuking thio Certificated Faemptlon,you
should berme aubµrt b the worker:Comperoatlon prmbions of the labor - _ TOTAL:
~ N Code,you must fort hwhh mrnply with such pmod.bro artMs permit aball be
CC
j deemed revoked. BUILDING FEE,
CONSTRUCTION LENDING AGINCY SEISMIC FEE
CL Ihereby.fil thatlherebacuretrunionleMNgage nrycy for the perform TOTAL ELECTRIC FEE
7 Z aha ofthe work/car which thio pemdtbbwed 6ec.3097,CW.C)
U O Lender.N.me - PLUMBING FEE -
LL F Lander.Add. QTY. MECHANICAL.PERMIT IEE MECHANICAL FEE
O W I certitythe l have read thbappllatbn and matethatthe above lnfomatlm Concorrect.fagm We plywhhaBdtyandowntyoraltunmudmtelaws PERMITISSUANCE 2s W FEES PAID:
> C tdatingtObulMing Ma ted ion,andh"rc authonamprnenttNeofthb
F = dry to enter upontM abovcmembnad Property for Wpedbn purpo,n. ALTFRORADDTOMBCFi Date RCCCI [M
— (We)agree to a emnlfy and hemi.the City of Cupertino
agaWtllablW dg Na,cvysa which b.nyw.yam,.c AIR HANDLING UNCr(r010,OD0 CFM) SUBTOTAL:
agairyt ul in .rya encs ntingdt
VN AIR HANDLING UNIT(OVER 10000 CFM) CONSTRUCTION TAX
Sig of AppBant/Con rador Date IXHAUSTHOOD(W/DLKM CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant orfwum building occupant store or handle h...rdou. HEATINGUNIT(70100,0DOBTLI) Date Recei t#
material a defined by the Cupertino Municipal Code,Chapter 9.12,and the
Hcaith.rd Safety Code 25532((.)? FiEATiNGUNIT(OVFRIK.00011Ttn TOTAL: O
I Ilt
iem t eprardc tum rnlrau a oavpaed by the lay Area davias VENTIIAIION FAN(SINCLE RESID) .ISSUANCE DATE
which emit mnlamWnteudeOnad by the Bay Area Ab
Quality Managemem 7 BOIIFR{OMP OFiP OR l00,ON BTI!) AMD
4Ye No
have real the h a a mated b nqu 25505,5533under Chapter 2&534..9 of O GR MP(OVER100.00)BTU)
the Gllfomb Heakh Safety Coda SMbv 75I hav5533ad2553/.7
urduWard that if lis - dbg been men0y love atenanL that itbmy NEW RESIDENTIAL hffAi. SFr JUL 3 31990
mpomaWllRy to fy e d enquire ntawhichmumbemd
prior to isua d rtlfl of Wxz
- r
f)wuthariW<d agent Date
TTOTAL, Y^ ISSUEDB
OFFICE COPY