26364 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO B ILDIN,-ELECPRICAL PERMIT NO,
BUH.DINGDIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 26364
BUILDING PRHJECf IUENTIFICA'1'ION
BUILDING ADDRESS: SANITARY NO. APPLICATIO�NSSUUaBMIITALDATH
A
V UNIT LOT ��'l Vt,�
O S NAMF,: PII)NE: CO CT I(„ti NA LIC NO: l•
\V\ NIC CONTROhp
ARCIII'IIiCI'/ NGINEI?R: LIC NO: ADDRESS: ❑
CONTACT: PHONE:
QTY. ELECTRIC PERMIT PEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MBCA
PERMIT ISSUANCE E]
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL 10B DESCRIPTION
POO Thereby of
3 ofth Business pmvisifesiosCoder 9(mmmccense with S(���►a0
00 fail fine lad)r f Division l of the Business and Professions Code,and my license is in PANELS
full force lass effect. UP TG 2M AMPS
t Z< ( License Class Loo.M
am D'A Date Comr«sur 201-Ig10 AMPS
F-NZ ARCHITECT'S DECLARATION SQ.FT.FLOOR AREA S/SQ.FT.
ZO«— lundcrsundm 1 shall be used blit records. OVER IDOIIAMPS
OZ—D my pts
r.«Y W SIGNS ELECTRICAL
gN � Licensed fessional
6 pxx. OWNER-BUILD DECLARATION SPECIAL.CIRCUIT/MISC.OaU Ihercby affirm dam em fr exempt from the Conwnofa License Law for the
W3LLya following crown,(Section 7031.5,Business and profeuiats Code:Any city m country TEMP.MID-R OR POLFINST. B nA
O J which requires a permit to consumer,alter,improve,demolish,or repair any sbucturt a Vee
prior m its issuance,allorcquireathcapplicamfo...ch permit ilea signed statement POWER DEVICES �� _ e
that he is licensed pursuant the provisions of the Contractor's License Law(Chapter I\
a o 9(canmmeing with Section7000),d Division 3 of Ne Bmsineas and Professions Col.) SWIMMING POOL ELECTRIa ( VALUATION
yYj—m onhm he is a.man here ..end abs basis for thealleged exemption.Anyviolauonof
C N cnoacvlpnyoOUTLETS-SWCHS- ITURSSwion 7031.5 by anyapplicantfor.pewit subjects thenpliIT
1.
Q Karc In.five hundred dollars($5110).
C—
m I,usowneroftheprnperty,ormyemployceswith wagesusunirsolecompensation, NEW RESIDEhGALEL'M pI STO IYPECONSIRUCTION
wil the work,and the structure isno,iatended proffered for sale(Sec.7044,Business
and Professions Cade:The Cunwcmex License Law does not apply m an owner of
propcnywhobuildsorimprovestherton,undwhodcesauch week himulfmforough his OCC,GROUP RFS.UNITS
ownemployees,provided that suchimprove ants arena imendedoroffend formic.It,
however,the building orimprovement is sold within one yemofecmpletion,theowncr- TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
sale")' QTY, PLUMBING PERMIT FEE FLOODZONC APN
consumer the project(Sec.oma Business end y%habom Code:)The Cen n.ws
License Lnwd«ano,npplytomown<rofpropeny whobuildsaimpmvesthercon,and PERMIT ISSUANCE
wbocomracts forsuch projects with acomracmrod licensed Pursuant.,he Conamc,ora FEa
ALTER DRAIN&V[iNT-WATER(EA) I -.
Limns.Law. SUMMARY
❑ 1 am exempt under Sec. ,B&P C f«this reason BACK FLOW PROTECT.DEVICE OUTST5MM
SANITARY Y—N-
0." Dam RECEIPTM
DRAINS-FLUOR,ROOF,AREA,GOND.
WORKMAN COMPENSATION DECLARATION SCHOOL TAX V
❑ I berehyuffirm that l have a cenifcateofconsem mself-insure,oracertifacate of FIXTURES-PER,TRAP RECEIPT#
Workers'Compensation Insurance.,.certified copy lhercof(Sce.3900,Lab C.)which PARK FEE Y_
covers all cm lm se's under,this permit. ECE""
P Y GAS-HA.SYSTEM- INC.INC40UTLHTS
' Policy# BUILDING DIVISION S
Company GAS-EA.SYSTEM OVER 4(EA) PLANC IECK FEE
❑ Cmifed copy is herehy furnished,
❑ Ccnitied copy ie fled wiN the city impaction division. GREASWINDUSTRLWASTEINTERCEPI'OR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREAS13TRAP SOILS FEE
COMPENSATION INSURANCE
(This section need not IN,completed ifthe permit is(prone hundrtddollvs(5BID) SEWER-SANITARY-STORM EA.200PT. ENERGY FEE
or less.)
I cenify that in 1110 perfmmance Of(he work for which this Permit is issued,l shall WATER II TATER WfVWI'/VLECTR
not employ any person in any manner so es to become subject to the Workers PAID
Z Compensation Lawsof Califomis. Date WATER SYSTEM/TRFATING Reels.#
Applicant
O0 NOTICE TO APPLICANT:IL after making,his Certificate of Exemption,you should NEW RESIDENTIAL PLMB, SQ.FT. TOTAL:
D+ U) become object 1.the Matures Compensation Porvisiona of the labor Cade,you must
lKi forthwith comply with such provisions or this Permit shal l he deemed revoked. BUILDING FL'E
aCONSTRUCTION LENDING AGENCY SEISMIC FEE
Vz I harebyaffiwlmt,la aisacon,vactma lendingagencyf«shepmAnneneeof TOTAL: ELECTRIC FEE
O the work for which this permit is issued(See 3091,Civ.CJ
Lender',Name r PLUMBING FEC
Q F Lender's Address Q'EY. MECHANICALPERMIT FIT
LU I cenify that 1 hav0 oral'his application and sum,hat Ibe above informnion is
L1. c..,.Iagmmo comply with All cis,and country oninam.and state law,rsham,m PERMIT ISSUANCE. MECHANICAL FEE
building emaswction.And h.reby.whorice represcnutivo of this city to enter upon Ne
(„) 'i shove-mcA,i.nrd property for Inspection purposes. ALTER OR ADD TO MECI I. CONSTRUCTION TAX
r7 (We)agree to save,indemnify and keep harmless the City of open no against
Iiebilifes,judgmenU,cosI nndexpenses wthchmayinanyway Accrvr�ageinst aid City AIR HANDLING UNIT(10 Iry000UND
int= egrantingmfthi,permit. �/i �/9
AIR IfANDLING UNIT(OVER 10,1X10 CFM)
Si01, VIM.of ApplienAVContmcta )am EXHAUST HOOD(W/DUCI'7
PAID
I IAZARDOUSMATERIALSDISCLOSURE HEATING UNIT(TO IM."BTU) Data Receip,p
Will the applicant or future building Occupant sore or handle havmdous material HEATING UNIT(OVER IOII,000BN) TOTAL:
as defined by the Cupertino Municipal Code,C'lupmr 9.12,and the Health and Safety
Cale,Sermon 25532(1)7 11 Yes ❑No VENTILATION PAN(SINGLE RFSID)
es
Will lair commentators
tors As defined
by the Bay equipment Quality
Mgnallb ILIA
BOILER-COMP(RHP OR 100,1100 BTU) ISSUANCE DATE
hauNuos air cotnaminvm es defined by the Bay Area Air Quality Mgnagemenl BOILER-COMP(OVER 100,DOOBTU) P A
Distriaf e
❑Yes ElNo
1 have read the hi uudous materials re9uiremNEW RCSIUI?NTIAL MECII. SQ.PT. MRY 11 1994ems under Chapter h 95 m the [��a//�%
ifthe building
oncurentlySection,8505,8537 responsibility
1undemand that J'
ifthe building does not currently have a mmnt,that it is my responsibility m notify she Ty
«cuplm of,he rtquircmenu which must be met prior m issuance of o Cenifiwte of C I I 1 Uf CUt Lh I�I�V
Occupancy, l/'—pj1svJ/�).
Owner or audamire l agent Dale I TOTAL: ISSUED BY:
OF
. . . r
4x6 CVRS TYP.
—ZZ v 2x4 SKYLIGHT
! VJAYUR PROOF SHT
KGTAI. PLASHING -nF•
2 x 6 RIM JOIST"TYP
AT OPUN(Nis
2x6 FRAMIa)q
AT 16"O.C. -rYP.
DOVBL6 JOISTS
6A. TIDS of OP6NI64
!
GYP. RD. FN
' HWED:
SKYLIQHT DETAIL A - A
MAY 111994
SCALE I/a " m 1 '^ D "
WLV4. IMPECTION DEPARTMEME
• UTY OF CUPERTma
r - 294 SKYLIGHT
WATER PROOF 4X6 CURB TYP.
M6TAL PLASHING4
TYP. ---i-►
I
DOUBLE RAFTERS EA
SIDE OP SKYLI414T
2 x 6 FRAMING AT 16° O,C. TYP•
2 x 6 RIM JO1ST TYP.
AT OPENINJS
! I
SKYLtGuT DETAIL_ S - B
•
OFFICE S CH L 6 V2 "
10200 VICKSIBURG DRIVE