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24677 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OFCUPFRT NO BUILDING-HLEC I RICAL PERMIT NO, a BUILDINuTVISIONl = APPLICATION/PERMIT PLUMBING-MECHANICAL BUILDING,PROJE.CII IIENI'IF'ICA'TION 24677 BUILDING ADDRESS) / pI 0 SANITARY NO. APPLICATION SUBMITTAL DATE `C.�� � UI �� I /✓v p� . 'I � Gf/oO7 � UNI p LDTN I � C C OW �S NAMI^ NE: CONTRACI'OR'SNAME: LIC NO: //`I lA( L('D (�G / elle C NIC CON TItOLN i�ARCHI'I'ECI'/ENGINIiER: LIC NO: ADDRESS: ❑ CO ACT: PHONE: ff �I GI D ��Ee/6j QTY. ELECTRIC PERMIT FEE ]],Jj ' BUILDING Pf:RMIT INFO y7J (al PERMIT ISSUANCE. - - BLDG ELECT PLUMB MECH eR ❑ ❑ ❑ LICENSED CON TRACTOR'S DECLARATION APPLIANCES-RCSIDF.NTIAI. TOB DESCRIPTION Qwz thereby aflinn lour l um licensed under provisionsofChopter9(commencing with u100❑ fallSccliwi]OOId flealvisl.n Jnllhe Business end Profaeslons CnJe,unJ my lkcmcis in PANELS t (� �� F�bU full TnrccrmA eflcct. l// FQ,zW License Class Lia# LJPT0260AMPS y Q y Date Contractor 201-1000 AMPS Z Ou,3Z ARCIIITECPS DECLARATION SQ,FT.FL R ARBA S/SQ.FT. O Z O I understood my plans shall he used as public records. OVER 1000 AMPS P;a.rn(_m,.44 SIGNS ELECTRICAL 3144 Y�6 Licensed Prnleuienal f�0ad OWNER-BUILDER DECLARATION SPECIAL CIRCUH'/MISC. KOyrV 1 hereby n.(Se that I am eumpt fmm the Contractors e:Anse Law for the tB3arn following ransoa(Sccti.n"/B31.5,Business and Professions Cule:Any city or county TEMP.METER OR POLE INST. O S which mquime a permit to construct,alter,improve,demolish,or repair any ftmcmrc m w>-. to its issuance,also the applicator forsuch Permit to fileasi nal statement POWER DEVICES prior quires pp pe g �C<p that he is licensed pursuant to the provisions of the Contractors Licenu Law(Chapter a e 9(commencing with Section 7")of Division 3 of to Business and Professions Code) SWIMMING POOL ELECTRIC asLU 1'10 .,ilial he ix eaempuherefrmadmd lire basis for NeullegW exemption.Anyvinlmionof OUTLETS- ITCHES-FIXTURES SWf"� a �zpT Section 7031.5 by any applicant turn permit subjects theapplicanfto a civil penally of nremm five hundreddolhas(8500). NFW RESIDENTIAL IiLECTR'_S Q,FT. Gm I,woorm"i ihepraperry,ormyemployees wirhwegesasmcirsnlecnmpensntinn, Q STORIES TYPCCONSTRUCTION 3_. to the work,and the structure is not intended centered fursale(Sec.7044,thisinmis and Profersion Cnda The Gmwe(ors License Law does not apply man owner of - propenywho hnildsor Improves thereon,and whodoes such work himselforthrough his owneatiployms,provided that such improvements mono,intended mothered forsale.If, OCC.GROAT' RES,UNITS h.wevc6 m.buildingor improvement is said within.ne year of completlon.the owner. builder will have the burden of covin that rest not build.rim for TOTAL: p g prove purpose of ala). ❑ hnr.wncnsf me pruperty,amexdmm usively cacting with licenuda+mmctoy to QTY. PLUMBING PERMIT FEE FLOOD ZONFi APN consumer the project(Sew.70,14,Business and Professions Code:)The Contractor's PERMIT ISSUANCE License Lawdoes not applyto an ownerofpropcny whofsoIdsorimpn+ves thereon,and who contracts forsuch projects with a conuacmr(s)licensed punuannothe Contracture [.feel.Low. ALTER-DRAIN&VENT-WATER(PA) FEE SUMMARY ❑ 1 am ewe or Sec. ,B&P C for This mown BACK FLOW PROTECT.DEVICE SANITARY OUTSIDE Y N Owns,. : D RECEIPT WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,NOOP,ARLA,COND. SCHOOLTAX Y N ❑ Thereby action list l have o cmifrcare command o ulf-insure,or a certificate of RECHIPTp FIXT UI MS-PER TRAP Woder%Compenention lnsumnce oracenified copy memM(Sm.JNW,Lob CJ which PARK FEE YN stwmardl employee's under this permit. GAS-Ii.SYSTEM-1 INC.4 OUTLETS RHCFlPT p Policy N BUILDING DIVISION FEES Company _ GAS-EA.SYSTEM-OVER 4(HA) PLANCHECK FRE, ❑ Ccnilicd copy ix hereby famished: - ❑ Certified copy is l fled with the city inspection division. GREASMNDUSTRI.WASTE INTERCEPTOR GRADING FEE ' CERTIFICATE OF HXEMPTION FROM WORKERS' GREASH TRAP SOILS FEE COMPI?NSATION INSURANCE ('This section need not be completed Blow permit is for one hundred dollars($10(f SEWER-SANITARY-S'FORM EA.2001T. ENERGY PER or less.) I cenilylhut le the perfrnmaneeofthe work for which this permit is issued,l shill WATER HEATER W/VENT/F.LECTR not employ any Person in any manner so as to become subject u)the Worked PAID .z Compensation lows of California. Date WATERSYSTEMOREATTNG Dau Receipt# Applicant Z 0 NOT ICE TO APPLICANT:IL after making this Cori of Elimination,you should NEW RESIDENTIAL PLMB. SQ.IT. TOTAL: � bcdome subject m the Workers Compensation provisions of the Labor Code,you must 7 forthwith comply with such provisions or this Permit a hall le deemed revoked. BUILDING FEE ��QO Q. (� CONSTRUCTIONLENDINGAGENCY SEISMIC FEF, k a z I himm fiffrrn than mem is a emover edon lending agency(.T row performance of V O the work for which this permit is issued(Sec.3097,Civ.C.) TOTAL: ELECTRIC FEE Ids Name O U Lc<nadecr'rs Address QTY. MECHANICAL PER MIT FEE PLUMBING FEE V . I teddy that I have read this application and state that the above infonnmion is �•' Ri correct.l agree it)comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE MECHANICAL FEE I-s building ennslrucrion,and hereby amhorizemprawradves ofods city to cubic upon Ilia CONSTRUCTION TAX V abevcmcndu onalpmperry fur iowicction purpos. ALTER OR ADD TO MECII. ' (We)agree to save,humanity sad keep hornless the City of Com inn ripma l liahilio.sJuiF ems,costs andeapmueewhich may in any way accrue against and City AIR HANDLING UNIT(To IOAJo CEM) rtP 'hc grunting. noir. �J 9 AIR HANDLING UNIT(OVER 10.000CF4) m um.�I 1iXHAUST HOOD(W/DUCT) Signature at ApplicanUCommcmr � Data PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTL) Date Receipt Will the applicant or future building.¢upant store or handle hmnrdom material u defined by Be Cupertino Municipal Code.Chapmr 9.12,such,Health and Safety HEATINGUMT(OVER 100,0011 BTU) TOTAL: SiSP Cale,Sectionx)? ❑Yeses 1:1 No VENTILATION FAN(SINGLE RFSIU) Will the applicant orfmurehuilding occupant meequipmem or Jeviceswhichcmit BOILER-COMP(3HP OR 100,00(1 RTU) ISSUANCE DATE haoum?nahm, it a.maminamY as defined by the Bay Are.Air Quality Monagemem pOILER-COMP(OVER 100,000 BTU) - P A ' 91 ❑Yes ❑No NEW RESIDENTIAL MCCIL- SQ.IT. I have rcml the hazardous materials requirements under Chapter 6.95.f ilia JAN -L1 1993 California I Iealm&Safety Calif.Sections 25505,25533 and 25534, 1 understood that if the building Arcs not cturwaly have a tenant,built ix my renpnwibiliry In nmify @a Oacupam of me emairemems which must be met prior 1.iswm.of.Cemfieate ol. I I Y WY CW}'.tn I HIV hcupaaey. Ownerorumhuriledagenl - Dee TOTAL: ISSUEDBY: 1216)h U"r OFFICE R�iN6 Mh'rtS !� G.T. SHIM d SKYLIGHT' �jtKc�lU Zcr i3 0 3 -;7/o /z - RAP'fEle3 APPi=2JVLv x4oCuRB JAN 19 1993 21( .; 2 IN ACCORDANCE WITH THE CITY Of `� BLDG. INSPECTION DEPARTM jZ CUPERTINO CODES AND ORDINANCES p \ f ITGfr;l M I/JG- DATE SIGNED v' 0p„ <1. `�� � ��Zu�E CK ��P"i1JEr This set of pans end spec:ucahcns US7 be kept on the jot,at a,: times 2nd it is un lawful to make anv c ,angel or alterations $K on same wdhou w ,:in pe.m:ssion from p ihe bui.ding Dep.. Ca r,f Cupe_Lino. The stamping al h s p n nd ser to be an z K q &,Z9"©iC E}e�T R SHALL WOt be ae a L p' mit cr to be an- ipproval of the V._:, .n of any pins if =nv C?; fl d Iib.. z .n S:a;e Law. X- 9- t:B - S41ee r=c_ _ - �c�sr 5 t�cenec�erci OFPIP F�_A CM T.