19956APPLICANT TO FILL IN INFORMATION WITHI ED LI ES — USE BALL POINT PEN ONLY
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PERMIT 1
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CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
DAIL
O
Contneor. Name: Lk. No:
BIIIIDINGELECIRICALIUJMBINGMKHANICAL
CATEGO
CONTROL
Arditect/Fsgirim: Lie No:
Q ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
nddreaabpI
PFR1,97TISSUANCE
j�-y ❑ _ ❑ ❑
L2S�
LICENSED CONTRACTORS DECLARATION
Ihereby aHbm that l am lensed under provWars of Chapter 9 (comment,
Ingwlth5e n7000)o, DtWgm3ofthe Budrcsand Profe=sCnde,and
APPLIANCFSRF_SIDEMIAL
JOB ��
Banse la In full form and effect.
PANELS
OatsLlceClan Lk.I
Date Contractor r
XYI-1000 AMPS
ARCHITECT'S DECLARATION
I understand my plans shall be used as public mounds,
OVERIODOAMPS
IT. FLOOR AREA
$/SQ. FT.
SIGNS UWTRICA
Licensed professional
'
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor'. License Law fee the
SPECIALCRtC[BT/
'
following reason. Section 7m15, Bushes and Prefesebns Code: My city or
mnntywhkhrequlmapemettommt Mtiter,Impmve,de=o h.ornpalr
any atructumpalmmitahence,'borsedipurh tto pond«anions of to
Ole • signed statement the t b II¢rued pursuant m the provisions of the
Canaan e. License 1. (Chapter 9 (commencing with Section 7000) of Diad-
don3 of the Buenes and ProfessionsCade) orthat he b exempt therefromand
TEMP'MEfF7t OR EIN
I'(%VFR DEVICES DATE
'
SWIMMING POOL ELECTRIC
VALUATION
the bub for the alleged exemption. My elodlon of Section 70115 by any
u
appfiont for a permit bye- the appIlcant to a Wil penaity of net more than
OUILETSSWTICHESFLYTURES
38 . 00
NEW RESmENTIAL ELFt7R S
five hundred doles (5500).
n1, as owner of the property, or my employees with wage s their note
O
'=CONSTRUCTION
STORIES
cmnNruadoe, wBldothe work, and the structure b out intendedor offered for
sale(Sce, 70K Buainces and Profracons Code: The Cent.a.e. Lame Law
V��
-
does =apply to an owner of property who bWldaor bnprove the.nand
who dosuchworkh eras1f «through wowsemploym, provided that such
OCC, GROUP
R6. UNI -173
_
Improvements are not Intended oroffemi foraale. If, however, the building«
bnprovemenrbeold wlthinorcysrofcmrylctbrtthe«wrier-bullderwOl love
TOTAL:
(7 _•�
Imo•
Xt rden of proving the he did not baud or improve for purpose of sale.).
f, s owner of the property, am excholvely contracting with Bomsed
mcto, to construct the project (Sm 7054, Buerm and professions Code:
QTY, PLUMBING PERMIT
.J
,FEE
PERMIT NUANCE
FLOOD ZONE
AM
.
The Cordsctor's Lineae Law does net apply to an owner d property who
Wilda or Improve thereon, and whn contracts fee wd, p,o)ects with a
on"rac'e(s)Brerued purwant to the Contractda License Law.
U I am exempt under Sec. B as P C for thio reason
ALTER -DRAIN& VENT - WATER (EA)
'
BACK FLOW PROTECT. DEVICE
FEE SUMMARY
DRAINS FLOOR ROOF, AREA,CONO.
FDOUNFS PER TRAP
SANITARY Y_ N_
RE= I
Owner t 9�—
WORK MAN I haw' a ml C ATION
❑1 herby affirm the 1 hart a certl0 of c nt m se0-Inure, « a
3K0, LenQ orkes'Comperedimlnsunntt«aanHkd ropy Nesafl5ee
SCIi0OL TAX Y N_
RECEIPT. a
GAS EA. SYSTEM -1 RJG4 OUTLETS
PARK FEE Y_ N_
poacy�bG
I
DIY
GAS F.A.SYSTEM-OOVER
Ce ny
DING
BUILDING DIVISION FE PS
CC copy bhereby fumbhed.
CenBled copy b filed with the city Inspection divizi
GRFASE/NDUSIRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASEIRAP
CERTIFICATE OF FXF]NPTRON FROM WORKERS'
COMPENSATION INSURANCE
Ca bice
(Thin I..) need net be compie4d If the permit b!«orae hundred dollar
PAID
Date Remi til
SEWER -MRM EA.7DQr1'
Rt00) or nify that an personinanerformance fthenar se as t chtw pemdtbbued,
Icenot employ
I shall not employ any pesos In any runner at s to become object to the
w«key ('arnpenadmn l.w. of California. Date
WATER FIFATM W/VENT/ELE=
FNERGY FEE Y N '
PAID
wATQC SYSTEM/IxE,nnc
ApplicanNOTICE
NOTICE TO APPLICANT:e after nukingtw Cti=p red mofttbn,you
Ch E, become ub}ct to theta yr t Compensation orth4p ofthe ]1,c
Ceenned u elced. hwith comply wllhwNprvvbbns orrhb pemrN vlWlt
deemed rewked.
Date Recti tic
NEW RESIDENTIAL PLMB. $QFI,.
TOTAL
BUILDING FEE �147,
5EISMIC "�(_
CONSTRUCTION LENDING AC¢ CY
lherebyamrmthatthere baconsrruction lending agency forthe perform
ante of the work for which this permit b Lowed (Sec. 3097, Civ. CI
TOTAL:
ELECTRIC FEE
Lender. Name
Lenaero Adds,
I ten0ythat I have and this appllatbna d stertor theabow bdomotior
QTY. MECHANICAL PERMIT FEE
PLUMBING FEE
MECHANICAL PEE
FEES PAID:
Isectlect.I.gmtocomplywithaUdtyardmuntyordbanmand statelaws
PERMIT ISSUANCE
retuning to building construction, and hereby authodre representatives of this
city to enter upon the abovcmerrtbrcd property for inspection purpose"
(Wa) ogee to sve, IMemN(y an d keep lorrrd m the City of Cupertiro
ALTERORADE)MMECH.
Dale' Recei ted
P
SUBTOTAL: s
ega1mt11abWtln,jadgnew, mstsaed expenses which mayor any wayacwe
against said City in consequenceof the grantln4bf this permit
CG�ym 6- .37VcTl 9�/IU
AIRIIANDLINGUNITTTOl0,=CFM)
AIR HANDLING UNIT (OVER I 0,=CFM)
CONSTRUCTION TAX
Slgnatumof AppBont/6 'lam Late
D(IIAUST HOOD(W/DUC)
CONSTRUCTION TAXPAID:
HAZAROOUS MATERIALS DISCLOSURE
HFATNGUMT(IO 100,00013TU)
WOltheappliantorfuture building occupant more or handle he,ardous
material as deOned by the Cupertino Municipal Cole, Chapter 9.17, and rhe
Date RMei [N
HEATING UNIT (OVER 100,000 BTI))
TOTAL:
Ikahh and Safety Cede Snctlm 75537 W7
RYs No
Wtheappeont« msbuBding«cupetuse«rylprnent odevices
which emit hazardous air contandnsnts s defined by the Bay Area Air
VENTILATION FAN (SINGLE RESID)
ISSUANCE `DATE
Ps'I�Y
BOILER-OOMP (IITPOR IM OM BTU)
Q�Lalfty Magement Wtrkt7
�J ) `naNo
Thaw read the h.m.. materials requismenb under Chapter 6.95 of
js9i�
BOMER-COMP(OVER IW,000 BTU)
the California Health 4c Safety Code, Sectlem 75505, 75533 and 75534. I
understand that If the Wilding does wt currently have a urunl'tbat it It my
I '• ,
NEW RESIDENTIAL MECFL SQ.F7.
mPonsrbBhy, to really the occupant of the requirements which must be net
prior tot uarceda Cenl/trete of Occuparuy.
yxls'c Bf r.(J(1?iElnry
la [j' _ _/
-y.,.,� /�a� �a I
UOF-RW 4W% -C I1,
O.vneroauthosiredagent Date
TOTAL:
ISSUEDSY: -r
OFFICE COPY