19966APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Bundles Pmect ldeminatlan
Raid Ing Address:
PERWIT NO.
�3 c-Iz;S7,) ZG., Dv—. Up rs t6 „ PE 6-
1996
m : one:
r-c�..0 ji &-,Q.OL- -
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
G –U -S'S
Cmtnao/e Name: Llc. No:
LtqBI111DINGdECIR1U4PLUMBINGMC�HANIGL
CATFLORY
CONTAOLa
Archltetl/Englmer: Llc Nv/
Q ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
-i
y-. C
AdIme, 60 1 1 1. J Ft
PFRMITLSSUANCEPLUM6
MUCH
l� [:][—] ❑
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that lam lkeved under provlsbn. of Chapter 9(®rimen
Ing with Section 7000) of Dlvisiou stv 3.fthe Buo es and PrefessioCode, and nyy
APPLIANCES-RESIDENTIALJOB
DF RITTION
It.. is In full fmw and tlfe
PANELS
D en.c Clan C.M
Dae caRTECE
puPLF X
Ml -1000
ARCHITECTS DECLARATION
IundetMand my plan eluBbe..w mpublicrtmNa
OVER 1000 AMPS
SQ. Fr. FLOOR AREA
$/9Q. FT.
SIGNSEIECTRICAL
LI¢nsed Professional -
E D I N
OWNERBUILDER DECLARATION
Ihereby.(nrmthatlam exemptfromthe CoMratlor: Llavalaw (¢the
SPMIALCIR=/MI9C
.
T
- .
7�{P.METEROR POLE INST. OM
]OWER DEVICES -
SWIMMING IDOL ELECI'ItIC
following rtewn.(Sea1m 700 I5, Buelnm and Aofmbv Cade: Myclty or
countywhlehrequbena permhtoromtvtl, alter, Improw,demolish,orrepalr
anyemmmprinir beuame.sb requimthe.ppBantf¢mchpermdtto
file a signed statement the he ls paved pursuant to the provisioro of the
Contractor's Lleenae Law (Chapter 9 (amnencing with Seabn 7000) of Dlvl-
sion3of the Busineseand Prdmlov Code).rthH hebeumptthere(mmard
R
Q
• /3 /
9a�
VALUATION -
thebaafafortheallegedesemptlm. My violation of Sectbn 7WIS by any
appfiant(or•pemJt aubJecb the.pplkatto. tlWl pevhy dn¢mort Hun
OUTLETSSW[TCHESFLYfURFS
aL. Oa
NEW RESIDENTIAL ELECTR �'�''
flvc�urndnd dollars ($50M.
UI, a owner of the property, or my employees with wages as their note
J
STORIES
TYPECONSTRUCTION'
mor"ounket, will d.tle work ad the rtvlure Is out, indended or affemd for
ale (Sec 70K Basions and Profmbna Code: The CMm
.tloe. Lame Law
—�
don notapply roan m,.f propenywho bulNeorimprovn therroRand
doessuehworkim
hself ¢through Ma.wnemploym, provded that such
OCC GROIII'
RES UNITS
Improvememsee not Intended .,offeredfor see. l4 however, thebulldin8 or
me
Impmventbwldw hlnomrarofcompletbn,theavne Wilderwlllluve
- TOTAL:
It -
2-3
t ben of proving the he did not bund or Improve fee purpone of ala.).
L as owner of the Property, am exekasweiy mntncting with Ifaved
n m
us" to vtrad the project(Sec 70K Rusinmdmbru
and P,Code:
QTY. PLUMBING PERMIT FEE
PFltMIT���
FIAOD ZONE
APN
The Contnnoes Llrerus Law don not apply to im owner d property who
bullda or Improve thenaR and who mntntla fa vreh ptojem with .•
cq,j da(s)Ilao.ed Ina meant W the Contnn./s Ll¢ve low.gACK
L_j I am exempt under Sec B k P C for this rtaaon
ALTER -DRAIN k VENT - WATER (EA)
- _
FEE SUMMARY .
FLOW PROTECT. DEVICE
OUTSI DE FEES
DRAINS FLOOR ROOF, AREA, COND.
FD(.NRES PER TRAP
SANITARY - Y_ N_
RECEI T 4
OwnerDate
WORKMANI hawa SATIO RATION
❑I booby affirm the I have . l r r est to opytheu a a
MID,�Aifiabof Worken'CanpevaHonlmura¢ma¢rtlnM ropythereof (Sec.
Palk, G
SCHOOLTAX Y_ N_
RE -C IF r a
GAS EI. SYSTEM -1 INC4OUlI TS
PARKFEE Y N
I
RF�maT1
GAS FA.SYSTEM-OVER4(EA)
Goata
��rry
BUILDING DIVISION FEES
I ICertl(Ied ropy 6 heedjth thehM.
LriJ Cenined copy Ls flled'Mth the eNy Ivpeebn dlWelon.
GREASE/INDUSTL, WASTE INTERCEPTOR
PLANCHECK FEE
GREASE TRAP
. CERTIFlUTE OF IXLTEPTION FROM WORKERS
PAID
gRWFR-SANITARY-STORM EA. 100FT.
COMPENSATION INSURANCE
(I'MsaedlonneedndbecompleteduthepermitbfroomhundreddoB m
Dale Reoei t#
WATERS TER W/VENT/o�.R
ENERGY FEE Y_ N_
PAIDAppilrai'
(sl°°)r*la`)
an the wmkfor
Ianoy tortoy to an personas to hlhb permit bbsued,
I cork not employ any person f any minter De a t. become subject to the
Wwkese'Compenatbn lawn ofGWoma. Date
wAT'ER SYSTEM/rREwTlac
NOTICE
NOTICE TO APPLIUto the cher making perhis Cerfiartunt pro o(Eaempt a Labor
should bamme.forth to the Woekers' Compevationprovbbvofthe Tail or
Date Re i t#
NEW RESIDENTIAL PLM B. SQFT.
TOTAL.
Code;you ,loo forthwith amply with such provlsbv orthls permit Mall be
deemed rcwked.
BUILDING ME
Li
SEISMIC FEE
CONSTRUCTION L DING AGENCY
1 herby affirm that then Is a mvtrudlen lend Ng agency for the perform
aoaoftheworkforwhkhthb permit i bus ed 6ec3097,CIv.C.)
TOTAL
ELECTRIC FEE
Lender's Naim .
LeMeraadd.
I certify that] have read thls mpplicetlonad state that the abm
ove Informuti
Iamrmd. Iagentoc mplywhh&Uc yandmuntyoH[nanae.ndg.tel .
-
QTY. MECHANICAL PERMIT FEE
PLUMBING FEE
MECHANICAL FEE
PERMIT ISSUANCE
FEES PAID:
relating to building rovtrutllon, and hereby auth.rlam represenatiws of thes
citytoenteruponthe above-mentbned propertyfa lmpetlbn purposes.
(We).grm toeave, Indemnify an d keep harrNm theCity Cu pertW
ALTERORADDTOMECH.
Date Recelpt#
SUBTOTAL:
r
agalmt BabiRtln,}ydgrmnu, mn..nd openers whkh myln any wayamue
agenift s cl Cay lo ennael.e.,af the graMin tMe pe
fon�h 6,2LjJ/�. &YGe�j
AIRHANDHNC UNTT(IO10,000CFM)
AIRHANDUNGIMTE(OVERl0,000CFM)
CONSTRUCTION TAX
Sigvture.f Appnant/Gsamwm Desk
Ea iA11SF HOOD(W/DLCD
CONSTRUCTION TAX PAID:
t
HAZARDOUS MATERIALS DLSCLOSURE
HEATING UNIT (TO 1W,(00 BTU)
Will the app"m or future building.ccVpent stow or handle havrdous
material as defined by tie Cupertino Muoldpe Code, Chapter 9.11, and the .
Date Rttei t#
HEATING UNIT (OVER 100,000 BTM
TOTAL:
IaHYesM Safety Cod, Scalaon 75531(.)?
nithe appliesntm tare building oocvpant one equipment or devks
wh kh end[ )uv rdm,, abcontaMvnts as defined by the Bay Area Air
VENTILATION FAN (SINGLE RESID)
ISSUANCE DATE
BOILER -COMP OHP OR 100,000 BM
Quality Management District?
Yen No
�e.�YspH
BOILERCOMP(OVFJt1W,000 BIT!)
have mad the luetague materials requirements under Chapter695 of
• Y
the California Health k SafetyCode, Setllov 25505, 2SSU and 75534. 1
'
NEW RESIDENTIAL MECH. SQn.
underarcithat lfthe boUdingdom not arrently have s tenant, that it es my
rnpovlbgUy to rally the oceepantdthe retrylrtmenta whleh must be met
prim to luoua. d a Certlfiatc dOmtpanry.
,a 7U
.a.
PJ
City of 0410 ;u -
ISSUED BY: fTV MC o
I
Ownermeithorbedagent Dale
TOTAL:
OFFICE COPY