19973APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ON °Y
Building Pao' nlaentlfkasion
Building Addrm:
PERMIT NO.
5m ctsra ae �u �� E
19973
e .: phone..
U P
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
BUILDINGS,ECIRKALPLUMBINGMECHAMCAL
ContnctXrr e:Na
L
CATEGORY
'
CONTROL
Archl tce/En nem �-+- L
Ck. No:
"7— 1
'QTY ELEC'T'RIC PERMIT. �
BUILDING PERMIT INFO
y
Add. (9PIsERh9TISSUAN(R
® ❑ 1:1 El
CONTRACTORS DECLARATION
Ihrrebya0lrm that l am llcenaed under prewision.,dChapuerg (commeri,
Ingw1th5 bn7000)ofDr,dm3ofthc Busiressiod Profesd.Cadc, and my
APPEIANCES-RFMEN1'IAL
JOB DE95dffFZNT__
Ibcrue Is In full form it effect.
PANELS
ae
LbenwCIsLICE
Date a,r
-
C
DJP(,FX
-IO)OAMPS
ARCHITECT'S DECLARATION
Iuoderstand my plaraahallbeueed as pubgere .
OVER 1000 AMPS
SQ. Fr. FLOOR AREA
S/SQ. FT.
SIGNS ELPLTRICA
Lkenxd Professional
OWNER -BUILDER DECLARATION
I hereby affimnthat I am emntpt from the Comnnor'a Llansclew f«the
SPECa1 /
f antywhidtrenq.u(S v ape mm15o, mBaa we d, aerr,'rbfpro, dC melhh,orcirttypsiorr
TEMP.
,
anymmmmpd«bibb ams abomuimtheapphl tf«suchpe to
file a signed abatement that he Is Ibensed pursuant to the provblom of the
POWER DEVICES
yyr,�q,,rG}W
Contractors License Law (Chapter 9(mmmendng with Se n7000)of Divi-
of the Buabomand PmfesebrmCodc)orthat he Iseaempt thertlmmsod
VALUATION
I he Wats for the alleged eaernt ton. Any violation of Seaton 70315 by any
appllnntforapemJ bjemtheapp"ntioadvlpemhyof tm mtlun
OVH.EISS-WITCFBSFIXTURES
NEW RESIDENTIAL ELECIR SQFr.
!W hundmddolhn(5500).'
rir, as owoer of the property, or my employees with wag. as the& sole
o
STORIES
TYVECONSTRLC ION
compensation, will do the wmlc and the cincture Isnot Imnded or offered for
sato (Sec 70K Buabess and Pnfeasbns Code: The Contractors IJ«nse law
V
dm not a pply to an owner of property who builds or Improve t hereon,and
who d.suchworkhlmseBorthesugh hlsownemployee, provided that nch
OCC.GROUP
RES. UMTS
improvemerm art not Intendedoroffened for Bale. IL however, thebullding or
impmvementhaaldwlthnomyearofcmrpletbnthcowner-builderw Varve
TOTAL
t denofpmvingthat heddnvbuildorlmpeovef«purposeofnk.t
as owner of the Property, am er luatveiy contracting with Ikenaed
- t ct. to comtnct the projed03. 701A, Buelnm and d
Profeons Code:
QrY. PLUMBING PERMIT FEEL
PERMIT ISSUANCE
FLOODZONE
APN
The Cemnctnes Limase Lew does not apply to an owner of property who
Wilds or Imp. thereon, and who, contracts f« such ptojecta with a
cjlrl or(s)il«nsN pvenunt to lheCmtnnars Ll ens. I..
LJ I am exemq under Sec (a P (� r thlp mavenOUTSIDEFEES
ALTER -DRAW 4 VENT- WATER 0'A)
gAp(p1OWP1ROTTCT. DEVICE
FEE SUMMARY
DRAINS pI.OpIL ROOF,ARFJ�, GOND.
SANITARY Y_ N_
BBC= /
Owner t
WORKMAN COMP E'NSAToat TION
❑1 hrref affirm that I have a «ntllblc t to xH-tmarrt, «a
.rtiflatc of odrers'Compenmadon lnsumm ora certified copy themof(Se
3gOD, Lb C)
FO(TURES PER TRAP
SCTiOOL TAX Y_ N
,.. RECEIPT 0
GAS EA. SYSTEM -1 INCA OUTLETS
PARKFEF Y_ N
ky I
RECEmT Y
CAS FA. SYSTEM-0VER t (EA)
Ca y
BUILDING DIVISION FEES
Certdied copyIs herebydwith t furnished.
CMlfled ropy Is TON with the city Inspection division.
GREASE/INDUSIRL WASTE MTRCE'TUR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ihiaaectbn need era he c«npletN B the permit Is(« ooe hundred dollars
PAID
Date Recel tit
SEWR-SANITARYSMEM EA 2XFT.
WATER FIRATEe W/VENT/EF.GTR
ENERGYFEE Y _ N
(M00)«1®J
a the war, ermlt la
I «not
so as to become
mpl.y an person,
T ork not employ any person (any miner at ss to become subject to the
n 1.t he
Wwken'Compewtlon Los of GllfomIs. Date
WATER S,ST�/TREATING
PAID
AppliraE
NOTICE TO APPLICANT. , after making thisCealllnk of Fremptbn, you
should become nbIoct to the Workers' Compensation pro bions of the labor
Date Recei t#
NEW RESIDENTIAL PLMB. SQFI.
TOTAL:
Code, yw oust (orthwBh comply with ouch pmvdbns mrthIs permed abull be
deemed invoked.
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
I heminyaffirm that then b s constnctbn kndbgagenry for the perform
ance of the work for which this permit Is asuN bee 309'1, Civ. C)
TOTAL
ELECTRIC FEE
QTY. MECHANICAL PERMIT FEE
PLUMBING FEE
lender• Name
Iender.Addms
1nalfythatIlavemadthIsappW tbnaniabatetluttheaboveof.r Tai
noomect. I agneetocomplywlth all cltyaM muntyoftaneesand abate laws
MECHANICAL IEE
PERMIT ISSUANCE
FEES PAID.
relating to building mnstruction, and hereby authortne representatives of this
dty to enter up on the above-mentbnel property for Wpectloo purposes.
Me) agm to save, bdcmnity an d E p harmless the City of Cu pea bo
ALTERORADDTOMECIL
Date RecCl t#
P
ageiret llebBitfs,}dgmeraa,mate aniexpenses which may In any way ameue
.8a lrm uld Ctry in conseque., fthe ming this pe
�Qvr► 61uo�, � ,/�
AIR HANDLING UNIT ITO 10,000 CFM)
SUBTOTAL: -Q
AR "° NG NTrowla000cMn
CONSTRUCTION TAX
Sigoature of Appli=t/CaaID'ater Date
EXHAUST HOOD(W/DICT)
CONSTRUCTION TAX PAID:
HATARDOUS MATERIALS DISCLOSURE
HEATING UNIT CFO lm,(IOO BTU)
Will the applicant «future bulidbg oaupant mom or handk lxvrdwe
Cede, material as defined by the Cupertino Municipal Ce, Chapter 9.1; and the
Date ReceiIq
HEATING UNIT (OVER 10,000 BTR)
TOTAL:
EYee N No kahh and Safety Code Section 8532(.)7
VENTILATION FAN (SINGLE REND)
ISSUANCEDATE
PAID,' A f P1
1CAID,'
ZJBl the appBcam or future building o pant use equipment or devkos
whish emit loi.daus air romanct.ms as dell rad by the Bay Arca Nr
Quality Management District?
4Yes ❑F� No
hevenadthe ha cuamaterials nNuirementsunder Chapter 695of
BOILER.COMP OHP OR 10,000 Bra)
BOM COMP(OVER10,000BTU)
the GB!«nth
thatf t h h Safety Code, Sectbns 755(5, 25533 and SSM. I
undersnMi(the building does era mrmntly have •tenant tbtltIsny
iespovlblllty to nd«y the oavpant of the requlrementa which rtup be met
ftyT t: /% N !-yU
NEW RESIDENTIAL MECH. - SQFI
primto Wuanmde C< fhteofomrpancy.
,.�L
Ati yyl,I in?TfID(1 14�
ISSUED BY: �./"w� t 1�`)Fas�S/�a✓V.
Owner«author .Iy,m Date
TOTAL
OFFICE COPY