20038APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY - V
Building Pm ect ldentlflntlm
PERMIT NO.
Build rg Address:
rr� G9-c5To +�� D� �►�L 2436 �- ,� r
20038
ro cme:.
a�.�H, U lP
CITY OF CUPERTINO- BUILDING DIVISION
APPLICATION I PERMIT
AF _,Z
q a
Cmtnnoes Naas: Lk. Nm
BUILDING-ELECTAICMLPLUMBING-MECHANICAL
CATEGORY
CONTROL
j�.
QrY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address Go CO ]55ru�
1 F
PFRMITISSUANCE 12 00
�1 PLUMB MMI
❑ I/Y ❑ ❑
LICE.NSEDCOmTdu OR'S RATION
Wwa
I khSyJe 70t I&DivIal. 3ofunderprwW d Pmfess.r9 (mmunenc
IngwithSMbn 7000)o deft mt3ofthe Buslreuand Pro/enim.Code,and
lienee bin fu0lorce and d(ect.
AITIdANCESRF_SIDEMTAL
)OB DESCRIPTION
PANELS
Cs L 1
Ic
Date
Dale CoManor
UP TO 2DOAM25
F itt J
20I.I000 AMPS
ARCHITECTS DECLARATION
I understand my plane shall he used a. publics— L
OVER=AMP9..
ARI
AARU3�
$/9Q. FT.
SIGNS EI.ECT91CM,
Lived Professional
I. D
rmthaOWNER-BUILDER DECLARATION
IhembyaffitIam emth Limnae lawforthe
ptfmme Comr.norb
[`'�
7
7 �,
T E R
-'
9�IALCIRCUIT/M79C
TEMP. METER OR POLE INST.
POWER DEVICES
. =ntynwgreaerequim1opn7Q3tom sin®ate mfp o, demo rlh,oyrdrctypaorr
nystmumpmolbame,arequthearwt
the a dgnod statement that he Is licensed pursoant to the pmvhlors of the
Contnnori Lu,eeselaw(Chapter9(mmrnennng with Senbn 70M of Divi-
.ion 3 ofthe Bu.ines. and Proftmbra Code) or that he is exempt therefrom and
C/
SWIMMING POOL ELECTRIC
VALUATION
tk Isis for the alleged exemption. Any violation of Searion 7m 15 by any
.pp0ont fora permit subjects the applkant to a dvil penalty of not more than
OUTLETSSW[TCFifSF1XTURES `'
-
NEW RESIDENTIAL ELICTR SQ.FT,
tiv hInsm rofiyri001.
my sup wdhwagn tkir wk
Lauownerll
STORIES
TYPECONSIRUCI]ON
of eworka,or
is
work andtksacturebrot Wended or of(e¢dror
mk(Se.7m, r
houunetk
Cob:Tk
sok tnotap an
_
apply to owmedfTtperty or lmp thereon,
dm rotapply torn umel or propertysuisbWldporenprovnlherroM1uch
who dmwch work hlmseBorthrough wown emptoyen, pmvdodthat such
OCC.GROUP
RES UNITS
Improvemc mm amtendedoroffered(rade. If,howe,mr,thebulldingor
impmvemerdbw wlthinonehe.rofc¢npletb tkownerbuMer Mlllove
.-TOTAL: Q
tlt�umlmofpmvingthrt hedb notbulldorunpmveforpurpmeofatale.).
ely ntrxting with Ifomsed
"L u owner of the Property, am eswNm
oontractms to mvtan t],e project(.See 70K Buhes
sand Professions Code:
QTY, PLUMBING PERMIT FEE
PERMIT ISSUANCE
FLOOD TONE
APN
The Cornnnor. Licerue Law dm not apply to an owner a property who
Wilds or Improve. tL¢eon, and who mmnes for woh profess with a
cWt[+n¢(U Roenaod pursuant to the Contndoes License Law.BACK
LJ I am eumpl under Sec B 4 P C for this reason
ALTER -DRAIN 4 VENT WATER (EA)
- FEE SUMMARY
FLOW PROTECT. DEVICE
DRAINS- FLOOR ROOF, AREA, COND.
FDIRIRFS PER TRAP
SANITARY Y_ N_
RF{EIT T s
Owner Date
WORKMAN COMPENSATION DECLARATION
❑I hereby arfirtn than T ears a ¢ItlOote of cm dif to )pythe rt, or a
¢00,La sof orken'Compevatlonlneuranm ora ¢trifled ropy thereof (Sec.
Tab CJ
SCHOOLTAX Y N'
RECEFT
GAS FA. SYSIEM-1 INCA OL LETS
PARKFFE Y N_
I'dk
aGAS
RECEIPT' a
FA. SYSTEM-0VER 4 (FM
Cam y -
BUILDING DI V ISION FF. GS
ified copy b hereby tuMth tmbhed.
hlBed ropy b (TIM �k'stY Ivpenbn division.,
GREASE/WDUS[RL WASTE INUMCEPIOR
PLANCHECKFEE
GREASE TRAP
CERTIFICATE OF UiEM PTION FROM WORKERS'
PAID
_
SENp�ygAN1TARYSroRM FA L'IOFT -
COMPENSATION INSURANCE
¢w.enlon need n¢ be completed Vthe permit b f¢ one hundred dollars
Date Recei [#
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y N
PAID
rrless.)
(91 o3)oryth
IaIn the penomwceofthe work farwNchtwpemltbbsued,
I shall n¢ employ any person In any manner so as to become subject to the
Workers Compawatbn laws a California. Date
WATER SYS[EMd TREATING
Date Recel t#
NEN, RESIDENTIAL PLMB: SQ.FT.
NAOnCEt
NOTICE Tomr subjC to the after mkloo. CenB1¢te of Eremppbbn yw
Coded kmmr su mento Workers' provolone omits Labor
TOTAL:
co such pru.tbn
Code, you rwrt forthwith comply with such provbbv ortw permit shall he
BUILDING FEE
deemed newked.
EISMIC FEE
CONSTRUCTION LENDING AGENCY
IhemItyaHtrm Chet there ba mnetrucrion lendingagency for the perform.
once of the work far which this permitSm le issued m 3097, Civ. C)
TOTAL
ELECTRIC FEE
p
PLUMBING FEE
Lender. sum -
Lender'.Addre..
1 aMirythat I have madthbappliotbn ami natethmthe above Information
Is core .1 9. to comply withal] cityand oauntyerdinanmand state laws
QTY. MECHANICAL PERMIT FEE
MECHANICAL FEE
PERMIT ISSUANCE
FEES PAID:
Hating to Wl lding comtronlm, and kreby ..thortre reprnenmtiw or tw
city to enter u Pon the ab mentiorad property for hapenlon pu rpoies.
(We) agree to save, Indemnify an d keep harmless the City of Cu pen ho,
ALTERORADDTOMI:CH.'
Date Receipt#
SUBTOTAL:
-8- mat llabWtln,0dgmrw, costa a ed expenses which may U any way a.w
.gaivtsaid City In consequence of the granum, of Iw Penna. '
MR HANDLING UNIT (TO 10,000 CFM)
AIRHANDLING uNTr(OVER]D,000ffhn
CONSTRUCTION TAX
-
Slgrature of Appll¢nt/Contnclor Date
EXHAUST HOOD(W/DLrD
CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT (R) 100,000 BTI)'
Will the appllont or future building otapant more or handle havnious
material sat defined by the Cup<nl. Murddpal Code, Chapter 9.1Z and the
Hearth ami Safety Code Shim 25537(a)7
❑ Yes rla��I
Date RCCeI t#
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
30
VENTILATION FAN (SINGLE RESm)
ISSUANCE DATE '
Will theappllont¢QtuW¢ building o pant use equipment or devim
which emit harardous an cools mounts as deliud by the Bay Area Mr
Quality M. ragemeM District?
4Yn ❑ No
BOILER -COMP (3LI'OR 1W,IX BTU)
BO LR{O.MP(OVER 100,OWB )
havenadthe hmdou.materiwrequiremnbunder Chapter 6.9So(
tk Calif.hHe.Ith4Safety Cud,Senbne255(5,25533and75536. I
understand that lithe building does not amently hive a tenant, that It h
%;PR 5 1990
RESIDENTIAL NEW RESIDIAL MECH. SQ.FT.
resporoibllky to notify the occupant of the mcinimmenb which rum k rot
.,
prior olsuatuxofa CerVficah, off Omr ncy.
City of rnnP rtino
ISSUED BY: / `(
nee or authorlaed sgcn Dote
rornL
OFFICE COPY