24560 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ECECIRICAL PERMTTNG, O
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
IIUIL111Net PR(1dKC'r 1OHN'1'IFICA1 ION
BUILDING ADDRESS: SANI'TARYNO. APPLICAI ION SUBMI'MAL DATE
po
UNIT# IAT#
OWNE S A PHONE: CON R LT AMI?: F .1{s.11Oy N/C CONTROL#
.ARCHITECT/ENGINEER: IAC NO: ADDRESS: tr'V� ❑
CONTACT: PHONE:
QTY. ELECTRIC PIiRMIT FEE BUILDING PERMIT INFO
j11.D0 ELI?CI' PLUMB EC I
PERMITISSUANCE E]FE]rar fC El
LICENSED CONGTLACTOR'SDECLfRATIAPPLIANCES-RESIDENTIAL
qeZ Thereby efrmlamlirnsoChNa9(commencingwish
�
F o o Section]000)of Division 3 of the Business and Professions Cade,and my license is in PANELS
p?ut fullforceandeffer.
QZ 1yOly License Class
Fy Lic.# UP TO 20)AMPS
h— Dare Contmror 201-1000 AMPS
ARCHITECTS DECLARATION ry■CQ. ARI? S/SQ.I'f.
Z Orn�' ndOVER]"AM
� N
o z—❑ I understand my PmnR ahan be ossa as panlm records.
@ J SIGNS ELECTRICAL,
YLicensed Professional E R
p,0,U
OWNER-BUILDERexempDECIARATION SPECIAL CIRCUIT/MISC.
XOapU. 1 hereby affirm that I em exempt from the Contrubrs License law for the
1+13 o.ti following reason(Sermon]NLS,Business end Professions Coek Any city or ttnmy TEMP.METP.R ORPOLE INS'I',
v1 C' which requires a permit to construct,eller,Improve,demolish,or repair any structureT� priits issuance,also requires theapplicam forsuchpermiuo file a signed statement POWER DEVICES
Town,
0 p
that he is licensed pursuant to Ne Provisions of the Contractor's License Law(Chapter
st- o 9(commencmogwdb Section 7W)of Division 3 ofthe Business and Professions Code) SWIMMING POOL ELECTRIC VALUATION
y1—m orthet he is exempt mwefwn and the basis fomheallegW exemption.Any violation of OIITLP,TS-SWITCBIS-FIXTURES
Za Section 7031.5 by any applicant for a Permit subjects the applicant a civil Penalty of
not re Nan five hundred dollars(SSgO).
C m I,asowne,."hepropeny,ormyeniployeeawithwagesassheirsolecompensadon. NEWRESIDENTIALELECI'R _SQ.FT. STORIES TYPECONSTRUCTION
i3— I Ne work,Cook: ra,Cmiu me,
Lided or Law
a,apply 9054,Business
and professions ldscri 1'he Contrereme.and License Law docs not apply to rc owner of
propenywyces,pdsorimpmvesch improvemenu anotihworkhimselfoMrough his OCC.GROUP RES,UNITS
wit employees,p or improvement
impmvementhin not ewofeempleered the owner-
howevepill have the building
teburden
ofmoem i that he within one yam of c prove onJ purposeTO'T'AL:
builder will have tM1e burden of proving that he did not build or improve for purpose of -
❑ I,as ownernflhepropercy,ate exdusivelyconvutingwith licenud contractors to QTY. PLUMBING PERMIT FEE FLOOD LONE APN
construct the project(Sec,]1X4,Business and Professions Code:)The Contractor's
License Lawdaes not applyleanoveneroPorpeny who builds or improves thereon,and PERMIT ISSUANCE
who commits forsuch projects with accomenor(s)licensed pursuant to the Comtactor's ALTER EA
License law. 1 ) FEESUMMARY
❑ I wn exempt underSec. ,B&P C for Ibis reason BACK FLOW PROTECT.DEVICE Gulf SANITARY Y D-I—N
—
Owner Dme RECEIPT
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOP,AREA,COND. SCHOOLTAX Y N
❑ I herebyaffrm that l have a certificate ofecosenrao self-mcauscore cenificueof - - RECI?IPTp
•)Workcrs'Compusation lnsumnce oracenifiMcopythercaf(Su.3800.Lab CJ which FIXTUR[S-PL'R TRAP PARK FEE YN
covers all employee's under this permitGAS-EA.SYSTEM.)INC.40UTLE'TS RECEIPT# -
PolicyN BUILDING DIVISION ITF_5 \
Company OAS-EA.SYSTEM-OVER4(EA) PLANCHECK FEF. 1 /
❑ Cmifiedeopyislorebyfumished.
❑ Cribbed copy is filnd with the city inspection division. GREASEBNDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This section reedit be completed mfma permit is farone hundred do]).($100) SEWER-SANITARY-STORM EA,2WITL ENERGY ITE
or less.)
I certify that in the performance of the work for which this permit is issued,l shall WATER HEATER W/VENT/ELECDt
not employ say person in any manner so as to became subject to the Workers PAID
Compensation Lawsof California. Date WATER SYSTEMIRRATING Dme Receipt#
Q z Applicant
Z 0 NOTICE TO APPLICANT.If,after nuking this Cercmficate of Exemption,you should NEW RESIDENTIAL FEAR. SQ.FT. TOTAL:
F" rA become subject o Ne Worker's Compemadon provisions of the labor Codq you muss
forthwith comply with such provismov.,his permit shall be deemed revoked. BUILDING ITE
CONSTRUCTION LENDING AGENCY SEISMICF
Vz Ihereby affirm that there is a construction lending agency for the peAornonce of
O the work for whichthis permit is issued(See,3091,Civ.C.) TOTAL: ELECTRICFI?E
heart Name
QF Lenders Address QTY. MECHANICAL PERMIT FEF. PLUMBING FEE
U I cenify tbt I have read this application and into that the above information is
coven.I agree to comply with all city and county ordinances and Rote laws relating to PERMIT ISSUANCE MECHANICAL FEE �•
building construction,and hereby audience mpmsenotives oftNscity memerupon the CONSTRUCTION TAX
U 'z above-mentioned properly for inspection purposes. ALTER OR ADD TO MECH.
(We)agree to save,indemnify and keep hrmlus the City of Cu item against
limbilitiea.judgments,cosuandexpenseswhichmayinanywayuc a 'nts' City AIR HANDLING UNIT(TO 10,000 CFM)
in conaeque the granting of Nis Permit.
• AIR HANDLING UNIT(OVER 10,0WCFM)
awreo A pian ommc r Due EXHAUSTHOOD(W/DUCI PAID
AZARDOUS MATERIA IS DISCLOSURE HEATING UNIT Q0100,000 BTU) Dom Rtt<iptp
Will Ne app cant or boom building occupant store or handle harardous material HEATING UNIT(OVER 100,000 BTU) TOTAL
as defined by the upenino Municipal Cale,Chapter 9.12,and the Health and Safety
Code,Susi 25532faI?
0Yes ❑No VENTILATION FAN(SINGLE RESID)
BOILER-COMP(3HP OR 100,000 BTU) ISSUANCE DATE
Will Ne implicate,orfuwrebuildingoceupentecuequipmentordevices which emit
hm#Nous it contaminants as defined by the Bay Area Air Quality Mamgement BOILER-COMP(OVER 100,00(1 BTU) /ks
Uisvict]
Lbuilding
Yes ❑No NEW RESIDENTIAL MECH. SQ.Fr. /J
read the harardous materials requirements under Chapter 6.95 of the �� �IyN s a.
ealth&Safety Cade,Sections 25505,25533 and 25534.1 understand that v b
g docs not currently have a tenant,that it is my responsibility mnotify thethe rcquircl.r._f
oricedagens Date 0— ISSUED BY: afYV
OFFICE
T R9
C SANTA CLARA COUNTY CONTROL NUMBER
• CENTRAL FIRE PROTECTION DISTRICT
14700 WINCHESTER BLVD. PERNT NUMBER 24560
LOS GATOS,CA 95030-1818 (408)378-4010
SERVICE BIc'r'TON SINCE 1947 FAX(408)3789342
PLAN REVIEW COMMENTS 93- 0018
CODESEC. SHEET NO.
1. No fire district conditions. OK to issue building permit.
•
JURIS. PLANS SPECS NEW REMODEL AS I CONST.DESCRIP. BY DATE PAGE
CUP ® ❑ ❑ ® ❑ HVAC G. BARNES 01/13/93 11
OF EC.IFLOOR FZ OCC OCC.LOAD AREA ARCHIENGJCONTRACTORIOWNER TP
IN-HOUSE
NAME OF FACILITY LOCATION
HEWLETT PACKARD 19111 PRUNERIDGE AV
Serving West Valley Cities of:
Cupertino, Monte Sereno, Saratoga, Town of Los Gatos, and Adjacent County Areas