24892 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITYOFCUPERTINO BUILDING-ELECTRICAL PERMIT NO. aw w
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. 'LJ CyJ�
'p.:" BUILDING PROJECT IDENTIFICATION Y r•
BUILDING ADDRESS: SANITARY NO. AITIJCATIONSUBMI'ITALDATE
�Y,s UNIT# LOT#
WNERS NAME: PIIONE: CN CONTItACfOR'S NAME: LIC NO: WC CONTROL#
.C
IRA s LIC NO:JJ O ADDRESS: �, AC
CONTACT: PHONE:y� p >,.;rt`;'.N(2-.a-,�.: - + y ;f + "t BUILDING PERMrr INFO',
L'� Asti lYv—�f/� CPERMffy `
Qy 0/ 3—O PERMIV''SUA E FEE
BLDG_ ELECT PLUMB ME❑CI{
LICENSED N CTOR'S DECLARATION APPL NCE.. - EgIDENTIAL a=7�yJ
;adz I hereby affirm Nat l amlicenxd under owisiovofCnaPlcr9(cammencing with LOB DESCRII'1'ION
3O Section 7")of Division]ofthe Business and Profusions Code.and my license is in PANE
fall to.and effort. l
.ZV License Class Lic.0 UP T02 AMPS l,
O 1 \
<Q.
' Dam Contman 2 AMPS rr {!
yZ ARCHITECTS DECLARATION SQ' . ��OO AREA M.FT
rs .
1 mccmnd my plans shall be uretards.
sed as public ts. O IOIXI AMPS
vtz�! NS ELECIRICA 600 �•
:EJ Licensed Profcssiand
�< OWNER-BUILDER DECLARATION SPECIALCIR ISC.
%iF I hereby affnm Nm 1 am exempt from the C.nwmm'x Liceme Law f
' following mason.(Section 7031.5.Business and Professions Code:My TEMP. R R POLE 1 T.
which Terminal a permit to consmict,alter,improve,demolish,ar rtpa' any s co m
iY prior to is issuance.also requires Ne applicant far melt pemtin.file uiF ed lux en PO ,VICES
ip0 That he is beerriwi pursuanno the provisions of the Committers Li tae to
(Y 9 lcommencing with Section 7")of Division J of The Business and t s e) S NiPOOL ECIRIC I VALUATIOI6k^
_y "at he is exempt therefrom and Ne basis for the alleged exemption.My viola- f OV-SW 'CHES-FIXTURES { �
.z< Smion]OI LS by any appliantfor epemtit xbjecm The applicant to pevlt
_' t more than five hundred dollars 15500). _
NEW ESLD AL ELECIR SQ.FT.
n❑ I.asnwnerofNepropeTty.wmyetnployceawithwagesastheirwlecompewtion, STORIES TYPECONSTRUCTION
;300 will clothe wod..and the structure is not{mmndcdaroffmal formle(Sec.]Df4,Buairtess
and Professions Cads:The Contractors License law does not apply to an owner of
property who buJdsorimptoves Jtemeorrand whodoes such workhimxvarduoughhi: OCC.GROUP RFS.UNITS
a
empl oyces,prov ideal the such improare e noamendcd ar oBered formic.If,
however,the buildingor improvement is sold withmone yeof completion.Neawner TOTAL:
builder will have the burden of proving that he did not build or improve for puryoae of _
all
TY:�`n�:=' " PLUMBING PERMIT�';F.i 'e' m uFEE'�' FLOOD ZONE APN
1��`Isxawner of Ne propemy,amexdusivelY convecting with lisxnsN contmnorsto � `r .,^j.=+;•. vK;�?5:
emV.1 n the project(See.7044.Business and Professions Code:)The Contractor's
Liceaxl.awd....... roan ownerof prapeny whobuildam improves Hereon,end PERMIT ISSUANCE
viocontmnsfor such pmjmm with acontmnm(s)licensed purinummNc Contracmrs ALTER (FA) �tw;irjl�% "- 'r'a'
Liceria Law. _ x.E%�f:� ,,..FEE SUMMARY
❑ Ian exempt uncl c. ,B&P C far Nis mase. BACK FLOW PRO .ONYiCH1 n L� 1
_ n�IF'F'T� � h t I SANITARY Y N
- DRAINS-FLOOR.ROOF.AREA.COND. ., RECEIPT#
WOR COMPENSATIONDECLARATIOr✓—�— ti \ SCHOOLTAX YN
1 hereby affirm that I have a certificate of coven.,self-insure,or.satificem of RECEIPT p
'Amkera CamN.n pansIns.ara cerificd copy Nre
caf(See.3800.Lab C.)which PARK TRAP PARK FEE Y N
•• reveall employ.x under this pc.i,. LAS-EA.SYSTEM-1 O T�t�9 RECEIPT#
rs
Palicv# �'` BUILDING 1 ISION FEES
Company GAS�,F¢SYSTEhl- PLANCHECK
❑ Cenifiad copy ishemby famished.
❑ Certified copy is Bled wiN the city inspection division. - ORW- MNDUSTRL WASTE INTERCEPTOR GRAIN
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP S S
COMPENSATION INSURANCE
(This union madnon he completed ifthe permit is intone hundred O.B.fS10O) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
art...I
I terrify that in the performance of The work for which This permit is issued,I shall WATERIIEATERWNENTIELEM
not employ any Person in any manner an as to become subject to the Workers PAID
Z ComNenxtion Lawaof Cilifomia. Da¢ WATER SYSTEM/IRFATING Data To
Applicant
2 NOTICE TO APPLICANT:If.oft.naking This Cemificnm of Exemption.you should NEW RESIDENTIAL PLMB, SQ,FT. TOTAL:
V) became subject o the Workers Compensation provisions of the labor Code.you must
forthwith comply wiN such Provisions car this Netmit shall be deemed revoked. BUILDING FE ^se
CONSTRUCTION LENDING AGENCY SEISMIC O
Z I hereby aft Net Nem is a convection lending agency for the performance of TOTAL: ELE I
O the work for which this permit is ixuad(Sec.3097,Civ.C.)
lander s Name
F Lenders Address QTY -;',„ MECHAMCALPERMIT,,;, FEE '+i MB G
C) I[edify that 1 have read This...licarkm and smile that the above informations .
C connect lagrcemcam I MECHA CAL FEE
pywnh all city and county ordinances and Stam laws relating t. PIiRMIT ISSUANCE
!n building construction,and hereby amborize representatives ofthis city to enterupon Ne CON UCTION
Z above an adonrd property for inspection purposes. ALTER OR ADD TO MECI I.
(We)agree To save,indemnify and keep humticss the City of Cupertino against
lisbilidaa,judgments,costs and expenses which may in any wayaccrueagaina said City AIR HANDLING UNIT LTO 10,000 CFM)
inconsequent h g'ng of Nis permit.
41 AIR HANDLING UNIT OVER 10,000 CFM)
art AVCa t ctor Dam EXHAUST HOOD(W/DUCD PAI
OUS MATERIALS DISCLOSURE
HEATING UNIT(TO IOO.WO BTU) Date Receipt#
Will The the Cunntor Municme ipal ng Code,
Chapter
or hanadd to hHxN.mmamdal HEATING UNIT(OVER I Of,"BTU) TOTAL.
u defined by the Cupcnino Municipal Codc.Chopmr 9.12,and the Health and Safety
Cade.Section 25532(a)? VENTILATION FAN(SINGLE RESID)
❑Vcs ❑No
BOILER-COMP(JHP OR 100.000 BTU)
ISSUANCE DATE
Will air contaminants
nts u builmed by the tuseequip Air ordevis Management A g�3
tar�dous air contaminants as defined by the Bay Arta Air Qualiq'Management BOILER-COMP(OVER IBB,DDO BTU) [A A € D
Ji ❑Yes ❑No NEW RESIDENTIAL MECH.—SQ,FT.
I have rend The Telemachus diamonds neminaments under Chager 6.95 of The OCT 27 1993
Celifamia Hrnhh&Safety Code,Sections 25505.25533 and 255M.1 understand Nat
if the building does not c...By have a levant that it is my rtsponsibilitr....city To,
.ecupant of The requirements which must be met prior to issuance of a Cmdriume of yl .I (,J(• V u Y
Oecupycy. �`••F,--1f
Owner or authorised agent Dam TOTAL: ISSUED BY: _ s�
OFFICE