27787 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO nim. ,. ,. PERMIT rvo. 8
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL.
NUILIiING PRO. IDENTIFICATION
BUI LDING ADDRESS: /[�//� I '� SANITARYNO. APPI.IPATIONSUBMHTALDATI!
OX SN siiE: IC�o TIO CONT CTOR'S NA LIC NO:
C� 5O N/C CUNTROLp
CHI'IECf/ENGINEER: LIC NO: ADDRESS:
0011
CONTACT: PHONE: x
QTY t' 8 CLECRIC PERMIT- GEE BUILDING PE MIT IN
RLDG ELECT PLUMB MECII
PERMIT ISSUANCE w
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
psay Ihereby affimrthat l am licensed underprovisions of Chapter9(commencing with
400 Scction700Uivisinnlnffhe Business and Rofcssions Cak,and my license is In ppNBLg
,IAof C full Clazndeffect.
pQ,Z W License Cls Lim.p UP TO 200 AMPS
N Q y Dalt Contrecmf 201-I000 AMPS
Z F,z ARCHITCIpSDECLARATION OVER 1000AMP5 SQ.FT.FLOOR AREA S/SQ.FT.
Cs Z�G I undersand my plans shall Named u public mcords.
I:.y�ID SIGNS ELECTRICAL - �1`�3
S�dd� Licensed Professional �Y
yy that
I am exempt
from
DECLARATION SPECIAL CIRCUIT/MISC.
X9,1 V I hereby affirm That 1 um exempt from Tice Conlmd Co License Lew for the
'W 3 k ati following reason(Section 7031.5,Business and Profeasiore Code:Any city or county TEMP.METER OR POLE INST.
�- Q.3 which requires n permit re conswa,alley,improve,hpermith,m mash any swnum
i°�vv1'1Y0 that to hei¢csused pursuant forth the previsionocant for do,ch Contractor's
file a License
ned Law(Chapter
POWER DEVICES
fyCOp 9(comisnding with Sstion7 )of Division the the usiness and Pro Tawalbepmr
ai yy� 'J(commencing with Safion]IX10 of of the Business end Profession Code SWIMMING POOL ELECTRIC
KOy- )° ) VALUATION
,Mn, on h7031.5 by fherefnront fthe Perist s beat theapaempli in. civilplation of FIXTURES `2."83", L+
I �
Y notdand than 6y anyapplidollrs(3500mif subjects the applicant mecivil penalty of OIffLETS-SWITCHPS- V_
0 nm more then five handrnl dollars(f500),
s m ❑ I,esownerafthc prnperty,ormy employeeswifhwageeoefheirsolec°mpensati°n, NEW RPSIDENTIAL CLGCTR —SQ,FT. STORIES 'TYPE CONSTRUCTION
a3— will do the work,and mastruclam is not intended oroffemd for sale(See.7044,Business �.
and Professions Come 'the Contractors License Law docs not apply to an owner of /
propertywhobuildsorimproves themon,and whodoessuch work himselfor through his
wnemr.the
improvement
one
ourrof dorolTered thssco mrH OCC.GROUP RES.UNITS
bowevew ill have
the
burden
of prom is hath within one year ori prove for
th purpose
o-
buiWerwill have the buNen of proving that he did not build or improve for purpou of
ala).
in eroftheproperty,am exclusively contracting with licensed conuacto t QTY: PLUMBING PERMIT FEE FLOODZONE APN
no' rte the project(Sec.7044,Business and Professions Code:)The Comreemr's
Livens nw ticosnot°pplYmun nwncrnfpr°perty who builds orimproves thereon,vnd PERMIT ISSUANCE
whocnnt cis for such projects with a conuaemr(s)licensed pirmanno the Contractor's ALTER PA
License Law. O ,FGF.SUMMARY
❑ 1 am exempt under Sec. ,B&P C for thio reason BACK FLOW PROTECT.DEVICE .1 is E:.
SANITARY YN
Owner Dote R T#
DRAMS-FLOOR,ROOF,AREA,COND.
WORKMAN COMPENSATION DECLARATIONSCHOOL TAX
❑ ihercby off Theft hoveattnif¢am of conunno elf-insum,ora cenificmc of FIXTURES-PER TNAP p
Workers Compensation Insurance ora comfort m
copy theo((See.3800,Lab C.)which PARK PEIi N
covers allemploydeunder this permih GAS-EA.SYSTEM-1 INC.4 OUTLETS
CECP p
omp p ETG ISION FEES
Compann y .
ElCertCertifiedcopy is hereby l'umishdGAS.
. CA.SYSTEM OVER I'IANCI fibm
❑ Cerfifed<opyis jtld with thecityinspediondivisian. GREASR`lNDUSTRLZASJf.1 OR GRADING E'Z
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE.
(This aatiot mad not be completed if the permit is for one hundred dollen(f 10 SEWER- 1 STORM EA.20D 17- , ENERGY FEE
rales")
I certify that in the performance office work for which this permit is issued,i shall WA 1 .A W/VFNT/ELECTR
nor employ any person in any manner vo as to become subject m the Worker' PAID
Compensation Lawsof Culifumia. Dare WATER SY TCMUREATING Dam Nip,It
0 z Applicant -
z NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMIL SQ.FI'. T L:
become subject to The Worker's Compensation provisions of the labor Code,you must
� > forthwith comply with such Provision or this permit shall bedamed invoked. BUILDING FEE L lititi—p
a CONSTRUCTION LENDING AGENCY SEISMIC FEE
z I hereby affirm that hem is a construction lending agency for the performanm of T ELECTRIC FP.
U C) The work for whbh this permit is issud(See 3097,Civ.C.)
Landers Name PLUMIi1NG
O ." Lenders Address QTY ty:r" ¢MLCI{ANICALIERMIT' FEE., WIT ��
U 1 certify that I have read this application and sate Thal the above information s
cnrten, l agree m comply with ally and coumy oninances and state laws relating to PERMIT ISSUANCE? MECHANICAL `�
Fs b°illi ng construction,and herebyauthonze,representeriveaof this city to enmropon the CONSTRUCTION TA
U ,z above-mentioned property for inspection purposes. ALTER OR ADD TO MF.CH. `
(We)agree to save,indemnify and keep hadidess the City of Cupertino against
Iiabilitiea,jdgroen6,c°ev, of exMnses whicM1may i any wayacerminamat said City AIR HANDLING UNIT(TO 10.00)CFM)
in amen longin of,h,a limit.
0_5Z AIR HANDLING UNIT(OVER 10,000 CFM)
Signare of lirmin uric r Data EXHAUST HOOD(W/DUCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(PO 100,000 BTU) Dote Receipt p
Will a applicant or future building accupam store or handle haamdom material HEATING UNIT(OVER 000,000 BTU) TOTAL:
us defined by the Cupertino Municipal Code,Chapter 9.12,and the Health ad nSafety
Cede,Section 25532(a)?
El Yes ❑No VENTILATION FAN(SINGLE RESID)
BOILER-COMP CHIP OR 1 W,000 BTU) ISSUANCE DATE
Will air co trommart asure,building by the
nBay Area Air
Management S
grdons air comaminants as defined by me Bay Area Alr Quality Management BOILER-COMP(OVER 100,000 BTU) PAID
istricfl �'1
❑Yes 0N NEW RESIDENTIAL MUCH. SQ.IT. ���
I have read the hazardous materials mquimments under Chapter 6.95 of the
Cutworms Health A,Safety Came,Sections 25505,25533 and 25534. 1 understand that Cary
25199
if the building does not currently have a Roam,that if is my responsibility to notify the Ory
occupant of the requirements which mus he me prior to issuance of a Certificate of
Occupancy.
Owner or amhonad agent Data L ISSUF.p By;—V "FS
-------- --- ------- ----- - - -------------- ------------------------ - - --------------------
OCT-L2-1?S'5 Oc:``7�M rON TO 11:57 ?,'O
G8e115959 KELL GOPYJM DE :CPP 7S5 Pal OCT /1 '?5 15:?S
October 11, 1998
Suilding. Division
City of Cupertino
10300 Torre Ave.
Cupertino Ca. 95014
If
Rei Lot 18/ 19832 Rodrigues Ave'. Nil
-
Building Division:
Cn page 02 of the plans for Lot 18, diagram 8 5 4 are to be omitted.
They ar8' not necessary for .he ^_onstruction of this home.
!e is
Sincerely,
AX4A4*aee- for Lot 18
n I
CSC O
CT !9
o Gyo�9f �
i
2