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23330 ,APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Building Project Identification PERMIT NO. Building Address: "UMS s spru N 3 3a0 rs ams: sas one: Z CITY OF CUPERTINO-BUILDING DIVISION •contract.age _ I LI .No:I/ ' APPLICATION / PERMIT L• Architect/Engineer. Lic Na BUILDING-ELECTRICALPL BINC-MECHANICAL CATEGORY CO l7� D f QTY ELECTRI MIT PEE BUILDING PERMIT INFO Address: I r D U,J V -( PERMIT ISSUANCE LICENSED CONTRACTOR'S DECLARA ION Ihembyafflrm APPLIANCES�NESIDIINTIAL JOB DESCRIPTION IngwlthSedioo 7000).!Dlvi.km3oHheBusincssanlI Pm(esslonsCodoand my Q^^ / Oc w^s, limnx 61n fuR f and dfed. a 11 PANED ` Re-111"I-0061- L Licen am LIeN Date.�C.ntnd.r - Orv� ( L 1iz ARCHITECTS D CEARATION 201-ICO-AMPS p�p�+++X{yX I understand my pians shall be used as public records. - 000 AMPS SQ.PT.FLOORAREAg/SQ.FT. Ez�j Licensed Professional NS EL TRI 1 Q6� WAS II Q OWNER-BUILDER DECLARATION SrfLAI LSC L v �Y 48 z �3 IhembyaffirmthatlamexemptfromtheConlract LlmnseLawforthe `` s �p qq following reason.(Section 70315,Business and Professions Code:Any city or FQc.untywhichrequlresapert tmcomtma,altepimpmve,demollsh,orrepalr TEMP.MERPOL ST. '� 3 nystructure prlorto Its lssuance,also requlrestheapplleant forsuch permit to EWER DEVI 5 �� V N�/ �' r60 file a signed statement that he is licensed pursuant to the provisions of the NT r 3w Contractors License Law(Chapter9(mrc nuncingwith Sectkm7000)of Divi- OS sion3ofthe Businessand Profsml.mCode)orthathe6exempttherefromand C ELECTRIC VALUATION the basis for the alleged exemption. Any violation of Section 70315 by any I1T1 1 applicant for a permit subjects the applicant to a civil penalty of not more than _ ` five hundred dollars($500. ❑I,as owner of the property,or my employees with wages as their soleL STORIES TYPE CONSTRUCTION compensation,will dothe work,andthestructure is=intended or offered for 0 sale(Sec 7044,Business and Profeaslom Code:The Contractors License law S$ does not apply to an owner of property who builds or improves thereon,and DATE OCC.GROIJP RES.UNITS d.essuch work himself or through hla.wnemplcyees,provided that such improvements are not intended oroffered forsale.If,however,thebuilding or TO improvement 6 sold within oneyearo(complelion,the owner-bullderwiil have th�urden of proving that he did net build or improve for purpose of sale.). QTY."WATER MBING PERMIT FEE FLOOD ZONE APN L j L as owner of the property,am exclusively contracting with licensed ISSUANCE mntndars to construct the project(Sec.7044,Business and Profession,Code: ��`The Contractors Llceme law don not apply to an owner of property who 4 VENT-WATEt(EA)builds or Improves thereon, and who contracts for such pTieda with aFBE SUMMARYcttt[ctor(s)licensed pursuant to the Contractor's License Law. PROTDci.DEVICELJ Iam exempt under Sec. B k P C for this masonOwner OR,ROOF,AREA,GOND. SANITARY Y N_DateREr:=RETL WORKMAN COMPENSATION DECLARATION \ .Ra SD{OOL TA% Y N_❑l hereby affirm that 1 have a certificate of consent to xlf-Insure,ora ` RECEIIT NcerHflcateofWorken'Compensationlns mnceoracertRledmpythemof(Sst. EM-i INCA OUTLETS _ 3800,Lab C.) /� PARK ITE Y N TIPT IT Coo ryany �� GAS EA.SYSTEM-OVER4 TEA) BUILDINCG DIVISION FEES Certified copy 6 he by fumish . CREASE/INDUSIRL WASTE INTERCE'TDR PLANCHECUEE 1 edified copy 6 filed with the city inspection division. -)a 6'7 I(j4 CERTIFICATE OF MEMPTION FROM WORKERS' GREASE TRAP s COMPENSATION INSURANCE SEWER-SANITARY-STORIA EA.20OFT. V Remi tit (Thbeedlon need nd Se completed Tithe permit 6!carona hundred dollare ($10D)orless.) WATER HEATER W/VENT/ELECTR ENE PEE Y N Icenot emplohat To y an p,.r.I.anf[manner foras tobwhich lhlapenNtis issued, I shall not employ any person In any manner m as to become subject to the WATER SYSTEM/TREATING vJVI Workcre'Compensation Laws o(Call(.rnla. Date PAID 0 Z Applicant Z oNOTICE TO APPLICANT.Imaking If,after ang this Certificate of Exemption,you NEW RESIDENTIAL PLMB. SQ,FT. Date Recei tIf become subject to the Workers'Compensation provlsions of the Labor TOT a. W Code,you moat forthwith comply with such provisions or this permit shall be W > deemed revoked. BUILDING FE f1 G CONSTRUCTION LENDING AGENCY SEISMIC FEE Z IherebyafOrm that them is a comtroctlon lending agency for the perform- O t� ELECTRIC FEE M Z ance.fthe workfor which n,6 permit 6 Issued(Sec.3097,Civ.C.) ELU:C RIC EEE V Leaders Name LL F Lenders Address QTY. MECHANICAL PERMIT FEE- MECHANICAL FEE O W I cerlifythat l have read this application and statethattheabove Information Isearded.I agreetocomplywith all cityand muntyotdlnances and statelaws PFRMITISSUANCE •� FEESTAID: Y C relating to building romtrudion,and hereby authorize representatives of this F Z city to enter upon the above-mentkmedp any for Inspection Purposes. ALTERORADDTOMECH, Date RCCCI t# (We)agrcc In denotify aa d rep ass the City of Cupertino P V ag.net li es,jud nle,coksand ex nsesw Ichmaylnenywayacerus AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: agar t I By nsequenm.(thegran gof Is permit. AIR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTION TAX ign of mratlor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARDOUS MATERIALS DISCLOSURE ill theappllcant or forum building occupant store or handle hazardous HEATING UNIT(TO 100,(100 BTU) Date Rece1 tit terial as defined by the Cupertino Municipal Code,Chapter 9.1 2,and the Health and Safety Code Section 25532(a)7 HEATING UNIT(OVER 100,000 BTO TOTAL: F1Yes No Will the applicant or tum building occupant use equipment or devices VENTILATION PAN(SINGLE RESID) ISSUANCE DATE which emit hazanlous air contaminants as defined by the Bay Area Air Quality Management Dbtridi BOILER-COMP OHP OR 300,000BTI) 4 Yea . No have read the haze our materials requirements under Chapter 6.95 of BOILER.COMP(OVER 100,000 BTU)46 - the California Health k Safety Code,Sections 75505,25533 and 25534.I understand that lithe building does not currently have.in...L that It 6 my NEW RESIDENTIAL MECH, SQ.I7. ^ mor to Issl Issuance notify requirements which must be met Y' D prior to Issuance otiyf a the ocate of cupant Ocof cupancy.req BY: \PP��(T(T� Owner or authodud agent Date ISSUED � OFFICE COPY r UI'Cry t live WESTFALL ENGINEERS . INC. CONSULTING ENGINEERS S 14583 BIG BASIN WAY SARATOGA, CA 95070 TEL: ( 408 )867-0244 FAX: ( 408 )867-6261 92025 April 28 , 1992 PROJECT: 21875 San Fernando Ave . Cupertino , CA To Whom It May Concern: This is to confirm that the foundation layout for the above referenced project complies with the building setbacks as per City standards . Per field survey on April 28 , 1992 , the building foundation at westerly property line is located 5 . 30 feet from the property line . pe4& R. r, Harry Babicka M L. S . 4953 r . • � GSc. G.�5:a MAY 71992 -... BLDG. INSPECTION DEPARTIIH CITY. OE CUPERTINO oF8RE COPY