250234PPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
rICA.
CITY OF CUI'ESIO NO APPLICATION/PF.RMI'P PLUMBING,-MEG-HANICAi.
BUILDING DIVISION ..rrr,I.—.."' r—narN,rc„.
I1— 25023
SANITARY NO. APPLICATIONSUBMITTALDATE
NO:
Soak g N/C CONTROL. X
PEE BUILDINGPERMIT INPO
B EL Cr PLUMB MECII
SQ. FI', FLOOR AREA
ISo�J"
FI?Ii SUMMARY
TSID : F .ES
SANITARY YN
RECEIPT #
SCI )OLTAX Y N
RF.CF.1P1'X
PAFf FEE Y N
RECEIPr#
BUILDING DIVISION FEES
CHECK PEE
GRADING PER
SOILS FTE
ENERGY FCC
PAID.
am Receipt#
TOTAL:
BUTLANG I iE
AlSkIt FEE
RCITE
PLUMBING ITC
MECHANICAL E
CONSTRUCI'I NTAX
PAID
am RcceiptN
T
Is
ISSUANCE DATE
PAID
ppR 29 1993
Of
ISSUED BY:
Ale. - - -
3 46 S % b ooh NIP
CONTACT: PHONE:I
I k u I ` `v '
QTY:'*.jX L JtF.LECTRIC PERMIT
TL PERMIT ISSUANCE
LICENSED CONTRACT'OR'S DECLARATION
APPLIANCES -RESIDENTIAL
mmz
t
FWO
aZ
Ihereby affirm that lam licensed underpmvisionsofChapter9(commencingwiN
Section
orceaml)of ef Division 3 aria, Business and Professions Code, and my license is in
l.icerruH�/Iyss / Lic.X , d i/
PANELS
UP T0 200 AMPS
ti 6 y
ZOvr'�
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F rn � J
Date 2
"I Canmac,.,
201- 1000 "n
ARCHITIll DECLARATION
I understand my plans shall be used as public records.
OVER TWO AMPS
SIGNS ELECTRICAL
Licensed Professional
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W '<0 K
a0. Oo R,
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OWNER -BUILDER m the CoATION
1 hereby e. (Se that 1 um exempt from the Gonias Co License Law for the
following reason. (Section'/07 LS, Business and Professions Code: Any city or county
which requires a permit to construct, ulcer, improve, demolish, or repair any structure
to its issuance, also the Ilcantfor such permit file a signed comment
pp pract gn
prior rel to the
that he is licensed pursuanno the provisions of the Contmmoh License Lew (Chapter
9(commencing with Section 7")of Division 3 of the Business and Professions Code)
or that be is exempt herefrom and the basis for the alleged exemption. Any violmionofOUTLETS-SWITCHES-Fq(TURP.S'
Section 7031.5 by any applicant for a permit subjects the applicant toecivil penalty of
not more than five hundred dollars($500).
❑ 1,asowneroftheproperty, ormyemployees with wages as theirsole compensation,
SPECIAL CIRCUIT/MISC.
TEMP.MEfER OR POLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
in ff
NEW RESIDENTIAL ELECfit _SQ,FT,
a3.
will do the work, and the smadare is not intended or offered for sale (Sec. 7044, Business
and Professions Cale: The Contractor's License law, does not apply to an owner of
property who builds mangroves thereon, and who does such work himself or through his
ownemployeds, provided thatsuchimprovemems are notimendadoroffered bersale. If,
however, the building or improvement is sold within one yearofcompletion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
QTY{'^' '-PLUMBING PERMIT
sale.).
❑ I,us ownerolthe propeny,am exclusively convecting with licensed ciamorenrs 10
consul the project (Sce. 7044, Business and Professions Code:) The Contractors
License Law does not apply tosur owner ofproperty who builds or improves thereon, and
PERMIT ISSUANCE
who comtrumts foriumb projects with a contiontens) licensed pursaantto the Contractor's
License Law.
pLTCR- DRAIN&VENT - WATER (PA)
❑ I am exempt under Sec. , B & PC for this reason
BACK FLOW PROTECT. PEINE
Owner Date
DRAINS -F -PSA )C
WORKMAN COMPENSATION DECLARATIONas
FlXTURES P
Ihereby affirm that l havcacenifteme ofconsem to self-imem. ora cenificam of
Workers' Compensation Insurance oracertified copy thereof (Sec.381X1, Lab CJ which
GAS - EA. SYS '1-1 INC. 40V L
. all employee's under this penr��-
c.ePolicy N
Cnmpeny K /C
GAS-F..SYSTTi
❑ certified copy is therebyythfurnished.theicy
ORFAS1.411tTIUSTRI, WASTE INTERCEPTOR
Certified copy is filed with the city inspection division.
CERTIFICATE. OF EXEMPTION FROM WORKERS'
GREASETRAP
COMPENSATIONINSURANCH
SEWER - SANITARY - STORM P.A. 200FT.
(This section aced not be completed if the permit is for one hundred dollars ($ 100)
or less.)
WATER HEATER W/VENT/ELECIR
I cenify that in the permanence ofthe work for which this permit is issued, l shall
not employ any person in any manner so ss to become subject to the Workers'
Q %.
Compermationlawsof Califomia. Dam -
Applicant
WATER SYSTIiM/IRFATING
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
NEW RESIDENTIAL PLMIL SQ. FT.
V)
become subject to the Workers Compensation powisiomofthe labor Code, you most
forthwith comply with such Provisions or this permit shall be deemed revoked.
G [�
V 2
O
QLcndI
LUlI
i$s
CONSTRUCTION LENDING AGENCY
1 hereby affirm that them is a construction lending agency for the performance of
@e work for which this permit is isearl (Sec. 3090. Civ. C.)
Lender's Name
-
TOTAL:
Address
QQ 'Y-. x" '. MECHANICAL PERMIT
"
I cenify Nat I have read Nis application and rote that the above information is
r ally Oa
Corect.Correct. lagree to comply with all<ity and county ordinances end storelawsws relatingg to
PERMIT ISSUANCE
building construction, tied hereby authorize representatives of this city to enter upon the
ALTER OR ADD TO MECN.
U Z
above-mcntionaJ property for inspection purposes,
Wc) agree to save, inJemnify anJ kcep harmless Ne City of Cupertino against
abilities, mems ostsandexpensesvv may in any way accrue against said City
AIR HANDLING UNIT 00 10.000 CFM)
i t caoved's c gr n Nix pe Tit.
A
% l f
AIR HANDLING UNIT(OVER 10,000CEM)
SI nsmrc ol'Appllc� omruutnr. ° '—
EXHAUST HOOD (W/DUCE)
HEATING UNIT(TO 100.000 BTU)
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building mccapam store or handle hazardous material
as defined by the Cupertino Municipal Cade, Chapter 9.12, and the Ileahh and Safety
HEATING UNIT' (OVER 10)'000 I7TU)
Code. Section 25532p)?- /
❑ Yes f_TV.fi,
VENTILATION FAN (SINGLE RISID)
BOILER- COMP (311P OR IW,M) ETU)
Will theapplieanterfmare building eccuionatieequipmentorde,ices whiehemit
BOILER - COMP (OVER 100,000 BTU)
hersrdo¢v air conmmvear; u efined by the Bay Area Air Quality Management
District?
1:1 Yea
NEW RF.SIDEN'I IAL MECI I. SQ, FT.
I have real the hmnNous mnmriais rtquircmenb under Chapmr 6.95 of the
California I rail &Safety Cele, gectians 25505, 25533 and 25534. 1 understood that
gilding doe yhave a that it is my resp onsibility to notify the
occupant e q m epLh m t be et prior to issuance d a Cenifil of
I1— 25023
SANITARY NO. APPLICATIONSUBMITTALDATE
NO:
Soak g N/C CONTROL. X
PEE BUILDINGPERMIT INPO
B EL Cr PLUMB MECII
SQ. FI', FLOOR AREA
ISo�J"
FI?Ii SUMMARY
TSID : F .ES
SANITARY YN
RECEIPT #
SCI )OLTAX Y N
RF.CF.1P1'X
PAFf FEE Y N
RECEIPr#
BUILDING DIVISION FEES
CHECK PEE
GRADING PER
SOILS FTE
ENERGY FCC
PAID.
am Receipt#
TOTAL:
BUTLANG I iE
AlSkIt FEE
RCITE
PLUMBING ITC
MECHANICAL E
CONSTRUCI'I NTAX
PAID
am RcceiptN
T
Is
ISSUANCE DATE
PAID
ppR 29 1993
Of
ISSUED BY: