19700 (2) U5�WIdIr,Addmss:
ANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building PWad Idendfleaaon PFJtMITNO.
josFrH G ac.L L c)- . 1970UCITY OFCUPERTINOQBUILDINGDIVISION a_, 3_90
ame: c / `_ /LIeNa: APPLICATION/ PERMIT
H /IS507- SS BUILDING—MECTRICAL-PLUMBING-MECIIAMCAL CATEGORYineer. r^ LIe Na:w 1ELL )I C^ - BUILDING PERMIT INFO
QTY ELECTRIC PERMIT FEE
Address: -WI°y _ - a,vo �
PERMITI55UANC
LICENSED CONTRACTOR'S DECLARATI
IMreby$firm that l am licensed under provisions of Chapter9(.mmenc. APPLIANCES-RE L JO DESCRIPTION
I tngwith Sedion7000)of Dlvlsion3ofthe Businemand PmfessimsCode,and my //
_ lianrcis inmlUIIIy��ome and effecr� QQ�S _ PANELS � �� / r�. 1y,�
Llcenea ClassLlc.Nsj' �z I="G J ` /Vs sO�J
Date'L�.+/ aCantna •ate -1000
AYA
ARCHITE S ICLARATION
µppµ!!ceO Zp I understand my plans son Is public mronL. OV 1 AMPS SQ.Fr.FLOOR AREA`/ S/SQ.FT.
EPJ
Licensed - •LFL77UCAL' 18L3 ' V I►vG-
<< tC, OWNBR-BUILDER DECLARATIO
rn 1 •:IAL CIITCUIT/MLSC
Lp., owinghereby af0rmthat Amexempt(mms the
and Profession
an for
-O 9L..p❑❑ fallowing reason.(l.I p rmi1.5,eumnaa and Pimprove, e: yd o -
F, s'� cwntywhlN requirnapertNttoromtmct,after,improve, h,or Ir SP.METIR OR POLE INST. 'a-s•'LTI.
4 any stacare prior to Its issuance,deorcqulrest eappli ch to
rNL file a signed statement that he is licensed pars an to pro to of a POWER DEVICES
.Contactors License Law(Chapter 9(.rtmcn g din o I. SWIMMING POOL ELECTRIC VALUATION
eion3ofthellusloessand Pmfemlom Code)o at sac In ra nd - .
a•33 the bass for the alleged exemption. Any o of Seco n 1.5 by any
'9 applicant fora permit subjedatheappllcant d Ipenalty more than OIIILETSSWITCHESFI%'TURES
five hundred dollars( NEW RESIDENTIAL ELECTR SQ.FT. ,$ STORIES t/rJ VTYPE CONSTRUCTION
as owner of the property,or my em oyer with wages a their sole
companatlon,wBldotha work,and the structureisnot Intended or mf(emd for
$
rule(Sec.704q Business and Professions Code:The Contract ole Llame law LKLM
does not apply to an owner of properly who builds or Improves thereon,and
who does suchwork himself or through his own employees,provided that such
Improamentsarenotintendedoraffered formic.Ifhowever,thebuildingor TOTAL: g, : M p E R
Improvement issold withinoneyearofcamp)etion,the owner-bu0derwlll have
t1jiL�urdcnofpmvingthat Mdid run Wild ori.prove for purpose of sale.). QTY, PLUMBING PERMIT FEE FLOOD ZONE 'tea^ppN -
u 4 as owner of the property,am exclusively contracting with licensed pp RPLUMB a� TE
.otadma to..tmd the project(Sec 7064,Business and Professions Code: i— r�
WilThe Contractors es the law don net apply comment f owner of property who ALTER-DRAIN&VENT-WATER(EA)
Wilda or improve thereon,and whohadoeLicense
ptojed,with a -
1}5Bf11. exempt order
toNeContractor'sLlees PLew. - FEE SUMMARY
L,J I sus exempt under Sac.' 0&P C for this reason BACKFLOW PROTECT.DEVICE nUT511
Avner - Date DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N_
RECEIPPTN
WORKMAN COMPENSATION DECLARATION FIXTURES.PER TRAP SCHOOLTAX Y N'
1 hereby affirm that 1 have a certificate of consent to m1f-Insure,ora RECEIPT N
- c 11 to of Worken'Compematlonlmunna ora arufled ropytham f(S.. GAS P.A.SYSTEM-1 INC.40IJILEI'S PARK FEF. Y. N
3800,Lb CJ
Paltry p GAS EA.SYSTEM-OVER 4(EA) AECEBef N
Co����mppppanv BUILDING DIVISION EEC
LJCcrtiBed.pyis Femby(uml M. CREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEB I
( CertNedcopyisfiled with lM tlly Inspection division. abs
CERTIFICATE OF EXEMPT ION FROM WORKERS' UREASE TRAP PAID
COMPENSATION INSURANCE Date Recei
(f his section need eat M completed 1lthe permitpedt ism n SEWER-SANITARY-STORM FA.200FL for ahundred dollars _
(S100)ales.) WATER HEATER W/VENT/LI.[CTR ENERGY FEE Y N
I certify that in the performance of thework forwhlch this permit is laced, —
I shall nm employ any person many manner n as to become wbjed to the - WATER SYSTIN/TREATING
Workers'Compensation Laws of California.Date PAID
.O Z Applicant - NEW RESIDENTIAL PLMB.__SQFT. Date RCceI [N
Z O .NOTICE TO APPLICANT:ILaRer ma king this Certificate of Exemption,you
should be.mesubjed to the Workers Compamatlon provisions ofthe Labor f TOTAL:
CC W Code,yW must forthwith amply withauch provisimetathis permRshallbe
reJO
caused voked. '
W p
CONSTRUCTION LENDING AGENCY - SEISMIC FEE
d Iherebyaffirmthat there is a comtmdlon lending agency for the perform- 70TgI. sC .ELECTRIC FEE "T-
.D Z an.of the wmNotr which this permit is Issued(See.3097,CIv.C.) J ELECTRIC
V 0 Lander's Name - - -
LL ~ Leaaeregaarea QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW Iati(ythatl have read this applicatlonand natethat theabove Information -
1 isarmd.lagreetocomply with ell dtyand.untyortlimncnand mate laws PERMITISSUANCE , - 2- FEE$PAID'. -
} relating to building mostrodlon,and hereby authomm representatives of this -
2 city to enter upon the above-rentlomd property for Inspection purposes. ALTERORADDTOMECH. Date Recei tit
— (We)agree to ave,'ndemN ly an d keep harmless the City of Cu Fenian - P
a aimtllabilltM jydgmente,roma and expenses which may in anywayamue AIR HANDLING UNIT(TO 10,(DOCFM) SUBTOTAL:
ag taid City In consequence oft grants of this permit
L 1 4TTv AIR HANDLING MET(OVER lo,mocr•M) - CONSTRUCTION TAX
Si mof Appilcant/Contrada Z Dat /u EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSD E
Wilttheappliant or future building occupant store or handle huardous HEATING UNIT(TO 100,000 RM
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the _ Date Recv1 t#
Health and Safety Cade Section 25532(a)7 I IEA TING UNIT(OVER 100,OM BTU) TOTAL:
MYea No
Willtheappliant aruW.building part me equipment or device VEMILATION FAN(SINGLE REBID) ISSUANCE DATE
which cMlhagumentsmtrict?contaminants.,defined by
tM Bay Area Air - i
Quality Management INstdct7 BOILER-COMP FIN OR 10000 BTU] PAID4 Yen Nc
I have read the hoar cue rtiatedals requirements under Chapter 6.95 of BORER-COMP(OVElt 100,000 BEV)
the California Health&Safety Code,Sections 25505,75537—75536. I t
undramnd that if the building does nm.rentiy have a tenant,that It is my NEWRESIDFMIALMECH. SQ.FT. Ga
respomlbilitytondilytheca,panto!the requlrementswhwh mu at be v JJVV
prior to lauanee of a Cedlfiate of Ocmp,ancy.
city of(rincl
Owner or authorlud agent Date 70TAI. —.671
ISSUE DB
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OFFICE COPY