28436 1
APPLICAN}f TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOB m"Ni;-ELECTRICAL PERMIT NO. 'LJ A ^lyJ� 4 3 6
APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING DIVISION BUILDING PROJECT IOEN'Fi FICATION
BUILDING AD0
S7-3`�—S. A 1 UNIT# LOTk SANITARY NO. 1�'II�S I'1'ALDATIi
OWNERS
NAME:� 4AW PR
PH E: CONTRACTOR'S NAME: LIC NO: N/C ^ ///C���ONTROLN SS
AHCIiI'l7iCTp3NG�INEIiR: LIC NO: ADDRESS: ❑ /���
Z LCAPt `
CONTACT: PHONE: BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
I ,w/D /(- BLDG ELE PLUMB M17 11
N WWI PERMIT ISSUANCE
ze
LICENSFD,C CT R'S IN
//�, APPLIANCES-BESIDIiNTIAL JOB DESCRIPTION
nCZ Thereby uflinnth lam llc�ovisa °Y ,
��� full f00 u«cu of effeeof itvision Sof th N sand Pro '•l/ u4i PANELS
FZW License Class I.it.N ons UPT02WAMPS G��, \�
yQy Date Courtroom r 201-ISX)AMPS
Z FON ARCHITECTS DECLARATION OVER 1000 AMPS SQ,I'1'.FLOOR AREA $/SQ.Fr.
OZ—❑ l understood my plans shall be used as public records.
<y2y) SIGNS ELECTRICAL.
W Y2, CT
Lianxd Professional
C,y a'6 OWNER-exempt ERrnDECLARATION SPI7C1AL CIRCUIT'/AtISC.
W 1 ngma%affirm that 1 am exempt from Ne Contractor's Co License Lew for the
m3wy following reason.Permit
to construct.
and imprme.de ionsCMe Any city or county TEMP.METER OR POLE INST.
F�c,_J which reyuiresa permit mcunsWq.alter.improve,demolish,or repair anY structure
�W}:F prior to its issuance,also requires the applicant(nrsuch permit to file a signed statement POWER DEVICES
K p shut he is licensed pursuant m the provisions of the CmmOm's License law(Chapter
aao� 9(conmrcncing with Scaion]WO)of Division 3of,hc Bmincaand Pmfcssimv Code) SWIMMING POOL ELECTRIC VALUATION
m that he is exempt shcmfrvm and the basis for the alleged exemption.Any violation of OVILFTS-SWITCHES-FIXTURES
FZQ Section 7031.5 by any applicant forapermis subjects she applicant lou civil penalty of �11 IS
F of more than five hundred dollars(15100). NEW RESIDENTIAL ELECfR 5 J
Co n❑ hnsownernfthepmp rty,ormyenrployceswithwagesustheirsolecompensation. Q STORIES TYPECONSTRUCTION
yg_ will Jo the work,andthe sureame is not imendedoroffered forsale(Sec.]044,Busisco;
and Professions CWc:The CometuaW's Lieunec I.nw does nut appy m m owner of ,r
pmpcnywhobuildsorimproveathcrcon,andwhodocssuchworkhi.ifor0uoughhis OCCGROUP HIS.UNITS
employces,provided that such improvements me not intendedor .
offered forsale.If, /
huwevcy the building or improvement is sold within one year ofe mpletion,the owner- ,
builds will have the burden of proving that he did not build or improve for purpose of
( rale.
I.nxnmro
wnolthe Pperty,ant exclusivevach
exclusively coning with licensed contractorsQTY. PLUMBING PERMIT FEE
contractors to ILOOD ZONE APN
,he project(Sec.7044.Buximess and professions Code:)The Centimeter's
f ce x fawdm,aamapplytoanuwnerofpt)pe ywhobuildsorimproves Ncmon,and PERMIT ISSUA� EE
onvuos for such projects with m ontraanr(s)licensed Pursuanuothe Conuecmh
License Law. ALTER-DHA N&'V ENT-WATER fi A) FEE SUMMARY
❑ I um exam# oder Sec. .B&P C for thin rtujon BACK IiOV(�PRO .DEVICE
OUTSIDE FEES
SANITARY YN
DRAINS-ILOOR.ROOF, REA, ND. RECEIPT#
WORKMAN COMPIiNSA'I'IOND ARATION ar SCDOOLTAX Y N
❑ 1 herehyaltirmtbmlhnveuccnifcam of conscn lf-in FIXTURES-PER TRAP HLCEIPfa
Workers'Cum,meation lnsunncemaceni6edcopyshccof(Sae.18W.1ab C.)which PARK FEE Y N
covers all employee's under this pemrit. GAS-FA.SYSTEM-I INC.40 'LETS Hh EIPfp
Policy# BI NO VISION FE'.
Company GAS-EA.SYSTEM-OVER 4(HA) PLANCHECK FE' 'O
❑ Cerificd copy is hereby fbmishcd.
❑ Certified copy is filed with the city im,weion division. GREASWINDUs'rRI.WASTE INTERCEPTOR GRADIN
CERTIFICATE OIs EXEMPTION FROM WORKERSGREASETRAP SOI V?E 01
COMPENSATION INSURANCE
Onix scrim need not be completed ifrhe Permit is forme hundred dollars(SIM) SEWER-SANITARY-STORM HA.2rgF1'. ENE 'Y F.E. cot
n less.)
Icrny any
in We performance manner
so as for becamthis ubjecpermit o issued,lkers WATER HIiATIiR WNGMI/Ii1.I1CTR
not,parlay any person in any manner as to became subject to the Workers' PAID
Compensution laws of Cnlifumin. Dates WATER SYSTIiM/IRIiAI'ING Rccciptp
O zApplicant
0 NOTICE TO APPLICANT.If.after making this Certificate of Exemption.you should NEW REiSIDENTIAL PLM B. SQ.Fr. TOTAL:
FZ) Im'mac subject to Na Workcrs Compensation provisions of the Labor Code,you must BUILDING FEE �y
jforthwith comply with such provisinu.. ,.his permit shall be demand revoked.
4ks Q CONSTRUCTION LENDING AGENCY SEISMIC ITE D
I hereby off iron,hat there is n construction lending agency lin the Performance of
Z) z ELECTRIC FEE
U O the work for whiclu his permit is issued(See309],Civ.C.)
Lender's Name PLUMBING FEE
Q' F Lenders Address QTY. MECHANICAL PERMIT FEE
U I certify that 1 have read this application and stale that the above information is MECHANICAL FFE
cmrea. lagrcc mcomPly with all city and county ordinances and scam laws relatinga PERMIT ISSUANCE
h VO buildingconswnion.and hereby amhariu represenmtives()firm city In enter upon the CONSTRUCT ION TAX
U z nMvomcramood property for inspection purposes. ALTER OR ADD TO MECH.
We)agree to save,indemnify and kttp harmless she City of Cupertino against
Iiahil ities,judgmenlx,costs card expenses which may in my way acerve against said City AIR HANDLING UNIT(TO 10,000 CFM)
in coexceluence of the granting of this permit.
AIR HANDLING UNIT(OVER 10.000 CFM)
Signature of ApIllicantlCnnlramnr Date EXHAUSTHOOD(W/DUCT) PAID
I IAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO IMJ000 BTU) Dam Receipt#
Will the applicant or future building occupant short or handle haurdous material TOTAL:
as defined by the Cupertino Municipal Curb,Chapter 9.12,and the Health and Safety HEATING ON]'It(OVER 100, 0 BTU)
Code.Setion 25532(u)]
❑Yes ❑No VENTILATION FAN(SINGLE RFSID) - C•' II !'
POILER-COME CUP OR 100,1]00 BTU) IUM ISSUANCE DA'IE
Will hair contaminants
a mart as defining bynecthe Bay Areectua Air Quality
Management J 41996
Joos air conmminana as Defined by the Bay Area Air Quality Management ROILER-COMP(OVER IOO,000 BTU) {�
listen' ❑ /x'ry
Yes ❑Nn NEW RESIDENTIAL MECH. SQ.FT, k/ 1I UI- (alJf-(:flf flyU
1 have read the humbleas materials requirements under Chapter 6.95 of the
California Health&Safety Cash.Sections 25505,25533 and 25534. 1 undersand that
if the building does not currently have a tcmam,that i,is my responsibility es notify the
.1 occupant of she requirements wM1icM1 mush M ren Orior b issuance of a Cenificae of
Occupancy.
Owner or authorimA agent Dahe T - ISSUED BY:
OFFICE
Inspection Query for a Specfic Permit Print 7/29/96
PERMIT# ISITUS ST SITUS STREET AVE,CT,ST,RD Lot# I INSDESCRIPT InsType
29926 10234 MANN DRIVE ITEMP ELEC
29926 10234 MANN DRIVE FOUNDATION
29926 10234 MANN DRIVE SUBFLOOR
_ 29926 10234 MANN DRIVE SUBFLOOR
29926 10234 MANN DRIVE U/F ELECT
29926 10234 MANN DRIVE U/F MECH
29926 10234 MANN DRIVE GARAGE SLAB
29926 10234 MANN DRIVE MECH
29926 10234 MANN DRIVE UNDFR PLBG
29926 10234 IMANN DRIVE UNDFLR FRME
I i
s Inspection Query for a Specfic Permit Print 7/29/96
DATEDESIRED I DateDone -specter Units I Pass/Fail
7/10/96
7/16/96 7/16/96 CC 2P
7/24/96
7/26/96 7/26/96 AD 2P
7/29/96
7/29/96
7/26/96 7/26/96 AD 1 P
7/26/96 7/26/96 AD 1 P
7/26/96 7/26/96 AD 1 P
• 7/26/96 7/26196 AD 1 P
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