20760APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project IdentificationPERMIT
BuBding Address:
l S ��� cepa
NO.
20760
ners ame: � me:
f¢WOSo" �-5 L"UtS-L'
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT -
BUILDING-ELECTRICALPLUMBINC-MECHAMCAL
%—�6�
Cdoto a Tic. No:
1�''^„` C_ I my -i— 716IL3
CATEGORY
CONTROLN
Archliect/Engineer. Lk. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Add... Sb SYN Pw6l\ �IJ
PERMITISSUANCE
IILUK� ELhC PLUME MEL"
x�Iii ® 1:1LICENSED
LQ
CONTRACTOR'S DECLARATION
I hereby offirm that l am Bcmud under provisions ofChapterg (commarc,
It...I Section 7000)of d effeon3o(the Buslneeeand Pro(estonsCode,and my
license is dion7o,�emdvisio �1
License Claw tJ Llc.tl /b ZZ
Date 7 —L�i . mntract
ARCHITECTS DECLARATION
I understand my plarushaB be used as public emends.
APPLIANCES -RESIDENTIAL
JOB DESCRII'170N
1T CT
J
PANELS
201-1000A.AIPS
OVER1000AMPS
SQ, Fr, FLOOR AREA
$/SQ. Fr.
SIGNS ELECTRICAL
Li ... d Professional
SPECIAL CIRCUIT/MISC
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
TEMP. METER OR POLE INST.
following reason.(SMIon 70313, Business and Professions, Code: Any city or
countywhich rcquimsa perouttomnstruct, alter, improve, demolish, orrepair
any simmers prior to Its issuance, also requires the applicant for such permit to
Ole a signed statement that he Is licensed pursuant to the provisions of the
POWER DEVICES
SWIMMING POOL El C
Contractors License Law (Chapter 9(mmmendng with Section 7000) of Divi-
slon3ofthe Bu4new.a drhofe i.ee C.de).,thmhebexempttherefmmand
VALUATION
the basis for the alleged exemption. Any violation of Section 70115 by any
applicant fora permit subjects the applicant to a civil penalty of not more than
OUILE7SSWITCI IF_S ES (7
Q Q�
NEWRESIDENDAL EL SQ}T.
fiv hu odmild.11ars(SS00).
N L as owner of the property, or my employees with wages as their sole
STORIES
TYPE CONSTRUCTION
compensation, will do the week and thetleuture Is not Intended or offered for
sale (Sec 7094, Business and Pretensions Code: The Contractors L come, law
does not apply to an owner of property who builds or improves thereon, and
who doessuchwork himself orthrough hlsownemployees, provided that such
improvements are not intended oroHered ferule. If, however, thebulldlegor
OCC.GROUP
RES. UNITS
Improvement le sold within oneyearofcompletlon, the owner-builderwill have
flit"prden of proving that he did not build orimprove fee purpossofsale.).
us, L as owner of the property, am exclusively contrating with licenced
entratons to com ut the project (Sm. 7091, Business and Professio s Code:
QTY. PLUMBI'�43JORMITNFEE
FLOOD ZONE
APN
PERMIT ISSUANCE i 4w
moo
The Contractor's License Law does napply to an owner of property who
Wild. .r Improves thereon, and who contracts for such ptojecis with a
egp(Tactor(a) licensed pursuant to the Contractor's License Law.
L -JI am exempt under Sem B & P C for this reamn
A TER -DRAIN & - WA R )
FEE SUMMARY
RA FLOW T.DEVI
D ROO
,�ys
T�" W
CAS F.A. .I INCA
SANITARY Y N
RECEIPT M
Owner Date
WOR KMAN COMPENSATION DECLARATION
❑I hereby Whorl that I have a cetlBeste .f mpeent to self-inwre, orTTM
mtifimteof Works Compepeatlmlpe mnamamtifkdmpytheme fpec.
3800, Lab Q
SQ -IDOL TA% Y_ N_
RECEIPT tl
PARK FEE Y N _
Policy tl
RECEIPT p
CAS PA. -0VER 4 (EAI
Cam any
BUILDING DIVISION FEES
�Cetified copy is heed with the
ed.city
❑Cor ifind copy Is lied with the city inspection division.
CR ' NDUST,iL WASTE EI'TO
PLANCHECK FEE
GREASETRAP
CERTIFICATE OF EXEM PTION FROM WOR KERS'
COMPENSATION INSURANCE
Trhisaetl.n need notobebe comcomplied tithe permit le (Drone hundred dollars
PAID
DR
ate emi Pt#
SEWER-SANITARY-STORM EA. 200PT.
WATER HEATER W/VENT/ELECTR
ENERGYFEE Y N
— —
PAID
Date Recef t#
G410a)eefew0
the person in o(thewmkforwhkh lMa permit la leered,
acetify emplhat oy
I shall not employ an;pere.n In any runner n as to m to the
Workers'Compen a (Cai errata ate 'T O
ApplicaNOTICnt
NOTICE TO e.ubjCANT:e after making this Certificate ss Ens of the ,you
should become subject to the Workers' n provisions of the Labor
WATER SYSILSI/TR[ATING
NEW RESIDENTIAL PLMB. SOFT.
TOTAL'
Code, you moat forthwith comply with such provblope orthU permit shall be
such provisions
deemed revoked.
U G 'E
SEISMIC FEE
O
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a mrutrutlon lending agency for the perform-
ance of the work for which this permit is Isaued (Sec. 3097, Cie. C.)
Lenders Name
Lenders Address
I cot ify that I have read this application and state that the above information
ecoet. I dgloom comply with all city and county ordinances and tate laws
TOTAL:
�a (1 b
ELECTRIC FEE
QTY. MECHANICAL PERMIT FEE
PLUMBING FEE
MECHANICAL FEE
PERMIT ISSUANCE
FEES PAID:
Mating to building construction, and hereby authortm representative. of the
city to enter upon the abovcmentioned property for Inspection purposes.
(We) agree to save, Indemnify an d keep harmless the City of Cupertino
agal Ilabilltim, jrdgere t costes dexpenseswhkhmsyinanywayeccree
rut aald Cit nm sequence of .granting of this penult.
+—J /
li
ALTER OR ADD TO METH.
Date Receipt#
'
AIR HANDLING UNIT(T010,000CFM)
:
SUBTOTAL:
AER HANDLING UNIT (OVER 10,030 CFM)
CONSTRUCTION TAX
Signature of Appllcart/Contraor
ctDate
EYHAUS'TIIOOD(W/DLII
CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT (T0100,000 BTU)
Will the applicant or future building occupant store or handle hazard...
material as defined by the Cupertino, Municipal Code, Chapter 9.1 2, and the
He❑alt and Safety Cede. 'goon 25532(x)7
Yen
Will the applicant or utum building occupant use equipment or device
Date Recei t#
HEATING UNIT (OVER 100,000 BTU)
._
AL:
L
b
VENTILATION PAN REBID)
ISSUANCE DATEoccupantme
which emit hazardous air contamlwnts as defined by the Bay Area Air
Quality MavgementD It7
Ye'-7V Na
JUL 1 195J
BOILER-COMPOHPOR100,0(DBTU)
BOILfR-CANP(OVER 100,00) BPR))
-Thave read the bozo ous material. requirements underChapter 6.95 of
the California Ileallh&Safety Code, Sections 25505,25533and 25534.1
ejty of Cu�Prfino
NEW RESIDENHAL MECH, SQ.FT.
understand that if the building does not currently have a tenant, that it b my
responsibility to notify the occupant of them Iremente which must be met
prior to uance a IOatcof Occd
G
ISSUED BY:
Owner or authorized agent Data
TOTAL:
OFFICE COPY