24175 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
BuildingM Pro Identification "° 141-75
. tlullding,bddms:
''1o361s Vo
G
CITY OF CUPERTINO•BUILDINGDNISION
�m D APPLICATION I PERMIT
vp Ardua
Red/Englr :r. •m
BUMMNGELRCIRRALPLUMBINGMFLHANICAL CATEGORY (DNTROL#
QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO
Add. PERMITL%UANCE 9= =1 Proraw—MECF17—
LICENSED CONTRACTORS DECLARATION 1:1 El El
IMmby aRbmthella lit seduederpm bimsafChepr9( APPELANCRSRE9OFNTIAL jusDFSC
IngwilhSetlbn7Mof Divi on3oftheB"S udPmresdm Coci,ndnV
Ibnnse bin fun form and efka. PANELS
Lkemrap♦37 LII
Date��'j�_g Contmdm
ARCHITECTS DECLARATION "1
mQZQ Iuedema plaro Shen be weed s public S. - OVER IBW AMPS nFLFLOORAREA S/SQ.FT.
fire Lkmmed Prefefflonsl SIGNSEIECTRSCat
rn$NWNW OWNEWBUILDER DECLARATION Imam
PA
IhendryalRrm<hetlameYmpt(mmtheCammofSLimneefaw(wthe
ZZ foWwing reeem.6emm 7nil5,Bush®aha liobrbnS Code:Mydtyor
5 oamtywhY:A mqubnapemJlmamtYmat,dter,improve,durolbh,wmpalrp.ME17RORPOIP INSf.
Yyatmmrmprlorwibbwamgalmrequlmstheappllmntfwmchpmmw )q)yEg DBVICPS
IpI file a diand Settlement that he b nonmed purmam to the p ovbbns d the
3 --� CmtrulotsLkxme law Chapter 9(commencing with Smrien 7610)of pv4 SYNC POOL ELSCTRIC
doe, aon 3 oftha Suelresana PrdmbmCede)orthat he b exempt lhemf,,,d VALUATION
the bads for the alleged exemption. My ,violation affiedbn 70315 by any OUSIFISSyJITCFESFI%11JRES '1
applicator fora pemtlt mblemmeapplleanito a Gull perukydnd murethan Z�Q #�
fivLjYndrdddWehepr. mob NEW RESIDEMEAL ELEC R_SQFI'. STORIES TYPECONS7RLCTION
z�e LJSYowmrdlhepmpenyornyemture is wahenadgeedaY fferdfor
O com05a,70KDoldothend Pretenders
Code.
bndbtddedmoRor Law
C eek Sena 703,BuSbws and Pmdesbro Cedr.TheCodmaors Llaensefaw
�B dmsnd appym owmar dpmperty who bulbus orImprovmthemmha,a
£^ whodomisuuddwom rkhim Umthrmghhbownemployee%pr idedthatwch CCCCROUP RES IlN17B
Improvement,—M intendMmoRerrdfmYb.Rhowever thebulMbger T07AL•
Impmvemedbsddwkhlnmwymrofcmq dimtheowmr-buWerwUlhave
I dandprMngllut MaMnYWlldor romforpurporedYb.L QTY. PLUMBING PERMIT FEE
L as owner d the propemy,am eckol dy omeradbg with licensed FLOOD IDNB APN
contraetmsmconslmdthe poled(See 701�Budnes and Pmfesbro Code: PFRMIT155UANCE
TM Comredofs Limnse law den an apply to an owner Of property who
bull"m Improve,theme,and who connote,for such plojab with a ALTEWDRANAVENT-WATER MU
r9innarctorlidlimused pumuant mmeContmdds License Law. BACK PIDWYROTECT.DEUCE .FEE SUMMARY
Lj I am earampt miler Sea B A P C for thin mann
. Owner Darr DRAINS-FLOOR,ROOF,AREA,GOND. SANITARY Y_ N_
WORKMAN COMPENSATION DECLARATIONRWM'T#
[31 hereby affirm that I have oe
ve a dlOml of ensued eew to "Sum, a FDnuims-PERTRAP SCHOOL TAX Y N
wdWmtedWorl,OWCampevYBminmmnmwamrdfiedcopytherra(Oce. GAS EA.SYSI'FAt-I WCd01717.kT5 PARK FEB J Fong RBCE7r#
3S0Q,LbCJ
N
CAS-PA.SYSI'EM-OVERd(EA) BUILDIINN'GDI
CC evDIVISION FEES
dgied copy Is hereby hrmbhed.
Bled cREAsg/imuBIRL WASIB 1NTF%FrroR PLANCHECK FEE
copy In heed with the mY inspection drvwm.
CERTIFICATE OF EXEMPTION FROM WORKERS' GRELSETRAP PAID
COMPENSATION INSURANCE SEWER-5ANITARY-SMEM EA 211X7• Date RDDei #
OTbeedbn reed nil Meompleld lithe peened bfmoonhundred dollars
alamtilr.J WATER IEATERw/VENT/ELECTR ENERGYFEE Y N
I mdltylMblm Prove many he manner
lwwWmtloS pe mat ctto11 ,
1 orkhan nm empty any person f any main. oo r Y became wbjen to lM WATERsYS1FM/TREATING
workman Compewebn IawsdGllfamb.Dile PAID
O Z Applicant NEWRE%DpMiALPLME SOFT. Date Recti t#
ZO shmldkWU� 0APPLmwtb,ager rYCongb tionpteofsxemmppthe yon
jr shonldbecomesublh-Uh eWorket marproabf=mvbbrooflhe Labor TOTAL'
Cedgyon newt lmthwah comply wlthmrh provYlmSwthb permit andlM
� � deemed revoked. BUILMQ FEE ''na
ll CCONSTRUCTION LENDING AGENCY SEISMIC FE
I Mrebya(flrmthatthem bacoruWdton bMingagereyfortlepefir r .fOC,W, ELECTRIC FEE
Z a=ofthewmkforwhkhthbpenMisk rodSm3Wy,CIv.CJ
(� O heede/s Name PLUMBING FEE
LL H Iardees Adder QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W to ifytMlhawmadthbappgotbnandmabthdtheabovelnfomdtlm
N a
brred.IagmWm plywamu
handlyandntywdlnar mdddelaws PERMIT ISSUANCE FEES PAID:
>- ndeing tobunding construction,and hembyauthodY mprYematbes dthb
j_ Z mymenterupontMabove-memtbadproperty(mlnspeenanpurp— ALTERORADDTOMDCIi. Date Reeei t#
V — (We)agree W Yvg IndenWfy an d keep hermits the City of Orpeabo
agabut lbbWtim,)mdgeans,rant,and experum which my In anyway Smut NR HANDLING UNIT(TO 10030 CFM) SUBTOTAL
-
of
Yid City renaquemeoflM gnmbgd WSpermK.
AIR HANDLING UNIT K)VER 10,000 CFM) CONSTRUCIIONTAX h
and p ill/Contraetm 0(HAUSTHOO)(W/DUC) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
III the appllmm or future building occupant mom or handle harardoro HPATINGUNIT(T01MAIXIM D DeM• Rech t# •,
material as delirod by lM Cupedlon Municipal Code,Chapr9.lZ and Ne
Hea Yesd SafelyCede Sec
id on25532(x)7 )EATING UNIT(DIVER 100,610 BTU) T A
El the applloSt orfurom building cmupantuee equlpmemwdeuke, VEN71LATION FAN SINGLE KFSID) ISSUANCE DATE
wNrh entll MYrdous ab omtsMnsmsasdeilad bylhe Bay Area Air
Quality Management Wtrlrt7 BOUFR.COMP O)EOR IfD,WO BTU)
Yen ❑❑FIo
ve read the han.9 mdedab requirements uaderCMpptekr6.95 of BOILER-COMP(OVOt 100=BTU) q
the California I ImIth A Sally Code,Sedro kn75:0%MW and 235.34.1 P A 1
understand that lfthebunding does rol currently he.a Imam,that it is my NEWRESIDINHALMECH SQ.FT
Trop.nslblWytondifythea pantdthemqulm or swhkhnumMmd ElCae `
prim m lmrance da CadlBab dOcapanry. /. ,7G I/����a���
Owrormwlhodad agent Dal issma,ni 7�jrVg
r v
TOTAL: r ren.. .
OFFICE COPY
•MltldVVMO NOOO1'ON NO O3INIW L{11{{
J C`Zr
14 L V
s° V
Qo
U� MOVED
� 4 SEP 21992
D
M40 j— BLDG. INSPECTION DEPARTMERL
lrt[rr rLnns ;
v CITY OF CUPERTINO
CBEC D BY
ING
DEPT.
" Df.. DFM'.
tv
• � � ��77��TT
OFFMV
•
U2-Z Ake
3+�3 �fj I l
' � 12 !
Z
I 5
,
i
i
. . . . . . . . .
L'
g
1
I
- f
_ Y
II
l /
i
Z
C � i
� cf�