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24166 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY tlulldin Pro'ca]demi(katlan 7 Pt]iMITN24166 416 6 ➢auamg waareaa: �rUls/.� CyzEK B 037 u -u io c w one: t .S 3 yY CITY OF CUPERTINO-BUILDING DIVISION canAPPLICAnONSUuMHiALDAiL o a Se.NP: APPLICATION /PERMIT Archite En ore "`� BUfLDINGELECTRIG4PLUMBING-MFLFiAMCAL CA Y ... COR1�pla gt Lk.No: /V t' :Q']y ELECTRICPERMIT, FEE BUILDING PERMIT INFO ddreu e . PERMITISSUANCE {� LICENSED CONTRACTOR'S DECLARATION El 0 l�l I hereby affirm that l am➢censed under provisions of Chapter 9(cvmmenc- APPLIANCES-RESIDENTIAL I / JOB DESCRIPTIOP It...iSection forceanDlWelon3o(the Businessand Pro/nsiondCode,andm license Is In full force end effect. PANELS "-IF v_11 x\J License Claa Licp -50-0112 C�a.a� �� Date ConhaRor ARCHITECTS DECLARATION 211-1000 AMPS N CO I understand my plans ahal be used as public records. OVER 1000 AMPS SQ.FT.FLOOR AREA E/SQ.FT. E Zd t, Licensed Professional SIGNSELECTRICAL << OWNER-BUILDER DECLARATION In] SPECIAL CItCI11T/MIST - p .hereby alormthat on 703 I ,Busspt Business ed Prolaorb License My or fo➢owing reason.irestap 70115,mortared, and PImprove, Code: h o city it O f.� TEMP.MEI'ER Oft POLE.NST. � K� 'file rcqubnapertNttocorotva,alter,improve,demolish,or repair anystr mmprlortoitshwance,ais mqulre}lheappllantforsuchpermitto POWER DEVICES ryG file a signed statement that he is licensed pursuant to the provisions of the 3" Contractor's License Law(Chapter9(rommencingwith Section 7000)olDlvl- �0 start3 of theBuslneesand ProfesabnaCade)or that he is exemptlherefromaM SWIMMING POOL ELECTRIC VALUATION the basis for the alleged exemption. Any violation of Section 7001.5 by any OUTLP.ISSWITCHFSFIXTURES t �j applicant for a permit subjeetsthe applicant to a civil penalty of nor moonthan E S five hundreddollarsthepro NEW RESIDENTIAL ELECTR SQFr. STOWES TYPE CONSTRUCTION WWWW �n ❑I,as owner of the property,or my employees with wages r thele dole compensation,wllldothe work and the stvdureisnot Intended or offend for O sale(Sfr. pply to an owner propeore Code The Contractors Llceme Law dm not apply roan owner o(prough his o Wildnem or improves provided hereoryand OCC.GROUP RES.UNITS who doessuch work not a throughhisownemplayeca,provided that gor improvements amnot Intendedoro(fec pleio If,however,the bulldingve TOTAL: Improvement iswld withlnonaycaro(completion,theowner-bullderwlll have the burden of proving that he did twt build or Improve for purpose ofsale.)., QTY, PLUMBING PERMIT FEE FLOOD ZONE ALIN F1 I,as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE contractors to ca.trod the Project(Sec.7044,Business and Profealmes Code: The Contractors License law don not apply to an owner of property who ALTER-DRAW Is VENT-WATER(EA) Wilds or Improves thereon, and who contracts for such pwiects with a cq➢tractor(s)licensed pursuant to the Contractor's License Law. - FEE SUMMARY LJ I am exempt under Sec B k P C for this..on BACK FLOW PROTECT.DEVICE OUTSIDE FEES Owner Date DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N— WORKMAN COMP DECLARATION RECEB'f p MEN ❑I hereby a(Rrm that I have•artlBate of consent to self-hus re,or a FIXTURES MR TRAP SCHOOL TAX Y_ N_ x certificate of Workers Compensation Insurance or a ortifled copy thereof(Sec, RECEIPTM GAS FASYSTEM 3800,Lab C.) - . -1 LICA OUTLETS PARK FIE V_ N '!cy p r RCEITT it m nBUILDING DIV ISION FEES Ce copy ishercSy famished. CAS PA.SYSTG-0VER d(EA) Cer➢iedcopyisflkddththncityimpediondivlsio . GREASE/INDUSIRL WASTE PLANCHECKPEESt CERTIFICATE OF EXEMPTION FROM WORKERS' GRFiASETRAP PAID 2s ^ COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.XIOFT. Date CCC. IN (lhlsaealon need not W completed the permit is!Prone hundred dollars 0100)or less.) WATER HEATER W/VENT/ELECTR ENERGY FEE Y N I certify that In the ped....of the work for which this permit la Wood, — I shall not employ any person In any manner w as to become subject to the WATER SYSTEM/TREATING Workers'Compensation Laws of Glifomia. Date PAID e O Z Appllant NEW RESIDENTIAL PLMB. SQk-r' Date Revel IM Z NOTICE TO APPELCANT:If,after making t his Certificate of Evemptkn,you Fshould become subject to the Warken'Compenaatlon provisions of the Labor TOTAL: fA Code,you most forthwith comply with such provisions orthis perMtshall be W > deemed revoked. BUILDING FEE jLI hereby'a!fi G CONSTRUCTION LEWDINGAGLNCY SEISMIC FEE rm that there is a construction lending agency for the perform- ELECTRIC FEE Z ance of the work for which this permit is Issued(Sec.3097,C1v.C.) TOTAL: O O lender:Name PLUMBING FEE 1L I— ..enders Add.. QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W I cedltythatl have read thisappliatlonand AiUethat lheabaveinformation D. iscoingtoluildino comply w➢hall h by.unty ordrapncesan atekws PERMIT ISSUANCE FEES } N relat to c vale and hereby out 10 rcpmen Ivn Pfthis Z dtyto enter upon the vcmenllno d rtyf ne 'I. urposn. ALTER OR ADOTO MECH. Dale Recei til — BY a toss rdemNfy en p har ea he C of Cupertino P against 11 tics,' d nb,cosida ms, hl may a wayaccrue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL: agahmt City n nxequenao gnntin lap AIR HANDLING UNIT(OVER 10,D10 CFM. CONSTRUCTION TAX Sig u pa / a Date- EXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HAZARD SMATERIALSDI LOSURE Will theappliantor future building occupant ore or handle hazardous HEATING UNIT(TO 100,000 BTU) matar0lasdeffied bythe Cupertino Munlapal ode,Chapier9.lZandthe Date ReceI tN I fealth'and Safety Code Section 75 la)7 HEATING UNIT(OVER 100,000 BrW TOTAL: ❑ Y. No Will the or uture bullding ocvpantusesquipment ordevices VENTILATION PAN(SINGLE FIND) ISPUANC DATE whlchemit hazandomalrconOnt mlnasasdeRned bylhe Bay Area Air �a' A i U Quality Managemen[DislrP4BOILER-COMP pFm OR 100,000 BTU! No I Yea OO No 4havcread the hm ouseraterialsrequiremen oder pter6.95of BOILER-COMP(OVER100,000BTU) . the GlBarris Health k SafetyCod v75 533 7SM.I SEP �undersla that lithe buildingdo n rmn nae ant,that it is my NEW RESIDENTIAL MECH. SQ.FP. ropo Iiry to (y theoccu o the , men hich must be net P� , Certifi uv pan CII Y Ur 1aUYCTll 114V Cy re ulhorirzd age Date TOTAL: ISSUED➢Y:� OFFICE COPY t 1 - - W -0 1 - i I y Q .M / 5t ffo -rte V--IFO ep x:e -rif w% c^f l—;F�vArT—tftj S v,ti Tv E r� _ - - - cote. - NMI MN ��{, 1 Pl'M�1NG r F !(r II{ 1 O� Ir'� E - �1 sm Al WWRI1101 loom �111)4 alp w t & Q tf1A1f 11E C11Y a 29 d"M A wa>ad w paw ao LOM -- 1RYwi1 Cis AND°pa"W6Millillaw -- — — k Pao geld snp 1D> R a A2- P fo "}dao 8wpplqAh CA r4OWarad 1104A )OOMW 010115 IRS [c 10 Sa slow Aug am 4 IA" di This 0 of pens end sDecln catiora i - W IM put sawq Hr It 40 alp ae OR Eq tha lob at ill times and k lA w ; owl wloltaRuaade put swtd Wbe ISO tsltd to vek& any ehxnges OF e1tue8eau - 1 _ f pa.mitlbil hon. _ 0n sane without w '116" � _ � � ij�V f - --- — - _ nl.tv of Cupom". The aplrlp;c+.cf,hsp:zt� T+ OWN" Wdy S3 sNALL NOT be hen pe mit of IID• W. ' b Abp 3N1 NitAl YI apprwRl of the vicia:iva al ay�truathw a3AOUddry M any City Ordnance a &84,42 614,U 1-• C44C1-1 cJ EC HWE D - AUG 2 7-1992 - ---- _---_�_— � _ _ • �- BLDG. INSPECTION DEPARTMEiL •` CITY OF CUPERTINQ ECL - - DRAWN p JOG NAME 1 -- This Is aneoriginal drawing wemm.d for your , , �,� i } _� L�1F+� ►� 1- G� paraoral use h connection with ■ proje withct belrq I �' C� planned for you by CaN/omle Sign Co. Thus designs are the property of CWftmh Sign Co. DAT ` REVISIONS f{ r��`- Clrr ►NONEt and stnaa not be reproduced or UhWhed M any G�-`r�G k?.f-rk LJfash © E Sign Co.4 e umcusomer, ague b pay CalH mis Ings SIGN O.$Lyn C11N wfn OI : r these drawMgs SCAIF ADDRESS an shown to any sign manufacturing company � c < for layout and design ►moi / 2 O � `J_� �` +�`✓ C�- � CUSTOMER APPROVAL: SHEET OF - F $40 WILLOW ST. SUITE 300 SAN JOSE,CA 95125 (408) 295-1887 FAX:(408) 295-2150 INVOICE t SALES !E/. s.n mse�uEcw•ar to - - _