28015 A @P_I,ICAN,T TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO 11111LUL\:-LLIA.IRILAL PERMITNG_ 28015
APPLICATION/PERMIT PLUMIIIN(:-AIF.CHANICAL
BUILDING DIVISION BUILDING PROJECT MEN'1'IFICATION aiv
BUILDING ADDRESS
� /s�C 1. f�/1�IY��+ I SANTI'ARYNO APPLICATION SUBMITTAL DAM
((91-1 ( 0 61Na& JRTH- UNIT I.OTN I�QLIIS
OWN/E�R/S1N'�AgM�ISi:` -7,1817 PHONE.
95 CON'(' V-S NAME LL • &V`S �N �-7I `J
I'�14 NCB e/4µ) `(},,HIV�/L./Vy�x I ^/1•��� 1 I N/C CONTROL R
ARCIIITECr/I:NGINEFR: LIC NO A�TV3O 11VLJt1X ll'JV 11.00$
CONTACT PHONE.
QTY. ELECTRIC PERMIT PoiE BUILDING PERMIT INFO
•L PLUMB A1-1
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION pppLANCES-RESIDENTIAL
MWZ' Ihereby affirm hat lam hire..sedmi lerpmv,smnsofChapmr9(commenemg wmh IOIt DESCRIPTION
�00 Section
hardddefet.Division Business and Professions Code,and my hcrnse ism �� •�'
�ZIF full..c Cl.d effect. E Lai C�
F.ZW I.Iecnne Clus. Lich y I UP T�OIW AMPS
mQy
Data Conn'nS' 1201-1000 AMPS _
8pNZ ARCHITECTS DEC RATIO I IOVER I000AMPS SQ IT,FLOOR AREA $/SQ.FT.
O�..,C 1 undersmnA my plans shall ed used as pub a TIO _
Q,y � Lmcnsed Pmlessionel I SIGNS ELECTRICAL
Cy W< OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
3 XO W u I M1erer,affirm hat 1 um
w exempt frontline Contmnors License Law for the 3 nlowmg re,wou (Section 7 031. .
Business and Professions Code:Any city or county I TEMR METER OR POLE INST.
lggqq"'�El w ach requires a pe,mn to construct,uher,unprare,demol.Sh,or repay my structure
200}� prior to its Issuance,also requires he applicant for such permit to File os,gned statement (POWER DEVICES
that he is licensed pursuant to the provisions of the Cantnem' I xc Lew(Chapinr
ldelp 911ommenem8wnh Section?"'ofp,vrsmnlofhe axles.and o eI I SWIMMING POOL ELECTRIC VALUATION
i[u..m nrhm he..exempt therefrom nnd,he busts fonhe alle edexemptmn.Anyvmladonof
tea Sation]031.5 by a,y applicant frapenn..sub3enst eapplicautaoaavdpensltyof � Ol1TLE SWITCHES-FIXTURES
not mom than five hundred dollars($500).
04 C3 I,asownerofthepropcny,ormyempinyres w,h egesashnraolecompensmion. I NEW RESID ALELECfR _SQ.FT. STORIES TYPECONSTRUCfION
a3= will dohhe work,and the sdunure is not inlendedorof mdfmadc(Sec.7044,Bmmcs
and Pontes.......Code The Ct and mr's License L does not apply m an owner of
prnpenywhobmldsorimpmve shercon,andwhod suchwork himselforthmugh his
employees,Provided that such improvements no m
Unndedminfreredfor le f. I I OCC GROUP RES.UNITS
however,he building ormmpmvementis sold with, oneyearoreampleuon,he w r �In ///...��� ,�{o
huddler will have the burden ofprovmg that he d. notbuild or prove u � ' T I•
sale). �r��-�/� PJUMBINGPERMI'r FEE FLOOD ZONE APN
❑ L as owner ofthe property,an exclusively rummin w .11Grg/a ^
mnnma the p r,nd(Sec 7 1 .Bmmem en Rofessio,s C U s e e�inect I /,�RMIT ISSUANCE
lacense Lawdeesnotapplyto rram nerofpro whobdilds p ereoo,and
w Ito eommen formu:hpro r,o,with a convect s)hcensed puts nrimhe Ciamonnor3. ALTER-DR IN&VENT-WA,F IPA( a;
Lcense Law I F FEE SUMMARY
❑ 1 amesempt under Sec ,B&P C for do con I SANITARY uGI'Y DFDF O-'Fq N
/ RACK FLO PROTECI'DEVICI?
Owner I ^ate RVIF-Ppli
WORKMAN COMPENSA ION DEC[. IOI DRAINS-FLOOR,ROOF,AREA,COND SCUOOLTAX Y N
. covers❑ Hom,hyaffitm that)M1aveecemOcumo and In sure.ofacenlfeem of RP"rIPTN
Wmkers'Cnmpcnsaion awrowed m mocrofied copyhereof(Sec.3600,Lab CJ whmh I FIXTURES-PER TRAP (PARK FEE Y N
all employee'sunder this Perron. GAS-fiA.SY$TEM-I INC.40fLLS RECEIPTN
Pohcyk
BUILDING DIVISION FEES
Corruption (GAS-LA.SYSTEAI-OVER 4(EA) PLANCHECK FEE
❑ Certified c,,,s hereby furrashed. _
❑ Ccmfied copy.filed wish henry mspmtion division. GREASEWNDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS FEE
COMPENSATION INSURANCE
plus section need not becompieted tithe pint is forme hundred dollars($100) I SEWER-SANITARY-STORM HA.200FT ENERGY FEE
or less) _
I certify hat to the performanceofhe work for which thi,pernt,s issued,Ishall WATER((RATER W/VENT/ELLCI'R
of employ an n in any m r so to eco 1b m the Workers' pA]p
z Co.prnsati .,ws al,fomIs rjy m s I WATER SYSTEM/1'RIATING Dote Rxe,ptp
Applicant ____ _ _ _ _
z NOTICE TOAPP}.CANT:I( firm this Certificate of Exemption,you should NfiW RfiSIpENT1AI,PLMB SQ.FT TOTAL
� .�r hcome sob)ect/fiheWokers Compy uhan provisions ofhe LuMmr Code,you must (J� q„
a7
forthwith comp with provisions or pennil shall eddeemed invoked. ' IBUILDING Fiz V 4�
QI hereby affirm that heis construction LEND lending agme,far the pert rrmanee m SEISM1IIC FEE. V� 4s
UO the work for which his perad is issued(See 3097,Cie.C.I TOT'AI-: ELECTRIC FIRE (/l�l��•+�
Leaders Nmr F Leader PLUMBING FEE
O
s Add, (QTY. MECHANICALPERMIT FEE
L) I certify that I have read his application and sham that the ahove mfovnetion is
.>' 0.W. i rcct.In to coo (hall cis yon g I MECHANICAL FEE
Tice pywi yund aunt hnnnces and come laws relutin ho PERMIT ISSUANCE
build.ngrnnsnucuon,and hereby auhhoriss represemativesofth,s city to enter upon the 1 TAX
U z aboremenhoned ro
property for inspection purposes. I ALTERORADDTOMECH CONSTRUCT TION
(W)agree m save,indemmfy and keep h s the City of Cupertino.,at...
huh. •n t t d xpensea wht nuny weyuccruc oganst said C.ry AIR HANDLING UNIT(TO 10.000 CFM)
5e quenc of li fraud of ths p AIR HANDLING UNIT(OVER 10,000 CFM)
S.gn:n of mmC /ate I EXHAUST HOOD(W/DUCf) PAID
IAZA SMATERIALS DISCLOSURE HEATING UNIT(T'0100,000 BTU) Doe Rece,pf-
Will the applicant or future building occupant atom or handle M1Vendous material HEATING,/NITIOVIiR IOO.q)O BTU) TOT
as defined by the Caperton'Munmip,l Code,Chapter 9 12,and the Health and Safety I
Code.Section 2.1532(a)' VENT]LATION FAN(SINGLE RESI D) 1 I
❑Yes 1:1 N..
BOILER-COME UHP OR 100,000 B1V) /��I�y"""" ISSUANCE DATE
WJHhcepphcndriam as&fd al by thenmw equipment uishlyc Maralgemert I *4 A ^.
.huznNous nor rnntaminanN as JefineA by the Bay Arce An Quality Management I BOILER-COMP(OVER IOO,gq BTU) Y I" q '
DianW "1 0
❑Yes ❑No I NEW RESIDENTIAL MECH. SQ IT
I lave real he hazardous materials requircme,ns under Chapter 695 of the
Cahfomm lleWth&Safety Cale,Sections 25505,25531 and 25514, Iundersand hat l✓h ,yQ�
if We budding Jocs not curemly timeannnnq tai it is my odp,...h.hry to nntlfy he `4/R/JJJ/�F///%)
occupant of the regmremems which must be met print m,ssuane,of o Cemficule of I LUMr,J
Occupancy eJ O
Owner or anlhoriLed agent D.ne TO PAL- (ISSUED BY:
OFFICE _
LOT N r
• I C6 O 4 4LIS(O
i
i
y
MAY 81995 D
ROD.91TY s n UN DEPAR a"r
C,�iANC� REC7P.
0170 �NSW6R�C#-i dr,
OFRCE COP
- _.. APPAc)X- LwA-rion) car 5kYe-lesW,
CC
,v
1
• J
h�3 -
r
7.X6 ��n40.C .
3RT44 51t>E: VIEW TYP. _
Df, l(o O.G.
.c .
f
A-35
L J
I
J015T t>EXAIr.,... P, NOT 70
� r.�G C(r➢LlN(T
(oXfo D.F. C3Ef�M 3(o" O.G.
I
I '
It
I f
iL J
4 �
, I
1 �
TOP VIEW IZfl�'f"�R
' - .NO'F YO SGMVfi