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ADDI If`APITTn CII 1 Iw IwcnnUATlnnl WITHIN RFn LINES — USE BALL POINT PEN ONLY -
- - -- �- Building Project Identification - '. - '
Building Address:
PERMIT NO. ^ ^
'/ J I JO
i35'3' t��Or2c3.a�.,,
GJ r J
wars a hone:
. - "1-( U `y KY -
CITY
"
OF CUPERTINO-BUILDING DIVISION
APPLICATION [PERMIT
BUILDING ELECTRICALPLIIMBING MECkiANI
AL
°
CnntractorsName� 9 /Lic No:
SO U I YI LORx1 P LU V'-x 6, wl E1 �/ Ip��1 14.
CATEGORY
CONTROL If
Archftect/Engineer.. Lic. No
i4?Y'•;
1' GLECfPRIC PEIjMTP�`� ; .t �,
10
'„ iFEE'I'
1,'thr, BUILDING PERMIT INFO
Address: Ck 0 o I LLD N V-13 ZL
PM&TISSUANCE'
" LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9(commenc-
APPLIANCESRFSIDENTIAL
JOBDFSCR811ION
PANELS
ingwith Section 7000) of Division ofthe Businessand ProfesslonsCods, and my.
ucense is In full DreragS doff et �/ ..
Licensec; �"J Lie.» 4 (f 3Ol ; -,T n— A
Dan, Contractor 07" R,TI I- L�-flY 1Nl�
- ARCHITECTS DECLARATION'.
I understand my plans shall be used i s public records.
-
201 -1030 AMPS
OVER 1000 AMPS
SQ. FT. FLOOR AREA
$ /SQ. FI'.
SIGNS ELECTRICAL
Licensed Professional
,
SPFCIALCIRCUIT /MT9C.
• OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License law for the
-
-
TEMP. METER OR POLE INST.
POWER DEVICES.
following reason. (Se Lion 7031.5, Business and Professions Code: Any city or
county which requires permit to construct, alter, Improve, derroibh, or repair
an ystromrre prior to its lssuancs, also requires theapplicant fcrsuch permit to
file a signed statement that he b licensed pursuant to the provisions of the
-
SWNTMING POOL a
Contractor's License Law (Chapter 9 (commencing with Section 7") of Dist-
ston3 of the Business and ProfessionsCods) orthat he fix exempt therefromand
V
VALUATIONS,
the basis for the alleged exemption.' Any violation of Section 7011.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
five hundred dollare ($500).. , - '
�l, as owner of the property, or my employees with wages as their sole
OE.�.� H
- -
_ ..
...
NEW RESIDENTIAL SQ
%
RIPS
TYPE CONSTRUCTION
compeaation,will dothe work andthestrueture is noHntended'or offered for
sale ( Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and
whodoessuchworkhlmselforthroughhi sownemployees,provided Natsuch
improverrentsarenotintended oroffered forsals. lf,howevegthebuildingor
!
OTC. GROIJII
,
- e
- AF5. I1NTT5
TOTAL:
improvement is sold within one yearofcompletion ,the owner- bullderwill have
tl�vrden of proving that he did not Wild or Improve for purpose of sale )'QTY;
u L as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business and Professions Code:
The Contaam's License Law does net apply to an owner of property who
builds or. improves thereon; and who oantacts1or such plojeas with a
c¢Rt &or(.)Ifcensed pursuant to the Contracor's License Law.
L� I am exempt under, See. B & P C for thins reason
'},�
q „'P6013IN' PERMIT •yt,?;
;.
;FEE;'
.,gpOD ZONE
'
APN
PERMIT ISSUANCE 1
/�
AL7II2 -DRAIN &VENT -WATER (EA)
,j' i FEE SUl14MARYn
,s.4
}
- - -
BACK FLOW PROTECT. DEVICE a
-
OUTSIDE FEES
DRAINS FLOOR, ROOF, AREA, COND.
-
SANITARY .Y_ N_ ,
RECEIPT If
Owner Date
WORKMAN COMPENSATION DECLARATION
MI hereby affirm that I have a certificate of consent to self - Insure, or a
certif loteo( Workers'Compevatlonlrndurance oracertifled copy thereof
3800. Lab C.) ,�
Policy ft SI fJ1: NNO BN
FIXTURES. I'FR TRAP
_ -. -
�.� -
SCI {ODL TAX_ Y - N' -
RECFR1Tp -
/
GAS FA. SYSTEM -1 INCAGUTLETS,-
••
PARK FEE - Y N_
, RECFB'Tg .�
GAS EA. SYSTEM- OVER 4(EA) •.
- Coro any-
BUILDING DIVISION FEES
�Certgiedcopybherebyththsdd !. -
�CcrtBred copy is hard y fu she dty inspection dt i Ion.
GREASE /INDUSTRL WASTE INTERCEPTOR'
•,
PLANCI-IECK FEE "•.
.
GREASE TRAIL -
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(this section need not be completed Bthe permit is forone hundred dollars
SEWER- SANITARY -STORM EA. 20017[.
DRIB Recei t#
WATERr1EATERW /VENT /ELECTR
.
ENERGY FEE Y_ N_
($1 ro)orlese.) work
Icenot email the permit is Issued,
in ny
WATER SYSTEM /TREATING
�
mante gorwhabeco
I shall not employ any person In any manner m u to become subject to the
person
Workers Compensation Laws of California. Date 4
PAID.
NEW RFSTDENTIAI. PLMB. _50.17[.
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should become subject to the Works. Compensation provisions of the Labor
•... Date ` Recei t #'
TOTAL:
'
-
BUILDING FEE.
Cade, you most forthwith comply with such provisions orthb permit shall be
deemed revoked..
- CONSTRUCTION LENDING AGENCY
°•
i -
SEISMIC FEE
SEISMIC FEE
-
IhembyafBrmthatthereisaconstructionlendingagency forthepe.rfcuri
arm ofthe work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name -
Lenders Address - .. - -
Imhlfy lhatl have read thisappllcaHmnand statethattheaboveinformatlon
Iscorrea.I agree to complywith all city and county ordinances and gate laws
- 7-
.
PLUMBING FEE'
QTY.
t;
' ' MECHANICAL; PERMIT
". FER
MECHANICAL PEE
'
- i,
PERMIT ISSUANCE
FEES PAID:
relating to building comtruction, and hereby authorize representatives of this
city toenterupont he above - mentioned property for inspection purposes.
(VI;e) agree to save, Indemnify an d keep harmless the City of Cupertino
d rants Band ex enses which In an ova accrue
sgalnstllabilltieYin R —t P Y Y Y
-
-
ALTER OR ADD TO METH:
Date - Recei t#
P
AIR HANDLING UNIT (TO 10,000 CFM)
..
SUBTOTAL:.
permit.
Bit City in con nyE of the granting oftMa permit
^
AIR HANDLINGUMT(OVER 10,000CFM)
CONSTRUCTION TAX
-
Signature - " - .Date,
AppiHAZA
EXHAUST HOOD(W /DUCT)
CONSTRUCTION TAX PAID:',
I DOUSor
. HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous
meterul as defined by the Cupertino Municip.I Code, Chapter 9.lZ a.d the
Fleahh and Safety Code Secion 25532(a)?
M Yes r! No .; ..
Will the applicant or future building occupant use equipment or devices
HFATNG UMT(TO 100,000 BTU)
Date Reeef t#
HEATING UNIT (OVER 100,000 BT1A -
.. .
. TOTA
VENTILATION FAN (SINGLE RESID)
..
ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area Air
Quality Management District? ,:•.
nF�I Yes j�INo
[have read the hazardous materials requir erants under Chapter 6.95 of
` p
"K -'�.�
V
-flat^
BOILFRdAMP DID? OR 100,000 BTU)
-
BOILER- COMP (OVER 100,000 BTU)
the California health &Safety Code, Sections 25505,25533 and 25534.]
understandthatlfthebuildingdasnotcurrentlyhaveatenangthat lHS y'•
responsnbtbty to notify the occupant ofthe requirements which must be mot
prior to issuance ofaCarBficate of Occupancy.
-
I� /4Y 26- ,-
' 'v
�,,:Yur. 199
ISSUED BY:
NEW RESIDENTIAL METH. SQ.I7.
,v
'Owner or authorlaagent,
d '. Dace;
t,
TOTAL:
' :".0010E COPY