28022APPLICANT TO FILL IN INFORMATION WITHIN RED LIMP-q. usP Pal I POINT Dom nYl v
IIIILDL LLI.C'I RICA],
CITY OF CUPF.R'PIN0 APPLICATION /PERMIT PLUMBING - MECHANICAL
BUILDING DTVISION
PERMUTING. O
BUILDING PROJECT IIIENTI EICATION
BUILDING ADDRHSS: -.a
UNITM I.OTM
SANITARY NO,
APPLICAGON SUBMITTAL DATE
CONTR 'SNA E:/J LIC NO:
lYr\
N/C CONTROLp
❑
A 111'IECT/ENGINEER: LICNO' -
ADD ..
PHONE:
Q9'Y.
ELECTRIC PCRMIT'
FIiE
BUILDING PERMIT INFO
rCONIACI:
PERM11'ISSUANCB
BLDG LELT PLUMB MECIi
❑ ❑ ❑
LICENSED CONIRACTORIS DECLARATION
.y MrcM1yaffimnhatlum l'mensnl nnderpmvisiomnfCM1Upmr9 (cmmmencingwith
ne. effiDivlsonJ of the Busines xnJ Professions Code,mtd my license is In
meandeffem.
gPpLIANCES- RESIDENTIAL
09 DESCRIVI'ION
�
�y)
PANELS
e Class Lich
iy Date Conmaeum
UPT02MAMPS
2111 -IOW AMPS
tQ11GIR
,Z ARCHITECTS DECLARATION
1 understand my plans shall be used as pu fluum ords.
ARHA
S /SQL FT
OVER IOW AMPS
ELECTRICAL
I�SIGNS
LsenuJ Pefesstonal
U OWNER - BUILDER DECLARATION
f-, I hereby m Erot thin 1 nor exempt from the Controller's License Law for the
h following rensen,(Seadon 7031.5, Business and Professions Code: Any city or county
which requires u permit to construe. almc improve, demolish, or repair any smucturc
pnFor to its issuance. also requires the applicant for such permit o fi le a signal statement
drat he is lleensnl pnrsaam to ate provisions of the Contractors License Law (Chapter
Y. 9(comme rem, with Section 7", of Uivision3 of the Business onJ Professions Code)
SPECIAL CIRCUEDMISC.
TEMP. MUTER OR POLE INST,
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUATION
y or that he is exempt therefrom wA the basis fradmi leged <nemp,mr. Any ekdatimnof
Y Senior 7031.5 by any applicant fm a tomtit subjects the applicam to a civil smalty of
a0 opt more than five handreal dollars PAWL
°m ❑ 1, asownerof thepmpcny ,ormyemployeuwithwagesazteirsole compensation,
_ will do the work,and the summate is not lntenfol nEmed forsale(Sec, 904,L Business
and Proma.simm Code: The Conmmors License Law Jules not apply as an owner of
progeny who buildsmimproves thereon, andud odoessuch work himselfterthrough his
own employees, provided that such improvements .00t imendeloroffered fertile. If,
I sever, the buildingor improvement Is sold within one ycufofenmpleties,Ihoowner-
milder will have the burden of proving that he did not build or improve for purpose of
sale.).
OUTLETS- SWITCHES - VIXMR17S
NEW RISIDENTIALELECR_SQ.I7..
STORIES
TYPE CONSTRUCTION
OCC. GROUP
RF.S, UNITS
TOTAL:
QTY,
PLUMBING PERMIT
FEE
El 1. 111, owner ofthe property, am exclusively contracting with Hennaed contractors to
rename, the pmjeel (Sec. 7044, Business anal professions C,,:) 'Me Contractor's
License Law does not apply to anownermf progeny who buildsorimpmves thereon, and
FLOODZONE
APN
PERMIT ISSUANCE
who contracts for such projects with acontractorfe) licensed puauem to the Contractor's
License Law.
❑ 1 nor exempt unAer Sec. , B & P C for ,his rwsan
ALTER - DRAIN & VENT. WAT131t (EA)
BACK FLOW PROTECT. DEVICE.
FEE SUMMARY
OUT' U E FEES
Owner Dent
SANITARY y_N_
RECEII'l'p
' WORKMAN COMPENSATION ceni uefern DECLARATION
❑ Thereby affirm that lhave acenificme mf ronsenun self- insure,macen.)Ililf
DRAINS - FLOOR, ROOP,AREA, COND
HOOL TAX Y N
IIXTUPHS - PER TRAP
onsets 11e.111reaonle, this vrru certifiW copy lheremf (See.7gW, Wit CJwhich
ors all employee's under this pcnnit.
RF.CEIPTR
PAR fill Y N__
HDIVISION
GAS - I?A. SYSTEM -1 INC UThISI'
Compact
Company
GAS - PA. SVS'fB VEIt4 (EA))
BUILDING DIVISION .S '
❑ Cenlllod copy is herehy fumisbed,
❑ CrnifiW Copy is filed wi0 the city inspection division.
PLANCIII ?CK ' ?II
GREAS- USTRL WASTE INTER O
GRADING FEE
CER I'IFICA'IE OF Ii E PUON FROM WORKERS'
COMPENSATION INSURANCE
G BE TRAP
LS
FEE SOI
(This sect ion need not be completed ifrhe permit is forms, hundred dollars ($100)
or less.)
SEWER- SANITARY - T01i WET.
ENERGY[—
I modify that in , h, Portmtance of," work fiellich his permit is issued. I shall
not employ any person in any manner so as to become subject m he Workers'
Compensation Lawsof C011fomia. Date
Applicant
WATER ItFTER W/VENP
PAID
WATER SYSTEM RF.A'TI G
Data ReceiplN
NOTICE I'O APPLICANT': If, flat emking,his Certificate of Exemption, you should
become subject o the Workers Compensation provisions of the Labor Core, you must
6nthwno comply with Fault p rv'nions or this Permit shut l he deemed revoked
`
WRESIDENTIAL , B,-SQ.('.
TOTAL:
B LDINGFEE eopj
CONSTRUCTION LENDING AGENCY
1 herehy of firm that is a construction lending agency for the performance of
,:he work for which this permit is issued (See. 3097. Cis. C.)
out Nome
ISMIC PEE
'IOTA L:
ELECTRIC FEE
Lenders Address
1 muily that 1 have raN his apphemum and sots Elm ,he shove mbommion is
'conk.
QTY.
MECHANICAL •RMIT
FEE;
PLUMBING FEE
I agree 10 comply with all city and county ordinances and male laws relining to
building contraction, and hereby aurhatee representatives of thiscity to enter upon the
,nbmve- mentioned property to, inspection purprnes.
(We) agree to save, indemnify and keep hotmless the City of Cupertino against
liebilitics,jadgmems. casts and expenses which racy in any way ac ,said by
a roes L true of granrng of this p, k
P[RMIT ISSUANCE
MIiCHANICAL Pon
ALTER OR ADD TO MECII. -
CONSTRUCTION TAX '
AIR HANDLING UNIT (TO IQBUO CFM)
AIR HANDLING UNIT (OVER IB,Bfp CFM)
�the
4 l
�y/hel/ R
Sign am Ic Apphemn /Conmem, Dote
EXHAUST HOOD(W/DUCn
PAID
HEATING UNIT (TO IW,05) BTU)
Dam ipt
I IAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant same or handle hazardous material
O..
as dented by the Cupertino Municipal Code. Chopler, 9.12, and the Health and Safer,
Code, Stamina 25532ho?
IIEATING UNIT (OVER 1(10,000 BTU)
VENTILATION PAN (SINGLE RESID)
❑ Yes ❑ No
Will For contaminants a inants e,building by the ay equipment Quality
OF... emus air commninants n defined by the Bay Area Air Quality Management
I Di.mdmr
BOILER - COMP(3HPOR 100.0W BTU)
BOILER. COMP (OVER INLODO BTU)
1$$LANCE DATE
Ir AID
,1
D
❑ Yea . ❑ No
AI .,
NEW RESIDENTIAL MECH.-SQ. FT.
I have read the hautAOUs materials requirements under Chaper 6.95 of the
if the wilding does b &Safety Core,Sedionsonal,l. iris y osper4. 1undenotif that
ifcupant of he quiremnts which hemel pitismyeasuccibili,y to notify the
Occupant of the requirements which must be me, prior m issuance of a Cenificme of
Occuponcy.
/� 1gg�
Cqy OF ry j
V
s.rl O
BY:
Owner ter vuthorueJ ,gem Dam
TOTAL:
ISSUED
OFFICE
APPROVED
IN ACCORDANCE WITH THE CITY PERTINO CODES AND 0 D NANCES
C 1S J
GATE ?lam
SIGNEO
This set of plans and 8 ecilications MUST
be kept on the job at all times and it is on,
lawful to make any changes or alterations
on same with(,ut written permission from
the building Dept, -City of Cupertino.
The stamping of this piar, and specifications
SHALL NOT be he,d to po mit or to be an
3PProval of the vroiatirr of any provisions
•)f any City O.d.nance or State Law, - -
0
47-
RIJIfF-
POPA ENGINEERS Inc.
MSTRUCTURAL ENGINEERINGCONSULTANTS
Golden Valley Office Center • 2542 S'. Bascom Ave. • Campbell, CA 95008
Phone: (408) 559.4202 Sulre 102 Fax: (408) 559 -3628
u
ON A P P, cA g
r No. CO3 45 y ),
Exp. 3/ 1/97
y�FOF CAL1f�F�°
n
I � ill
p /m 7 7=BlYC ¢'d!Y 1-07,
N� SaJtS CEPmRT 2U�5 7'/7£= rl1 /L.05-A 7'r.D
77l'E IfW1) Pf -`.SEQ ON. V/5(Jd1 J'
if-.SS Urtl1� r
Ph 55 / ✓E 5v1' t9 P2ESS UrB.; �etw "Dc-
/
W /A/d.' LS %±CjYPGti55fJC;E
05 E'd /j-7 �hPP,L'OX (°•° c.
,���iGN : �PJ'1tE•d �' /r reS 1. /�P 2V•f'1 L '
70 7,E5 /sT '.0a/9/- ?/le!'ivL) /two R.�71,nUnLG
I T,�'uS /S7�d
.�Y 7� i`C7il- 'lv.r',v� vv�l -� • .-�rroT�'��c�r
,, cnAGE :
0
' Jb� G �yo.d K yam• ° /Z c..,0 /PQ
r yr
r
, I � ✓S r'qx � IPTaf
/P ,OTC% !{.1 +i'tL .BE.`' USED __. •
X /7 C
,
7/i�AC/'NG
rlllbk5E = �,c 3� = Z��i —�• SASE :� l�X �J' /2 = 27i�' /•,
T2y d' GM U z v i r% # �} Uerzn
�PT Nn S �ECnlA /NS7'ECJ>m� f[ =�o
PIP
✓'J Pin., o�
J' 2, —x Pd'
=$ a POPA ENGINEERS Inc.
\ STRUCTURAL ENGINEERING CONSULTANTS'
Golden Valley Office Center - 2542 S. Bascom Ave. • Campbell, CA 85008
Phone: (408),559.4202 Suite 102 Fax: (408) 559 -3628
0
rr ;t?zA-1'twcf�, r7yC o; T
7-1-Z-1 z !. ry y
Q/° /'✓fix Z, �> /un = .�J�� x /, �� _ 94xr �
✓79
7
P3
0 I
Z
z 10 /
Z
3
z /
�f 117c°✓,Jx /,n✓3xGlL /.�lv /OJz✓, /'
7 iv
1
U5� ��U /.V.iI"LEN7 " SGtiV�1 -('�.£ °✓,cG7>,aN.
,II T 2 U�nC L A 5/ �U1 L d E P 7-741(-
fis 4 /N z.
.K /off -/> G /a3 4OIL
ATE Job No.
POPA ENGINEERS Inc.
on Y STRUCTURAL ENGINEERING CONSULTANTS
'd By Golden Valley Office Censer • 2542 S. Bascom Ave. • Campbell, CA 95008
Phone: (40.7) 5594202 Suite 10: Fax: (408) 5593828
em
r
Ilk
P17 dF' -
-T�NCE Aa�•7
� -
14i /nro
r1J
1. I
lG P /E4 x 7 ro;
/to '
/
�
^JI
O
—
/ ,I
r
na I
�F4
TE7*111L 1'A!G lV4.ZL' .
wK
a
dE7eL . 6 EG -7ta•N
x'7-n LIFe,-
/f-7
VEzriC��S
j i
... 77£5 @ Z4 rPC
'
m
� ! Wit,• �
Job No.
INA
POPA ENGIN�ERS,Inc.
Design By
p mew) STRUCTURAL
ENGINEERING CONSULTANTS
Chk'd By
Golden Valley Office Center
• 2542 S. Bascom Ave. • Campbel6 CA 95006
Phone: (406) 559 -4202
Suite 102 Fax: (406) 5593620
Ot
- wamasa4ovmwa®ncxear�cv-