23839 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO.
BuR�Addreaa: � 23839
MAL DATE
nsra a �+O
KL oZs — CITY OF CUPERTINO-BUILDING DIVISION
III cn b raNam: Lie No- APPLICATION 1 PERMIT -7—93
Irl BUILDING-ELECnUCALPLUMBING-MECH LAICAL CAT[GORY CONTROLN
Architect/Engl - L+c.Noi
^ QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Address:11�1 1 ,. SPA-\5K
OS : PERMiTISSUANCE �.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirmthat lam lkensed under pro lacesof Chapkr9(mmmenc APPLIANCES-RESIDENTIAL JOB DESCRIPI ION
+ngwlth Se ion7000of DlAsbn3ofthe Busir =dProfesstonsCade,and my PANELS '�rw
license+sln f e nd cited. FL-rV1� .
Licer,le C Lie p n�
Date 1100 Contractor
UP TO 2DO AMPS
ARCHITECPSDECLAR ON 201.3000 AMPS
qre0 Z I understand my plans shad be used as recordsOVER
p
. OVER IOW AM AMPS � SQ.FT.FLOOR AREA -E/SQ.FT.
O❑
Fi o U Licensed Professional SIGNSELECTRICAL �(}� .• .. .
«<<a�.gt OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MLSC
I hereby affirmthat l am exempt imenthe Contractor'slicenw l.wfor the �
Z following reason.(Section 7031.5,Business and Professions Code:Any city or TEMP.METER OR POLE INST.
��I"� muntywhkhrequiresaperm+tt...trud,eller,Unprove,demolish,or repair fI----�as p e �`
§i�ee anystmd mptl wiftbauame,ahomqulmtheappRnMforsuch permltm ppWgg DEVICES (\ ❑ F� Y 1 E
R y ilk a signed statement that he is licensed pursuant to the provisions of the y�f I YY VVV
Ow
Contractor's License Law(Chepter9(comnencingwlth Sedion7W0)o(Divl- SWATMING POOL ELECTRIC UATION
I-,30 sion3ofthe Buslnessand ProfembroCode)arlhathebexsmplthemfromand
< the bask for the alleged exemption. My Aviation of Section 70315 by any OUTLETS-SWITCHES-FIXTURES �{T JI
appRet m
ca^t for a permit subjectsthe applicant to a civil penalty of not than
five hundred doll.,(ES00). NEWREKDENTIALELECTR_�uQFT. STORIES TYPE CONSTRUCTION
I,as owner of the property,or my employees with wages ss their sok
I. mmpem doM willdo the work and lhestruclure is not intended or offeredfor -
"pa4', p sale(Sec.7004,Buekesnta
s and Prof.imu Code:The Coct^/s License Law
does not apply to,en owner of property who builds or improves thereon,and OCG GROUP RFS.UMTS
whodoessuchworkht.1f rthrough Msownemploy.,p.Medthatsuch ^
Improvements are nor lnlended oroffered far uk.IL however,thebullding er TOTAL: PRO
ImprovementkwldweNnomyearofcompldlon,theowner-bu0derwillhave .. . 6 4
t rden of proving that he did not build orlmpeave for purpose ofsaleJ. QTF;,j`+,,G?;`aYLUMBING P$RMIT,111,"T?� +' FLOOD ZONE APN
JL as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
contmehars to consumer the project(Sec.7096,Business and Professions Code:
The Contractor's Limnx Law does net apply to an owner of property who ALTER-DRAIN k VEM-WATER(EA) _
Wilds or Improves thereon, and who contracts for such projects with a F$$SUMMARY•
c ( ec
s)Ilanaed pursuant to the Contractor's LlceneeLima.Law. BAIX FLOW PROTFLT.DEVICE
am exempt under S . w
B k P C for this iean - _Iva
Owner Dale DRAINS FLOOR ROOF,AREA,CONTI. I SANITARY RECE N
WORKMAN COMPENSATION DECLARATIONS
PER TRAP SC7{OOL TAX Y_ N_
�p—Q�{•hereby affirm that I have•certificate o!consent to ee8-kwre,orFD(TURFRECETT N
�nlRate ofWorkeri Compevatlonlruunnaoamrtlfkd ropy lherrof(Sec. GAS EA.SYSTEM-11NCA OUTLETS. PARK FEE Y N
7800.Lab S) RECEPT M
I'°IIryNn, �14—CT�aQ� - GAS PA.9YSTEM-OVER4(EA) BUILDING DIVISION FEES
Com an�B
rtlfled copybhereby(umlehed. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
CertNed ropy b filed with the city InspMion division.
CERTIFICATE OF EXEMPTION FROM WORKERS' - GRF-ASETRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA MET - Date Recei the
TThksectbn need net he completed+(the permit Is for one hundred dollars
(S100)rnless.) WATEREN
HEATER W/VT/ELECTR ENERGYFEE Y_ N—
I artlfy that in the performance of the work forwhich this permit le Issued,
I shill not employ any person In any manner w as to became subject to the WATER SYSTEM/TREATING
Workers'CompensatlonlAwsoi Cdlforela.Date PAID
ZZ APPIica^t NEWRESIDF-NTIALPLMB. SQFT. Date Recei tic
Z O NOTICETO APPLICANT.If,after making this Certificate of Exemption,you
N should become subject to the Workers'Compensation provisions ofthe Labor TOTAL:
Cade,you swat forthwith comply with such provkbru orthls permit shall heB G -,
m
deeed revoked.
W CONSTRUCTION LENDING AGENCY - SEISMIC FEE
a I herebyaffirmthat there is a construction lendingagency for Ne perform TOTAL: ELECTRIC FEE O r+
D Z anmoflhe work forwhlchthb permit is issued(Sec.3097,Cie.C.)
0 O Lcrder's NamePLUMBING FEE .�•
F Lc^dm's Addmas QTY• . MECHANICAL PERMIT FEE MECHANICAL FEE
LL U I corlifylhat l have readth+s applicatlonand statethattheaboveinformation
O W bcorred.I agmto comply with all city and county ordinances and state laws PERMIT ISSUANCE k. FEES PAID: .
>. a relatleg to building construction,and hereby authorise representatives of this
(_ N city to enter upon the above-mentioned property for Inspection purposes. ALTERORADDTOMECH.
_ 2harmless, - Date Receipt#
(Wtlagrcc to Odgm^demNtyan expenses
whichthe ymy.crue AIR HANDLING UNIT CFO 10,000 CFM(
V agalnstllabllltlee,jadgments,mstsand expenses which may In anyway accrue SUBTOTAL:
ag mcuybinn n on gra ❑ of th apertn+t' CONSTRUCTION TAX
AIR HANDLING uNTr roVE210,0DCFM)
t+-reof Applicant/ContactorUcke EXHAUST HOOD M/DUCT) CONSTRUCTION TAX PAID: ,
HAZARDOUS MAT RALS DISCLOS
Will the applicant or town,building occupant store or Udle hanrdvus HFATINGUMT(TOIOo,000BT1n Date Recei tic
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the
I ealth and Safety Cade Section 25532(x)7 HEATING UNIT(OVER 100,000 BTU) TOTAL.
❑Yea , MN.
Will the applicant orfuture building occupant use equlpncnt or devices VFNILATION FAN(SINGLE RFSID) ISSUANCE DATE
which emit hanrdous air contaminants as defined by the Bay Area Air
Q�La,hty Management Dkirltl7 BOILER-COMP OHPOR 100,000 BTU)
Yes n�1 No
have read the ha>ar7oua material.requirements under Chapter 6.95 of BOR-ER.COMP(OVER 100,000 BTU)
the California Health k Safety Code,Sections 25505,25533 and 25534.1 ,,fP,aa
understand that if the building docs not currently have a tenant,that it is my NEW RESIDENTIAL MECIL 'SQ.ET P let
occupant to not lfy the opant of the requirements which must be mete'1
prior to Issuance of a Certificate of 0¢u panty. ✓V
/l
�
Ownerorauthmemdagent Data ISSUED BY:Cr/ qq
i TOTAL:
OFFICE COPY rra///per