20614 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Buildln Pro'ed ldentlficatlon - PERMIT NO.
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nets 20614
ams: file, Me
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3 Mee. CITY OF CUPERTINO-BUILDING DIVISION j' •� ��J�
LI°No: APPLICATION / PERMIT
BUILDINC-ELECTRICALPLUMBING-MECHANICAL CATEGORY CONTROL
Architect/Engineers Llc.No:
QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO
Address: �0✓S—�/UTQ/U(19 AA,-P a PERMITISSUANCE ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provhronsof Chapter 9(commenc- APPLIANCES-RESIDENTIAL JOB DESCRfI'T[ON
ingwlth Sed1on7000)of Divhl°n3o[theeusinessandProfesslonsCode,andmy
license h In full and effect, rANE7 S r-
Llcenre CI_ss _ Lic.R J �g r.Y U G H �u�o �(Q
Data 1 ontnator�'r' f s
ARCHITECPS DECLARATION 201-1000 AMPS 2'-(� X3�rs
0CZO I understand my plamahall be used as publicremMo. DHFR 1000 AMPS SQ.FI.FLOOR AREA S/SQ.FT.
(0 Licensed Pro(easWwl SIGNS ELECTRICAL
OWNER-BUILDER DECLARATION *CMCLIT/M�C
OOZE�n Ihereb asormthatlamexemptfrom.Ica.. dProfcontrdoossLicenseCode:Law fort he
foll°wing reason.(Section 7031.5,eualness and Professions Code:Any city°r T.P� G7 anystmcture prlorto its issuancealsorequlrestheapplicant forsuch permitto file a signed rtaterrent that he la Ilcensed pursuant to the provisions of theContractors License Law(Chapter9(commencingwlthSeaton7000)ofDivr-
/'tslon 3 ofthe Business and Pndesslms Code)orthat he h exempt therefromand 7FLDODW�E
� the basis for the alleged exemption. AnyviolationofSectlon7031.5byany r/applicant for a permit subjects the applicant to a civil penalty of not moethan five hundred dollars &500).❑L. owner of the property,or my employees with wages m[herr sole SQFL ST. TYPE CONSTRUCTION
C c°m(Sac.744,wWdess and Professions
Codurehmtintended oroffered comeLfor
5J�O sale(Sec.apply
to show and f property Code:The Cortmor
tor'sover thereon law
u, $ does not apply to an owner of properly who builds or Improves thereon,and
who dceaeuchw°rkMmsegorthr°ugh his own employees,provided that such C. RES UMTS
Improvements are not intended or offered for sale.If,however,the building or TOTAL:
improvement is sold within one yearofoempleliory the ownerbuilderwill have '
tljurden of proving that he did not build or improve for purpose of sale.). QTY, PLUMBING PERMIT FEEAPN
u L as owner of the property,am exclusively contracting with licensed ppgMpISSUANCE
mntract°m to consumd the project(Sec,7044,Business and Professions Code:
no Contractor's License law does not apply to an owner a property who ALTER-DRAIN&VENT-WATER(EA)
builds °r impes rovthemon,and who contracts for sock ptojects with a
C ador(s)licensed pursuant m the Contractor's License Law.
15gpQC PLOW PROSECT.DEVICE FEE SUMMARY
1 am exempt under Sec. B&P C for this remon
Owner DRAINS FLOOR ROOF,AREA,COND, SANITARY Y N
Date RECEIPT k
WORKMAN COMPENSATION DECLARATION
j ❑I hereby affirm that I have o rertiBate a(consent to opy thereof
ora FIXTURES-PER TRA}' SCHOOL TAX Y N
certifi1.b C.) orken'CompereaHan Wunnre ora certified copy thereof(Sec. RECEIPT
N
3800,Lab C.) GAS EA.SYSTTAd-11NC.40lITLE1'S PARK FEE Y N
Polity B RECEIPT M
Com any GAS EA.SYSITM-OVER BUILDINGPTVISION FEES
�==ficd copy h herefiled w th the
GREASEANDUST'RL WASTE INTERCEPTOR PLANCHECK FEE
❑CertlEed copy h filed with the city inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP IPAID
COMPENSATION INSURANCE
(Thlssectlon need not becompl Tlithe permit h(Drone hundred dollars SEINER-SANTTARY STORM EA 20OFT Date Recei t#
(51I notify
WATER HEATER W/VENT/ELECTR ENERGYFEE Y N
Ill not that la the perlormanceo(tmarmer.as to h this permit is issued, —
I shall not employ any pereon In manner n as tybeco sub'd o the
Workers'C nLawsof 11 Date F�Z- .^}fJ WATER SYSTEM/TREATING PAID
0 Z Applicant ° ice.__ Date Recei tN
Z O NOTICE TO AI'I'j.ICANT:[f it nu�king this Certificate of Exemption,you NEW RESIDENTIAL PLMB. SQ.FT.
should become 4Gbjec[to tis Wo Compensation provisions of the Labor TOTAL:
q9 Code,you must forthwith mmplyw11hauchpmv tomorthhper tshallbe
W > deersedrevoked.. B
UILDINGE IG
CL CONSTRUCTION LENDING AGENCY
I hembyafflrmthat there Is a construction lending agency for the per(orn,
D Z ance ofthe workforwhich this permit is heated(Sec.3097,Civ.C.) TOTAL:
U 0 lender's Name E
LL ~ Lender's Address QTY. MECHANICAL PERMIT FEE L FEE.
O W Icertlfythatl haveread this appllcatmnand statethatthe above Information
CL hcorrcd.I agree to comply with ail city and county ordinances and laws PERMITISSUANCE relating to building coreatmction,and hereby authorise representatives of thisH Z city to enter upon the gxwv uxmtimxd property for Wpection purposes. ALTER OR ADD TO MECH.
(We)agree to save,Indemnify an d keep harmless the City of Cupertno Receipt#
again bllrHca,pdgmanh, gaand expenses which may In any way accrue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL'
a rsb Id City In s qs m ofthe granting of this permit.
4y 'G, AIR HANDLING UNIT(OVER 10,000C[M) CONSTRUCTION TAX
Sigreor Ap 1 nt/ .Dais&°, Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
H RDOUS MATERIALS DISCLOSURE
Willtheapplicant orfuturebuildingompantsmreorhandlehaaardaus HEATING UNIT(TO 100,ODO BIIn Date Recei f#
material as detlnad by tM Cupertino Municipal Code,Chapter 9.12,and the
I lealth and Safety Cad a Section 25532(a)2 HEATING UNIT(OVER 100,000 BTU) TOTAL:
0
❑ Yea No
Will the applicant or future building occupant use equipment ordevices VENDLATION FAN(SINGLE RESID) ISSUANCE DATE
which emit haaardous air contaminants as defined by the Bay Area Air ��
Quality Management District? BOILER-COMP QHP OR 100,0(10 BTU)
4 Yes g No
have read the bazar us materials requlremenh under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU) JUN 2 6 1990
the Califemia}lealth&Safety Code,Sedions 25505,25533 and 25534.I
understand that lithe building does not currently have a tenant,that it is my NEWRESIDENTIALMECH. SQ.Ff.
responaibility to notify the occupant of the requirements which must be fret
prior to issuance of a Certificate of0ccupancy. all at
_`^us
4 e
Owner Or authonud agent Date - ISSUED BY:
TOTAL:
OFFICE COPY
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�N �•G. Lic. # 520347
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IUP El_,EVATION �; : ��x� �� • �.
I � jlot tbwi 1.
Neoprene gasket Acrylic pyramid Sloped, _
� •i'r , Acrylic dome gutter
+ !.- ., Aluminum cap mitered _-----
a d at corners Jr=J .. .. i. _ --- . pRl•
APP.R.6V'gb
RDANCE Vy�J T CITY Ot I !
IN, A�Cco �jI
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wPBRTINO 60DES'AN[POR I S
'DATE pr Of screws - --- - -
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SIGNE 1/t
ntl:;'specifications M
lThis s t of .ah. ,
lawful o ke q .chin es or alteratio
be ke on•the_ b..at•Mtimes and it is w
'an sarge AK5-1 1vtittb6 permission Ire �I l
the bulidin _lie ii._Clty.1 u t � - — - - - S� G�•L.��I�0fv
The sump+ g oil,his'p'sr `�: .V: -
SHAL NOi be tearIs-..,.. -- - -- - -- - -
y
ippro at of lhQ w to t n , ap� vi- +''
it anh C,. t d inn IE r 4
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_.. JUN -'1 1991)
BLDG CME[dL
IW OF. CUPERnNQ
DFRCE , COPY