23249 ^Building Project Identification" _ —_ _—_ _ _ PFYMIT NO.
Building Address: Gk G- vE 23249
1 - - �y''' one.
�aetL Z.'7 CCL CITY OF CUPERTINO13UILDING DIVISION
' Lk.No: APPLICATION I PERMIT �-"
rchltect/Engineer. ��1y�— BUILDING-FIPCTRICAL-PLUMBING-MP.CI IAMCAL CATEGORY CO
����QQqq�� BUILDING PERMIT INFO
Ir7S�O I'EIthHTI55UANCE In
����JJ��������TTTTIC. C '9 OECLARATIO
I hereby affirm that l am licensed under provhionsof Chapter 9(commnc APPLIANCES-RESIDENTIAL OB DISCRIPDO
Ingwith Sectlo 7000)of Dlvlston3oflhe Buslnessand ProfendorsCode,and my
Isle lul§_je and PANCS
License Cie. Uc.0
Date Contractor
ARCHITECTS DECLARATION 201-IODUAMPS
gyp!p sZ I understand my plan"shall be used as public records. OVER 1 W0 AMPS SQ.Fr.FLOOR AREA sm.Fr.
E d Licensed PM.raboal SIGNS ELECTRICAL
«< tkBu OWNER-BUILDER DECLARATION
Ih.mbyafi.thatlameaempl(monthe Contramr's License Law forthe SpECIALCIRCUIT/M15C
�OTr��i following reason.(Section 7011.5,Busirm and Professions Code:Any city or TEMP.METER ORIOLE INST.
f7 cwntywhich requires permit tomrotmcy alter,Improve,demolhh,orrepalr
3 S < anyatmcture prlarto Its immusnce,also require.theapptimnt for such permit to POWER DEVICES V file•signed statement that he is licensed pursuant to the provisions of the
Contractors License Law(Chapter 9(commencing with Stolon 7000)of Divi. SWIMMING POOL ELECTRIC
Ion3ollhe Ru,innsand Prdeoiam CMelorlh,lh,bes,mptthemfmmand �sVALUATION
O OUILETSSN7ICHFSFlXMZES
s Sn the basis for the alleged exemption. Any violation of Section 7011.5 by any 1 F O LtB
i <X applicant fora permit sub"the applicant to a civil penalty of not nem than ` � s0
/ive red dollars(SM. NEW RESIDENTIAL ELECIR
GGGIII �n ,as owner of the property,or my employees with wages as that'sole STORIES TYPE CONSTRUCTION
< co tion,will do the work,and the structure is not intended or offered for
q s (Sec.70M Business and Profmns ioCade:The Contractors License Law I r 1
d not apply to in owner of property who builds or Improves thereon,and UP.OCC.GRO _, RIR.I/NITS
whodcessuchworkhlmeelf orlhroigh hlsown employees,provided that such I� IJ -
Improvementsarerwtlnlended oraffered(roma.Khowever,lhebulldingor T J L 1i_
Improvement heold wlthln°nay"arofcomplellon,thaowner-butlderwlll have
tlRknden of proving that he did out bulldor improve for purpose of sale.). Qjy, ,;A,PLUMBINGPERMiT1OE, 1 AI'N
U L as owner of the Property,am exclusively contracting with licensed PpRMiT ISSUANCE
contract°.to consW ct the pm)ed(Set 7014 Business and Professions Cade:
se n it
71.Contractor's LlnnLaw doapply to an owner of property who
Wilds or Improves thereon,and who contracts for much P(o)em with a ALTER-DRAIN&VENT-WATER(EN
cclor(s)licensed pursuant to the Contractor's License Law. .,FEE SUMMARY I
TT, am exempt under Sec 0& P C for this recon BACK FLOW PROTECT.DEVICE
Owner DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N_
Date RECD a
WORK MAN COMPENSATION DECLARATION EIXTIIRES PER TRAP SCI100L TAX Y_ N
QI hereby aBlrm Nst I have a lmu,.to of consent to apythwrc,(S . RECEIPT F
3800,ceelficabC.Werken'Compensallon/nsunnreovacertlfled copylhereaf(Sec' GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N
3800,IabCJ
Policy E RECEIPT I
Com any GAS EA.SV9TEM-OVER4(EA) BU ILDING D I VIS ION FE ES
Ce IRedcopyisherebyfumlehed. CREASE/INDUSTRLWASTE IFITERCEIa7DR PLANCHECK FEE Go
rtlBed copy Is filed with the city inspection division.
CERTIFICATE OF IXEMITION FROM WORKERS' GREASETRAP PAID
COMPENSATION INSURANCE
(rhlasectlon need out becomplaled lithe permll hfmonehundred dollars SEWER-SANITARY-STDRM EA.200F1', Date RewiptN
(EI00)orfy that
WATER HEATER W/VENT/ELCCTR ENERGYFEE Y N—
I
thatln the person
anner.r to boo eesub)ermit hexed,
I shall not employ any person In any manner ao as t°become eubkct to tha WATER SYSIPM/TREATING
Worken Compensation laws of Gllfomla.Date PAID
Z NOUCApplicant of D 14.1tN
Z O Nouldb conar.uLICA1.the .'karakingehis enCeion pr vismm;att the
I`rEW RESIDCNITAL PLMB. SQ.FT.
_ sode,Yo mus a forth itthe Worken'such prwtlonprovhbmrmit s Lab be AI,;
N deemed
muss forthwith comply with each provisions orlhh permit shall be U
_ > deemed revoked. _
L 'p CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby ofBrmthat there is a construction lending agency for the perforrn- TOTAL:
0 ELECTRIC FEE t'
7 ance of the work for which this permit h issued(Sec.3097,Civ.C.)
J _ Lrndees Name PLUMBING FEE
L I— Lanlee.Addren Qrv. o ^MECHANICAL-PERMIT"'? -"aFEE,v-
WImrllfylhallhavereadlhbapplicallonandstatelhattheabovelnformatlon MECHANICAL FEE
hcorrect,I agree to comply with all cilyand county ordinanoes and state laws PERMIT ISSUANCE FEES PAID:
► N relating to building construction,and hereby aulhodea representatives of this
Z city to enter upon the above.mentioned pmperty for Inspection purposes. ALTER OR ADDTO MECH.
(We)agree to save,Indemnity an d keep harmhse the City of Cupertino Date ReceiptA
against liabilities,ludg, aostund expense.which may lnanywayaccru. AIR HANDLING UNIT(TO 10,000CFM) SUBTOTAL:
P. id City lntb ague t seting M lh it. AIR HANDLING UNIT(OVFR t0,0DOCFM) CONSTRUCTION TAX
of ppllon oral' Date IXIIAl15'TIIOOD(W/DUCT) CONSTRUCTION TAX PAID:
IIA]ARDO MATIEMALSO15CLOSURE
Will the applicant or future building occupan mme or handle h.rd., HEATING UMT(TO 100,00)BN) _ Date RCCCIpIB
malerlaiade(Ined by the Cupertino Munlctpal Coda Chapter 9.17,and the TOT
I lealth and Safely Code Section 75531(.)7 HEATING UNIT(OVER 1011,000 BTU)
I I Yn No .
III lheappllcantor mrc buildingoccupantumequlpmentmdevima VFNDLATIONFAN(SINGLERESID) JCSI1AP(ODATE
which emR harardom air coolaMnnls as de0ned bythe Bay Area Air Y AA V
Quallly Management District? R0ILER-COMP(3IIPORIf DU0BTU)
We ❑❑No
have rcadihebavNouN)s ma
tterials requirements under Chapter 6.95 of MOILER.COMP(OV R100,000BFEB 2 51992
he GThfernla I lealth&Safety Code,Stolons 25505,25533 and 25534.I
understand that[(the building does not currently have.tenant,that it b my NEW RESIDENTIAL MECH. SQ.FT
rapmollulity toedify the occupant of the requirements which must be met CITY Uf CUrr(%IH4U
prior to Issuance of a CeUIflcale of Occupancy.
Owner or eulhorimd.gens Date - ISSUEDB\Y
TOTAL:
OFFICE COPY