23326Mrr LIIaPAI.I I V rRV elm vra, ...• caw s.n•ras — ,, w.11 . j _ v.ar.
Building Project Identification
Building -Add—. ('LL'Cf�CG�E«_ D�`
PERMITNO.
23326
Lnets aces: � ` 1 '�\one:
A i /i E2 f N E jo H 10s C,N 2 j j- K
j CITY OP CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
BNLDINr—MMTRICALPLUMBING.MECHAMCAL
°°�'d�•N+me Lie. No:
i LV ' er
CATEGORY
CONTROL
Arehited/Engineer. Lk. N.
OiY f,;ELfiCTRIC PER { �+
'
'+FE6
' BUILDING PERMIT INFO
Address:
PERMITISSUANCE
Mikil
❑ EJIf��.a El
LICENSED CONTRACTOR'S DECLARATION
Iheh by SedlOIrmllalamlcenxd under provbinnsof Cssimicde,and c
i ngwlh5ec11on 7000) of d effeon3o(lhe Buelne.and Profe.lone Code, end my
licensebInfull cores And k.0
Date h® Lk.a
Date Contractor
APPLIANCES -RESIDENTIAL
JOB DESCRIPTION
' -
PANESLice
UP TO 2DO AM
ARCHITECPS DECLARATION
I understand my plansshall be used as public records.
IDI -1000 1'9
OVER 1000 AMPS
SQ. Fr. FLOOR AREA
$/SQ.FT.
Licensed Professional
SIGNSELECTRICAL
OWNER -BUILDER DECLARATION
rmthaLLto+m eixempt laronme.thaend Pmfeorl License Anydtn
following reason.
cwntywhich renfulma permdttoomnslmct, alter, improve, demoli,har repair
anytlructur prior)mite Issuance,alenrequlres the applicant forsuch permit to
(Ile x signed statement that he b licensed pursuant to the provhlom of the
Contractor's License Law (Chapter 9(rommendng with Seaton 7000) of Dlvl-
Akm3 of the Business Professions C.,10mthm he h exempt lherefromand
the basis for the alleged exemption. Any violation of Section 7RHS by any
applicant fora perndn subjMe the applkant to • dull penslty of cad morclhan
e dreddalb,t (5500),
I, sowner of the property, or my employees with wages as their Bole
c p satlon,wlldolhe work and theetmdureh not intended or offered for
'li
SPECIAL CBRCUR/MLSC
IFMP.METER ORPOLE INS).
POWER DEVICES DAME
SWBIIMING IDOL ELECTRIC
ALUATION
OUTLETS -SWITCHES
NEW RESIDPNTIALELFG77t SQFL
STOWGS
TYIPECONSiRI1ClIOK
le (Sec. 7014 Buelns and Professions Code: The Contradoes License Law
does not apply to an gw.er of properly who build.., Improves thereon and
who doessuchwork hlmxlorthrough his own employees, provided that such
Improvements are not Intended orolfered lm sale. If, however, nhebulldlng or
Improvement haold wllhlnmayearofeam Idlon,theowner-bullderwlll hove
ll)S�urden of proving that he dId not bulldor Improve (or pu rpose of sale.).
u L +e owner of the property, am exclusively contracting with licensed
mntradors to mvtrud the project (Sec, 7074 Bualnen and Prme.ions Code:
The Contractors License Law does not apply to an owner of property who
Wild. or Improv. thereon, and who mntrcde to, such ptoeda with a
cgp(pdm(s) licensed p- art to the Contractor's License Law.
LII am exempt under Sec. B & P C for this rc.on
TOTAL:
y
QTy; PLUMBING PERMIT^�'
PERMIT ISSUANCE
ALTER -DRAIN & VENT - WATER (EA)
_
"FEES
e`0
OCC.GROUP
RIS. MI
FT,OOD ZONE
AI'N
BACK FLOW PROTECT. DEVICE
+4.+' ... FEE SUMMARY
Owner Dale
DRAINS FLOOR ROOF, AREA, COND.
FIXTURES. PER TRAP
SANITARY Y_ N—
RECEIPT #_
WORKMAN COMPENSATION DECLARATION
Of hereby ailren that I have a.rtl0cane of conxm to m1f4exu s, m a
cedlficate o(Worken'Compensation Insurance ora rectified copythemo((Sec.
3500, Lab C.)
Policy R
S IUUI, TAX Y_ N_
RECEIPT B
GAS EA. SYSTEM -I INCA OUTLETS
PARK FEE Y N
RECEIPT 1
Co��—��—mlPPlll'rrraaaaaa ny
PCZ11ed copy h hercbyfhthe cityed.
Certlled copy h flbd with nbe city Inspection division.
GAS EA. SYSTEM -OVER l (EA)
CREASE/INDUSML WASTE INTERCEPTOR
BUILDING DIVISION FEES
PLANCHECIC FEE
GREASETRAP
CERTIFICATE OF ID(EMPFION FROM WORKERS'
COMPENSATION INSURANCE
(Fhb n
section cae cad becomplded I(nhe permit h lorone hundred dollen
PAID
Date RO i IN
SEWER-SANFFARY-STORM FA. 200F1'.
(5100)mfytha
I ll hui nhan In Any person in an lhewmk an a tobeco eesub)ecrmit is ho be'wed
I shall not employ any perwn In any manner at u to become subjM to nhe Compenabnlaws of Gllfom
la. Dale
Applicant
NOTICE co MPLICANT: a after nt'Co thio Ct[on pro is Exemption, you
shouldbecomesubject to the ply wit'Compensationprovhlonsomits tabor
Cada you must forthwith comply with each provisions orchis paced) shall be
deemed revoked.
WAT )EATER W/VENT/ELECTR
ENERGYFEE Y N —
Dale Revel iN
TER SYSTEM/ EATING
dee,PAID
NEWR DENTIAL PLMB._SQ.EF.
TOTAL:
G FEE
CONSTRUCTION LENDING AGENCY
Iherebyam0rm that there is a ronsWctlon lending agency for the perform
ante olthe work for which this permO is Issued (Sec. 3097, Civ. C.)
Londe"Name
Lender's .demes
I certify Char a have read thioappBcatlon cad datethat theabove
TO
f—
SMIC FEE
ELECTRIC FEE
,:.
QTY. ; MECHANICAL ya88W�ITix-.
?+';FEES; `
PLUMBING FEE
MECHANICAL FEE
d gate Iso.
reroingt building comply tion,.all dtywd county lnancesand gate
relating to building constmdlon, and hereby authorize representatives olthb
city to enter upon the above-mentioned LoXrty for inspection purpose.
(We) agree to.vs, Indemnity an a ep harmless the City of Cupertino
a Instllablllth, judgmen/e, rorte+cad expenses whkh may In anywayamme
a Ina Id Clty in ron+ryuenca a(nhe gra get Isperret. 1
VVV
PERMIT ISSUANCE
ALTER OR ADD TO MFCH.
FEES PAID:
Date RecelplN
AIR HANDLING UNIT 10,000 CFM)
SUBTOTAL:
AIR HANDLING UNIT(OVER 10,IX00 CIM)
CONSTRUCTION TAX
Rgestues of App)cant/Contradm Dat
HA2AZMSMATERIA SCLOSURF. � -') ,
Will the Applicant orfuture building occupantstore or handle hazard...
material as defined by the Cupertino Municipal Code, Chapter 9.1 7, and the
I e.kh and SafetyCode SMlon 75532(x)7
❑ Yea N No
FXHAUS'FIIOOD(W/DUCT)
CONSTRUCTION TAX PAID:
[)ate ReCelpt _
TO
HEATING UNIT (TO 100,000 BM
-
HEATING UNIT (OVER 100,0013 BTU)
VFNDLATION FAN (SINGLERESID)�I(�
Will the applicant or future Wilding occupant use equiprrenl°r devices
which emlro
l hazardous air ntaMrunts as dented by the Bay Area Air
Quality Management District?
Y" "° of
haveread rhe& Sous materials 25533 and 25534.
the Gliandt HealthIf &Safety CodsSMkns75505,ve a tenant,
understand that n tifyhe the occuping ant
that It man
responsibility .Certiicate ofoc(therequlrcmenta which mualbe rrct
of thenot wi h menta which
prior to lesuance ofa Certificate o(Omrpancy.
CE DATE
C EB 19 1992
r
1'F� Ur �IVit ry11PI11
CIT ,
ISSUEOB�,.J (�/r/`s��'
MOILER -COMP IMP OR 100,004 BTIA
BOILGR-COMP 100,1100BN)
NEW RESIDENTIAL MEGs. SQ.R.
Ownrr or wthorlud agent Date
rornL
OFFICE COPY