23556 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
Building Project Identification PERMITNO.
Building Address: n I ''++ 23556
nems ane: e23 �V s �`�
Q EV, tO l." —Cj t. Q CITY OF CUPERTINO-B I ING VISION ��.i
GVO ane �P5.7� 4=N�� APPLICATI PE MI
A Its G`t BUILDINGELECTRI ALIUMBw HAM L CATEGORY CO :Z
Lk.N.
L/
\1�' Q�1 QTY EL IC PE FEE BUILDING PERMIT INFO
Address VV 0/a� ,I ~� T CE �� 91 *15 _
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter9(rommenc DE JOB DFSCRB-11UN
Ingwlthse i.n70M)of DiWslon3oflhe Buslwsand ProfesdonsCade,and
license Is in full fora and effect.
Liana Class LI,N
Date Contractor ^ .
ARCHITECTS DECLARATION Ml-1
QOC ]understand myptamshallbeused as publieremrds. OV SQ.FT.FL IEA S/SQ.FT.
p5d E6 Licensed Profenbna] SIGNSCA �/a,
HN
OWNER-BUILDER DECLARATION SPECIAL IRC /MLSC Z Ci
1"iu�f IherebyafBrmthat l am exempt fromthe Contradorb License law/ar the
oo Q following reason.(Section 7031.5,Business and Professions Cade:Any city or
Fz~ county which requires permit to comomcl,after,improv,demBsh,orre
opalr TEMP. OR POLE INST.
any structure prior to its issuance,also requires the applicant fasuch permit to POWER EVICES
O file a signed statement that he is licensed pursuant to the provisions of the
04 Contracto/s License law(CUpter9(commencingwith Sect1on7000)ofDlvi-
S �nSwN460NG IDOL ELECTRIC
OS sion3 ofthe Business and ProfenionsCode)orthat he 6 exempt therefromand VALUATION
O the basis for the alleged exemption. Any violation of Section 70115 by any, E7'SSWITCHESFIXTURFS Le q Lk.,
appbmntforaperndtsub)ec theappllcanttoadvilpemltyofnmm mthan \\\
live hundred
owner of the property,
ro SQ}T, STORIES TYPE CONSTRUCTION
R NEW RESIDENTIAL ELECTR
�n ❑Lasownerofthetworlty,orhe empbyenoti ween as theresolo
d for
5 'compenation,wllldotheworrof.f.ea Code:rehe ConttendedoicurtseLaw
O noesSer. pply 7DK tofloalneavaMf property
Code: orimpctols License Law
B don not apply torn owner of(prough who nempor improovidedthat and O
who dcemntss such am nhimselfedorough hbownemp,howeprovidediver,the lding r
Improvements wlntendneyear/seedfor pleio theh er-buflderwflI have A
improvementresold within he did of build
fner-buose of sl have
t mdeno neerprovingof the pro did not bexcl canny contra ting with(sale.). QTY. PLUMBING PERMIT FE
�I,as owner of the property,am exclusively Business
and Pro with Professions
'
rontractonto romWctthe project(Sec.70tq,Buslneo and Protmiom Code: PERMIT ISSUANCE
The Contractor i License Law does nes apply to an owner of property who l`7
ALTER-DRAIN hVENT-WATER(EA)
Wilds or improver thereon,and who contracts for such pkejects with a
,,4a.ctor(s)Bansed pursuant to the Coaradoes License Law. EE J'
LJ am exempt under Sea B k P C for this reason BACK FLOW PROTECT.DEVICE
Owner Date - DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N_
RECEIPT
WORKMAN COMPENSATION DECLARATION N
10 F11 hereby affirm Insure,or that have a certificate of consent to self- F'IX'IVRE^'PER TRAP SCHOOL 7A% Y N
RECEIPT N
arts(isateo(Workers'Compensation Insurance oracertified ropy thereof(Sec. GAS FA,SYSTEM-1 INCAOUTLETS PARK FEE Y N
3licy0 RECE
CJ —
B'TM
Policy N GAS.EA.SYSTG4OVFR 4(PA)
Com any BUILDING DIVISION FEES ,
�
Cedlfied copy 6 hereby furnished. GREASE/WDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
❑CertlBed copy 6Ned with the city Inspection division.
CERTIFICATE OF EXEMPIDON FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE
(Phis sectioSEW ER.SANTTARKsroRM EA.20lAT. Date
n need not becompleted Ethe perMt 6 forone hundred dollars
($100)or len.) WATER HEATER W/VENT/ELECTR ENERGYFE Y
I coolly that N the performance of the work for which this permit is loved,
I shall nes employ any person in any manner m as to become subject to the WATER SYSTEM/TREATING
Workers'Compensation Laws of Callfomla.Date PAID
Z Z Applicant NEW RESIDENTIAL PLMB. Sl
Recef till
O NOTICE TO APPLICANT:If, uk
after mooing this Certificate of Exemption,you
Fshould become subject to the Workers'CompewHon provisions of the Labor TOTAL:
N
Code,you=at forthwith comply with such provisions or this permit shall be BUILDING
W ] deemed revoked.
CONSTRUCTION LENDING AGENCY SEISMIC FEE
a lherebya(firmther there lea construction lending agency for the perform- TO qq ELECTRIC FEE
0 Z ane oflhe workforwhlchth6permit66wed(Sec.3097,CIv.C.) ® V
OO ouroftewor PLUMBING FEE Q
F Lender'.Addmas QTY. MECRANICAL PERMIT FEE
O W Icertifythalhavereadth6appliatbnandaatethattheabovelnfonrouon MECHANICAL FEE
a 6mre
rct.]agree to complywithW city and county ordinances and date laws PERMITISSUANCE �" FEES PAID:
>. relating to building construction,and hereby authorize repreaentativa o(th6
IA city to enter upon the abcwo-m cloned property for inspection purposes, ALTERORADDTOMECH.
? (We)agme to ave,indemnify an d keep harrdea the City of Cu pen but Date Recei t#
VI ails not 11.10 )udR7n sandexp nsm which mayin any wa a e AIR HANDLING UNIT(TO 10,000CFM) SUBTOTAL:
agalmt city In Fon o the gr,nting of his permit. AIR HANDLING UNIT(OVER t0,000CFM) CONSTRUCTION TAX
r11jr�Ith..dSoctyC
EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HA RDD MATERIALS DISCLOSURE
heappli I future ildingomvpantstoreorhandiehazardous HEATING UNIT(TO 100,000 BM Date Renetasdefined theCupe no Municipal Cod,Chapter 9.12,and the
Section 32(a)7 HEATING UMT(OVER 100,000 BTN TOTshe applicant orfutum building occupant use equipment or devices VENDIATION FAN(SINGLE RESID) L ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area Air
slaty Managernom District? BOILER-CAMP OIQ'OR 100,000 BTUl P A I D
aY Yrs ❑No
I have read the h.[u us materials requirements under Chapter 6,95 of BOILER-COMP(OVER100,000 BTU)
the California Health k Safety Code,Sections 75505,75533 and 255M.1 MAY 29 1992
understand that ifthebulldingdonnaarrentlyhaveatenant,lhatit6my - NEW RESIDENTIAL MECH. SQ.FT
responsibility to notify the occupant of the requlmments which must be met
prior to hunts me of a Certificate of Occvpa nay.
C11Y UI- (;Urc:nu tvps
Owner or authorlud agent Data A t ISSUED817V
OFFICE COPY
_�i:C5:.v3f27,9��Y,\' ,•:v17P�p�=/,QYY'+f,!/! \}�:-\/YI(!�`'�/.cSr �--�� " �/ ;
.r b' ♦ / '�F '% ` �- r \Lt al /// 9\F01-2'c-. /h.
\
\\\ � iP•' ,t:�\••- !/X, 1,
.ha h!y ♦♦ ii \ y � _`� //J ♦ \c.,j' / H•- -(l(.!1
,, ,���' it •,;� �i ..�F -.'��`�.'��;wJz .Ci. .�\`yP' , �:1��/'� :�p@'�w i ;�`1� r}- ?�e!� ��`�.JIK " `�ty�' 'k `/!` xa��' .'1\1�` w, "Grk;
- �. i . 1 i 1 i n �,�/\ /, 1\ /• .:r:w ,�.%i \yam r0, i,.<f
2`e•.� No. 886
Cert tract of W-CrIllnutry `
Tidy of ( uprrtinu -Z _
_ 19rl1MrtmPti# of Nitilhing jjn iV
4 This cert ficate issued pursuant to the requirements of Section 307 of the _��
/ ¢ : Uniform Building Code certifying that ing that at the time of issuance this structure-
in compliance with the various ordinances of the city regulating building
1
construction or use. For the following: xt
Use Classification Tenant Improvement Bldg. Permit No. 23556
Group B2 - Type Construction V—N Use Zone Planned Development
Ownerof Building Sobrato Development Address at
y �r Building Address 10731 Bibb Road Locality Cupertino, California
A
By: Tne Antnnbac-i
Date: Alrnnat I 1992 - •`
tit Building Official
/ _ n
-
ii .-
_» - POST IM A CONSPICUOUS ILAC[ - .
'
�Y _./
�- i^,:Q l �N• {T � -�. �J y h,(�j`� 1��i m�if y:l�1' . 1 Y �'' 'ZrC+'�� ..
. � ''�C:\t` �'ir� �'.1`; ITJ�1?� � \t,`l`• �!�" —\ � �•I�i.r\f. �!f'r'��^ ^ 1��� It1'' I,��,y,-� 2\ � ?�' 'C•� 11.5i1�/�� - ) .,/� •_ `�,` ��• '' �q�'r _{
�\+tStiir/��: \\\\♦♦ .ir//!h r O♦. rr/rir�x ., j d�.\.�Y/irn. UJ\"�iR:,` 9iii/ry�+�'\t:�'iri - � \\ 9i/,�y�V�•6ii _ -'. _ L..
, h ��� `�%'3./ !�-♦� ,�jgum, ` .ar 1. 1`% . ,�:✓r/;'D, n>•�-ISE � e�+"%� ,� i\\\1�,g / � nU\\� �//1,: .s ��rf /� v C��i♦V��j�. //4rr'.
= �. (:: / -.0 C-'� J///� t :,. n�/. ,t: 'qj\\.,. ..^ . 4/ r,�l: ♦•\;..7�>MI tea... R:%:vaJ.• .: \k.nn 'moi: '"�%"4i
nY. - : _ / �^. // tF ..9 QCT'•;' I.n �-..;fin::• s�
•.OIIY 100.1 � / ..