24683 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-F,LF.0 I RICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING�MECHANICAL 24683
BUILDING PROJECT IDENTIFICATION
BUILDING O� S� SANITARY NO. APPLICATION SUBMITTAL DATE
UNIT# LOT#
��
CONTRACTOR'S NAME: LIC NO: 1 ,�
N/C CONTROL#
RCHITECI'/ENGINEE : I # LICN AD E'S: , 7
0Ve e pe , a ❑
C NT 4 , IW E:
aTJ{'[,7_ QTY. ELECTRIC PERMIT BUILDING PERMIT INFO
BLDG ECT U MEC
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL BDES PTI N
qz Ihereby affirm that i am licensed under provisionsof Cleapter9(commermagwith
00 Socdon]000)of Division3oftha Business and Professions Code,and on,license is in PANELS
(�UF full force and effect. I
GZZU License Class Lic.# U 0200AMPS
ya4 Dam Command
r 2 1 i P
FyZ ARCHITECTS DECLARATION O RI S SQ.FT,FLOOR AREA $/SQ.FT.
ZO z G I underhand my plans shall be used as public records.
P4 � SI S RICAL Iyl . "246 ^�
Licensed Professional 1 — �� KJ
m OWNER-BUILDER DECLARATION SCIAL CIRWIT/MISC.
yyOtiF I hereby affirm that 1 am exempt from the Commutor's License Law for Ne
uK13LLm following reesom.(Section]031.5,Business and Professions Code:AMycitymcnunty TEMP.M. .RNR PO IN
1❑" which requires a permit m construct,ulher,impmve,demolish,or repair any structure
A }� prior to its issuance,also requires the applicant for such permit to Rleasigned etahemem POW I S
WY' O that he Is licensed pursuant m the provisions of the Connector's License Lew(CM1apier
a e� 9(commeneing with Suchi..7000)of Division duffle Business and Pnd'essiuns Code) SWIM IN P L LECTkIC a.� VALUATION t.9
' aSatan h703].ampttherefromend the basisforthalleged exemption.Any violation of OUTL S SWITCHES-F ORES
} Section9031.5 by anydreddollforepermitwbjeen the eppliaem hata civil penalty of
not more than five hundred Jnllnrs(851x1). NEW RESIDE .LECTR S .FT.
m ❑ I,asownerofhheprnperty,ormyemployeeswitliwagesashheirsolecompensation, Q STORI TYPECONSTRUCTION
y will do thework,and the stmcwreis not inheadedoreffered fmsele(Sec.9044,Business
add Professions Code:The Contmnofs License Law does not apply m na owner of
property whobuildscrimproves thenar,and whodoes such workhimselforthroughhis
wnemployeea,provide Imprvemenpmvememtnet imrrofco platio ,theo owner,
OCC.GROUP RES.UNITI;
huwevegillhathe v the burden
of pmantiehat liwithin one t build of completion,theeoese of �!
builder will have the harden of proving that he did rant build or impmve for purpose of
sale.).
Fl1,as nwmerofthe property,me exclusivelycioneming with licensed contracho TY. PLUMBINGPEIT FEE FLOODZONE APN
con tram Me project(Sec.7044,Business and Professions Code:)The Connector's PERMIT ISSUANCE
License Lawdoesnm m
apply unownerofproperty,who builds arimproves thereon,and
who mandate forsuch projects with econvamor(s)licensed pursuant to the Grumman's ALTER License Law. ->\) r 1 1 FEE SUMMARY
El am exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICE O TSIDE FEE
S T Y Y
Owner Date RECEIPT#
OO
R
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR, F,A A,CONVATE C 'Ax JY_N_
❑ Ihereby affirm then M1aveecenificaheofrnnsem to self-inmre,ora ceni0cam of
FIXTURES-PERTRAP RECEIPT#
Workers'Compensahion lnsuranco oreceniBW urpy Hereof(Sw.3800,Lab CJ which �� PARK FEB Y N
covers all employee's under this permit GAS-EA SYSTEM-1 INC.4 OUTLE C3 RECEIPT#
Policy# BUILDING DIVISION FEES
O' YC1fied copy is hereby famished. I GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
Certified copy is filed with the city inspection division. GREASEANDUS9'RL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This section need Morita completed lithe permit is fourth,hundred dollars($IOU) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE �.
orless.)
Icertify that in the performance of the work for which this permit is issued,Ishall WATER HEATER W/VENT/F.LECTR
not employ any person in any manner as to become subject to the Workers' PAID
Compensation Lawsof California. Dem so WATER SYSTENUTREATING Date Receipt#
Z Applicant
NOTICE TO APPLICANT:Matter makin this Certificate of Exemt n TOTAL:
g Pio e,you should NEW RESIDENTIAL PLATE. SQ.FT.
tz-1 (q berowithcomply it Worker's Compensation provisionsshall ft he Labor Code,you
^�^
forthwith comply with such provisionsonhis Permit shell be deemed rcvokeJ.. BUILDING PEE
a Q
CON TRUCf10N LENDING AGENCY SEISMIC FEE
� z Ihercblit -1hauha, ondruchion lending agency for the performance of L l ELECTRIC FEF.
C) the work for which this permh le n ouad(Sec.3097,Civ.CJ
p..1 defy Name
fe Address PLUMBING FEE
� U QTY. MECHANICAL PERMIT FEE
enify that I have read this app anon and sante that the above information is
�" L1a agreemcomply wit nllcitya nal,miil esandstabomwerclmingto PERM]"T ISSUANCE MECHANICAL FF,E
c'merinn,end he byauthori eramusement cof as city to enter upon the
and n fo ' f ALTER OR ADD TO MECH.
CONSTRUCTION TAX
C) ec 1. in ten fy and Cepnsee ass the 'ry of Cupertino against
Ilnbl eas,j eats,croshs and ich way cueagainstsaid City AIR 14ANDLING UNIT(TO 10,000 CFM)
in and are the granting o1 's pe it.
AIR HANDLING UNIT(OVER 10,1100 CFM)
n.are picanUComrnor I e• Ja EXHAUST HOOD(W/DUC`D PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Dale Remlpt#
Will the applicant orfutura building occupant shore or handle hazardous material HEATING UNIT(OVER I(IO.00II BTU)
as defined by the Calandra Municipal Code,Chapter 9.12,and the Health and Safety
Code,Semen 25532(a)P VENTILATION PAN(SINGLE REBID)
❑Yes ❑No
Will thea licanturfutumbuildin BOILER-COME QHP OR 100,000 BTU) IS�A�N�CF.DATE
pp g by the Bay A e Air Qualit ces whichemit ff
hazardous air comaminanw ns defined by the Bey Aree Air Quality Management BOILER-COMP(OVER 100,000 BTU)
District? 11 -1 p� 1 9[I
❑Yes No NEW RESIDENTIAL MECII. SQ.FT. JAN 6 1993
1 have read the hazardous materials requirements under Chapter 6.95 of the ry'I 1' V
California Health&Safety Code,Sections 25505,25533 and 25534. 1 understand that VVI- I.UYGfi/
if thebuildingdoesnotmnt,wichrtx,he thanitis myrespareof a tenncfy the
omupato of the requidmams which mum ed mm prior m issuance of a Certificate of
Occnpmhcy.
Owner m mulamixci agent Data ISSUED BY:
OFFICE
APPLIGAN ITU FILL III INFUHIVIA I LUN wi Hill ntc.r uut.>- Ube UHLL PUIH 1 PLIq UNL v
Cl'rY OF CUI'ERTINO BUILDING-ELEC'IRB:AI. PERMG'NO.
BUILDING DIVISION APPLICATI IT PLUM ING-REORIT FICIIANICA6 , 24683
BUILIIING PROJECT IANIPICAT W�,s v
BAILDINNGG ADI)I ss. SANITARY NO. API'LICAr10N SUBMI'I'I ALDAIll
2rb 6092,% UNITM LOT#
(JW1MiRS NAl111::� _ ` f QIIj)NE^ �� CONTRnQC10R'SNAME: , LIC NO:
{CLC�JJ'^,JUS NAME:
4/�`F rr /yI/Zl a(r{�J NIC CONT It(ILM
I(CIII'IEC1'piNGINEIi : LICN AD s S: s ❑
K,te c,e P
C)Nr 'r: )•I}pyE: '' "I + �f ,"e , Iiln ?•s'%e�l;�a ,tt BUItiDING PERMIT INFO h.° "
QTY. ll_ ,ELECTRIC PERMIT;!,';)% , l x T°'
BI DC P.ECr u MEC I
PERMITISSUANCC
LICENSED CONTRACTOR'S UEChARA'IION
APPLIANCE be
)O DPS Prl N
CIaz I hereby affhnt that l Am licensed under Prnvoinnsor Chapmr9(commmacio,with
µ40W0 Section 7001 Division Jof the Business And Professions Code,and Any l r-te,is in PANELS
fall force and affect. U 0200 AMPS /
`�gyl License Claes Lie.Al
titiy Doc Contraam 211 IB( P.
F yZ. ARCI IITECTS DECLARATION O R N I 'S SQ.Fr.FLOOR ARG SISQ. T.
I Oq^ 1 nderstand myplunsshall he use daspublicrecords. -
��yFW SI( S "IRICAI. CV
Licensed Profeaxion:d ^f
.,04< a OWNER-BUILDER DECLARATION Sl-CIALCIRCUIT/MISC.
�OaO 1 hereby affirm that 1 nm exempt from the Coal aao,License Low for the
'y3ay following re a(Section]OJLS,Easiness and Professions Cnda Any city nr county TEMP.M'.'IiR PO. IN.
=LLJ
,1 which rapdre.sa permit to construct,idle,Improve,demolish,or repair any swaurc
ps$ prior to its Lesuance,Also requires the applicant for well permil to"ensign, statementPOWP IC:S
y a yy
r<O Ihnt he is licmraeJ pursuant to the rmvisinns of the Contractor's License Lnw(Chnpmn ,
'• o�' 9(annm
msingwith Secfi.n]lXllpnf Dlvisinn l.fthe❑nnsinessnnd l'nda.aions Cnde) SWIM IN P I, :LECTRIC VALUATION OUA
nrfind heisesa"aInrctionrAnd the le,kforlhcnllelmdcaanplier,Any eici lo,aid Curl, 5 SWDGIIPS www......
CZQ Section 2031.5 by Rnyapplienm for A,rac ,abjece,the npPEcwt to a,40 penally.( /'
$ notmore@anfivchundreldollars($5f ). r 80
a' o ❑ 1,es.wnerofthepropcny,ormycmployccswithwngesaalhcirxwlerornpats.Ion, NEW RESIDENT eLECTR SQ.FT. STORY I'YI'E CONSRUCIION
yrg°J° wllldo the work,RnA thenm¢mrala not lmm�Jul or nrferel hnsnlc(SecJ044,Burnham,
and Profe..I ns Cala"rhe Conmacmr's License Lnw Jacs na apply to nn owner.f
properiywhobuildsoriinpnweslhcreon,mnJwlmdocssuchworkhi.,sdfnrthmughhis
OCC GROUP �RE^.UNIT[
ntployecs,pnwideJ lL:n web impmvcmm�ts nrenol inlendalnndrercA fnrsnle.IL � N
however,the have
building or ingawp.,ent is sold within one build
of cnprove f r the owner- ��.
bt llrler will have the burden of proving lhtl badirt unt bu ld o(nprovc for purpose f
❑ Ira nwoannlepmheny,nneael .aivwlywAmrtu rgwthlAe Ca,
TY PLUMBING PERMITi' > �I,FEEa. ' FLOOU9.ONE AI'N
nsmner the project(See.70,14,Business still Pmfwssions Code)Ibe Cmttraanr'a
License LRwdues not apply to An ownerofproperty who bnlita orf.,proves Bmreor.and 1, PER MI'r ISSUANCE I
whacontracts forstch projectsw Ibntani c6onAlicene,calnrxtonmthe Commois A*
License Law. ALTER-DRAIN di VENT-WA'I ER EPA) yryY 9t,�Fsh«•.'dFEB VNIMARlr�14, F'.J
❑ 1 nm camnpt once'Scc. fl k P C for Ihi.v rmn.mn BACK PLOW PROTECT.DEVICE SANITARY O IY DL ELLS
N
Owner —Dole— DRAINS-PL00R200PAREACOND. RECEIPTN
WORKMAN COMPENSAT , , ,ION DECLARA'I ION SCIIOOLTAX YN
❑ Ihercby arpnn lhntihuve nemifrcnte nrcnnsm.,self insure,macenipe.e ofRECEIPI'll
Warriors,Compens.ionInsurance nracedifiN cnpylhereof(Sec.3g011,I,ah CJ which I9T21XT'URIS-PIiR TRAP .•� PARK ITC Y N
RECEIN#
rs al l employee's under this panni( GAS-EA.SYSTEM.I INC.4 OUTLETS
PolicyM BUILDING DIVISION FTiIiS
rCo 'ny GAS-PA.SYSTEM OVER 4(CA) PLANCIIECK PCE
Cenired copy Is hereby furnished.
❑ Cenipelre,is pled will,the elty imr,ciiondivisimr. GREASPpNDUSTRL WASTE INTERCEPTOR GRADING PER
C177RI'I I9CA1 E OF EXEMPiON PROM WORKERS, GREASE'I'RAP SOILS PEC
COMPENSATION INSURANCE
ffhi.ssectirnumed not becompleml E!tic permit is for one hundred dollars(SIDE SEWER-SANITARY-STORM EA.20017. ENERGY PEE �....
or less.?
I cau By,lnt in be perfo.,....e of lire work for which tM1in pennills isomd.I shall WA'I ER I WATER WNENTIE:LECrR
A.,employ Any Perswn In try m A, te become subject 1.the Workers' PAID
,z Compenaad.n LA.,.f CNlf AAAia. Dam so WAI'ERSYSrEMORVA'IING Dale Receipt
Applicant
700 NOTICE TO APPLICANT:If,After makingthis Certifcam of Eaenform,you should NEW RESIDENTIAL.PLMIL SQ.II'. TOTAL:
a V] become subject o the Worker'A Contpen.antion provisions of lire Labor Code,you omit
fnnhwitb comply will.such pravisi.os or this permit shall be diannal revoked. BUILDING FT:P.
w Q CO STRUCI'ION LEN DING AG ENCY SEISMIC EEE
Uz I hereby affirm then!her ' construction lending Agency for the performance of h
Ibe work fm which Ibis permh is Pencd(Scc.J09],Civ.C.) L �� CLGCDTIC PEC
dor. Name )aenraa ]
�' h ned as _ QTY. '.rEPMECHANICAL PERMIT, �y�j y�11FEH, +'I' PLUMBING PEE
JELI en fy that I have rend @rs app .ion and state that the rtow. nfnrnatmn is MECHANICAL PrsE
>" rs agree ace mBlywithnllcllyo .only orzl' n sRIolmatalawsrelmh,gm PCRMI'I ISSUANCE ��
tiamovetinn,andhc by euthoricrcprcsemai nceDliiacitytnemmrrprmthe CONS'IR UCI'ION TA%
U al , I Ioncrl pmtrad,fu 'Aspcaion arrows ALTER OR ADD TO MFCIL
w m anvq inde airy and re csa llm 'ly ar Cnpcti o.Against
Iia1M1 ics,jt cnmecol,rnJaha way c cagninstwid Cily AIR HANDLING UNIr(r0 UL01N)CPM)
intern yncnc thegranlingal eisperi it.
AIR I IANDLIN I UNIT(OVER 10.000 CPM)
arc p!
rcant/Comm
rmr DAIe• EXHAUST HOOD(W/DUCT)
PAID
HAZARDOUS MA'rFRIALS DISCLOSURE BEATING UNIT'(TO 100,000 BTI) Dam Receipt A
Will the applicant or future building ecenpant sloe or handle saaardions material
"defined by Ne Cupeni e,Municipal Cele,Charier 9.12,wd the I1w10,and Safely HEA-i'INC,UNIT'(OVER 100,000 BTU) "O
Cook,Section 25532(x)9
❑Yes ❑ Na VENTILATION PAN(SINGLE RLSID)
ISSUANC-DATE
pp gaxcupnn yuipmcn BOILER-COMI'(311POR 100,000 BTL)
Will lM1en lic:mt nr future builAin Brice tmAcviceswhich emit I i
hvaninns Air contaminants as dernml by the Bay Area Air Quality M..gemem BOILER-COMP(OVER ICO."BTU)
Dtstct dJA 9
❑Yes ❑No NEWRE.SIDENTIALMECIL SQ,FE 1983
1 have read the hazardous materials requirements under Chapter 6.95 of dm �1
itCalifornian, IIcnIIh tF Snfcfy Code,Sections A man t,th25591..255..4. Itma.'aanJ that r!Ik I,Jr UUrCYtl�
it the rnRding Aar not currently have n tenant,lhnl it ilia ay rc25534. 1 on m,nmol ,he
oeanp.J or lire rervimano to which intim he Amt prior m Isw.Art,or A Certl Fcatw of
Oeltlpancy.
Ownenn aunt hrn izeAagcrn _ _ Done. I ISSUED BY:
OFFICE