24431 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO
Building Address:
_ G-2_ 4,u-F^¢� VL ' 24' fie to
ne e^ ` � '��� /Z CITY OF CUPERTINO-BUILDING DIVISION
sena nLr/aName: Lk.Nor APPLICATION I PERMIT kl,
t" BUR.DINGE,ECTRICAL-PLUMBING-MFCHANICAL CATEGORY CONTROL It
rArchRect/Engiuer.
Lk.No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: PERNUTISSUANCE ISLUG ELWI
�1 a[�
LICENSED CONTRACTOR'S DECLARATION - I,f� ?
T hereby affU tlutlamlkme uMe pr Wonso(Chapwr9(rmnmen APPLIANCES-RESIDENTIAL JOB DEECR017ION
ingwlth Sactior700BofDlviefon3 ofthe BusiracsmdProfesalonsC„ode,and my �0 i�,a U
1�S
�
license is In full force and effect. PANELS r
Wcense Chea Lle.N C
Date Contractor 201 1000 AMPS o
ARCHITECTSDECLARATION
ut
aO Zp Iundedtand my phaehaB be used upublic reroNn OVER 1000 AMT'S SQ.FT,FLOOR AREA 3/SQ.FT.
Licensed Professional SIGNS ELECTRICAL
OWNER-BUILDER DECLARATION
�+ a
I herebyafflrmtlul]am exempt from Iles Contractor's License law for the SPECIALCO(CUIT/MLSC
following reuon.(Sccilon 7031.5,Buelncu and Pro(enl...Code:An city or
O H o ty TEMP,MEfER ORPOLE INSf.
g;� a oustradohrequireso ptemYltomrutmctiresthapmve,demolch,ormit to
any etggreeoweroltshat he Isalso eirsed ntheappRcantforaurh permit to POWER DEVICES
Ole a signed salement that he h Bcensed punumt to the provhlon.of the
Dw Contractor'.License Law(Chapter9(mmmencingwBhScaHon7000)ofDivi.
1„•E, sion3ofthe Busmnemd Profeulom Corte)orthathehemmpttherefromand SWIMMING POOL ELECTRIC VALUATION
16 the basis for the alleged exemption. Any violation of Section 70315 by any OUTLETS-SWITCHES-FIXTURES applicant fees permit subjects theappllm
eanl to a civil perahy of net ore than
�7 five ndrdd dolhd(f500). SQ.Fr. TYPE CONSTRUKTION
R G° NEW RFSIDENMALELECTR FT.
�n I,as owner of the property,or my employees with wages a their sole
O Pation,wilidothe work and lhestmcture farm intended or offered for
7044,Busbssa and Profession.Code:The Contactors Llceae Law
does not apply to an owner of property who Wilds or improves thereon,and OCC.GROII!' RFS.UNITS
who doessuch work himself or through Ms own employees,provided that such
Improvements are not Intended oro(fered fro sale.If,however,thebuilding or TOTAL;
improvereentissold withlnoneyearofcompldiomtheowner-buRderMiI have
tillkiden of pmving that he did not Wild or Improve for purple oEE fsale.). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
L as owner of the property,am exclusively 04,Business
ros ncting with licensed PERMIT ISSUANCE
contractorstornuWRthe project nor
teas nand of
Code:
The Contractor's impro License law don net apmtr tom owner of property who ALTER-DRAM&VENT-WATER(EA)
Wilds or Improves thereon,ad who roicur's for such ptokem with a FEE SUMMARY
cgB(lactor exempt
Pursuant(Othe Conlradors Llanx Lew. BACK FLOW PROTECT.DEVICE
1_I I am.:scop under Sec B&P C for this reason
DRAINS FLOOR,ROOF,AREA,COND. SANITARY Y N
Owner Date RECEIPT Y
e WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N
[]1 hereby ef(Irm ce
that I have• rtificaca
te of consent to lfwrc
-in ,or FTXTl1RES PER TRAP
RECE PT N
ificam a0)'LabolWorken'CompeaaHonlaunnce oracertilled ropythereo((Sec. GAS EA. PARK FEE Y N
3800. # BBC77 V
Poliry N
ComCanGAS.EA.SYSTEM-OVCR d(FA)
BUILDING DIVISION FEES
edified
copy is hereby furnished. CREASE/INDUSTRL WASTE INTERCEPTOR
[7CertHled copy h filed with the city Inspection divlslon.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP PAID
COMPENSATION INSURANCE SEWER-SANIfARY-S7DRM EA 200F1' Date Recei Uf
(Thi,section need not becompleted lfthepemdl h(monehundred dollars dtk --
($100)orleu3 WATER FffA3FR W/VENT/m er.1.R ENERGY FEE Y N
I certifythat In the performance of the work forwhlch this predrill.hatim,
I shall nm employ any person In any manner so as to become subject to the WATER SYSTEM/TREATING
Workers•Compensation Lan of California. Date PAID
Z Z Ncant O nCE TO APPLICANT:If,after nuking this Certificate of traptbn,you NEW RESIDENTIAL PCMB. SOFT. Date RCcel tM
O should became subject to the Worked'Compensation provig of the Labor TOTA '
LO Code,you=at forthwith comply with such provhioruorths permit shall be �s
W > deemed revoked.
C CONSTRUCTION LENDING AGENCY SEISMIC FEE
CL
I hereby affirmthat there Is a construction lending agency for the perform- ELECTRIC FEE
0 Z once of the workfor which this permit hissued(Se.3097,CIv.C.) TOTAL:
02 lander•.Name PLUMBING FEE
ly f Undersnddrea QTY. MECHANICAL PERMIT TEE MECHANICAL FEE
O W Indlfythatlhavemadthhapphatbna"dalelhattheabove Nformrtion
'.correct l agree to comply with all city and county ordinances and sate law, PERMITISSUANCE FEES PAID:
Nrelating rebuilding construction,and bembyauthorizerepresentatWesoftha
Z etytoentcrupontbeaWvo-rrentlened property for Inspection purposes. ALTER OR ADDTD MECIL Date Recei tN
_ (We)agree to save,indemnify an d keep harmless the City of Cupertino
against liabilities,Judgmenm,"sand expenses which may In mywayarcrue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL:
against said City In consequenceofthe gra ng tial It.
AIRHANDLING UNIT(OVER 10,IDOCFA) CONSTRUCTION TAX
Sigr9mooo Applicant/Contractor Date EXHAUST HOOD(W/DUCT CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant orfulure building omapant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date Retei t
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the
Health and Safety Code Section 75532(a)7 HEATING UNRT(OVER 100,000 BTU) TOTA .
❑Yon No
Will the applicant Rome building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hazardous air rontannnanm as defined by the Bay Area Air BOB,ER COMPOHPOR 100,001)BTU)
u�ality Mamgeneent Distdci7
4hve read the baza oYes
pp�� pp
i aus materials requiremens under Chapter6.95 of BOILPR-COMp(OVER 100,000 BTU) Ir W B
the California Health&Safety Code,Sections 25505,25533 and 25534. I
understand that if the building don non currently have a tenant,that it is my NEW REIDI IAL MECO. SQ.FT NOV 4
responsibility to notify the occupant of the requirements which must be met 1992
prior to Issuance o(a CertiOate of Occvpaney,
CITY
Owner or authodzed agent Data ISSUED BY:
TOTAL:
OFFICE COPY
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------ ---- --- -- -- - '� - - -- -�' - - -- - -----� J UrrE-- \ I have studied this sketch and completely DFAVONG • JOB NAME: /! .♦ ��\t I i�Vc
understand its contents. Any changes or _ - p
G-J' 01,-,7 ��. � f O1 additions will be billed as an extra. - 6F � J(r�T VR_. `✓�E �f:Nc�
SCALE INTERNATIONAL
- - - — - — <. L�c� SIGN:
DATE: /` l ITCHIN&BAT
FICE
COPY--
Perspective Drawings are Artistic renderings and AFPgOVALS DATE should not be considered as drawn to scale. Because DRAWN- - - ---- - -- -_--- ---- _ -- . --_ _ -/-_ - .- _- , ��_---- of visual distortion in forced perspective drawings and
Li1KBt#.L possible plan changes these drawings should not be :HECnEo
Z considered contractual Reeiseo IDESIGNER- LpiZY 'fes- j--yDN
BISHOP ORAPMCSrACCUPRESS
REORDER No A61M