19982APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY X,
Bulldln M ProIdentlftcatlm
Bu�4roo crI.ITD Y.
PERMIT NO.
19982
one:
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CITY OF CUPERTINO6BUILDINGDIVISION
APPLICATION / PERMIT
BUAIEINGE.FLTWLGM
CAPLUMBINMECHACAL
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Contradors N.mg,
l
CATEGORY
CONTROL,1S37
Ar<hhed/Enr. Lk.'Na
K r +
QTY ELECTRICPERMIT FEE
BUILDING PERMIT INFO
f
Address 6 0 9 S C S
1:1 El ❑
PELhBTISSUANCE
LICENSED CONTRACTORS DECLARATION
IFereby Wlrmthm l am lkeraed uMerprovM¢adChaptar9(mmanmc
Ing with Sedbn 7008) of Dlvidmn 3 ofthe Business and Pmfnel Code, and my
APPEANCESRFSIDENIAL
JOB DESCRIPTION
Ikenp is in full forat and effe .
Lkense CIot,Lie
Dae cto
Contrar
PANELS
1
S.K L � �)
. l `--� �V-S I
-
ARCHITECTS DECLARATION
I understand my plaro shall be used u public records
OVER 1000 AMPS
SQ. FT. FLOOR AREA
5/SQ. FT.
SIGNS Fre^vrr'AL
Lknn Prot.lonal
OWNER -BUILDER DECLARATION
I hereby affirm that I sm exempt from the Cordraeorb License Law for the
.. ( f 6 D —
SPECIALCIRCUfT/MISC
TEMP.MECEt ORPOLEINST.
following reaaon. (Section 7031,5, Busher aM Pmfessbw Code: Any city or
muntywhlchrequ4 ape tomru c,alter,Mpmve,dert h,or¢palr
anyarudu¢prlmtoibL ameaL mrtqulrntheappUa tforwchper to
file. signed statement thrt he b Bamsed pumuant to the pro loos of the
POWER DEVICES
J .
_
SWaMNGPOOLLIECTRIC
OUTLETSSWITCI-IES-FIXTUIRES
Contractor.Lice. Law (Chapter 9(mmmend.g with Section 7000) of Divi.
.,an3ofthe Bu sinem and PrderbroCode) or that he ef exempt therefromaM
the baset, for the alleged exemption. Any vldatlon of •'dlon 70315 by any
.ppurart fora pemrmit wb} the applicant to a,fvIl penalty d n¢rrn¢ than
VALUATION
S^ e0
L/ O OJ
/
NEW RESIDENTIAL Fr BcTR SQ FT'
nmartaada.
lts5am.
nl, as owner of the property, or my employees with wages. their sole
SID
TYPECONSTRLCTION
romper tion,will do the w¢k.aed the strudvm b not intended or offered for
sale (Sec 70K B..lneu antiPmfesbbU¢roe
m Code: The Cooad.e. I.w
dm wt a pply to an owner of property who halide or improv. t hereon, and
who do.wch work himself or through his m
own employe., provided that wch
OCC.CROIIIa
RES. UNITS
impmvemeds are not Intended oroffered for sale. If, however,thebuilding or
Impwvermnt is" wlthlnomyearofm pletbgthewvner-bullderwlll have
TOTAL:
'
rt ben of proving trotne
he did t WJ]d or improve for .e parpof.k.).
L as owner of the property, am exclusively oontracting with licensed
t to mratrud the projed(See 7044, Busher and Poo(mbw Code:
Ory. PLUMBING PERMIT FEE
PERMIT ISSUANCE
FLOOD ZDI•IL
APN
.
The Contactors License law don not apply to an owner of property who
builds or Improv. therton, and who mntads for ch p'k} wbb a
ryupdor(q hoensed pu.wnt to the. Vada,'. Lice. law.
LJ 1 am exempt under Sec B k P C for this reawn
ALTER -DRAIN 4 VENT -WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAWS FLOOR, ROOF, AREA, ODND.
SANITARY Y_ N_
RECEPI
AIn!
Owner ORKM ra��- �Ir-'Date ry—
IQ
WORKMAN CO—CI IPFNSATIO •kohaeen AT O—I N
❑1 here affirm that I have a ¢klflcalc of4aM1rnt to sell-Iwrt, ¢ a
artl(lot<of orken'Camperoatim lrmunn¢¢a ¢rti(led ropy thereof C.ec.
Lab C.)
I�RES.�TRAP
$pjDq, TAX Y_ N_
�f4
GAS EA.SYSI.EN-1 QJC.4017[LETS
PARK FEE Y N
Pal.W,
CAS EA. SYSITM-OOVER
Coms y
DING DIVISION
BUILDING DIV 1510N FE CS
Certified ropy b heed Mt],t bhed.
Cedl/led ropy b filed Mt], the My Iropedlon division.
GREASE/WDUSTRL WASTE 1NTEtCEPIOR
PLANCHECKFEE
GREASETRAP
CERTIEGTE OF EXEMPTION FROM WORKERS
PAID
S0WER-SANTTARY-STORM E700FT
COMPENSATION INSURANCE
(TMeeMbnneed fid be cmnplatM B the perMt b f¢ ora hundrtd doll.A
Date Rtxci IN -
(s1m ngyt.)
I ¢Am mploy my peo in soy oe caner w as Moh rneerodt is basset,
I shall not employ any.anon b any manner m v to becnne wbJect to the
v'Compennatbn laws of GlRomla. Dae
WATER EEATERW/VENT/EIXCTR
ENERGY FEE Y N
PAID
WATER SYSTEM/TREATING
Appll
Appllant
NVTICE TO APPECANT:R, cher making thio Ceddlnte of Esempbn,you
Date Rcecl t#
NETVRmDF1NrtAI. PLn19.SQtT
TOTAL:
ehald become wbfed to the Worken: Comeroatbn provbiu. of the Labor
Code, yw eons f¢thwth comply with wrh provbloro or this Fermlt.hall he
deemed revoked.
BUILDING��• R
SEISMIC FEE$�-
CONSTRUCTION LENDING AGENCY
Iherebyafflrmthatthereba mvtruriw lending agesa]y' fortheperform
anon of the work for which this Nmrdt b b M(Set, 3097,CIv. C)
TOTAL
ELECTRIC FEE
PLUMBING FEE
Landers Adds.
1,t . 1hrtlhavemplthioth all dty and rpay rdtrar.ionforto Zion
bmimto aJnntocomply tatebws
QTY. MECHANICAL PERMIT FEE
MECHANICALFEE
PERMIT ISSUANCE
FEES PAID:
m,&llcdya yauetyo mpn nna
rtlating to building mrotroction, aM hcrtby wthorlu rtp¢rnmtiv. of thio
dty to enterupon the abnd,mudlysand propertyf¢Iropectbn pu
(We) agree to prig 1MemNly and keep the City.( Cupenlro
ALTER OR ADD70 MECH.
Date Recel t#
AIR FIANDLINC [MIT (1'010,000 CFT.0
SUBTOTAL.
esrM.s
against Habi11t1.,ydgmequenoetsaM exams which may in anywryanzue
gaWt.ald Cityb con.equnue o(the gnminR dthl. pennB.
L�„�� J+ �
AIR I-IANDIl NC I1NIT tOvlA lo,00pcFbO
CON$TfiUL'ITON TAX
Sigvtuire o/Appb¢nt/C I' PT e
EXHAUSTHOODM/DUCT
CONSTRUCTION TA
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT CFO IDD,000 BTU)
WBl the applkard or futurt building oavpant siort or haMkhavndous
nutcrlal a. defimd byt Cupertino MuMdpalCMCCh pier9.17, and the
DaRLCeI IM
HEATING UNIT (OVER 100,IIN RTU)
TOT A .
Tieahhannl Safety Code Section 2553LG)7
Y. No
VENTIIATIONFAN (SINGLE IZE9U)
ISSUANCE DATE '
p y-- 4
� �e% 7 d{� �� it \-d,
ordevkes
Illtbefhpplid.a tv¢nnjoat. omapantuse the Bay Area
whichyMtragrment WcvntamWrdeas drflrN by the Bay Ar. A1C
Quality hiavgemend Dbtrk.7
4Yee F� No
hariemaatheh aaat,maerfabrequkemenbunderCh pter6.95of
BOILER -NMP OI-0'DR100,0[q BTU) �
BOILELCVMP(OVER 100,0008
the C.19.b Health h SafetyCite, Se .25505, 75533 and 25534. I
t
NEW RESIDENTIAL MECH. SQ.FT.
underztaM that lithe buBdingdoes not currently have a tenant, that it b my
_
r.porobBLLyto notify the ocapant of the requirements which must be met
prior to fswarue da CMilbta o(Ocv parry.
-
��' .""
ISSUED BY:
Owneror.uthorbed •gent Date
TOTAL:
OFFICE COPY