19988APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Build) Prot Identification
B°�i,g Add'
PERMIT NO.
23500 i a� R VI
u
19 9 8 8
Fhdne.
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
e�
Contractor'. Name: Ix, No:
BIAIDINGFLBCTRICAI�I'L[JMBINGMECHAMCAL
CATFCARY
CONTROL Y -
Arehltnt/En 81^Kn Llc No:
QTY ELECTRIC PERMIT - FEE
- BUILDING PERMIT INFO
Address, S
PERMITISSUANCE
❑ ❑ ❑
LICENSED CONTRACTORS DECLARATION '
Ihereby&H tlutlamlie wdunderpr WO of Chapter9(oarmim
Ingwith Seabn 70W)orpNelon3ofthellusirassand ProfndonCodpand my
- APPLIANCESRESi[DENTIAL
JOB DESCRIPTION
license 1. In full fora and effM..
PANELSI
Lice. Cla.
Date Contractor
UPTO0
ARCHITECT'S DECLARATION
I understand ery plare.hallheuaed n public reoada
OVER 1000 AMPS SQ. FT. FLOOR AREA VSQ Ff.
Licensed PrefeealorW
OWNER -BUILDER DECLARATION
lh mbyafBrm Hutlamexemptfrom Ne Comractare Lianas Lawfothe
following..(Sectfon 7m15, Bwinesand Profession Cde:Aoytltyor
muntywhk requlrnapert tome d,alter,Impmve,demo h,ormpairP
SIGNS ELI) TRICAL -
SI'CLIAL CIRCIITT/hQSC L E D IN
TEMP. g pct OR POLE INST.•
U -E R ��-
anystructura prior to its lssuaree a bo requires the appBont for such permit to
file a algned aaterrent that he is Licensed pursuant to the provfebr a of the
Contractor's Lkenx Law (Chapter 9(mmmencing with Section 7000) of Doo -
,,m3 of Ne Business and ProrensbroCode) orNrt he b exempt Neafromard
LOWER DEVICES
SWIMMING
ATIO
the basis for the alleged exemption. Any vldabon of Seetbn 70315 by any
appbnnt for. permed subjects the applleant to a ctvll penalty of not morethan
OI17LE1SSWITCIIESETI(7'L1RF5
five hundred dollars C;5M.
❑1, as owner or the property, or my employees wit v
with wagestheir sok
NEW RISmENTfAL ELkZ7R SQFI'. STORIES TYPE CONS7Rp
LGTN
compeosation, will do the work. and the stmobare Is rot intended or offered for
sale See.7DM, Bushes, ami Profeabv Cade: The Comnsior. U. I w
e30
don not apply to an owner of property who builds or imprwn thereon, and
who don each work himself athrmugh his own employees, provided Net arch
OCC. GROUP RES. UNITS'
Improvemcntnart not Intended oroffered forsale. If, however, the building or
Impmvementl.wid whhln mmeycarofcompletiun,the miner-bullderwlB love
TOTAL; 6-2 iDr
thrkardeh of provfeg that he did not build or improve for purpose ofsale.).
LLj I, owner of the property, am ex lestvely mntrxtlng with litensed
to whet uct the project (Sec 706{, Bushes and ami Professions Code:
QTY, _ PLUMBING PERMIT FEE' FID0D7ONE AIN
pygMI.I. ISSUANCE
.
The Commemes License Lsw dm not apply to an owner d property who
builds or Improves thereon, and who mmaGa for such ploleetz with a
ryL�ctor(s) Banned pomaantro the Coroadne. Lice. law.BAIX
LJ I am exempt under Sec B k P C for this reams
ALTER -DRAIN 6 VENT -WATER (EA)
FLOW PROTECT. DEVICE .FEE SUMMARY
OUTS DE FEES
S
DRAINFLOOR ROOF, AREA,(OND. -
FDS PER TRAP
SANITARY Y N_
RFSCEPI a
Owner - Duk
WORIGNAN COMPENSATION DECLARATION
❑I hereby affirm that I have a certificate of con>nt to self-Nsert, or a
artW�eorworkera•eanpenartlon lrw,rNaor.amried ropy thereof e5ec.
3800, Lab G)
Sp{OOLTAX Y_ N
xecElTT OF
GAS EA. INCL OUTLETS
PARK FEE Y_ N_ .
Fairy Y
ECEIPTa
RECEIPT
GAS FA. SYSTEM -OVER 4 (FA)
-
BUILDWG DIV
ISION FES
Certfed ropy b herebyed.
F-1Certifiedropy Is filed wth the city inspection division.
GREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECK '
GREASE TRAP
CERTIFICATE OF EI(EMPT[ON FROM WORKERS'
COMPENSATION INSURANCE
CM, section nerd not he completed B the pend[ b for.. hand red dollars
PAID
Dale Reoei I#
gEWER-SAMI'ARY SIDRM EA NOF7
($lao)a1mlms..)
I dor rt U the per(ortvna of the work forwMch thele permitk Issued,
I .loll mat employ any person N any manner at a, lo become object to the
Workerv'Compewtlon revs of Glifomla. pate
WATERHEAIERW/VENT/ITIC7R
ENERGYFEE Y N
.
PAIDAppU.
WATER SYSTEM/TREATING
NOTICE
NOTICEhould co s, APPLICANT: a after rs Co thensatinlpro o(Ene of the
eode,yo<oun mb}ctm the Workers Compewtionprovkis
Date Remi t#
NES, RESIDENTIAL PLMB. SQFL
TOTAL:
permhe Ubedbor
Cade, d r round forthwith comply with such provisions or this permed eFall be
deemed revoked.
BUILDING
SEISMIC FEE
CONSTRICTION LENDING AGENCY
TherebyafBrm Wtthere bammtructlon lerdingagenry forthe pedorm
nre of the work for which thin permit Is Issued 6ec 3041, Cie, CJ
Lender's
- TOTAL
ELECTRIC FEE
0 Q
-
QTY. MECHANICAL' PERMIT' FEE
PLUMBING FEE -
Name
LendersAddres
I certify Nat I1uve read thio appButbnard state thrtthe above Inlorwtlon
bmrmx. lagreetocomplywflhaUtlyaMm tyord nmandstatelaet
MECHANICAL FEB
PERMIT ISSUANCE
FEES PAID:.
relating to Wilding mrmmcttom, and hthM
ereby aur representatives ofthis
"
dtytoenteruponthe abwrmenBorcdproperty for lnspeMonpurposes.
(We) agree to save, Irdemmly an d keep harmless the City of Cupertino
ALTERORADDTOMLCIL
Date - Receipt#
SUBTOTAL:
agaWtlWbWtles, Fudgments,anb andnpenan which mayb any wayamue
against said City In consequence of the graining of Ni. permit
AIR HANDLING UNIT(TO 10,000 CFM)
ATR HAN NG UNIT(OVER 1Q(00CFM)
CONSTRUCTIONTAX
Signature of Appllont/CmtractR Date
EXHAUST HOOD(W/DVTs
CONSTRUCTION TAX PAID:
IIAZAROOUS MATERIALS DISCLOSURE
.
HFATINGUMT(TO300,ODOBIU)
WWtheapplkantatuture WEdkg oaapant store or lurdk havrdous
material as dented by the Cupertino Municipal Code, Chapter 9.17, and the
Health and Safety Code Section 25537(a)7
❑ Yn No
Will theappbantR tort budding omupant use equipment or ti v
which emit harardee. air mmamlruw as defined by the Bay Area Air
INy Maregcmnnt Diurltl7
shave
Dale Recei t#
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
(yt G
VENTILATION FAN (SINGLE RFSID)
ISSUANCE DATE
e r^i
PAM'
AM'
BOILER -CAMP OM'OR 100,000 BTU)
Yes, ❑ No
BOILERCOMP(OVER 100,000 BTU)'
read the hovrdousmaterials requirements under Chapter 695 of
the CsfomU Health&Safety code, Section, 25505, 25533 end 25534. V
bD
�rl\ 2 rJ- t[1
NEW RESIDENTIAL MECal SQ}7.
understand that if Ne budding does not mamntly have a tenant. that it my
" 3990
responsibility to notify the oavpam of Ne he u r mems which *rust be met
Zt issuanceofa Certl(lateof Ori parry.
/fipc�i / �ifrn2(
City of f`�(fr^1p I'� /��
ISSUED BY:
I
Owner or authMud agent
TOTAL
OFFICE COPY