20597APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Prom ldendflod
Building Address:
PFR.MIT NO.
20597
Ownev ams: e:
Fitr(
CITY OFCUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
BUfIDINGEL9CIRICM_MUMBINGM9CHM,1CAL
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C its Nam Nu
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CATEGORY
CONTROL 0
A it \ C _53 ' Lk. No:
QTY ELECTRICPERMIT FEE
BUILDING PERMIT INFO
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Add - Wy %T—
❑ ❑ .�
PERMITISSUANCE
LICENSED CONTRACTORS DECLARATION
I hereby affirm that l am lleemsed under pmvblms of Chapter 9(commenc
I ng with Section 7000) of Dlvidm 3 o(the Business and Pmle onaCode,and
ho=ve 61n c.v q.
License m Lk.a (i �e
Date Cantndor LDUP
APPLIANCES-RESDENIAL
JOB DESCR�1'ION
SCRIP .�N('�
bT �/�L/
P
PANES
TO 200 AMPS
�'I� AMPS
ARCHITECTS DECLARATION
I understand my plans shall be used as public reoada
KJU
OVER1000AMPS
k ��}L Alt�wi
N
$.FT.
SIGNS ELECTRICAL IF TM
SPECIAL CIRCUIT/ML9C
Licensed Prdesbwl
DECLARATION
OWNERex rcpt from
Thereby afBmthat OWNE exempt n the IAMrartors LkeveLAW for the
/egowing reason. (Sedlm 7015, Businer and Pmfesabv Codr. Any dty or
countywhkhrcqulmapemittocovhuc Atenlmptovcdem016h,orm
CC vv
P 1 T Q
ly 1 , a
//��
Q 9/
Y
.
='(P'AfE'1'IRORIVLE INST. DATE
an stmdure nortol66 arce,abo
Y P rtqukntheat to the lmaudipeof t e
Ne • signed etatemmt thrt he (Chapter (.ed pursuant to the pon 70= f the
Contractor's3ofthLkeve Law andProapter9(commndng With he
nherafof Old-
.bn3 of the Bualneseand Prdesbro Code) orthrt he b exempt therc(romand
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUATION
the basis for the dkged ezemptbn. Any ddatlon d Section 70715 by any
apermhsub the appBvnt to•ddl pevlty .!sat rtorethan
OUII%I55WITCHESSFEXTURFS
NEW RFMTAL ELECTR SQFT.
If unt(or
Ilv�und red dollen he pr . .
I,sowner of the property, or rtry employees with wages utheir sok
SRDw6
M'G CONSIRl1CTK1N
a
compevatlm, will do the work, and the structure 6 not Intended or offered for
oak (Sce. 7049, Buslma ant Profesabro Code: The COMrsdora Lim. Lw
don not apply to an owner of property who builds or Improves thereon, and
whodoessuchwerkhlm.elf orthmughha.nemplmyen, provided that and
OCC.GROUP
RES, UNITS
Impmvem artortIntendedorofferedforoak. I/,however,ehebuildiogor
Improve mboldwithinomyearofcmnplebntheownerbullderw i1 ve
TOTAL
t" edenOfpmvfngthAhedld mtwudorlmprweforpusposeofaak.).
LJ S as owner of the property, am exchraively contracting with licensed
contractors to construct the pm*d(See. 7DK Bumnes. and Pmfesebv Cade:
QTY. PLUMBING PERMIT FEE
PERMIT ISSU N E
FLOOD TONE
APN
The CoMnctor's License Law dm no, apply to an owner d Property who
Wor Improves Nceon, and who comnm for such pRo}ects with •
orfs) Ilnved pu mint to the Contractor's License law,
LJ 1 am exempt under Sec B It P C for this reason
��-0RA W k VENT - WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
OU`TSI DE FEES
DRAINS FLOOR ROOF, ARRA, COND.
SANITARY Y_ N
RE�FLT a
Owner Date
WORKMAN COMP FNSATION DECLARATION
_�/Ilhcrtby •/firm that I have • certificate d amsent to self -Uwe, or a
cc�klawe �o/)Worken�'Clomperoarlon lvu oeora mniif/led copythered CSec.
1390 abn� (O Ij O7 y
�'_'2
FD(TUIffS PER ]RAI' �
`Ai00L TAX Y_ N_
R�T1
GAS. F.A. SYSTEM -1 WC4 OUTLFIS
PARK FEE RECEIPT
GAS EA. SYSIFMOVER 4 MA)
Com n).�) L� �}1.
BUILDING DI VISIONFEES
Certified copy 6 herebyth the cited.y r' di
nlned copy 6 filed with the dry wpectbn dI Wim.
GREASE/WDUSTRL WASE IhIMCIPTOR
PLANCHECKFEE
'
GREASE TRAP
CERTIHCATEOFF](FMPTIONFROMWORKERS
PAID
EA. STORM EA. 700FT.
COMPENSATION INSURANCE
(This section need not be completed V the perm3 b for one hundred dollars
Date Reeal ill
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y N
PAID
(5100)mless3
I or
.0 ti the performance of the work for which eros pemmt 66sued,
emper any person f any minermscobecome ub)ed to the
Workers
worker: campen.atbn L.w.dalummla. Drte
WATERSYSTEM/TREATING
AppNOTICE
NonceTOAPPbcwNr:eassnmkingte ticnproiaE.empptteLabo
ahmumbemmaubjh it the pmvbbpermitns of
Date RL i tit
NEWRETIIDENTIALPLMB. • SQFT.
TOTAL:
pm lslo
Code, you milt, forthwith comply with ouch prvv6bro or this prim shall be
ply With Ibe
deemed rooked.BUILDING
F II
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
IhercbyafBrmtfat then bacovtruction kMing agency for the perform
ani of the wora ec for which this permit 6 issued (S 3071, Civ. C)
TOTAL
ELECTRIC FEE
PLUMBING FEE
Lander. Name
Lander.Addnaa
I mrtlfythd I have mad this appBeatlonand rtatethn theabove information
6correY. Iagrtemcamply wBh all dtyand county Oedbanmandstaklaws
QTY. MECHANICAL PERMIT FEE
MECHANICAL FEE
PERMIT ISSUANCE
FEESPA] D:
reladngtobulldingoommuction,and herebyauth«b mpmaemativesolth6
dty to <nterupon th e- ntbned erty for Inspection purpoan.
M'e)agree to damnify rte burMmth f_Iry Or Cupenlru
Vertoma"
ALM OR ADD TO MECH.
Date Recelptk
SUBTOTAL:
ago WtllabWt 'u ndex name ch Inanywayaccue
agv taald I ansequc it .Min permit.
AIR HANDLING UNIT (IO 10,000 CFM)
ADR HANDLING UNIT (OVER 1 Q000 CFM)
CONSTRUCTIONTAX
Slgv pp one/ rotor Dater
DCHAUSTHOOD M/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
HEATINGUMTEO 10D,000BTU
WOltheapplloM ex futurebulldingaapant uort Or handk havrdow
mterlal s defined by the CupeOIM Munldpal Cady Chapter 9.17, and the
Ikahhand Safely Code m75537(a)7
171Yea .
-
Date RttCI IN
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
VENTILATION FAN (SINGLE RE4D)
ISSUANCE DATE
EJAID
ID
Will theappllaMtort building occupant use equipment or device
Which cede hasrtlm I Ir contambums as deRvd by the Bay Arta Air
Q.Afty Mavm
gceet trk17
BOILER -COMP DMP OHP OR IOKlin
BA
Yes No
3OILER-0DMP(OVER I MODO BTU)
have read the m.m cdab requirements under Chapter 695 of
the Ca lifsmla Health & Safety Cade, Sect Ions 255W, 25533 and 25534.1
Und eatand that) Ildingd mently have a tenant, twt it 6 my
7
JUL 3 1 1990 '
NEWRESIDENTIALMECHL SQFf
raporofb0lty not the occV td requim whkhmutbemt
P to ne Certlf of parry.
r� ��
1'h All' 7
ISSUEDBY: I(f�V1,/e�Ll
aolhoriruda nt Dart
iOTAL:
OFFICE COPY