20834APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification -
Build Lig Add.:
3y5_0m a,'st0
PFX.WT NO.
20834
Owner e one.
lernf�.n,e
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
Vr«Q
C 's Na Lk. No:
Arch /Fnglra+:r. Llc No:
BUILDING-ELECTWCALML BINGMr�CHAMCAL
CATEGORY CONTROL
.
BUILDING PERMIT INFO
QTy ELECTRIC PERMIT FEE
Adams
❑ ❑ ❑
PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION
IhmbyaBlrmtbatlunikeseduMerpm Woroaf Clupler9(aam c
Ingwlth l an3of"he Bustmvand rrv(eetlonaCode, and
dfeG
ingn th l nUP
APPLIANCES RESIDENIIAL
B UES
DESCRRRION
^ ^—
PANFIS
Vale Cbm can q_
Date Contractor 14442S./
ARCHITECTS DECLARATION
l.nder,t dM lyphmiluUbeusedupubhcmcorda
TO 2DO AMPS
-/ V .�•c�µ
201-IODOAMIS
OVERIOOOAMPS
SQ. FT. FLOOR AREA f/SQ. Fr.
SIGNSELECTRICAL
Limnx Prof mbnal
OWNER-BUILDERDECLARATION
I hereby.. twtIamexempt/mmthe Co of.dixCeroe Lawd the
county whld requima permit romnatmd, alter, Lnprove, demolbh,orrrpalr
enuntyf-dlngreason.(Seaa p 9ml S,Buaruc •it Rmpume, emohhny depar
SPEC1ALCIRCUIT/M19C
TFL{P.METFR OR POLE INST.
anyaru=mprWtolbl arc,aL mhqulmtheappemt/mauchpermkto
Ob a signed statement that he h Ikenaed pursuant to the provlaloro of the
Contu,xW". Lken Law (Cl pter9(mnurcndng with Setlbn 7000) of DM-
alon3 ofthe Bualnemand Prof®bra Code) orthat he b exempt thereGomaM
POWER DEVICES r
LUA ON
SWIMMING POOL 1d.ECTRIC
the bails for <h<ilbged exenrytlmr. Any Wolatlonof Section90115byany
appUo tforapem nbjecbtheappecanttoadNlpemhydnumorethin
OULEISSW1TCfiF_SFl)O'URFS
T E
NEWRElIDENTTALEII=_gQFT.
Ove hundred dolbm ($500).
F11,n owner of the property, or myemployea with wages as their sole
compcvatlon,wRl dolhe wvk, and the strumare, b not Intended or offered for
RIIS
TYPE CONSTRUCTION
.le (Sec 9064, Buelnew and Ph emioro Code: The c.m.d.e. U. Law
dm nm.pply to an owner of pmpetywho buildsorlmpmvn therto"and
mchworkhi U«throughhbownemploym, provided thatsuch
OCC. GROUT' RES UNITSwhod«
Lnpmvemenbart not Intended or.ff ned for sale. It howenr, the Wilding«
Improvement esold whhlnoneyearufc repletion, the ownerbuItderwill have
TOTAL:
UAJ�urdxn of proving that he did nert Wild or improve for purpose of sale.).
as of the pros
L owner property, am ehulve)y corroding with 11«naed
contractor, to mrotrud tie pmject (See 9014, Buslnem and Prof.ams Code:
QTY. PLUMBING PERMIT FEE
PERMIT NUANCE
'FLOOD ZDNE APN
The Contradorb Lm rue Law don not apply to an owner d property who
WOds or Imprao thereon, and who contracts for such projects wkh a
qnq�orW lumnaed punvant to the Contndcas Lleroe Law.
LJI am exempt under Sec B k P C for this re,aon
ALTER.DRAP76 VENT - WATER (EM
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR, ROOF, AREA, COND.
SANITARY Y_ N_
RECEIPT
Owner •. Date
WORKMAN COMPENSATION DECLARATION
hereby a(flrtn that I have a «rfigeb of conn nt to self-bau e, w a
r
e fW Com�pero/aHa/rn lrraauumm, m!anUflextccoopy thereof(Sec.
FIXTURES PER TRAP
SCI{ppI, TAX Y_ N
RECEIPT a
GAS EA. SYSTEM -1 INC4 OUTLETS
PARKFEE Y N
Polh, 0 I_TcjC OGh'/(// Y � eJ�
REC1= 4
GAS FA. SYSCEM-OVER 4 (EA)
Cr, ray h /r'
cent pyb ere fumlahM.
ertified copy b f0ed with the eity iropedlnn dWblon.
BUILDING DIVISION FEES
eRFiL¢/INDt3sIw.wASTE 1NTERGE]'TOR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF E(.'MPTION FROM WORKERS
COMPENSATIONcomple INSURANCE
(Thlseenbn need not INSdthepRANGEmut ore hundred Oolbn
PAID
Date Recti tp
SEWFR.SANTTARY STORM EA 2XFT
I certify that In the perfomunm dthe wuck forwhich this pemat b issued,
WATER t-QATFR w/vFNr/EI.EClx
ENERGYFEE Y N
I shall not employ any person b any manner w as to become subject to the
Werkerd Compenmtbn lAwa of California. Daze
WATER SYSTEM/TREATING .
PAID
AppNOTICE
Date Reoei tq
NEW RESIDENTIAL PL.MB. SQFT.
,you
NOTICE TO rx, sub CAM: a after mking t e Certificate la Em of the
become sub}ctlothe Workeri Comperoatbnprovbls
TOTAL:
C -de, peofthetabor
CMnxdrx rt(orthwith comply with each pmvNbro or this permit chill be
daemW rerokea.
BUILDING FEE
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
I hemby.firm that there b a corobuctloo lending agency for the perform
an«oftheworkforwhkhthb pertnttbLwed See 3M, CN. C.)
TOTAL ,
ELECTRIC FEE
QTY. MECHANICAL PERMIT FEE
PLUMBING FEE
L<ndeb Name
Lender'.Addreu
l anifythat l Hvemad thio appllatlonaM gatethat theabove bfomwlon
ix onne l.gm to complywith all ckyaM munryoWbanry ane state lawn
mlating to W tiding corveruetten, and hereby authorize repreebtwe d thio
MECHANICAL FEE
PERMIT ISSUANCE aCYD
FEES PAID:
citytoenteru above-rrc red property f« Irupetion ptup..
(We) agr Lid d keep harmle� the City d CupertlCupertinoagalM�
ALTER OR ADD TO MECH.-
Dale Recei tk
d s.3Serayrn.nywayamue
oredp,
"HANDLING UNIT (To tOpOocM)
SUBTOTALI
AIR HANDLING UNTT(OVER 10," CFM)
CONSTRUCTION TAX
Sigvtumd AppBa Date
IXFiAVST HOODIW/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS
HAZARDOUS MATERIALS DISCLOSURE
"{EATING UNIT (TO 100,1100 BTU
WWthc app0®rat the
goaipalCmom Ch pier 9.h and
Cupertino
rtutenal as deBrud by ebc Cupertlw MuNtlpal Cada Chapter 9.12, and the
tkalth and Safety Cod on 2S33(a)i
FF��I Ye
Date Rxei to
HEATING UNIT (OVER 100,000 BIT)
TOTAL:
''``
GgOk
VENTILATION FAN SINGLE RMD)
ISSUANCE DATE
iYWtheappikan uWllding oeeupantuseequlpnxentordevlces
whkh end t hazendous air ounummanb as deRned by the Bay Area AL
BOII.ER-COMP OHP OR 100,IXV BTU
Quality Maragement 7
4Y. o
Fuve read the h ous materials requirement, under Chapter 49S of
BOaGR-CONr(OVER 1W,000 BTI)
the California H a SafetyCod" Se�nlors 795[5, 15533 and 25536.1
NEW RESIDENTIAL MEo-I. SQ.FT.
u MenbMt } t( eliding do (,(urrently hry steer,", "Fut itbmy
rapondbil fy the o he require to whkh rturt W met
In rt 1a Ce'd f avpan
J U L 3 11990 _
^
`Date
ISSUED BY:
O
TOTAL: 3(}0�
OFFICE COPY