27247 NirrLluNn I I v nLL rat rnrvnmN r rvn ver I urn seas unw-uOe oMe.e.nasus r ren vnL r
CITY OF CUPERTINO BUILDING.- M• r•I:anSrr No.
BUILDING DIVISION APPLICATION/PERMIT PING PRO ME
II)INTMC 27247_
BUILDING O BCP BNT C N.r.4,
BUILDI1^/ p^,(ING AIDQRISS: SANITARY NO. AIgS.ICAl10N SUBMITTAL DAII'.
LOT 0
O t 5 - PDONIL COMMA '(lR:S NA j'.: -�A �. LIC NO: NIC CONIROLN
Cill'IECTp1tGINItiJt LIC NO: ADDRESS: ■V�ei�✓f���" ❑
\ CONTACT: 1'FIONC �s � 1+ cHa2`v t,
VLTp�. 9 4t Ai .t-$"',�'ygg°�''f PVRMIT PLUME O
.krt ISSUANe^a"'GSIUC^FW-'-vPBR'110l:�!�ti1'�1<' h'1i yyt+J,�t BLQG ELECT PI.UOMfl ME01
PERMIT ISSUANCE �t - rsL�Ji
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL IORDISCRIMION
OKZ Ihereby vfflm@alI an llcemd under pmvidamofChapteref(conmeming with
s10W0 Section 7000)d Division Jof the Bushes and Profusions Cde.md my license b in PANELS
<-Zw full License
andeffect. t��
cedcw Liccnm Clad LIc.N UPl03W AMPS J
y Q LL Dnc Conuecl« 201-1000 AMPS
=y SQ.17.MOOR AREA S/SQ V.I.
yb ARCHITECTS DECLARATION OVER IOW AMPS
O Z�qqq 1 nndera ml my plans shell k ured as public records.
LiSIGNS ELECTRICAL
�kdd ttnsed lYnfeuimml
Rd 6 OWNER BUILDER DECLARATION SPECIAL CIRNO/MISC.
O U I hereby ur( that 1 am exempt frmm the Cosion&Cc License law Ire the
kON following leason.IS«sion7OJI.5.Business and Rofeneion.Cade:Any dlY or cnumy TEMP.METER OR TOLE INST.
which requires a Permit to cords,slier,improve,demolish,m repair any s nscmro
Y� priurm id bAtimer.rdso requires lhe.pplicam fonmch permiuo file.signed statement POWER DEVICES
<p Ih.t he is licensed Personal to the provisions.(the Convector.I.imnse Law(Chapter
C y.
Is. 9(commencing with Section 1000)of Division 7 of Ne Business and DSWIMMING POOL ELECTRIC VALUATION
ofesnionn Cade)
_y car that he is exempt and the basis for the alleged exemption.Any violation of OUTLETS-SWRCfiES-FIXll11LE5
} SecRnn7031.5 by any applicant for a Permit subjects the applicant ma civil penalty of
Ot one than Tim hundred dollen(3500). NEW RESIDENTIALELECIR _SQ.FT. SIORICS 1YPI:C'ONSIRUCIIO
LunwnemOhepropenY.ormyemploY«swish wage anheireolecampeme0on,
wit he
work,end lhenmcmre lamsihtenddornffercJ fnreelelS«,JOII,Budrmea
N.,Pru m Code:The Convucmr's License law does not apply in an owner of
pmpenywMtbuild.mimpmvevtherwn,andwhodm.swhwMhimslfmthmughhinWC-GROUP RFS.UNIIS
wn employee,pmviJed Ihvt ouch imprnvemenb ve nos imcndd omffetd for sale.IL
Inweveq Ibe bnilAinp m imprnvcmem L told within one yen of complaion,theowno' TOTAL:
builder will have the burden of prming thin he did and bond m Imtmve fm Perform of
sale.)., , � lV;,y,YA4t' � OOU :SAPNQ
rel,
construct the pmjecs(Sec.7014,Busines and Professions Castel The -untraxim. PERMIT ISSU CC
Littnae Law docs nm apply loan owner of property who builds or Improve thereon,and
who mml W q formch prnjects with.cmnvactm(s)licensed pursuant to the Contractor's -
LicenseLaw. ALTIiR-TAINA VENT-WATER(FA) 14iKb i'.is+ ^PFi85UMMARY
❑ 1 am exempt under S«. .B 4,P C for this ream BACK ylIGW
PROTECT.DEVICE
SANITARY Y N_
(honer Dee DR S-FLOOR,BOOP.AREA.COND. RECEIPTN
WORKMAN COMPENSATION on toARATION SCHOOL TAX Y N
Ih'CompaBnn thatram a or.Ordfiedonumsool'(S.sclf ure,oneml0cateuf IVRES-PERTRAp REGEIPTN
min,1 Comtets'ionlmurm«me«niOd crpty thereof(S«.1gW,Lab C.)which PARK FEE Y_N_
covers allemploy«'s under this permit GAS-EA,SYSTEM-I INC.4 OUTLETS RDIVISION
Policy N BUILDING D1Yi$IGN IIFS
Company GAS-EA.SYSTEM OVER 4(Eq PLANCIIECK HE
❑ Certified copy is hcrchy famished.
❑ CeniBd crgy is filed wiN the city inspection divbion. ORFASEANOUSIRLWASTEINTP.RCEPI'OR GRADING FPI
CERTIFICATE.OF EXEMPTION FROM WORKERS' OREASETRAP SOILS FCC
COMPENSATION INSURANCE
(Thin n«tion sed nm be completed if the permlOsfm one hundred dollen 100) SEWER.SANITARY-STORM EA.20017. . EROY FEE
or les.)
I certify that in she parfrmmamed Ver work for which Nie permit is Vasa Ishall WATER IIEATTRW ENT 'CTR
nm employ any Priam in any mamnr an u to hecmrc subject to theorkern' PAID
C'rmrynnvnim laws of Cdifmmie. Mie WA'IIiRSYSIEM/TR 1' U:ne Rccrlpt0
O Z Applicems
yryz O NOTICETO APPLICANT:IL firer making thb CeAOcned Eaempriomy should NE ll 1.MR. SQ.FT. TOTAL:
F-I Vy hcconrcnuM1j«I mlhe Workers Compensum pmvieimanf the labor Code. must
rFFrr++++� fmlhwithcmmrly wRh such rmrlslms mlhir permR.hell be deemd mvnkd.0 BUILDING FF:E
GG SI:ISMI (ER
[� NNem Is ac ION LtimlINO AGCNCY
Uz ink for
Yhich this pi iusued( .3097.lending agency for the pcdrammceo T ELE KITE
U O the work for which this permit Is Issued(S«.7119],Civ.C.)
G. Ir I<drrs N.nw . 's 2�.:u11 i (� .UMOINGFEE
O IV+ Isnddn Addrna kt.,.� IMbldlAN1CAL. HhMI�I':
I unify shat I have read this application and sum that the above informal.ie ;'v�^
W crrts«t. lege«mcomply with sll city cad county mJineme ad sate laws mle0ng to P MIT ISSUANCE MECIIANICALITE
U) buildingconxvuction,and hereby eushd«mpremmadve of thiscity memerupm the NNS'ntUCT10N TA%
aM1ove-meIi...dpmpeny for impop
action Proses. AL OR ADD TO MECIi.
O (We)agf«m sv..Indemnify and keep handles the City of Ci pcnlivagelnn
labilivaijuJgmenv,cot.andexpemu whichmay inlay way arcmeagaimOaid City AIR IIA LING UNIT0010,01111 CFM)
ran.,.,squame the grmsing al thin perch.
AlR FIANDi. GUNIT(OVER IO,WtO CPM)
//—/—
n AFFIcam/Cnntncmr Data EXIIAUST If 00 WIDUCIT PAID
HAZARDOUS MATERIALS DISCLOSURE IIEATING UNITOO ,NXI BTU) Data Receipt N
ill theapplicant m future building occupant more m handle hazardous malarial [BEATING UNIT(OVGRI Ol'U) TOTAL''
defined by the Cupertino Municipal Code,Chapter 9.13,and the I I<ehh ed Safety
Sectim 355]2(.)7 VEN"n1AT1ON PAN(SINGLE RPSID)
❑Ya ❑No
S U CF^DATB
Will theaprlicantnr future handing occupanmse etipmenl ordevicas which emit BOILER-COMP(JIIP OR 100,gX1 BTU)
ezardoui air conmminame as defined by[be flay Area Air Quality Management ROILIiR-COMP(OVER 100,000 BTU) NO
'S
insias7 r 1 1994
❑Yes ❑No NEW RESIDENTIAL. F.CII, Q.M
1 have lead the harenmus mmeialc regdreatemn under Chapter 6.95 nr Rte ^ airy Vr Wrt"I Hilo
e.lmd.Hehh a SO.,Cord.Section.2.550.5.35573 and 255]4. 1 mderstmd thin
if the building dons nm cunedy have a Vacant,that 11 1%my roprmsibilhy to notify the
mentons of Rn reyulremrmx which must Ise met prim to issuance of a CeniOcem of
fxetpmcy.
OwnerorwlMaisd agent Dam / T ISSUED BY:
OFFICE