23080 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification - PERMIT NO.
B.0ding�g``Address: 23080
'V
hers came: APPLICATION SUIPMII IAL 5KT17
5 CITY OF CUPERTINO-BUILDING DIVISION
Contractor's Name.uLIl.Nl: APPLICATION / PERMIT
5 ��' UN h BUILDINGELECTRICAL�PLUMBINGMFCRAMCAL CATEGORY CONTROL#
ArehBM/Engineer. Lk.No:
nQTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address:I IC a
PERMITISSUANC'E ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION
thereby
licensedunderButlrova.d PrfChapterodc,an me APPLIANCES-RESIDENTIAL JOB DESCRITION
In ease i Section force
d offs on3ofthe Bualnessand Pro(ealonsCode,and my
Ilrerue Is In full!caro.and d(M. PANELS
Llrense Clan - LB,#
Data Contractor - 2011000 AMPS
ARCHITECTS DECLARATION
oto O I understand my plans shall be used a public records. OVER 1000 AMPS SQ.Fr.FLOOR AREA s/ .Fr.
Licensed Professional SIGNS ELECTRICAL
6 rOWNER-BUILDER DECLARATION
es IT SPECIAL CIRCUIT/MLSC
Z t' I hereby affirm that l amexempt from the Contractors License Law for the
following reason.(Section 7MIS,Business and Professions Code:Any city or
FF TR.SIa.MEi'QI ORI'OLEINSr.
,� countywhlch requuesa permittocomtmct,siren Improve,demollah,or repair
S Q any structuretaementslawancgaW licensed
pursuant to the revision of to POSER DEVICES
ES' U floe a accord statement
ens eLa that he t r 9(cod pursuant to the tion 70M) f the
3 u,r1� Contractor's License law(Chapter9(commendngwlth Section 7000)o(Divl- SWIMMING POOL ELECTRIC UA
F�OJ siun3oftheBusinessand Profs Code)orthathebemmptthemfmmand VALTION
the basis for the alleged exemption. Any violation of Section 7031.5 by any OUTLETSSSWITCHEBFIXTURES
applicant fora permit subjects the applicant to a civil penalty of not more than D Q
five hundred dollars(55M. NEW RESIDENTIAL ELECTR
❑I,as owner of the property,or my employees with wages as their sok SQ FT' TYPE CONSTRUCTION
C mmpenuHon,will do the work and the structure is not Wended or offered for
5 sale ffSec.7044,Business and Professioro Code:The ContnRo's License Law
(pj $ does not apply to an owner of property who build.or Improves thereon and OCC.GROUP RIS.UNITS
W who doessuchw°rk himselforthmugh hlsown employees,provided that such
Improvements arc not Intended oroffered for sale.If,however,the Wilding or TOTAL:
Mpowement V sold within one yearofoomplelbn,the owner-Wilderwlli have
tryRkurden of proving that he did not baud or Improve for purpose of sale.). QTY. PLUMBING PERMIT FEE
Ias owner of the property,am exclusively contracting with licensed FLOOD ZONE APN
J L
contractors to mn•wct the project(See,7044,Business and Professions Code: PERMIT ISSUANCE
The Conlredoes License Law does not apply to an owner M property who ALTER-DRAW AVENT-WATER(EA)
Wilds or improves thereon, and who contracts for such p(ojecea with a
cjV.c1m(s)licensed pursuant to the Commotors License Law. FEE SUMMARY
IJ I am exempt under Sec. B k P C for this reason BACK FLOW PROTECT.DEVICE OUTSI DE FEES
•� Owner _ _-_----Date ,re ^r DRAINS FLOOR ROOP,AREA,COND. SUMMARY Y_ N
WORKMAN COMPENSATION DECLARATION RECEIPT#
❑I hereby afflrm that I have a certificate of cement to self-ie. T S '
mrtifiote ofWo•v-�^^ -" � RECEIT#
3800,lab C.) I Y_ N_
P.Rcy 11 RECEIPT#
Com ny_ JILDING DIVISION FEES
Certifiedn 1
Certified ".0/20/93" PERMIT INSPECTION ACTIVITY FOR PERMIT 14 23080'-, ..'�IKFEE
R
10500 DAVIDSON
CERT '
(Thissectionn to Recei t#
` ($100)br lea.) --{?JSPEET[DN LATE .E Y_ N_
I eartuy that In
I shall
oulumotlmfo3 INSPECTOR COD---�—/F/F COMMENT—
wnrlrera cnmpen PATE DONE TYPE OF IN5PECIION
O Z Applicant_ Ta----^---�•T to ReCei t#
Z 0 .NOTICE TO AP - . , - , i '
H y
cAaay ,.Rio; 12/16/91 CHIMNEY STRAP, p0 C TOTAL:
C EE
W > deemed revoked. 30 p
F3 E 12/t6191 REBAR
E
CL Inereby alarm P
D Z anre of the work fo ` `
V O Lender.Na me_ 12/20/91 STRAPS J0 '-EE
LL H Lender's Address- 1L FEE
O 111
01rertflythat l ha
a Bomeect.lagreeta -
N reld.gtobuilding ,
F Z dtytoenteruponti - Recei tP
(We)agree to a --- P
V agaustllabNtles,N, .__...._...._,..,...y wayacaue AIR HANDLING UNIT CFO to,"CFM) SUBTOTAL:
agafrutsafd Cilyfn consequence of senting M this Permit. .
AIR HANDLING vNrr rovER l(LBBe CFM) CONSTRUCTION TAX
Signature of AppplIcant/CCion=tractor Date EXHAUST HOOD(w/DUCn CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE '
Willthe applicant onfuturebuildfng ocavpantstore or handle haaardous HEATING UNIT(TO 100,000 BTU)' Date Reeel tin
material as defined by the Cupertino Municipal Cafe,Chapter 9.12 and the
Health and Safety Code Section 25531(a)? HEATING UNIT(OVER 100,000 BTU) TOTAL:
1-1Yes Ira��I No
ISSUANCE DATE
Will theapplicant,,t tore building occupant use equipment or devices VENTILATION PAN(SINGLE RFSID)
which emit hazardous air contaminants as defined by the Bay Area Air ,
s Iity Management District? - BOILER-COMP(311P OR 100,0W BTU) p `` D
Yes ❑n No P A 1
have react the baa12us materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU)
a the California Health k Safety Code,Sections 25505,25533 and 25534.1
understand that ifthebuilding does not comedy have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.Fr. DEC - 9 1991
responsibility to notify the occupant of the requirements which most be met
prior to Issuance of a Certificate of Occupancy. 1
-GI
Owner or authorlmd agent Data ISSUED BY:
TOTAL:
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification - PERMIT NO.
B.0ding�g``Address: 23080
'V
hers came: APPLICATION SUIPMII IAL 5KT17
5 CITY OF CUPERTINO-BUILDING DIVISION
Contractor's Name.uLIl.Nl: APPLICATION / PERMIT
5 ��' UN h BUILDINGELECTRICAL�PLUMBINGMFCRAMCAL CATEGORY CONTROL#
ArehBM/Engineer. Lk.No:
nQTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address:I IC a
PERMITISSUANC'E ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION
thereby
licensedunderButlrova.d PrfChapterodc,an me APPLIANCES-RESIDENTIAL JOB DESCRITION
In ease i Section force
d offs on3ofthe Bualnessand Pro(ealonsCode,and my
Ilrerue Is In full!caro.and d(M. PANELS
Llrense Clan - LB,#
Data Contractor - 2011000 AMPS
ARCHITECTS DECLARATION
oto O I understand my plans shall be used a public records. OVER 1000 AMPS SQ.Fr.FLOOR AREA s/ .Fr.
Licensed Professional SIGNS ELECTRICAL
6 rOWNER-BUILDER DECLARATION
es IT SPECIAL CIRCUIT/MLSC
Z t' I hereby affirm that l amexempt from the Contractors License Law for the
following reason.(Section 7MIS,Business and Professions Code:Any city or
FF TR.SIa.MEi'QI ORI'OLEINSr.
,� countywhlch requuesa permittocomtmct,siren Improve,demollah,or repair
S Q any structuretaementslawancgaW licensed
pursuant to the revision of to POSER DEVICES
ES' U floe a accord statement
ens eLa that he t r 9(cod pursuant to the tion 70M) f the
3 u,r1� Contractor's License law(Chapter9(commendngwlth Section 7000)o(Divl- SWIMMING POOL ELECTRIC UA
F�OJ siun3oftheBusinessand Profs Code)orthathebemmptthemfmmand VALTION
the basis for the alleged exemption. Any violation of Section 7031.5 by any OUTLETSSSWITCHEBFIXTURES
applicant fora permit subjects the applicant to a civil penalty of not more than D Q
five hundred dollars(55M. NEW RESIDENTIAL ELECTR
❑I,as owner of the property,or my employees with wages as their sok SQ FT' TYPE CONSTRUCTION
C mmpenuHon,will do the work and the structure is not Wended or offered for
5 sale ffSec.7044,Business and Professioro Code:The ContnRo's License Law
(pj $ does not apply to an owner of property who build.or Improves thereon and OCC.GROUP RIS.UNITS
W who doessuchw°rk himselforthmugh hlsown employees,provided that such
Improvements arc not Intended oroffered for sale.If,however,the Wilding or TOTAL:
Mpowement V sold within one yearofoomplelbn,the owner-Wilderwlli have
tryRkurden of proving that he did not baud or Improve for purpose of sale.). QTY. PLUMBING PERMIT FEE
Ias owner of the property,am exclusively contracting with licensed FLOOD ZONE APN
J L
contractors to mn•wct the project(See,7044,Business and Professions Code: PERMIT ISSUANCE
The Conlredoes License Law does not apply to an owner M property who ALTER-DRAW AVENT-WATER(EA)
Wilds or improves thereon, and who contracts for such p(ojecea with a
cjV.c1m(s)licensed pursuant to the Commotors License Law. FEE SUMMARY
IJ I am exempt under Sec. B k P C for this reason BACK FLOW PROTECT.DEVICE OUTSI DE FEES
•� Owner _ _-_----Date ,re ^r DRAINS FLOOR ROOP,AREA,COND. SUMMARY Y_ N
WORKMAN COMPENSATION DECLARATION RECEIPT#
❑I hereby afflrm that I have a certificate of cement to self-ie. T S '
mrtifiote ofWo•v-�^^ -" � RECEIT#
3800,lab C.) I Y_ N_
P.Rcy 11 RECEIPT#
Com ny_ JILDING DIVISION FEES
Certifiedn 1
Certified ".0/20/93" PERMIT INSPECTION ACTIVITY FOR PERMIT 14 23080'-, ..'�IKFEE
R
10500 DAVIDSON
CERT '
(Thissectionn to Recei t#
` ($100)br lea.) --{?JSPEET[DN LATE .E Y_ N_
I eartuy that In
I shall
oulumotlmfo3 INSPECTOR COD---�—/F/F COMMENT—
wnrlrera cnmpen PATE DONE TYPE OF IN5PECIION
O Z Applicant_ Ta----^---�•T to ReCei t#
Z 0 .NOTICE TO AP - . , - , i '
H y
cAaay ,.Rio; 12/16/91 CHIMNEY STRAP, p0 C TOTAL:
C EE
W > deemed revoked. 30 p
F3 E 12/t6191 REBAR
E
CL Inereby alarm P
D Z anre of the work fo ` `
V O Lender.Na me_ 12/20/91 STRAPS J0 '-EE
LL H Lender's Address- 1L FEE
O 111
01rertflythat l ha
a Bomeect.lagreeta -
N reld.gtobuilding ,
F Z dtytoenteruponti - Recei tP
(We)agree to a --- P
V agaustllabNtles,N, .__...._...._,..,...y wayacaue AIR HANDLING UNIT CFO to,"CFM) SUBTOTAL:
agafrutsafd Cilyfn consequence of senting M this Permit. .
AIR HANDLING vNrr rovER l(LBBe CFM) CONSTRUCTION TAX
Signature of AppplIcant/CCion=tractor Date EXHAUST HOOD(w/DUCn CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE '
Willthe applicant onfuturebuildfng ocavpantstore or handle haaardous HEATING UNIT(TO 100,000 BTU)' Date Reeel tin
material as defined by the Cupertino Municipal Cafe,Chapter 9.12 and the
Health and Safety Code Section 25531(a)? HEATING UNIT(OVER 100,000 BTU) TOTAL:
1-1Yes Ira��I No
ISSUANCE DATE
Will theapplicant,,t tore building occupant use equipment or devices VENTILATION PAN(SINGLE RFSID)
which emit hazardous air contaminants as defined by the Bay Area Air ,
s Iity Management District? - BOILER-COMP(311P OR 100,0W BTU) p `` D
Yes ❑n No P A 1
have react the baa12us materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU)
a the California Health k Safety Code,Sections 25505,25533 and 25534.1
understand that ifthebuilding does not comedy have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.Fr. DEC - 9 1991
responsibility to notify the occupant of the requirements which most be met
prior to Issuance of a Certificate of Occupancy. 1
-GI
Owner or authorlmd agent Data ISSUED BY:
TOTAL:
OFFICE COPY