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S 1556 f APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-BERM RICAL PEtIT NO. 1556 CAL BUILDING DIVISION APPLICATIONtPERMIT PING PRODBING CTIDENTIFIC BUILDING PROJECT IDENTIFICATION BUIIAINGADURP_SS: SANITARY No. APPLICATION SUBMITTAL DAT[ I SOO R\1 12-OP AVE-: , L-klve-q? OWNER'SNAMH: PHONE: CON'I'RACI OR'S NAME: LIC NO: t21(}TKrNs S(o3-73 B(- LJAV-/t2/OEGmop COvr7R. X97 we coNTaol.a RCHITECf/IiNGINE R: LIC NO: aC55: /fin VtjG vl ^y� per, ❑ N Y 'L1LIx/r`L S\J r /.a J 17 CONTACT: PHONE: - - BUILDING PERMIT INFO !'gip �4nn/ r Velz- W� ���I ❑ Consultant Fees Paid by Applicant(Initial) a ELECT PLUMB MECH CPP Li'l[��V ❑ ❑ ❑ LICENSPI)CONTRAC'IGR'S DECI.ARATION QTY ELECTRIC PERMIT FEE ETI 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION ooz with Seelom 7000).fDivision J ofthe Business and Professions Crsk,and my license is RESIDENTIAL, FNTIAL, y PERMIT ISSUANCE Fy�� intull force and cR t. 6s .S1Ss-7� ❑SPDWL ❑KITCHEN REMODEL 6FQQ Licntse Clas Lion APPLIANCILS-RESHMIN'1'IAL [I ADDITION ❑PLUMBING R -PIPH N<L Date�Comrncmc� ❑MULTI-UNIT' [3 STRUCTURAL F-�on ARCHITECTS DECLARATION PANELS MODIFICATION zp to z 1 understand my plans shall b,used as public retools oz=o UPT02MAMPS [I INTERIOR ❑CHIMNEY REPAIR 1a-Fca Licensed PmI..sionul 201-1000AMPS IMPROVEMENT SWIMMING POOLS Ck ; OWNER-BUILDER DECLARATION OVER IU(IIIAMPS [I BATH REMODHLREPAIR D i ATI N C Q I hereby affirm that 1 ant exempt from the Conaactor's License Law far the �4�( d U following..,on.(Section 703 1.5,Business and Professions Code:Any city ar county SIGNS ELECTRICAL ❑OTHER I+1 LL O F" which requires a Permit to construct,cher,improve,demolish,or repair any xavcturc prior to its issuance,also requires the applic5m for such permit to file u signed statement SPECIAL Cl RCUIT/M)SC. _ d y, that he is licensed pursuant n the provisions of Ne Contractors License Law(Chapter 9 , ¢1IXM a��0 (commencing with Section 7000)of Division]of Ne Business and professions;Code)or TEMP.MEIER OR POLE INST R d c eL Ihot he is exempt therefrom and the her...for the alleged exempsion.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION coo tett IIiILhan Ive hundredJllufs(SSgpttil.objectstheapplicanl ton civil penallyof POWER DEVICES ❑TENANT ❑FOOD SERVICE SSC ❑ Las owner of the ryopeny.or my emplaytts with wages us theirsole compensation, SWIMMING POOL ELECTRIC OTHER FiMF:NT will do the work,and the structure is not intended or offered for sale(Sec.]DW.Business ❑OTHER mand Professions Code:The Contractor's Licene,Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES 4i property who hui Ids or improves therein,and who does such work himself or through his own employees,provided that such inmpmvcra is arc no,intended or offered for NEW RESIDENTIAL ELEC'R SQ FI'. sale.If.however,the building or improvement is sold within one year ofcompletion,the SQ F1'.FLOOR AREA S/SQ.FT. caner-builder will have the burden of proving that he did not build or improve for pur- pose of sale.). I,as owner of the property,am exclusively contracting with licensed contractors it, T TA instruct the project(Sec.70,W.Business and Profesaionx Cade)The Comramm's Li- - censcLawdocsnotapplytoanownerofproperty who builds or improves thereon,and QTY. PLUMBINGPERMIT &EF who contracts for such projects with a caricaturist licensed pursuant o the Contractors License Law. PERMIT ISSUANCE - ❑lamexemplunderSm. ,B&PCmrthlsmawn ALTER-BRAIN&VENT-WATER(EAI f VALUATION sme, Date WORKER'S COMPENSATION DECLARATION BACK PLOW PROTECT.DEVICE I herehy elfint under penalty of pc jury one noire following dedunc n e: ' I have and will maintain a Cciifcate of Consenin self-insure for Workers Campeau- DRAINS-FLOOR.ROOF,AREA,COND. A.� STORIES TYPE CONsTRUC'fl0i s lmd.a provided for by Section 3700of the Labn Crude,for the perfmmenm of circ work fee which this permit is i.aucal, FIXTURES-PER TRAP I have and will mninmin Workers Compensation Insurance,as required by Section - 3700 ofthe l.aor Cad"for lire p"formarc,nflhe work forwhich Inkisrmil is issued. GAS-P.A.SYSTEM-1 INC.4 OITt LEFS '• sTI�ry�C.GROUP APN My Wode Itu¢yn5NR ce carrier and Policy numb, ¢,, , Cartier: -lZfa`tJ Policy No.: rzo'Ylk91 `yam GAS-CA.SYS BIM-OVER 4(EA) C17RTIFICAIE OF EXEMPTION FROM WORKERS' GREASIIINUUSTRI.WASTE IN'11i0.CEPT0R COMPENSATION INSURANCE BUILDING DIVISION FEES (This welmeneelms becompleledlfthepeemii lsforonehundreddellars($1O) GREASCT'RAP or las.) PLANCHECK PP.P. I certify that in the perforromeeofthe work far which this permit is issued,Ishill SEWER-SANITARY-STURM CA.2110 FT. nm employany person in i ymannerxo as to betonmsubject a the Wvekers'Compm- ENERGY FC:C zsution Laws of California.Date WATER 1117ATER W/VENT/F.LEC'I R Z Q Applicaal I GRADING PEC y NOTICE TO APPLICANT.If,after making this Cenifcate of Exemption,you should WATER SYSTEMITRPATING H become.subject m the Worker s Compensation provisions of the Labor Cale,you most SOILS FEE sir I othwi ih comply with such provisions or this permit shall be deenced revoked. WATER SERVICE Q = Z CONSTRUCTION LENDINGAGENCY' NEW RESIDENTAAI.1'LMB. SQ.FR ji - U Date i a I for whihthi Pe there isscsmaracnonlendingagency fonhe pcdomtancc ofthe work for which Nix permit is ieweJ(Sec.309],Civ.CJ OI'N:I.cndcn's Na au T(71'A1.Inder'I Address 1 ccnify that 1 have mad this application and state Nt the aove infotmmian isG FF.Ecored l agree to comply with all city and county onimanees andstate laws relining to QTY, MECHANICAL PERMIT LIEF.U 7. didingcnnslrvmion,turd botchy autheri eceprosentatives of(bischy merterupondre PF.I?above contained property Ior inspection purposes. PERMIT ISSUANCE IC FEE (We),.,.save,indemnify and keep hannl,.ate City of Cupertino against liubilitesjudgments,costs and expenses which may in anyway acerae against said City ALTER OR ADD TO MECH. PLUMBING FF.E in onsequence of the grunting of this permit. APPLICA N'1'UNDP " NDS AN WI LL COM PLY WI'T'H A LL NON.POINT AIR DAN DIA NO UNI'1'(TO 10,000 CFM) MECHANICAL HE SOURCE At 10 .� Zy AIR HANDLING UNIT(OV ER 10.0X)CFM) CONSTRUCTION TAX Si7ha�rdrms pplianuCnnaudor Date EXIIAUST HOOD(W/DUCD HOUSING MITIGATION FEE HAZARDOUS MAI1?RIALS DISCLOSURE _ e applicant or future building occupant store or handle hwardous ordinial HEATING UNIT(To 100.000 BTIJ) usthe Cupcnino Municipal Cafe,Chapter 9.12,and the Health and Safety Cr25532(x)] HEATING UNIT(OVER I(I(I,WI)BTU) n VENTI[.A'I'ION FAN ISI NG I.E RESI D) PAIDDam Receipt p e official orfuture building occupant use equipmet or devices whichBOILER-COMPIJHI'OR If11,IMNtHTU7 s air contaminants as defined by the Bay Area Air Quality Management TOl'AL: !strict° 1^ryry/N�t BOILER-COMP(OVER 100.000 BTU) ❑Yen � (have read tit,hvallous materials mquiremcm mad Chance 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE fomia Health&Safety Cork,Sections 25505,23533 and 25534.1 understand thabif the NEW RESIDENTIAL MECH. SQ.FT. building dons not concretely have.rearm,that it is nny mspansiblllly to notify therccupent of Ne earreopr am mr 4? '11 tf0c page unconey.aI prn ent TOTAL: ISSUED BY: OFFICE zJ Y u r d ? 7 0 3 to ^ Y d ; r ; aQ sk � I N Z Q + Lil — m r Ng � z _ CP W L a M �0 c=, C9 O W [LLI II 1 1LL I� W 0 N O V U) J LELM I' Fo N µ i - a s � N � i x S f APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-BERM RICAL PEtIT NO. 1556 CAL BUILDING DIVISION APPLICATIONtPERMIT PING PRODBING CTIDENTIFIC BUILDING PROJECT IDENTIFICATION BUIIAINGADURP_SS: SANITARY No. APPLICATION SUBMITTAL DAT[ I SOO R\1 12-OP AVE-: , L-klve-q? OWNER'SNAMH: PHONE: CON'I'RACI OR'S NAME: LIC NO: t21(}TKrNs S(o3-73 B(- LJAV-/t2/OEGmop COvr7R. X97 we coNTaol.a RCHITECf/IiNGINE R: LIC NO: aC55: /fin VtjG vl ^y� per, ❑ N Y 'L1LIx/r`L S\J r /.a J 17 CONTACT: PHONE: - - BUILDING PERMIT INFO !'gip �4nn/ r Velz- W� ���I ❑ Consultant Fees Paid by Applicant(Initial) a ELECT PLUMB MECH CPP Li'l[��V ❑ ❑ ❑ LICENSPI)CONTRAC'IGR'S DECI.ARATION QTY ELECTRIC PERMIT FEE ETI 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION ooz with Seelom 7000).fDivision J ofthe Business and Professions Crsk,and my license is RESIDENTIAL, FNTIAL, y PERMIT ISSUANCE Fy�� intull force and cR t. 6s .S1Ss-7� ❑SPDWL ❑KITCHEN REMODEL 6FQQ Licntse Clas Lion APPLIANCILS-RESHMIN'1'IAL [I ADDITION ❑PLUMBING R -PIPH N<L Date�Comrncmc� ❑MULTI-UNIT' [3 STRUCTURAL F-�on ARCHITECTS DECLARATION PANELS MODIFICATION zp to z 1 understand my plans shall b,used as public retools oz=o UPT02MAMPS [I INTERIOR ❑CHIMNEY REPAIR 1a-Fca Licensed PmI..sionul 201-1000AMPS IMPROVEMENT SWIMMING POOLS Ck ; OWNER-BUILDER DECLARATION OVER IU(IIIAMPS [I BATH REMODHLREPAIR D i ATI N C Q I hereby affirm that 1 ant exempt from the Conaactor's License Law far the �4�( d U following..,on.(Section 703 1.5,Business and Professions Code:Any city ar county SIGNS ELECTRICAL ❑OTHER I+1 LL O F" which requires a Permit to construct,cher,improve,demolish,or repair any xavcturc prior to its issuance,also requires the applic5m for such permit to file u signed statement SPECIAL Cl RCUIT/M)SC. _ d y, that he is licensed pursuant n the provisions of Ne Contractors License Law(Chapter 9 , ¢1IXM a��0 (commencing with Section 7000)of Division]of Ne Business and professions;Code)or TEMP.MEIER OR POLE INST R d c eL Ihot he is exempt therefrom and the her...for the alleged exempsion.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION coo tett IIiILhan Ive hundredJllufs(SSgpttil.objectstheapplicanl ton civil penallyof POWER DEVICES ❑TENANT ❑FOOD SERVICE SSC ❑ Las owner of the ryopeny.or my emplaytts with wages us theirsole compensation, SWIMMING POOL ELECTRIC OTHER FiMF:NT will do the work,and the structure is not intended or offered for sale(Sec.]DW.Business ❑OTHER mand Professions Code:The Contractor's Licene,Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES 4i property who hui Ids or improves therein,and who does such work himself or through his own employees,provided that such inmpmvcra is arc no,intended or offered for NEW RESIDENTIAL ELEC'R SQ FI'. sale.If.however,the building or improvement is sold within one year ofcompletion,the SQ F1'.FLOOR AREA S/SQ.FT. caner-builder will have the burden of proving that he did not build or improve for pur- pose of sale.). I,as owner of the property,am exclusively contracting with licensed contractors it, T TA instruct the project(Sec.70,W.Business and Profesaionx Cade)The Comramm's Li- - censcLawdocsnotapplytoanownerofproperty who builds or improves thereon,and QTY. PLUMBINGPERMIT &EF who contracts for such projects with a caricaturist licensed pursuant o the Contractors License Law. PERMIT ISSUANCE - ❑lamexemplunderSm. ,B&PCmrthlsmawn ALTER-BRAIN&VENT-WATER(EAI f VALUATION sme, Date WORKER'S COMPENSATION DECLARATION BACK PLOW PROTECT.DEVICE I herehy elfint under penalty of pc jury one noire following dedunc n e: ' I have and will maintain a Cciifcate of Consenin self-insure for Workers Campeau- DRAINS-FLOOR.ROOF,AREA,COND. A.� STORIES TYPE CONsTRUC'fl0i s lmd.a provided for by Section 3700of the Labn Crude,for the perfmmenm of circ work fee which this permit is i.aucal, FIXTURES-PER TRAP I have and will mninmin Workers Compensation Insurance,as required by Section - 3700 ofthe l.aor Cad"for lire p"formarc,nflhe work forwhich Inkisrmil is issued. GAS-P.A.SYSTEM-1 INC.4 OITt LEFS '• sTI�ry�C.GROUP APN My Wode Itu¢yn5NR ce carrier and Policy numb, ¢,, , Cartier: -lZfa`tJ Policy No.: rzo'Ylk91 `yam GAS-CA.SYS BIM-OVER 4(EA) C17RTIFICAIE OF EXEMPTION FROM WORKERS' GREASIIINUUSTRI.WASTE IN'11i0.CEPT0R COMPENSATION INSURANCE BUILDING DIVISION FEES (This welmeneelms becompleledlfthepeemii lsforonehundreddellars($1O) GREASCT'RAP or las.) PLANCHECK PP.P. I certify that in the perforromeeofthe work far which this permit is issued,Ishill SEWER-SANITARY-STURM CA.2110 FT. nm employany person in i ymannerxo as to betonmsubject a the Wvekers'Compm- ENERGY FC:C zsution Laws of California.Date WATER 1117ATER W/VENT/F.LEC'I R Z Q Applicaal I GRADING PEC y NOTICE TO APPLICANT.If,after making this Cenifcate of Exemption,you should WATER SYSTEMITRPATING H become.subject m the Worker s Compensation provisions of the Labor Cale,you most SOILS FEE sir I othwi ih comply with such provisions or this permit shall be deenced revoked. WATER SERVICE Q = Z CONSTRUCTION LENDINGAGENCY' NEW RESIDENTAAI.1'LMB. SQ.FR ji - U Date i a I for whihthi Pe there isscsmaracnonlendingagency fonhe pcdomtancc ofthe work for which Nix permit is ieweJ(Sec.309],Civ.CJ OI'N:I.cndcn's Na au T(71'A1.Inder'I Address 1 ccnify that 1 have mad this application and state Nt the aove infotmmian isG FF.Ecored l agree to comply with all city and county onimanees andstate laws relining to QTY, MECHANICAL PERMIT LIEF.U 7. didingcnnslrvmion,turd botchy autheri eceprosentatives of(bischy merterupondre PF.I?above contained property Ior inspection purposes. PERMIT ISSUANCE IC FEE (We),.,.save,indemnify and keep hannl,.ate City of Cupertino against liubilitesjudgments,costs and expenses which may in anyway acerae against said City ALTER OR ADD TO MECH. PLUMBING FF.E in onsequence of the grunting of this permit. APPLICA N'1'UNDP " NDS AN WI LL COM PLY WI'T'H A LL NON.POINT AIR DAN DIA NO UNI'1'(TO 10,000 CFM) MECHANICAL HE SOURCE At 10 .� Zy AIR HANDLING UNIT(OV ER 10.0X)CFM) CONSTRUCTION TAX Si7ha�rdrms pplianuCnnaudor Date EXIIAUST HOOD(W/DUCD HOUSING MITIGATION FEE HAZARDOUS MAI1?RIALS DISCLOSURE _ e applicant or future building occupant store or handle hwardous ordinial HEATING UNIT(To 100.000 BTIJ) usthe Cupcnino Municipal Cafe,Chapter 9.12,and the Health and Safety Cr25532(x)] HEATING UNIT(OVER I(I(I,WI)BTU) n VENTI[.A'I'ION FAN ISI NG I.E RESI D) PAIDDam Receipt p e official orfuture building occupant use equipmet or devices whichBOILER-COMPIJHI'OR If11,IMNtHTU7 s air contaminants as defined by the Bay Area Air Quality Management TOl'AL: !,trio? 1^ryry/N�t BOILER-COMP(OVER 100.000 BTU) ❑Yen � (have read tit,hvallous materials mquiremcm mad Chance 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE fomia Health&Safety Cork,Sections 25505,23533 and 25534.1 understand thabif the NEW RESIDENTIAL MECH. SQ.FT. building dons not concretely have.rearm,that it is nny mspansiblllly to notify therccupent of Ne earreopr am mr 4? '11 tf0c page unconey.aI prn ent TOTAL: ISSUED BY: OFFICE zJ Y u r d ? 7 0 3 to ^ Y d ; r ; aQ sk � I N Z Q + Lil — m r Ng � z _ CP W L a M �0 c=, C9 O W [LLI II 1 1LL I� W 0 N O V U) J LELM I' Fo N µ i - a s � N � i x S