26057 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO -MECHANICAL--- eERMIT rvo. O
BUILDING DIVISION APPLICATION/PERMIT PLUM ROJECTDENTFIC
_ BUILDING PROJECT IDENTIFICATION
57
BUILDING ADDRESS:
�� '/��['' tL SANITARY NO. APPLICATION SUBMITTAL DATE
UNIT#�V� LOT
O SNA PHONE:
LIC NO
y ~% — p 7 9 GO ACR :
WC CONTROL#
aRCHITEC(ENGINEER: LINO:
ADDRESS: ❑
CONT A PHONE: x`` ,
Lt;Yxi ' ELE6TRICPERMIT - PEE BUILDING PERMIT(NPO
M s s �C� F 7 PERMIT ISSUANCE BLDG GEC PLUMB ME❑CH
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL IIIOROBB DESCRIPTION
nwz Ihereby affirm that l am licensed underprovisions of ChapRr9(commencing with
1a100 Section]000)of Division 3 mthe Business and Profession Cade,and my license is in PANELS
TUU full force and effect.
FW Licenu Class ' Lic.# UPTO200AMPS f
.QT Date Convector 201-IOW AMPS
Fy3 ARCHITECTSDECLARATION OVER 1000 AMPS - SQ.FT.FL RFA $/SQ.Er.
z0OZ� 1 understand my plans shall homed.,public records.
ern SIGNS ELEC RICAL
Licermed Professional
OWNER-BUILDER DECLARATION DECLARATION SPECIAL CIRCUITIMISC.
Oe, Thereby affirm that I am exempt from the Contractor's License Law for the
W 3 W y following reason.(Section 7031.5,Business and Professions Code:Any city or countyTEMP,METER OR POLE INST.
FC fS ON; which requires a pemdno construct,after,improve,demolish,or repair any structure
panorto its issuance,alsorequires the applicant for such perninofile asigned statement POWER DEVICES
eW ta1
<0 that he is licensed pursuant to the provisions of the Convector's License Law(Chapter
a>•4CK 9(commencing with Section]000)of Division 3 of Ne Business and Professions Code) SWIMMING POOL ELECTRIC ON
XW,f2 c or that he is exempt therefrom and the basis for the alleged exemption.Any violation of UTLEpS-SWITCHES-FIXTURES 00""Q
Section 7031.5 by any applicam for a permit subjects the applicant to a civil penalty of 0 not more than Eve hundred dollars($500). NEW RESIDENTIAL ELECTR _SQ.PT. —STORIES TYPE CONSTRUCTION
ww ro ❑ I,asownemfthepmp rty,ormyemployecswithwMesutheirsolewmpensadon,
43— swilldo the work,andthe structure isnotintended proffered fortivE(SecJ044,Business
and Professions Code:The Contractors License Law does not apply to an owner of -
propertywh iamildsorimpowesthereon,andwhodocamch work himselforthroughhis
1 dedrhatsuchim OCC.GROUP EAPN
ITS
I
however,the building improvement sold withintne lntecfeamplumin,thaownerf- -
gordenof,menyearp Lo
builder will have the burden of proving that he did not build or improve for purpose of
}}
❑ I,asownerofthepropeny,amexclusivelycontmetingwitblicenudcontractono Q I•^ ' 'PLUMBING PERMIT FET. -_____FLOOD ZONE
concoct the project(Sec.7044,Business and Professions CodaO TTa Contractor's PERMIT ISSUANCE
License Law does not apply 0 an ownerafpropeny who builds or improves tenon,and
who contracts for such projects with a contrachodid licensed pursuant to the Contractors
License Law. ALgER-DRAIN&VENT-WA' (EA) FEE SUMMARY
❑ I am exempt made,Sec. ,B&P C for this..an BACK FLOW PROTECT.DEVICE(,,",
SANITARY Y N
Owner Date RECEIPT#
DRAINS-FLOOR,ROOF,ARE ,CO
WORKMAN COMPENSATION DECL1.ARATION SCHOOL TAX Y N
❑
Workers
Compensation
or a certified
comentpytherof(Sec.380,Lab C.)ait,ofwhich POSTURES-PER TRAP RECEIPT#
Workcrs'Compensation Insuranceorncenified cnpY thereof(Sec.3800.Lab CJ which PARK FEE Y N
cmvo,all employee's ander this pertniL GAS-EA.SYSTEM-I INC.4 OUTLETS RECEIPT#
Policy# BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4 A) PLANCHECK FEE
[I Certified copy is hereby f rmished. (E
❑ Ccnified copy ix filed with the city inspection division. GREASFANDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This seclumbeed rmtbe completed iftha Permit is for one hundred dollars($100) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
or less.)
I certify that in the perfortnence ofthe work for which this Permit is issued,l shallWATER HEATER W/VENIVELECTR
not employ any person in any manner to as 0 become subject to me Workers' PAID
Comatiopensn Lawsif California. Date WATER SYSIEMITREATING Date Receipt#
Applicant
�rO�riiyy
0— NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should ['�
NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
r A become subject to the Worker's Compensation provisions of the Labor Code,you mast
Lei 7 forthwith comply with such provisions m this permit shall he deemed revoked. BUILDING FE
W C1CONSTRUCTION LENDING AGENCY SEISMIC FEE
hereby affirm that them is a construction lending agency for the Performance of
U O
thew for which this permit is issued(Sec.3090,Civ.CJ TOTAL: ELECTRIC FEE
w0 FLendei a Narne-
Lenders Address . ''.,` '".MECHANICAL PERMIT - FEE PLUMBING FEE
,[��,a 1 verify that I have read Ws application and state that the above information is
a" omet l agree to comply with all city and county ordinances and stain laws relating to PERMIT ISSUANCE MECHANICAL FEE
V) )byilding construction,and hereby notarize representatives of this city to enter uponthe - CONSTRUCDONTAX
U 7 above-mentioned property for inspection purposes. ALTER OR ADD TO MUCH.
r7 (We)agree to save,indemnify and keep harmless the
�C�Yoy°��f nln g
liabilities,judgments,vstsandea,mars which may many / AIR HANDLING UNIT(TO 10,000 CFM)
in cit quence thegruntingof {-1
ASR HANDLING UNIT(OVER 10,000 CFM)
Signature of titan C Da¢ EXHAUST HOOD(W/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT(TO 100,00)BTU) Date Receipt
Will the applicant or future building occupant atom or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health end Safety HEATING UNIT(OVER I W,WO BTU) TOTAL:
Code,Section 25532D)? VENTILATION PAN(SINGLB RBSID)
1:1 yr, El No
- ISSUANCE DATE
Will the aWlicantorfnturebullding oceupantuseequipmentordeviceswhichemit BOILER-COMP IMP OR 100,000 BTU) r
hazardous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,0(0 BTU) PAID
District? y+
❑Yes 0 N NEW RESIDENTIAL MECIL SQ.FT. • rrk
Y 24 /�
I have read the hazardous materials requirements under Chapter 6.95 of the 1994 '
California Health&Safety Code,Sections 25505,25533 and 25534. 1 understand that
ifthe building does not currently have a tenant.that it is my responsibility 0 notify the CITY Ur t;t,rrHIINU�
cecupam of the rogdiraments which most be met prior to issuance of a Cenificate of
Occupancy. , •J�/�(
Owner or authoriud agent Date TOTAL: ISSUED BY:
OFFICE
4� SANTA CLARA COUNTY
CENTRAL FIRE PROTECTION DISTRICT I CONTROL NUMBER
• 14700 WINCHESTER BLVD.
C LOS GATOS,CA 95030.1818 (408)378-4010 PERMT NUMBER
SERVICE �crTON SINCE 1947 FAX(408)378-9342
PLAN REVIEW COMMENTS
CODE/SEC, SHEET NO. ,
G^I u I (C t-2 C
CL I JL
C�c(%L\
�J� S d 1 LGA (_` �� / •.�,\ `�lLLii ./vLCA•r�
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r ..a•, �"C.'l �1CG"l�(.1�4� /)}l(,G� CG-.�> 1 �� 47 J� L 1( L--
/ JURIB PUNS SPECS NEW REMODEL AS CONST.DESCRIP. BY DATE
PACE
. OF
SEC.IFLOOR F2 I OCC I OCC.LOAD AREA APC NdCONTRACTOR/OWNER f--� [fp-
NAME OF FACILITY
til ! n� w LLI /C5(� ��
Serving West Valley Cities of:
Cupertino, Monte Sereno, Saratoga, Town of Los Gatos, and Adjacent County Areas
Paterson.110002
CUPERTINO SANITARY DISTRICT
20065 Stevens Creek Blvd., Bldg. C PRS:
• Cupertino, California 95014 CHB: _
(408) 235-7071 AEF:
"OVER THE COUNTER REVIEW"
Date: F=e-6 -Z4 17 f�
File: CuSD- MOIJ
Building Dept-Cupertino
City of Cupertino
Community Development Department- Building
10300 Torre Ave.
Cupertino, CA 95014-3202
Re: Subject: -T, r
Name: Cv,,_�JS Ma .,A-'s GvJIL 11
Address: /v SG (, S. 7)e 4e; z a jS
City/State:
APN: 3c, 9- 3 $.-037
Control/Plan Ck No:
Permit No:
Gentlemen:
The Cupertino Sanitary District has reviewed the plans for the subject project:
Parcel is connected to sanitary sewer.
• ❑ Parcel is not connected to sanitary sewer. Refer plans to County Health Department.
The following Conditions/Requirements are made:
1V"-- No additional fees or permits required by the District.
❑ Cupertino Sanitary District Fees or Permits are required for the subject
improvements please do not issue any building/grading permits
❑ Plans must be submitted to the Industrial Waste Division of the San Jose /Santa Clara
Water Pollution Control Plant(Phone 945-5307) for their review and recommendations
for pre treatment device requirements. Please Do Not Issue building permit until these
requirements have been transmitted to you by the District.
V}-- The following Conditions/ ommend :of'i apply:
E—Locate and raise to grade a property line cleanout.
❑ Install a backflow protective device- verify serviceability if existing.
6- Break areas authorized minor electrical appliances only.
<❑ No disposal or dishwasher installations.
❑ No added lab/office equipment which results in additional waste water discharge.
❑ Other: ..............................................................................I.......................................
The condensate from any HVAC equipment, su ce a r or irrigation water shall not be discharged to
the sanitary sewer.
CUPERTINO SANITARY DISTRICT
20065 Stevens Creek Blvd., Bldg. C PRS: _
Cupertino, California 95014 CHB: _
. (408) 235-7071 AEF:
"OVER THE COUNTER REVIEW
Date: ]=z to z
File: CuSD- MOPJ
City of Cupertino Building Dept-Cupertino
Community Development Department- Building
10300 Torre Ave.
Cupertino, CA 95014-3202
Re: Subject: -T, r
Name: CvQ�+s Ma,n�'s Gv,�d JJ
Address: /o SGL 5 . 7�e 4n z a
City/State:
APN: 3G 9-3 S - 037
Control/Plan Ck No:
Permit No:
Gentlemen:
The Cupertino Sanitary District has reviewed the plans for the subject project:
• Parcel is connected to sanitary sewer.
❑ Parcel is not connected to sanitary sewer. Refer plans to County Health Department.
The following Conditions/Requirements are made:
— No additional fees or permits required by the District.
❑ Cupertino Sanitary District Fees or Permits are required for the subject
improvements please do not issue any building/grading permits
❑ Plans must be submitted to the Industrial Waste Division of the San Jose/Santa Clara
Water Pollution Control Plant (Phone 945-5307) for their review and recommendations
for pre treatment device requirements. Please Do Not Issue building permit until these
requirements have been transmitted to you by the District.
�- The following Conditions/ ommend ' apply:
E--Locate and raise to grade a property line cleanout.
❑ Install a backflow protective device-verify serviceability if existing.
itl� Break areas authorized minor electrical appliances only.
(❑ No disposal or dishwasher installations.
❑ No added lab/office equipment which results in additional waste water discharge.
❑ Other: ......................................................................................................................
The condensate from any HVAC a uipment, su ce a r or irrigation water shall not be discharged to
the sanitary sewer.
• FINDING OF UNREASONABLE HARDSHIP
City of Date
Department of Enforcing Official
Project Name Permit Number
Address
The above named project has been granted an exception from the requirements of the State of California
Title 24 accessibility standards,based upon the following criteria:
1. The cost of access feature(s) is
2. The cost of all construction contemplated is afar T oma
3. A. The impact of proposed improvements on financial feasibility of the project is
B. The access feature increases the cost of construction by
4. The accessibility feature(s)which would be gained or lost is
5. Type of facility under construction is r
It is used by the general public for the purpose of DcP,O
The following persons provided information on the above section:
Firm Cin7f(` M� NG 9S Ult-p fNGFirm
Address /6t 7 / I Address
• Signature Signature
The determination of unreasonable hardship and this documentation do not allow a blanket exemption
from the access requirements. The exception provided for by this form applies to the following item of the
project:
As specified by Title 24 (check one)
O 1. Equivalent facilitation will be provided, as specified in Section
O 2. Equivalent facilitation will be provided,as determined by this enforcing body.
See Section . Equivalent factilitation will be
O 3. No provision of equivalent facilitation is necessary. See Section
The legal constraints are
The physical constraints arc
O 4. The approval of an appeals board is necessary to ratify the determination of
unreasonable hardship. See Section
and Section 2-105(b) 110.
The legal constraints are
The physical constraints are
This documentation and determination of unreasonable hardship are developed in consultation with:
Signature of Enforcing Official Date
•
1.
ti
• ADDENDUM TO UNREASONABLE HARDSHIP
To assist the Building Department in making a better decision, it is suggested the Applicant provide the
following information:
1. Total cost of entire project: 3�6 7� o o O
2. Total cost of project with full compliant nc�ndheereencet all handicap requirements:
3. Difference in Cost(s) A 22 DOC) r
4. If you feel that full compliance is too much of a hardship for your project, please itemize your
reasons:
features of ourproperty?
5. What are you proposing to do in an effort to upgrade the handicap y
winword/hrdshp
2.
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