31085 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL. PERMIT NO, 31085
Y 'I1 O H
BUILDING DIVISION APPLICATIOWPERMIT M,OMBING-MECHANICAL 3
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DXIT
Vz cz _ Cv pE2TI A� OI CA 02
OWNER'S NAME: ; PII�ON�E'. CONTRACTOR'S NAMF� LIC NO:
N _ WC CONTROL x
'CHHECTIENGINEER: UC NO: ADDRESS: VrL— ❑
CONTACT: PHONE: BUILDING PERMIT INFO
Q�A A 9- ic—, crib -0-I g 1 64 ❑ Co..IWni Fm Paid by Applicant(Initial) � ELECT PLUMB MFCH
-TA4 ovH-PSov�J 75th - 14 z(10 ((el ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby affirm that I am licensed under pmvisioru of ChWer 9(commeneio6 JOB DESCRIPTION
F
„ 00 with Section7")of Di vision,vision,3 of me Hueinw and Pmfesiunv Code,cold my license is
in fell L¢c oral dial. RESIDENTIAL:
O PERMIT ISSUANCE
�Uz�j license Class Lic.x ❑SFDWL El KITCHEN RIitv10DEL
�QiDae Convector APPLIANCES-RESIDFIAL []ADDITION ❑PLUMBING RE-PIPE
'Do, ARCHIECPSDECLARATION PANES El MULTI-UNIT ❑STRUCTURAL
ZOnsZ I undcrsund my dans alWl thea used ea public oaccW, MODIFICATION
OZ—a UPTO 2W AMPS [I INTERIOR ❑CHIMNEY REPAIR
Licensed Professional 201-IQX)AMPS IMPROVPI.IEN1'
OWNER-BUILDERD[CLARATION IIXXI AMPS ❑BATH REMODEUT]EPAIR QDENIOLITION
Q 1 hereby a1Brm[het 1 fm escort.
pt from she Cantrvcnu's Losses.law for the OVER
K 3 4 U following reason.ISseiivn M315.Business and Profesaiwm Code:Any city or county SIGNS ELECTRICAL ❑OTHER
41 wmuch requires is permn to euma 4 aloes,improve,dnmlish,or repair any most
F'LL� 'savor it,issuance,abu rcyuiro the,ii,kcdm forsuch lcrosiin filevsignad stetc.i SPECIALCIRCUITWI,SC.
Ho"
p�y
that he is liceosd l iwonothe pmv..ionsofthe Commemis Lt.law(Ch,oc,9
H y o"0 (commencing with Smion 70M)ofDivision 3 of the Bmircas and Profusion.Cody or TEMP,METFER OR POLE INST. COMMERCIAL:
6 y that he,is exempt tbertfnnn and the thesis for the alleged exemption.Any violation of ❑NEW BLDGIADDITFON ❑DEMOLITION
'ALL
Section 710 l S by any Whistat Fort pend,subjects to eppli.m•civil penally of POWER DEVICES
�y [I TENANT ❑FOOD SERVICE
y
not nam than five hundred dollar($SW).
�a6n - I,usowrcr ,the pmpcny,tvmyemptnYceswimwvgum Ncirsole crtmpcnmtion,
SWIMMING POOL[LP,LTRIC IMPROVEMENT
y� Il dtfeatiox Cdthe he Cor isnots Li" I-sow ciffered
rod a,lo.o W,Hwmcu El OTHER
W— err Flssfusimss Code The Corrosion's Lind wi Law arses nm apply to an nwrcr of UTIJTfS-SWRCHIS-IIXTURGS
hpropicnyis own whobuilds m viukol thtM1wish and wM10 does such ruwsxFded of Intentthorough
his own cmpt however,
the
pmv'.t.,t that such mall11 wild
an,one intended m offered for NEW RISIULNTIAL ELECLR SQ FT.
saR.ILhowevenme Wil thingorimp f Movant 11ssdhe didno h Yam nfmmlrt,fon.Ne SQ.FT.FLOOR AREA S/SU,F-I'.
owner-Wilder will have the harden of pawing mel he ort Wlld or lmptova[m Wr-
own V('
n 1nso J.
I u owner of*It Scs,.7 .am exclusivelysad Prof v ting with Bernthal convectors m
comvuct the project(.See.'!(1t4,Bairca and Profesiau Code:)This,ConuxtKa appti- tFEE cens,lawdoes oa ly m en oximi pnin W «peny wildsimprovea termn,adQT-Y. PLUMBING PERMIT MAR 17 f�C'D
with commas fursuch onjects with scontmctions)Iicen.vuth
l pursuanoe Comracmis
Lccn.e Uw.
❑ ctrptun 6See. ,B&PCfnr misruwn YF,RMI'1'ISSUANCF.
I
_ CITY Uf t urtMIINU
Oa 97 ALTER-DRAIN&VENT-WAIF EA)sa VALUATION
WORKER'S COMMISSATI DECIARATION��I BACK FLOW PROTECT.DEVICE
I hereby aFn t under penalty of perjury one d the hAlowing dewWations, L-k%k-"�p6`x
L lhuvc and will—morin a Cmnfl.'sof Comenuosclf-insure for Worlcrx Coo,co- DRAINS-FLOOR,ROOF.AREA.GOND. STORIES TYPE CONSTRUCTION
union,as Provided for by Section 3700 of the Labor Crile,for me pMorance of the
words fm which mis pcnalt is iaunL FIXTURES-PER TRAP
❑I have W will maintain Workers Cornletwaim fewraxe,as required by Section Ap
37Mofthe labor Cacti for 0e perfsmwue ofde wok for which oris permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS UP APN
My Witmer s Compcnsalion loo mncc<unicr end Policy number arc:
Came,. Poky No.: GAS-G.SYSTEM-0V FR 4(G)
CERTIFICATE OF EXHIMPION FROM WORKERS'
COMPIN'SATION INSURANCE GRFASMNDUSTRL WASTE INIERCEPIDR
TNH vnionr lmv becwpkl lfde pemutufmorc hurtlrddnlWn l51W1 LDL -DrvISION
or leas.l GREASETRAP Six 11jTp
I cattily tint in the perfommncenfthe work for which thispmnit isl ssod,I stoll SEWER-SANITARY-S I"RM FA.2IX)VT
not employ any Octan in any manrcr ext on w became subject tome W'orterl Compca- ENERGY
Z0 scion ApphV of California.Dae WATER HEATER W/VENT)E_EC IR
h NOTICE TO APPLIGNT.IL after rm4ng this Ccnlf ae of Exemption,yea slsould WATER SYS JxT`REATING
become subjeet m the Wmkce%Compenwlion pmvisiou of Nc labor Ctvk,you must
WfoMwim.omply with such prnvlainm or this permit shall W deemed revoked. WATER SERVICE
0. 0 CONSTRUCTION LENDING AGENCY NEW HTSIDFlITAL PIdB. SQ.FT. jFEEr
z Thereby df that Vert 4aconmuctim lording agmeY for the RHsxmvec of Reset,W-a the wort fm which this prmdt is issued(Sec.304l.Civ.C.)
p F"' larder',None TOTAL:
U Istvlds
Add,,. TOTAL'.
Ly, Wy cenify Net 1 have red this eppliaaim artd sem that the above inFmntion is 14 roneel.lagree mromplywiNell cityand county aditurce.eM swcl.wrowingto QTY, MECHANICALPERMIT Z , sas
aWve-rrcmioned pco sany for inspcxtion ptupo,ev PERMIT ISSUANCE
(We)agree to save,itxkmnify and keep hmmle.ss Nc City of Cupertim again ELECTRIC FEE
Halt ilica joil,rats.cools oml capcovex which may in any way.crocugons,said City ALTER OR ADD TO M ECI I.
in ronsequence M the granting M Nim peril PLUMBING FEL?
APPLEPPLI UNMRSTANDS WILL WITH A�NON�POINT AIRHANDLING UNIT(TD 10.000 CFM) MECHANICAL FEE
AP E REG ONS C
3 ie —1 -AIR HANDLING UNIT(OVER 10.00(l,CFM) CONSTRUCTION TAX
Signamenf Applicsot muacmr IAm EXHAUST PIOOD(WIDUCn HOUSING MITIGATION FF.
FI I DOUS MATERIALS DISCLOSURE
Will the gplicarit orfwwe Wilding occupw sae m handle,lxrmdoo,material HEATING UNIT fro 100.000 BTU)
as dcfod by de Cupenim Munieipl Code,ChWhcu 9.12,and the Health and Safety
Code,&,-tion 115320.)? HEATING UNI'(OVER 100.000 BTU)
❑Yu )(No VENTILATION FAN(SINGLE RESLD) PAID
Tac Reeciptx
Will de eircenttmfumrt Wilding occupantuse ea AirQlmdevice which BOILER-COMP CHIP OR 100,100 BTU)
41 t ha vdota air conmmir•Ms a defined by de Bay Area Air Quality Marmgemem TOTAL:
¢2t? BOILER-COMP(OVER 100.000 BTU[
Yet, X.
AIR CONDITIONER
1 have rmd the M1vardas macrids raryirertrnts mala Cheptu 6.93 of Oe Cdi� ISSUANCE DATE
mi Health&Safety Code,Salvors 23305.25533 and 25534.1 unkramid the J the
Wi gallas y havealcemnL Nm it is hilar ...lily de NEW'RESIDENTIAL MECH. SO.FT.
In-
M'�i Y Y rpt/ti�muF t
dui .� 1 VCO-to n CenviZ.r/-I,
Owner nr vum egcnmrusl•i ,•T�-� , TOTAL:
ISSUED BY:
OFFICE
fYh,
deg 1T 50"W " 0
r A
134.214 •,
Electric Service
Panel douse Plan
Retaining Wall Note: To be<onsisten[
1'-��x
Points are the units used, Plan
ere
(New Const.)
� Poinb.temts of feet
a
n
N
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m �
P
i
Electrical t
Service
010 OF Cable t.,r
.y Conduit for 60'
Underground
for
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W
Oe9 9e I �
0O SCafe 10, ,
1
Proposed
Storage
0sq R X.o" MAR 17 1997
10'•g" Max
Height 61-0, BLDG.INSPECTION DEPARTMENT
CITY OF CUPERTINO
C,
To MAS( Ui
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LRN:
5._0
N 52 deg 43.35'E
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No. Street Lot No.
CITY Of Cumml0
APPLICATION FOR BUILDING PERMIT
MAR 16 1971 City of Cupertino
Sanitary No.
Permit No.
u
E � Application is hereby made for a permit[o
3 a story,Tyipe eZ Building
v j r4 in accordance with
to be occupied only as A.;.
o i
° N PLuis,Specifications and Plot-Plan filed herewith�'- PI Ck Fee
r
c
i .. Estimated Value of Improvements,5 :3•,'Lo Fee S /-I `—
oIt is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
c
> all other laws applicable to the construction, location, and use of buildings within the City of
o Cupertino will be complied with.
c
3 NOwner
,3 . Addres _
/ M
BYE x-'X4i70r)LS--/-G- M.
�h E .Phone 52// —� �jej� Approv
W °O `f �� •�_ �' 3 Inspector
—1 I State License
P` v
RECORD OF INSPECTION APPROVALS
BUI^LJDINJL,,
T�� � S'VC 49 MISC.
PAD FIN L
FOUNDATION
UNDERFLOOR
FRAME
LATH & PLASTER
GRADING FINAL
FINALB9 !/
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