24530 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO N ILD:NG-ELECTRICAL PERMITNO. w O
APPLICATION/PERMIT PLUMBING-MECHANIC L 'LJ
BUIhDING DIVISION BUILDER,PROJECT:DENTIFICA-1'[ON
'BUILDING ADDRESS: J� (� y� SANITARY NO. APPLICATION SUBMITTAL DATE
�� /� [/ C/ / Lx� ON]f# LOT#
OWNERS NA ' PHONE: CO ACTOR'S NAME: I LL ll
NIU CONTHOLN
\RCHITF.CT NGINIER: LIC NO: ADDRESSS X�
v S
CONTACT: PHONE:
QTY. ELECTRIC PERMIT FEE AUILUING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE ❑ 11 ❑ ❑
LICENSED COM1TRACI'OR'S DECLARATION APPLIANCES-RESIDENTIAL LOB DESCRIPTION
I hereby affirm that l am locossd underprovisionsof Chaptr9(commessingwith �^
=00 Section]000)of Division 3 ofthe Business and Professions Coda and my license is in PANELS (�/V.
u� full force arms ct. pry[ c Co e- `E-QVeV Idn
E-Lw License Class Lie,It ¢�06 �] UP T02tX1AMPs
mQy Date Contractor 201-1000 AMPS
Z~Oyv ARCHITECT"S DECLARATION OVER I"AMPS SQ.M.FLOOR AREA S/SQ.FT.
zc) I— I understand my plans.hall he used as public records. ,[ C�
SIGNS ELECTRICAL
Qy$j License Professional
w ty�Q OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
XOaF I hereby affirm that I am exempt(tete the Contranm's License Law for the
LEhofollowing reason,Neen.n70315,IL,mass and Professions Code:Any city or county TEMP.METER OR POLE.INST.
H I which requires a Nor it to condrach alter.improve,demolish,or repair any structure
SW}:� priermits ivsu:mre,alvn reyuiresmeapplicnm lorsuchpermit to flea,vigncd statement POWER DEVICES
LW tE�p that he is licensed,....coal to the provisions of the Cmnmclmh License Law(Chapter
o.ao 9(commencing with Section 7")of Division 3 of the Business and Professions Crude) SWIMMING POOL(ELECTRIC VALUATION
tyxj�y orthat he is exempt therefrom and the basis for lheallegeexamatim Any violation of OUTLETS-SWITCHES-FIXTURE$
FlaSection 7031.5 by any applicant for a permit subjects the applicantto a civil penahy of
�ZC not morethurt
rofthednddol,ormye001. NEWRESIDENTIALELECTR Q ST( 1 TYPE CONSTRUCTION
CFo ❑ 1,asnwncroftheproPeny,ormycmployceswilh wagesavM1eirsnlewmpensation, TA Li
111
W will J.the work.and the structure is not inlendedoroffele heredc(SccJOJ4,Business __
and Professions Cale:The Contractor's License Law does not apply men owner of 1
propcnywhobuilds or mproves thereon,and whodos such work himself anhroughhls 116.17 11 TPP
ownemployacs,providedthat suchimprovementsurenotintendeorolieredforsme.If. GO R U RBS.UNITS
however.the buildings improvement is sold within one yearofcomplmion.theowner- 'ter
builder will have the burden of proving that he did not build or improve for purpose of YA 7
sale).
❑ I,as ownerofthe property.amexclusivelycommeting with licensed comosetotsto QTY. PLUMBING PER FEE FLOOD] APN
onstmet the Project(Sec.?OM,Business and Professions Code:)The Contractor's
License law does not apply to an owner ofprolxny who builds or improves thereon,and PERMIT ISSUANCE
whocommes l itrsuch projects with a conametar(s)licensed pursuant to the Contractor's ALTER License Low. EA) FEE SUMMARY
Cl I am exempt Lnder Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICE OUTSIDE FIEFS
SANITARY YN
Cosner DRAINS-FLOOR.ROOF,AREA,COND. RECEIPT#
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ 1herebyaffrm that l haveacedificam ofc.nsent rexelf-insure,oro certificate of FIXTURES-PER TRAP RECEIPT#
Workers'Compensation Insurance or a cerifed copy l6ereof(Sce.3800,Lab C.)which PARK FEE Y N
covers all employee',.mulattos permit. GAS-EA.SYSTEM-1 INC.4 OUTLETS RECEIVI'#
Policy b
Company BUILDING DIVISION FEES
_
❑ Certified copy is hereby famished, GAS-FA.SYSTIEM.OVEft4GIA) PLANCHECK PHE
❑ CenifiN copy is fled with the city inspection division. GREASEVINDUSTRI.WASTE INTERCEPTOR
GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(Thissechon need not be complete fmapermit is follow hundred diallam(SIM) SEWER-SANITARY-STORM EA.2MP3'. ENERGY PED
.r Ices.)
I certify lLm it tc perfurmana of the workforwhlch fusee 'r"see,Isbell WATER HEA"H?R W/VENT/ELECTR 7/
not employ
any crson many manner so as m me sub I he fk PAID
Atl�am eo ,ws of i tat. a¢ WATER SYSTEMTREATINO Dmc RecciptX
02 NOTICETOAPPLICANT:If
after making EdsCmi me of F.xcmption.you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
F" [q become subject mthe Workers Compensation Prov ns of the labor Code,you mus
� ; forthwith comply with such provisions orthis permnsha"be deemcdnvoked. BUILDING FEE
CONSTRUCTION LENDING AGENCY SEISMIC FEE VV
Z I hereby aflimt that there is a construction leading agency for the performance of
U O the work(or which'his permit is issued(Sce.3097,Civ,C.) TOTAL: ELECTRIC FEE
CL he miles Name
ULanders Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
1 certify that 1 have read Nis application and stem tbm me above information is
cornet.lagrce mcomply with all city and county ordinances and lea srelming to PERMIT ISSUANCE MECHANICAL FEE
(n 4constrmion,and hereby authori entativws oft .city to ter upon the
UZ d fnopcny for inspeci n,ugm sx ALTER OR ADD TO MIECI I. CONSTRUCTION'IAX
10 save,mdwmify nd keen mless e City ofC unm.a,mes
ants.coils undexpe us wM1i myin ywayecc againstsaidCity AIR IIANDLING lINl1'(TO IB,000CPM)
to f t ranting of Or AIR HANDLINGUNIT(OVERIg000CFM)
aanUConuano ate EXHAUST HOOD(W/DUCD PAID
HAZARDOUS MA ,RIALS DISCLOSURE HEATING UNIT(TO W,WOBTU) Data Rweipl##^a
Will the applicum nr[umrc build' aarem unl sl.ra or M1anJle bamrdnux ma¢rinl
as define by the Cupertino Municipal Cee,Chapter 9.12.and the Health and Safety HEATING UNIT(OV ER 1 00,(80 BTU) TOTAL: S
Code,Section 25532(x)?
11 Yes 0N VENTILATION FAN(SINGLE RESID)
Will the applicant (mart building occupant use equipment or devices which emit
BOILER-COMP UHP OR 100,000 BTU) ISSUANCE DATE
nva.dous air comaminawnas m defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU) P A 9
Uinria? D
❑Yes ❑No NEW RESIDENTIAL MEC11. SQ,F)'.
1 have read the harardoua materials nquiremems under Chapter 695 of the DEC 1 1992
Culifomia Health&Safefy CWe,Sections 25505,8533 and 25534. I.ndemland that
if the building dues not currently have a tenant,that it is my responsibility to many the
weapon of the requirements which must W met prior m issuance of a Ceniftcate of C I I Y ✓r CUren r u PsiOccupancy. -
Owner or aulhnrrzcd agent Data TOTAL: ISSUED BY:�` 'laz `Vlv L4
OFFICE
APOLLO SKYLIGHTS
CENTENNIAL BUILDERS, INC.
1680 Hertel Ave. San Martin, CA 95046
1 (408) 68&9091 Phone/Fax
I2.2 - - - - I - -,
•25 r I� VEL
-- - 1 1992
Q ®6D®. INSPECTION DEPART<$EU
CITY OE CUPERIWQ
PW r PLA Ns
CNECKED BY
ATI 121J
-
PLAN INC- DEPT, j
DATE -
I /
S.S
V
JOkPPROVE0
IN ACC N E WITH THE CITY U. —
CUPERTINO C QES
AND ORDINANCES
OATEN — —
SIGNED
This set of pians and specificationsPt)S7
be kept on the job of all times and it is un
lawful to make any changes or alterations
on same without w,itten permss88
the building Deption from
., City of Cupertiny:
o. S
the
into
this p.an _nd specifications
THAI-L NOT i t
be he d to pe:ma or to be an t— Ai
of the violation of any provisions
O it name Gl State(law..
4,