24637 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING- ' LA PERMIT NO.
APPLICATIONIPERMIT PING BINGPROD CT IDE(TICAL 24637-
BUILDING
4 6 3 7
NUII,DINIi DIVISION BUILDING PROJECT CHANIFlCATIO\'
BUILDMWG ADDRESS: ^ SAND'ARYNO. APPIJCATIONSUBMGTALDATIi
V FEu UNIT♦ LOT
OWNERScpkj COIRLIC NO:
NC � NIC ` CONTROU
.� ARCI IITECVENG INFER: LIC NO: ADOMIll ❑
CONTACT: PHONE
QTY. ELECTRIC PERMIT EEE BUILDING PERMIT INF-0
BLOC ELECT PLUMB MF,CII
PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
awz I lcmby affmn Nm lom livemcdmolcr laovisiomofChepmr9(c.n.in,wish JOB DESCRIPTION
u100 gem.700(Oof Division 3 M ft Buv o,,add Pro Code,W my licenme is in PANF{S ��rrYY��
FxI full fiatwdeffect. '�'�-{p .
<j Licensee LiaN UPTO200AMPS I
,<- Dare Co .mm 201-Ill AMPS
ZOyC' ARCHITECT'S DECLARATION OVER IIXp AMPS SQ.FT.FLOOR AREA $/SQ.CL
umknumd mY PU^t X11 bc toted m Public records.
j
ui SIGNS ELECTRICAL
<N�' Licensed Professimlul
Ky�< OWNER-BUILDER DECLARATION SPECIAL CIRCUITMISC.
I herehy affirm duo 1 mn exemq frau the Comreyor'n License Law for the
ul3utn foll.mg eeeson.(.Seetion 7031.5,Business tons!Pmfessmu Cade:Any city oscmmry TEMP.Iv ER OR POLE INST.
which rtyuirea a pvmit to conmmet,Ow.ma rove,demolish.ce repair any auucuue
Y5 pnnr'maiaumlce,nlso'ryuiro Nc aPPlkvnt[m wch Penniva Neasigrcdatuemrn' POWER DEVICES
K,<<0 thou he u licensed Punu.m to to Pmvisimn of the Convur«s Llrcnse Lew(Chapte,
old9(cmmmlcing with Swaim 7000).(Divium 3 of the Business add Pmftnnons Code) SWIMMING POOL ELECTRIC VALUATION
X .Nm he is eaemq thctefmm and flw heti.for ano.11eged esevion.Any violadcm of
�Z< Se70315 by any.pplirsm,for•permit wNects th .,fcamm a civil penalty of OUTLET'S-SWITCHES-FIXTURES
nor roma then five hunNd dollar,($5(111).
w�$ ❑ I,uowrcrof Nepmperty,mmyempinyeuwlN wags.+Neirsdecanpvmation. NEW RESIDENTIAL ELECTR _S).FT. S GRIFS EAM
d3— wdll do New.k,andce hs,Coeltnminxnded.of. fasa,(Sec.to an counrcv
and Profa'slnns G1.k:The ConOvmmr's License law Inv rot apply m an owns or
peoperty wM baits m irryxova demon,wd wM Joey such work himself m Nmugh bis
mngoyeeq Pro csd rhnwchim is sold jfl nrennlimendedmordine,fossula
If, OCC.GROUP RES.UNITS
Mwevcr,the building a iminnvemrnt it toll within one ywofmomgctiad,the
butte will Ivve the burden of proving Nu he did nt.bNld m improve fm MPsse of
sale.). QTY. PLUMBING PERMIT FEE FL DZONE
❑ I,u nwnmofthepropcn LL.Rosins v sbdP,foin Cn,te:)The Comclunes
mnmel the Protea(Sec.]DM,Ihuineu end Nofeaims Code:)The Cm'rvn«s
.hoc[jeemlies sntapplj mannwncrofgapeny wlw bulldmositnt love Corcog . PERMIT ISSUANCE -
Ij ..�rc�f.such Pojxm wiN•mnuacta(s)Ikznaed pnnnant'o theCmdnaora
TJcrns Loss. ALI17R-DRAIN&VENT-WATER(FA) FEE SUMMARY
❑ I am eaemq order Sw. ,B&P C far Nu rearm BACK FLOW PROTECT.DEVICE O
SANITARY Y N
Owner Date DRAINS-FLOOR,ROOF,AREI,COND. RECEIPTY
O a WORKMAN COMPENSATION DE ON SCHOOL TAX YN
❑ ers Co affi im[miu ecenifi ifieaa.annosc(Sm.3 o,a bCficmeof RECEIITY
Wohcn Coedwe Wim lnwmnxemecenl0edc Fl%TIIRFS-PER'TIlAP
RY fle+.nf(Sm.JB00.lub C.l whkh PARK PEE Y N
en all employs'•mtdehthis pe mh. GAS-IA.SYSTEM-I INC. OUTLETS RECEIPT Y
Polley k BUILDING DIVISION FEES
Com Y GAS-EA,SYSTEM-0VFR 4(EA) PLANCIIECKFEE
-erdred cmPr it hereby ranirlea.
'coifed copy is filed miN the city inspe.ion di vision. GRFASFJINDUSTRL WASTE INTERCEPTOR GRADING FFE
CERTIFICATE OF EXEMPTION MOM WORKERS' GREASE TRAP SOILS FEF.
COMPENSATION INSURANCE
(Otisaeetion necdms beconeplesm if'he PemNufm osx "Hans($100) SEWER-SANITARY-STORM LA.2f1(IFT. ENERGY FET:
or Ina.)
I mtify But in the perfarwcx ofde work fer which Nu jesmah E Tuual,I"I WATER HEIFER WNEN7MLECIR
rot employ .ny Eason in any enavv tio as to become owl to the WodemPAID
Z Comq+ualimlawsof C.lifomi, Dbt. WATER SYSTEM,TREATING Dare ReaiptY
Appl
O 10E TO APPLICANT:If.aOcmmnk'mg'his CeniBeereof Femytion.yen should NEW RF31DEXUAI.Ell SQ,M. TOTAL:
bec.nesubJect to Nc Workcr't Comprnwial pov4bre of We labor Code,you mus
foMwbh eonryly with aueh pmvia.0 es this pe-mi dull be damN rooked. BUILDING FEE
y Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
ZD Z I kot,,affirm Nat them is a mobe rim lending.gency for thepttfonneonc M
V O 1Mw.Af,which this permit is issued(Sec.3097.Civ.C.) TOTAL ELECTRIC FRE
Isndcta
N.
Ixnda's Adme., QTY. MECHANICAL PERMIT FEE PLUMBING FEE
I certify Nu I Tuve mad his aPplicl and tone thud flit above idd.nwim is
>. Ell eanmt.I.$rm b,. ,Iy wi'hall city enol econl ordieum<.andsam lows miming to PERMITISSUANCE MECIIAMCALFEE
1" milding c..mm.end hedebyauNoriie repeexntuives of Nis city,.emefupon Ne CONSTRUCTION TAX
U Z +Love-menumcd poputy f.im,eetim pmgvcs. ALTER OR ADD TO MECII.
(We)sl m save,Indemnify and kwp huml,,s Ne Chy of Cup.tim ogmnm
liabili'ies.judgmmgeassaMenprnsa which may In anyway scmue against aid City AIR HANDLING UNIT(TO W."CEM)
wnsyurnn of Ne granting of this pe,mit.
AR HANDLINO UNIT(OVER 10,000 CFM)
I
Si aiMTmofArq4i,neoCvmmc Dmc EXHAUST IIOOD(W/DUCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNITOO IM,"BTU) Ds'e RecsipdN
Will the ap licant oe fumes building.'mupant n'.e or maalle ha ardws muelml
v defined by the CuNnino Municipal Code,Cl 9.12 and Ne Heats and Safny BEATING UNIT(OVER 1001X10 BTU) TAL:
Code,SeeOm 2553I0o)7
❑Ya El No VENTILATION FAN(SINGLE RESID)
Will 1Me licmu.fmurchuildln BOIf.PJl-COMP(31{EOR 10),M)NTH)
ISSUANCE DATE
pp g.apanrua yuipnxntadevicrawhichemit
• ha ,otos air mnamidunu u dctiwl by the Bay Am A'u Quality Managencdu BOBFR-COMP(OVER Im'"BTU)
DNarict7
❑Yes ❑No NEW RESIDPN'DAL FfECIi. SQ.FT. PAID
I have sW the htr ms mmcnals mquianenu under Oup'o 0.95 of the
Cnifimm.heeled&Safny Code.Sections 25.105,25533rd 25534.I umlersrand Nat DEC 21
if the building docs romomently mently havedes it uhmm,dit is my respmuibiliy to dwtify Ne 1992
occupant of Nu let iremems which mus no tont pnor m ivtomcc of a Cmifvate of
Occupucy C11 1
V r ton
OwmrmouN.lzed agent
Ends, TOTALj ISSUED BY:
OFFICE