23802 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY *
Building Proes Idemlf"flon 7 ` Lx PERMIT NO.
Building Address: c.�aao �s G � ger 23802
nese +me: ane:
L�,.3nrnAB' c17 R� 733-9. CITY OF CUPERTINO-BUILDING DIVISION
t ids Name: No: APPLICATION /PERMIT
n�n+Lru.(z 7kw�La� /�Nvl% �83�g
�rhnen/Englncer. BUfI.DINGdFG1RKA4PLUMBINGMECHANr.1 CATEGORY CONTROLY
�f1=43>2tn L/ BUILDING PERMIT INFO
3S > A i .0 Q ELECTRIC PERMIT FEE
IT SSIJANICE
LICENSE-DCONTRACTOR'SDECLARATION
IherebyafflrtnthatlamlkmaeduMerprwWe of Chapter9(mmmim APPLIANCES-RESIDENTIAL )OB DESCRIPI'TON
Ingwllh 5«Jon 7000)01 DMJan3ofthe BuJmssand PyfpaJmaCade,and
�i/
lloenc4lnfullla�and effect ` `ate PANELS G�1. rL
Lkeswc Cor .J Lk.I
DateCorina
ARCHITE -1 AMPS
ro X I urierM
dstamy pbro shall bused se ere public record. OVER IODO AMPS SQ.FT.FLOOR AREA $/SQ.FT.
O
WO
LI¢nxd Professional SIGNS ELECTRICAL 1 CC
6 pWa OWNER-BUILDER DECLARATION
Thereby alBrmthatlam exenspt from the Comranor's LI¢nr Law for the 9aF.CIAL CiRCUR/MIS
q? fclbwingmason.QM1on 701315,Bwlner and Pmrmbv Code:Any dry or � y
F�C� n hkhr Ireea to mmmru Jter,ion rove,demolb TEMP.MEIEi RI'OLEINSf
mar tyw equ permB K P horrepJr
a nyrtructumprbrblts ame,ab mrtqulantheappBwtf«euchpc to IVVJpR
O
file•tlgned statement that he b Brenned pursuant to the provisions of tliv
q Contractor's Llceva l,aw(Chapter9(comrmnctngwkhSeddon700D)ofD11- asI
i �0� abn3olthe Buslnnesnd PrdmbnsCade)orthahebexemptthrrtlromand SWfi'WI'NC CTRIC VALUATION V8
•..11 the basis for the alleged exemption. Any Wdxbn of Section 7m15 6/any �
mdtI�F�v�
°PPU.tforapewb*a theappB tt..d pe.hyd...mthan v �C
five hundred d.11.tS50U1.
1,as ower of the property,.,my empbyc wdh wag.as their sok NEW RESIDENTIAL ELL= 'T' STOIULS TYPE CON'STRT=)N
mmpewHon,wBl do the wink,andthe stmdurt b rot blended or offered for
t O sale(See.70K Bwlnd and Professions Code:The Conrado/s Lleemue Law
$ do.not.pply to an ower of property who builds or mop.thereu,and OCC.GROIII' RLI UNITS
who do.such work hhnself or through his mw
own employees,plded that such
Improvements arerot Intendedoroffemed forsale.If,however,thebulldleg«
Impmvementbsa thlnomrarofcompinbn,tFeaw buBderw UB ve _
rdenofproWngthathedb na WBd or(mpmv¢r«purp.eoraale.>. QTY. PLUMBING PERMIT FEE
Lj L as owner of the property,am exclusively comna,mg w licensed F-�D AIaN
mntractms to construct the projeet(Sm 70K BuslnmaM Professions Code: PFRMITISSUANCE
The Contmdoe.Lire.Law daes rod apply to an owner a(property who
Wilda or improves thereon, and who corm m for suds Injects w h a ALS"DRAIN&VENT-WAIER
CEli¢sscl puesuant to the Cmtrador's License Law. FEE SUMMARY
LJ I am e.empt under Sec B& P C for this men BACK FLOW PROTEICT.DEVICE OLrrSI DF FEES
DRAINS FIQOR,ROOF, SANITARY Y_ N_
^.� Owner Date RE{FIPTI
WOR qct ailOMPENSAifi NDECI.ARATION FD(Tl1RFS I'ER.IRAP SCHOOLTA% Y_ N_
❑1 hereby affirm that I have•¢rtlf{ate of cmrnt to self-Ivo rc,«a �EEPT s
¢rtifi.te of Warkan'ComprruJlm lvuran¢«a¢reified mpytheroo((Sec.
Iib CJ GAS EA.SYSTEM-I PARK FEE Y N
3BOO,
Policy
DI N-C D1 a
Co ray GEA' ) BUILDING DI VI510\FEES
O edified ropy b hereby fumniJied. GREASE/ ASIT INTERCEPTOR PND Ct�F#OG t
Certified copy b filed with the sty Inpedbn division.
CERTIFICATE OF EXEMPTION FROM WORKERS GREASE
Ca becom ATIONINSURANCE SEWEILSANTEARY EA 700FT DRIB Recei tN
(fhor t..)n need rod he complied II the pennit b/mom hundred dollars
6100)«ImJ WATERLIEATERW/VERT/ELLER ENERGYFEE Y N
I¢rtuy thou Nthe perfornun¢oftha work forwnich tnis pemmlt is issued,
I shall not empby any person In any manner n n to become subject to the WATER SYSIkM/TRGTING
Workers'Compenaatbn U.of G.Brmnla.Dae ' PAID
O = Applicant NEW RESIDENTIAL PIMB. SQF. Date Recei tN
Z O NOTICE TO APPLICANT:If,after making this CertBble of Exe, ior,you
should become sobered to the Workero'Comperuatbn pmwbbv of the Irbor TAIL
~ N Code,you moose forthw h ovnply with such provisions orthb permit shall he
cc f W > deemed invoked.
CONSTRUCTION LENDING AGFNCY 5EISMIC FEE
CL E3 lhereby.Pormthat them b a coretrunlan lending agency for the perform, ELECTRIC FEE
M Z once of the work/or whkh this permit Is issued(Sec 309'7,Cly.C.) TOTAL
U O 1,oder.Name PLUMBING FEE
LL I,nder.Addmas QTY. MECHANICAL PERMIT FEE
O W lmeLfythatih wmadthbappL.WnaMratet ttheaboveWomwbn MECHANICAL FEE
bcorml.I agreeto complywth all dtyand county ordinances and state laws PERMIT ISSUANCE FEES PAID:
. > C relating to bullding construction,and hereby author.,rep,,entawn of thio
f" N sty to enter upon the abovrmembned property for impedbn purposes. ALTER OR ADDTO MECH.
Z (We)agree to save,Indemnily an d keep harmless the City of Cupertba Date Re ci tit
U agalvt Wbliftles,jodgmerds,coatsaM expenses whteh may N anywvyseeue ADO HANDLING UNIT(TO 10,000 CFM) SUBTOTAL'
agerbut said City In m.equen¢or the granting a(this permit.
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX t
Slgnatumol AppBmant/Contras« Date EX1IAUST HOOD(W/DLrD CONSTRUCAN PAID:
HAZARDOUS MATERIALS DISCLOSURE tI1,
Will the applseant«future building ar pant store or luMle havmdous EIFATTNG UNIT(TO 1W,000 Biro Date Receipt
material as defir,d by the Cupertino Municipal Cede,Chapter 9.1 Z and the
IIeahhaMSafetyC Ian7S532(s)T HEATING UNIT(OVER 100,000 BTT, QI
qNoYIs
RIUmapplk . =Wlldingorcvpantuseequlpmsrdordcioes VENTILATION FAN 6INGLE RE51D) ISSUANCE DATE
whkh eMt hard air contambunt...defirad bytha Bay Arca Ab �s q
Quality Management taja No BOILER{OMP PED'OR 1W.0(O BTln IC M ' D
ITS Ye a 7(S�No
love mad the hy- E�mateaab mequirtmenb ander Clupter G95 of BOILER-CUMP(OVFlt 100.0110 BTU) JUN 28
theCallfomla Health&Sfery Cade,Sections 75506,I5 Sand7 M_ I 1994
understand lhit If thebuDdtn oes not eurre t ha tcnar4 that R b my NEW RESTDENMI,MESH. SQFT
respavmBltytonatily the pa a swhkh rtwel be rens
P .0 d o / CII1 Ur uUmnf Ncj
mer or u gent /e(] ISSUED BY:
DIAL
OFFICE COPY