27143 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOIJILDING-FEVC RI? - PERMITNO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-.MECHANICAL 27143
BUILDING PROJECT IDKNOVICATION'
BUILDING ADDRESS: 'SANDfARY NO. APPLICATION SUBMPFCAL DAM
z03,,� B/Guc WA y
UNITN LOT 1
O 'NERS NAME: PHONE: CONTRACI OR' NAME: WC NO: `
0VA/4 1 as-�is�l rcfi� Pew GagF�u NNA] VnD
Cl 11FECI7INOINEBW LIC NO: ADDRESS
IC S ❑
rS/ GNMJC- d
CONI ACT PHONE: QTY. ELECTRIC PERMIT. FEE BUILDING PERMIT INFO
LOC CLECT PLUMB MECH
PERNIT ISSUANCE ❑ ❑ ❑
LICENSED CONTRACTORS DECLARATION APPIJANCPS-RESIDENTIAL
pnZ I hereb,.Mmrhot l am lic.d.mi m,kicm.fCh,icr 9(cammenctri'with JOB DESCRIPTION -
�0f0= Section]000)of Oivisim 3 ofthe Business aril Pmfcaima Code,teal no,OmLa a In PANES
rcUC1 full
FZUWd force,anefft.
Li., bes
Lic.N
pence Contractor
301-IMAMPS
f—y L ARCHITECTS DECLARATION SQ.FT.FI- ARP.S ySQ.FT.
ZOrn— I undmaard my plxm shale used v public recor
l bblids. OVER 1000 AMPS
OZ _
Q� u Li«vd ProfessionalProfessionalOWNIJUBUILDCR DECLARATION SIPF,CIALLCLSC.
CIRCUIT/M
%K C) cu 1 hereby affirm the I am exempt form to Cmrramns Livertx law f«Ne
W3v.� following reason.(Secrim]0313,Business and Pofesabu Cad-Any city«ammy TEMP.METER OR POLE INST.
tlr.OQ which rtyuirex a perm,to c«utmo,idler,improve,Mrrol ish,caro air tiny evncrme
K ¢� pri«to iu issuance,ahm requires the applicant for suchermit Pto file.JgrM cal POWER DEVICES
C a that he is licenser]prrnu n to the povw«u o(te Conu.eols lic'me law(Chapter
O
M 9(c,mmscnciny wi@Section](yp)of D vision 3 of the Bmic..�vhd Prfevians Code) SWIMMING POOL ELECTRIC VALUATION
W=h or that he is exempt ticrtfun and rhe Nati,fm to alleged escmptim.Anyviduiern of
tK, Scction70313 by any applicant(«a penin subjects the applicant to•Jdl penalty OU'R.EfS-SWITCHES-Fl%TURFS
rL,2
not more than fate humbW dollar,($5001.
CLp ❑ I,vowrcrofthepopvry,«myempbyeawlW wapesutdrwlecorrhpem.twi. NEW RESIDENTW.ELELTR _SQ.FT. STORIES TYPIC NSllt 10
4d3� will dothcwmk,Cumene Contract-,
«attend t«sJ.,1,1..emircss
and PnhfY.iaw Cale:The Cnnroxroi a Liamae law Jrca rot apply to en owner of
,m,i wlobulldaorimpovea termer oil whodoes such work himselferterso hhis
cmpbym,prvidcd tw suchimpovcrtcnu ecnorinrrndM oroffvedf«sJC IL OCC.GRO RNfIS
M1owevcr,the M1uilJing«impovemmr iveold witM1in orc yemof<umplenon,to ownm- 'DOTAL:
Iva lJc will have the burJro M mvinp thus he did.build or improve for pupme of
vk.).
❑ La.owncrofthe pnhpi one exdmivdyemlm'nering with liccucdconvactmem QTY. PLUMBING PERMIT FEE FL Z 1. APN
c«cone to M*I(Sec.7(1 B.6..M Pro ealom Cod-)The Conti. , PBRMR ISSUANCE
license law Eau.grply m w owrarofp ,,t,who builds«impovnrhvcm,.rd
who wovenx fn,urn pnj«I,wish ecnmr sOmO)II«naed wwart rote Convammr's
U.Law. ALTER-DRAIN&VEN(-WATER(EA) FEE SUMMARY
❑ 1 un.,.sept uMer Sec. ,B&P C(a Kir,maaen BACK FLOW PROTECT.DEVICE SANUARY Y N
Owrcr Dam DRAWS-FLOOR,ROOF,AREA COND. RECFJPTN
WORKMANCOMPG'SATIONDECLARATION SCHOOLTAX Y N
❑ IbecbyaMmtutl Faveacmificavofco itoelf-imum,«.L ificveof RF.CEHvI'0
FIXTURES-PER TRAP
work at emp,,ce'snErm.rccpenit. Mmpy ttrrmfl6m 3x00,Tab C.)which � PARK FEE Y N
cmcy Jl cmdoyrc'suMcr this prnnit. GAS-EA,SYSTEM IINC.4Ol1T1.ETS REIVISI N
Policy N BUILDING DIVISION FEES
Company GAS-EA_SYSTEM-0VFR 0(EA) PLANCHECK FEE
Cl Cmifcdropyislertbyfmnis .
❑ CcnifeJ cagy is Ned wile Ne chy Imptctiw didJoa GREASFIINDUSFRL WASTE WTTRCEF"FOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS GREASETRAP Y SOILS FEF,
COMPENSATION INSURANCE
(This section red rom
et a npleud iftc pmm'u furmle hundred dollan(f100) SEW LR- -STORM FA.]81PT. ENERGY FEE
«Inv)
1 mify tut in thcpMmmwha of the work fir which Nx Permit i.Ivwd.I th 1 WATER /VENI'/ELECfII
not employ any person in any manor a u to bec«rc wbjeet m Ore PAID
Z CmnTemYiest awaof CJOomi.. Dare R YSTEM/IRFATING Dora Receipt
Aplicwt
NOTICE TO APPI.ICAM':If,after wkirig this Carifiote of Es should F. FSIDFMIAL PI1.10. SQ.F1'. TOTAL
bec ie subject to Oa Worker,Cornpmolien Povi.:vgpf the 1 .you mens
fothwiN comply wimmich prvialma or this pcmi be okel BUILDING FEE
1 (� CONSTRUCTION LENDING A SEISMIC FEE
5 Z 1 hereby ulTrm Oat tart it.c«uvuctuon lading agenc to perfmm�ce
U O to workfor whicL Itis permit is issucd(Sec.309],Civ.C) \\ TOTAL ELECTRIC HE
O
Lcocicra
NName
PLUMBING ITE
Lccr'a Name QTY. MECHANICAL PERMIT FEE
I ceni(y tin 1 have rod Bit,appliaion ed sate tw the above inf,mon eo is
G'I c,xrtct.I.yrx rmcmmply wihh.11 city and comDordirunc�a aril name 4wa rtlatny to PERMIT ISSUANCE MECHANICAL FEE
_ miluing cannrcmra amd herebyinicl rcpemlatves MWs city,romerupon the
U above marmenm Property(«trapcmmm pimposes. ALTERORADDTOMECH. CONSIRUCIONTAX
(We)agree to save,indemnify and keep harmless be City of CLpmino eg.irt
habilities,judgments,cru aM exprssn which may In my wey.cmue agJnn vie City AIR I IANDUNG ON IT(TO 10.020 CFM)
in— of Ne p.nfrrg of mit
w r]1 /14./ AIR HANDLING UNIT[OVER IO.000 CFM)
of ApplbvyConrncm eeA Tare Y EXHAUSI'IIOOD(W/DUCD
PAID
FTA%ARDOUSilchn IAIS DISCLOSURE
HEATING UNIT(TO 100,0011 BTU) Date Receipt
Will the applicant m(marebuildingos.Char suart«hmdkharmdo mrrwmi.l HEATING UNR(OVER 100.000 BTU) TA
v defrcd by the Cupenim Mmiclpal Crile,Cn.pre 9.12,and to IIea1N nrd Safny
Code.Section 2553BmT' VENTILATION FAN(SINGLE RESID)
C3 Yet ❑No
BOILER-COMP(3UP OR BIo,0))HTU) ISSUANCE DATE,
Will Nee(pplicant«fwurt huilding«cupant uaecNuipnmt«Jevim whichmnt �j
Memo? sir mnumivnu as defmM by to Bay Area Air QualityQu. Mvagemenr BOILER-COW(OVER 100.000 BTU)
ENTI 'I(�(]/J
❑yea EI No NEW RESIDAL MF.CIL SQ.FT. OCT 11 1994
1 have mead the,hvmdau melimals requimrcnts urea CTaper 6.95 of rhe
Calif«nu Heald)&Safety Code,See.25505,25533 and 255}1. 1 undcrvaN Nat
Iflite buiUrt,does not cmrtnly have Beam,that it is no,responsibility to minty to Cf YUr UUf[Y.sl"ss
eoeupum of the rtyvirtnxnu which mull be mer prim m issuance of a Cmificate of
Occupmwy, v V"— ` r
Owoo-mamhmirnlegrnt Da¢ TOTAL ISSUHDBY:
OFFICE
• 4x6 cvRB TYP.
^ 2 x4 SkYuGIIT
i WA R PRooF SHT
NGTAL FLASHING TrP•
2X � RIM JoisT'TYP
AT OPENINGS
2x6 FRAM04
AT 16"o.C. TYP.
'i
Do„plc JoISYS
EA. sI D6 of oPnrJIH4
t '
,
GYP. I?D, FN
SKYLIGHT DETAIL A - A
'SCALE '/2 " a I '- 0 " ,J OCT 11 W4
BLDG. INSPECTION DEPARTMENT
CITY OF CUPERTINO
2x4 YKY04NT
WAreA PROOF SHT 4x6 CURS TYP.
MEFAL KAMING
TYP. "Z—r
DOUpLG PAFTEAS FA
SIOL OF SKYLIGHT
BRCECopy
2 x l FRAMING r}T 16 ° oC• TYp.
APPROVED
2 xI� AF��1 °��� Wit THE CITY OF
AIWA 11 b sCODES AND ORDINANCES
DATE
SIGNED __ _
This set of plans and specifications MUST
be kept on the jcb at it; times and it is un
lawful to make any changes or alterations
S K`Y L t C,u T DETAIL 8 - 13 on same without wr:ten permission from
the building Dept., Ciiy of Cupaitno.
S CA L r V2 ' I `— 0" The stamping of this plan and specifications
SHALL NOT be held to permit or to be an
approval of the violation of any provisions
of any City Ordinance or State Law,