29305 APPLIrANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. 29305� �O
HUII-DING DI VISION APPLICATIONIPERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIF'ICA'TION 1
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DAI
�T O(o O — R �)
1 OWNEN'SN ME: PHONE: ` CONTRACTOR'S NAME: =gr / LICNO:
C\4Its
NIC CONT'NOL#
\R iCf11TEC /E IHF� L: LI' O: ADDRESS: El
CONTACT: S PHONE: BUILDING PERMIT INFO
Ln �'� ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB NIECH
V`••1-.ICIiNS""COM'RACTOR(;SU"'I.ARATION QTY ELECTRIC PERMIT FEE
]hereby affirm mm am licensed under provisions of Cal 9(i,mantendng JOB DESCRIPTION
,QZ with Sal1om7000)of Division 3oftho Buslmestand Pmfcssions Code,aodmylioanw is RESIDENTIAL
F O in fall force and effect. PERMIT ISSUANC
��F ❑SFDWL ElKITCHEN REMODEL
Q U U Liccnu Class Lic.k
lnzW Dare Comvaclar APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
F.71a ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL
Z O n Z I understand my plans shall be used as public mcards "10
_^. MODIFICATION
O" a UP TO 280 AMPS CLU ❑INTERIOR 1:1 CHIMNEY REPAIR
�� .,.IA4 1-¢coned Profcsionul 2tll-Ifx10AMPS - Iry�y�.NT�I❑❑ppTTyF/��1��AA1� TP�F�/�� p r
Q the lam exempt OWNER-BUILDER RA']']ON OVER 1000 AMPS �76EFYRt'PABtJY7t4MO¢ICJ(E��TTE�
❑C 1 hereby alien OW 1 and exempt from the Cunvucmr'e Limnse Low for the
3 6 FU- following mason.(Section]0315.Business and Professions Code:Any cityor county SIGNS ELECTRICAL C I f ll
[vl U.y which requires a Permit to construct,alter,improve,demolish,or repair any gmcmm n1V
F"LLO< prior m its issuance,also requires the applicant for such Permit file a signed nmament SPECIAL CIRCUIT/MISC.
E%}J Nat he is licensed pursuant 1.the provisions offConuactots Licence Law(Chapter 9
W L'�Q (commencing with Section 7000)of Division 3oflhe Business and Professions Code)., TEMP.METER OR POLE]NST. COMMER,IAL,
0.a cy Iha he is exempt therefrom.nil the basis for the alleged exemption.Any violation of
,+N Section 7031.5 by any.pplicant for a permit%objects the applicant to a civil penalty of POWER DEVICES ❑NEW BLDG/ADDITION [D DEMOLITION
amore lM1an five hundred dollars($SILO), ❑TENANT ❑FOODSERVICE
n<
< [-] Los own.ofthe pro,erty. tiny employees with wages as tbcirsole compensation, SW MING POOL ELECT RIC IMPROVEMENT
FO will do the work,and thcsvucmrc is not intended mothered for sale(Sec.7014,Business COTHER
3 m and Professions Crile:The Comracmr's License Law Jcee nm apply m an owner of ETS-SWITCHES-FIXTURES
propcny who builds or improves Hereon,and who does such work himself ar through .
his own employ..prmided that such improvements art not intended or offered for NEW ENTIA ELECTR SQ ET.
sale If.however.Rte building or impmvenenl is sold withinone ycaofcomplaimn.the SQ.FTPL RARER S/SQ.FT
can inllder,will M1ave rM1e bunlan of proving that he did nm build or improve for put-
Pas "sale.).
1 o at or the pmlkny,am excimively Contracting with licensed Contractor)Ili '
41 met inject and Protestants Cade:)'Due Comrucmr's],i-
'tamcLa Iapply wanowncrofPro who miles or improves thereon,and QTY. BIN ERMIT FEE MAR 19199
whoco r 1 for such projects with a comments, 'c nsedpursuantmthe Contractors
Licca 1 PERMIT ISSUA CF
❑ a c under Sec. .PCforthisreawrn C1IY ur
ler
Date ALTER-DRAIN&VENT ER(EA) VALU1ATyION' v
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE �O
]her yaffinn under]anahy of perjury one of the following dedamtians: U
❑I Invwnd will maintaian CenifaamofConacnunwl6im refer Worker's Compen- DRAINS. FLOOR,ROOF,AREA,COND.
nation,as provided for by Sectio 9900 of the Labor Code,for the pa forniance of the STORIES TYPE CONS'TRUCI'IOt
work or which this recruit is issued C1FIXTURES-1'ER TRAP
❑ 1 have and will maintain Worker's Compensation Insuranceas required by Section
37M of the Lab.Carle,for the performance of the work for which this Permit isisnued. GAS-EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP pPN
My Worker's Compensation Insurance carrier and Policy numre
counter a :
Cartier: Policy No.: GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASMNDUSTRL WASTE INTERCEPTOR
(This section need not he completed if the pemtit is for one hundred dollars IS 100) RUILUINO DIV IS #FEES
or Icsn,) GREASE TRA I'
PLANCHECK FF.Ii
(certify teal int he lelany mmenceof 1,to brk for wmiaa to'he
Wtarma orks"
al,I hall,.. SEWER-SANITARY-STORM EA.2W FT.
not employ aw any personacre any manner so as to become mhject m the N'nrker,L Compen ENERGY FEE
Z moan Laws or C:Jifornia.Data Z WATER HEATER W/VENT/ELECI'ft
2 Applicant Z y NOTICE TO APPLICANT:IL.Rer making Nis Certificate of Exemption,you should GRADING FE
F become subject to the Workers Com - WATER SYSTEM/fRLATING
a fon avith comply with such p or
Permit
ons of We labor Cade,you must SOUS FEE
Qpywi provisions or this Pcnnit ahallMObstetrical revoked. WATER SERVICE
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT PAID
U O l hereby olHmuhat there is.conamalso lending agency for the performance of ate Receipt#
W H the work for which this permit is issued(See.3097,Civ.C.)
0
Lcndars Name
U TOTAL:
(seder's Address F T M 1 canny det I have=it chis application and slate that the above infomurion is BUILDING FE
fit collard.I agrte to comply with all city and county ordinances and state laws relining In QTY. MECHANICAL PERMIT FEE
U{Z buildingconsmation,and hmbymnhoriaempieuraives ofthiscoy to emac urym the SEISMIC FE
aMwc-mentioned property far inspection Proposes, PERMIT ISSUANCE.
(We)agree m save,indemnify vad keep harmless the City of Cupertino against. ELECTRIC aE ` I
liobilities,judgmeas,costs and expenses which may in anyway acerae agaimt sold City AL1'GR OR ADD TO MECfI.
m ntmeynence of the gmming of lhls Permit. PLUMBING
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IO.gA)CFM)
SOURCE REGULATIONS. MECHANICAL FEE
AIR HANDLING UNIT(OVER I0,000 CFM) . CONSTRUCTIONTAX
Sgnaure ofpppbcaHA7AmOor Date EXHAUST HOOD(W/DUCq
HA].ANDOUSh1AT,exampSUISCLOSURE HOUSING MITIGATION 'F.
Willy the Cicamino Muniuture ipal o e,Chaptsmrcor handle Heard and
Safety HEATING UNIT I'TD IUL,ODO BTU)
m defined by the Cupertino Municipal Caxlc.Chapter 9.12,and the Health and Safety
Cute,Section 2553200'1 FIBAT]NO UNIT(OVEN 100,000 BTU) �..�
❑Yes ❑Nn
VENTILATION PAN(SINGLE RLSID) PAID
Will the applicant of future building occupant axe equipment of devices which Date Bee to
ectal haurdous air ronmminanm w defined by the Bay Arta Air Quality Managemem BOILER-COMP(3HP OR IOO.t]W BTU)
Uisrrial
❑Yes ON. BOILER-COMP(OVER 100,000 BTU) TOTAL:
I have read the h.nr h w minimal,no ximmcmn under Chapter 6.95 of the Cell- AIR CONDITIONER
firma.Health&Safety Cadc,Sections 255115,25533 and 25534.1 understand that if the ISSUANCE DATE
huichng Jaesnm carcnJy have.tenter,that nisnl hilii to motif thcwcuant NEW RESIDENTIAL MECH. SQ.PT,
y rtxpmxl Y Y p
of the requirements which must M met primno isuanee o!v Cenificoe of Occupancy.
Owner or authonud agent
Data TO ISSUED BY:
OFFICE
JUL— r-96 MON 9 :53 LRS ASSOCIATES 7450336 P. 01
i
�U
July 1, 1996
City of Cupertino
10300 Torre Ave
Cupertino, CA 95014 _ 3
attn: Alan Dorsett
RE: Permit #29305
Dear Alan:
It has been noted that 2 inch roof drains were used when the plans called for 3 inch. Due
tro the small roof size, 2 inch will be sufficient to drain the roof.
. If you have any questions or comments please feel free to contact me at your convenience.
Sincerely
LRS ASSOCIATES, INC.
EUddy Shen, A
President
•
LRS ASSOCIATES
ArChiteeture and Planning
102 PERSIAN DRIVE,SUITE 201 •SUNNYVALE, CA 94089•408 745.0331 •FAX 408 '745-0336