26621 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO sli'e.LEUIRICA PERMITNO,
APPLICATION/PERMIT PLUMBING.-MECHANICAL 26621
H(aI,UING DIVISION BUILDING PROJECT IDENTIFICATION
IiHRJDING ADDRESS' SANITARY NO. APPPI_ICYDONSUBMfITALDAT
UNITb LOTM
O iRS NAME1/��!'` PHONE: CONTRACTOR'S NAME: LIC NO L
.r TA„�1�1 NIC CONTROLp
':IIITECI'/ENGINEER: LIC NO: ADDRESS VI V i Vis I � I l�l/` ❑
'ON'1'nCl': PHONE: V BUB.DING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
BL ECT' PLUMB MECH
PERMIT ISSUANCE EL❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DF.SCRIPI'ION
Qocz Iherebyaffint NCb
al l am licensed underpmvisionsrfaptec9(commencing with
RQ 00 Section700(Bof Division 3ofthe Business and Professions Code.and my limns is in PANES
K F full forte and effect.
License Class Lic.M UP T0200 AMPS
w=y Date Coayon, 201-1000 AMPS
Z0'—'z ARCHITECTS DECLARATION OVER 1000 AMPS SQ.FT.FLOOR AREA !I/SQFT.
OZ-0 I understand my plans sheil be used u public records.
w SIGNS ELECTRICAL
YF,; Licensed Professional
ycc< OWNER BUILDER DECLARATION SPECIAL CIRCUIDMTSC.
K0 a u 1 herchy affirm that 1 am exempt from the Contractor.License,Law for the
W3:L following rmtoo.(Section 9031.5,Bminessamd Professions Code:Any city.,county TEMP.METER OR POLE INST.
"o which requires a permit to construct,alar,improve,demolish,or mpav any sw<mm
��Y� prionoin issuance,also requites the epplicantfm such permiuo fileasigned smtem. POWER DEVICES
C�O that he is licensed pursuant to the provisions of the Contrecmr's Lice.rae Lew(Chapter
dXOLL 9(commencing with Section 9000)of Division 3 ofthe Business and Profusions Code) SWIMMING POOL ELECTRIC ttVAL O�N
m.h:u he is exempttherefrom and the basis fomhe alleged exemption.Any cadmium of OUTLETS-SWITCHES-FlXTURES
FZa Section 9031.5 by any applicant for a permit subjects the applicant a civil penalty of / DO s►
��O m mmu than five hundred dollars($50E.
c, ❑ I,mownerofthe n NEW RESIDENTIAL ELECIR 5 ,IT.
grope y,ormycmployeeswitb waguutheirsolecompeuation, Q STORII3S 'I'YPI,CONSTRUCT101
1, 22will do the work,and the structure is not intended proffered forsale(Sec.7(FLL Business
and Professions CMc:The Contractor's License Law does not apply to an owner of
progeny who builds or improves thereon,and who does such work himself or through his
wnempinyees,provided that such improvememserenrt intendcdorofferedforsale.IL r 1 C.GROUP RES.UNITS
hewevcr,the building orimprrvemem is sold within one year or completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of fl-va. its 11
sale.} QTY. PLUM GP PERMIT hl � FLOOD ZONE, APN
❑ Las ownerdthepmpe 0orl, Business and Professions
Cade:)
The Contetorsm y
construct the project(Sec oano Business and Professions or
The Coreaacre PERMIT ISSUANCE DA de' 1I
License Lawsdoesfor not apply tpanownerafpropevy who builds or improves Nereon,and
whence L.etsforsuch pmjecn with aconrectortte)licensed pursuanuathe Compactors ALTER-DRAIN&VENT-WATER EA
ll
License Law. 1 ) FEE SUMMARY
❑ I am exempt under Sec. ,B&P C for this moon BACK FLOW PROTECT,DEVICE 0 0 SI DF FEES
SANITARY Y_N
Owner Date DRAINS-FLUOR,ROOF,AREA,COND. RECEIPI'p
WORKMAN COMPENSATION DECLARATION SCHOOL TAX YN
Ihembyamrm Nainsummecerace"i i copythere f(Sec.3,or Lab C.)whichamof FIXTURES-PER TRAP RFCEIPTN
n'Compensntion lmumnce oracertif copythere (Scc.38W,Lab C.)which PARK FEE
/ colica YN__
pile di pumy9- -
policy -TT GAS-EA.SYSTEM-I INC.40UTLF:TS REC1dPTX
Compann y sr,;i;� A T BUILDING DIVISION FEES
❑ CemBed cppynhercby fumished.�� GAS-GA.SYSTEM-OVER4(IiA) PLANCIIF,CK FEF
❑ Citified copy is filed with the city inspection division. GREASEIINDUSTRL WASTE INTERCEPTOR GRADING FF.E
CERTIFICATE OF EXEMPTION FROM WORKERS GREASETRAP SOILS FEE
COMPENSATION INSURANCE
('This section need not Ise completed ifthe permit is(crone hundred dollars($IW) SEWER.SANITARY-STORMEA.200FT. ENERGY FEE
or less.) t
I certify that in Ne peRorrnme,ofthe work for which this Permit is isaued.I shall WATER HEATER W/VENDELECTR
not employ any person in any mariner m as to become subject to the WorkersPAID
Z Compensation Laws of Califomia. Date WATER SYSTENUTREATING Dam Recciptp
Applicant
zQ NOTICE TO APPLICANT:If,after mikingmis Certificate of Exemption,you.should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
F-' V) become subjat to the Workers Compensation Provisions ofthc labor Code.you must
Cv > forthwith comply with such provisions at this permit shall be deemed revoked. BUILDING FEE
La C Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
5 Z Ihereby affirm that hem is a construction lending agency for the performance of
U O the work for which this gamut is issued(Sec.3097,Civ.C.) TOTAL: ELECfR IC FEE
lender's Name
0 U Lenders Address QTY. MECHANICAL PERMIT FEE PLUMBING PEE
I certify that I have read Nis application and stain that the above information is
correct. Iagree to comply with all city and county ordinances and state laws rotating to PERMIT ISSUANCE MECHANICAL FEF,
building construction,and hereby autlsurize representatives ofthiscny to enter upon the
U Z ainve-mentioned property fm inspection purposes. ALTER OR ADD TO MECIL CONSTRUM]ON TAX
(We)agree to mve,indemnify and keep harmless the City of Cupertino against
has itiea.jud anteaters and expenses which may in my way aseemeagainst said City AIR HANDLING UNIT(70 HillflE CFM)
nscque ooh ranting or this permit.
�•. 1/ �} AIR HANDLING UNIT(OVER 10,04)0 CFM)
am o ApplicanU ommce. V am 7 EXHAUS(HOOD(W/OUCq
PAID
HAZARDOUS MATERIALS DISCLOSURE mm
HEATING UNIT(TO 100,000 BTU) Date RcmiplY
Will the applicant or future building occupant erre or handle hazardous material
u defined by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 100.000 BTU) TOTAL:
Cade.Section 25532(n)^
❑Yes El No VENTILATION FAN(SINGLE.RESID)
Will the applicant orfuturebuildingoccupan[ux equipmenmrdevi<es whichemil
BOILER-COMP(3HP OR IOO,04JU BTU) ISSUANCE DATE
!mous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP OVER 1 W,11041 BTU) P AQ
❑Yes ❑No
NEW RESIDENTIAL MECII. SQ.FT.
L
have read the hazmdous materials requim Bark,ander Cheptcr fi 95 of the JUIN 21 1994
min IlealtM1&Sufny Cnde.Sections 255(15,25533 and 25534. 1 undecanmd thatuilding does not currently have a tenant,that it is my responsiility to notify the
m of the requirements which must MinclpriertoixsuanceofaCertificatetera,.m authonud agent Date TOTAL: ISSUED BY:
OFFICE—
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Input Permit Number: IS1078
MMUM VIMM UUM Taff GPff Tff,�
PERMIT#: 1.9 It, %RCHITECT: F RICHARD MEEK /ALUATION: 54756
APN ICENSE#:37539002 ISSIDATE: 12 23 97
-US STREET: HYDE 3UBDATE: 12 23 97
IF
It SITUS NO#: 940 PLCHKDONE:
TYPE: ATE CODE:
/E,CTSTRD: AV
N,S,E,W: ESCRIPTION: ADDITION BLD DEPT:
NO# _NGDEPT
CITY: CLI
PLANDEPT:
—
ZIP: 95014 A:ILCHKREQ: CM
;ATEGORY CTRFIRE:
M,03 -0T#: )ATEDUE:
SANDIST:
41
tt
ID- immercial -iLTHDEPT3TRCTENG:
OWNER: BRADFORD CHRIS CA-sq
*1#
OWNER NOHYDE AV CE-sq#ft; TOTAL:
INSPHOLD
ADDRES CN-scl
"t I YSTREETZIP: CUPERTINO CA
'HONE: --sidential
RN-sq#ft#:
)NTRACTOR: RE-sq#h#:
LIC#: US-scift#: 0 Search by
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