25322APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING. ErEcOtT ^
BUILDING DIVISION APPLICATION/PERMITPLUMBING - MECHANICAL
BUILDINGI•RO3F.C1' MEN"ITFICATION
PERMIT NO.
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G J J L L
BUILDING ADDRESS:
SANITARY NO.
APPLICATION SUBMITTAL DATE
/
/ /�I��� � UNITN LOT
/r1 .icy
i QONTROL
OWNERS NAME: I'IIONE:
L/�Lr'IL�i/Ili
RCHITECf/INGINEER: LIC NO:
C �iOlt S NAME: - - LIC NO:
iaOLp S
N/C
MV
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ADD � 5:
�.X1j r.L.SA",If— WC)
CONTACT: PHONE:
QTY, ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
BLDG' E PLUMB
PHRMI'I' ISSUANCE,
f�
'C�►
AS
LICENSED CONTRACfOR'S DECLARATION
1 hereby affca that I am licensed underpmvisiom ofaripter9 (commencing with
APPLIANCES - RESIDENTIAL
IOB DESC ION
ppNEIS
UPT020L)AMPS
Sll(armandefDivision Jolthe Business and Professions Cotle, atW mylicenx is in
full force and effect.
License Class LIC.#
�� /
Dam Cut=
201-111(1!1 AMPS
ARCHITECTS DECLARATION-
I understand my plans shall he used as puM1iic re
OVER 100) AMPScords.
SQ. IT. FLOOR AREA
L
$/SQ. FT.
SIGNS ELECTRICAL`
Licensed Pmfcssionul
OWNER BUILDER DECLARATIONSPECIALCIRCUOMISC.
!a
I hereby affirm that I am exempt from the Contractors License Law for the
TEMP. METER OR POLE INSi
following neamn.(Section 7031.5, Business and Professions Cade: Any city or county
which requires a permit to consumer, atter. improve, demolish, or repair any stmcmre
prorto its issuance, also requires the applicant(orsuch Permit o file a signed statement
POWER DEVICES
Ent he is licenxd pursuant to the provisions of the Contractor's License Law (Chapter
9(commencing with Section?1100)ofheision 3ofthe Businessand Pmfcssions Cade)
mdmtheisexcorm thfi
creno and rhe basis for the alleged exemption. Any violation o
Section 7031.5 by any applicant for a permit subjects the upplicantto neivil penalty of
SWIMMING POOL ELECTRIC
VALUA9'ION
n oG
3 1{j(�
�•(�
U9y.ET5-SWITCHES- FIXTURES
t more than five hundred dollars (SSW).
❑ I,osowneroftheprnpeny.ormyemploymiwithwagaeatheirsolecompensation,
NEW RPSIDIiNT1AL ELECfR _SQ. FT.
STORIES
TYPE CONSTRUCTION
will do the work,..d the structure iannl intendW awdfered (orale (Sec. 7044, Business
and Professions Cmc:'ITc Cmarmum s Licenae Law data not apply no an uwna of
property who builds or improves thereon, and who does such work Intnselfon through his
on employees, providedthat such impmvememana, not imendedoro(fend for sale. if,
OCC. GROUP
RES. UNITS
L
however, the building or improvement is sold within one yeurof ximpletion, lhamatic -
builder will have the burden of proving that he did not build or improve for purpose of
QTY, PLUMBING PERMIT FEE
sale.). .
❑ Lmownerof rhepmpcny,em exdusivelyromreaing withlicenxd convenorsm
FLOOD ZONE
- APN
construct dee project (Sec. 7044, Business and Professions CodcJ The Commnur's
License Law dcea not apply ev an owner of propeny who bui ids or i reproves thereon, an0
PERMIT ISSUANCE "
who contracts forsuch projects with resurrectionist Iicerucd pursuant tods, Contractors
Liccnx Law.
ALTER - DRAIN A, VENT- WATER (EA)
FEE SUMMARY
❑ I am exempt under Sec. , B & P C for this reason
BACK FLOW PROTECT. DEVICE
OUTSIDE MEN
SANITARY YN
RECEIPI'p
Owner --Dow-DRAINS
- FLOORROOFAREA, GOND.
,, ,
WORKMAN COMPENSATION DECLARATION
SCHOOLTAX Y N
❑ Thereby effitn Nmlhuveecenificam ofconsennn self -insure. ora ttnif¢me of
Workma'Compensation Insurance ora cerifiW copy thercoffsee. 3800, I.ab C.) which
FIXTURES-PERMAP /a
RECHIP`Fp
PARKME Y N
coven all employee's under this Pamir.
Policy #
OAS - G. SYSTEM -1 INCA OUTLETS
EIPT p
B .DI U ISION IT
Company
GAS - EA. SYSTEM-OVER4(IA)
PLAN F.E
❑ Cenifiedcopyisherebyfumiahed.
GREASIWNDUSTRL WASTE INTERCEPTOR
G N 9ili
El copy is Bled with the city inspection division.
CHR'I'IFICAI 13 OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
GREASE'I'RAP',
SOILS Ili
SEWER - SANITARY - STORM EA. 200PT. -
ENERGY ITC
(This section need not be completed tribe permit is furonehundred dollwa($10m)
nr less.)
WATER HFATER W/VENIFIBLECfR
I certifyrhat in the pcormoranee of the work for which lhia permit is issued,I shall
not employ any person to my manner so as to become subject to the Worker
PAID
WATER SYSTEMiTREATING
Compenaationlawsof Califomia. Date
Applicant
Data In
NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should
NEW RESIDENTIAL' PLMIL SQ FR.
TOTAL:
hecnme suejen to the Worker'a Compensation provisions of the Labor Code, you mu.at
forthwith comply with such provixinns we permit seal l be deemed revoked.
-
BUILDING FEE o
SEISMIC PER "
CONSTRUCTION LENDING AGENCY
Ihereby sffina that hem is a concoction lending agency for dre performance of
the work for which this permit is issued (Sec, 309], Civ. C.)
I<ndds Name
A
ELECIBIC FEE
Lenders AddressQTY.
MECHANICAL PERMIT FEE
PLUMBING FEE 2�
1 certify that I have read this application moisture that the above information is
lugrec nr comply with all city end county onlinnncesmdamtelawarelntingrc,
PIiRMI'1' ISSUANCE' �/"
MECHANICAL PHILcorrect.
building construction, and hereby north art re representatives of this city Io enter upon the
abovememioned sty for inspection Purposes.
LITER OR ADD TO MECII. ��
CONSTRUCTION TAX
IWe) a o ave, indemnify end keep hennleas 16, City of Cupenium against
liabilitics,jud r ,costs andexpenses wNch may i wayeecmeagainstsald City
AIR HANDLING UNIT (TO 10.001) CFM)
in mnxyu a the gmptiago it
AIR HANDLING UNIT (OVER 10,000 CFM)
EXHAUST HOOD(W/DUCT)
SigrmTmKfAppfic7mACorb,Ft41F Dem
PAID
HEA9'INC, UNIT (In 100,000131'U)
HAZARDOUS MATERIALS DISCLOSURE
])ate Receipt #
Will the applicant or fuwm building weria, a store or handle heenrdoux material
as defined by the Cupertino Municipal Cale, Chapter 9.12, and the Health and Safety
HEATING UNIT(OVER 100,000 BTU)
'O
Cale. genion 255121e)?
❑ Yes El No
VPMILATION FAN (SINGLE RBID)
Will thea licantorfuturebuildin «cu nmx ui pm
pp g
BOILER- COMP CHIP OR 100,000 BTU)
ISSUANCE ATE
- - BOILER - COMP (OVER 100,000 RTU)
air contaminants as defined by the Bey Arca Air Quality Management
he A it Quality Management
District'
IJiavim? -
PAID '
❑ Yes ❑ No
1 have read the hey
thematerials requirements un25534.1ur 6.95 o
Chapter of the
t1
�u� 8 O�
NEW RESIDENTIAL MECH, SQ. FIL
California Health Code, 33under
Cale, Sections 25505.25533 erso that
_�
Nv
if the building does not currently have a mnanL that it is my responsibility to notify the
occupant of the requirements which must be mer prior to issuance of. Cenifieme of
Occupancy.
ry
t ' / tfYIINU
ISSUED ItY:
Owner or authorized agent Data
L:
01-MUL
(ITNo. 905
%V'rdifirat of (�rrn ttnr .
Ti#y of Tuppriino
743pparimpni of "Eniibing Jns.ppriion
This certificate issued pursuant to the requirements of Section 307 of the
Uniform Building Code certifying that at the time of issuance this structure rias
in compliance with the various ordinances of the city regulating building
construction or use. For the following:
Use Classification Computer Literacy Bookstore BIdg.PermitNo. 25322
Group B_2 lype Construction Type 1 UsezonePlanned Development
Owner of Building Cupertino Gateway Partners Address One Infiniate Loop
Building Address One Infinite Loop Locality Cupertino, California
By: Joe Antonucci
Date: September 16 1993
Building Official
POST /N A CONSPICUOUS PLACE
11
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