19891 A%PLICANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO. '
Building Address: a�� s - 1 .9891
as'%
nets are: Phone: - A DATE
CITY OF CUPERTINOIBUILDING DIVISION �C r0o
r cantredar'.Name: Lie.No: f APPLICATION I PERMIT l� L
Architect/Engimer. He.N. .BUILDING-ELECTECALPLUMBINC-MECHAMCAL CATEGORY CONTROL N '
01Y, ELECTRIC PERMIT 1. FEEBUILDING PERMIT INFO
Address.- - ' PERMITISSUANCE
' LICENSED CONTRACTOR'S DECLARATION -
Iherebyaffirmthatlamlicensed under provbionso(Chapwr 9 foo.c APPLIANC6SRESIDENTIAL TOB D[SCRB'1'[ON
Ing with Section 7000)of Division 3 ofthe Buslnessand ProfessionCude,andeny - r -
LlccrelslnfuBfomceanddfed. PANELS \ F� r-s F '
lienee Cbss Lffec 1 IhJ)It—,y /Com\
Date Contractor
ARCH ITECPS DECLARATION' 201-IOGOAMI-S
PQ!9O Zp I understand my plans shall be used as public records. OVER IOW AMPS .SQ.4LLODR AREA S/SQ.FT.
Eh Licensed Professional SIGNS ELEC A -
6g OWNER-BUILDER DECLARATION
SPECIALCIRC /M75C -
(� Ihercb afflrmthal l am exemptfromthe Contradoes License Law for the
x p� Q5 following mason.( Section 70715, usiness and Professions Code:Any city or
'r71" muntywhich requires a permit to construct,alter,improve,demolish,orrepalr TEMP.MBTGR RI'OLEI •
g� anystmcturepriortalbbsuance,ahorequlrestheappliantforsuchperemin POWER DEVICES
f9�K
file a signed statement that M is Iicenaed pursuant to the proWalom of the 1
3w Contractor's License Law(Chapter9(commencing with Section 7000)o(Divl- SWIMMING IDOL ELECTRIC -
OJ sloa3 ofthe Business and Professions Code)orthat he is exempt therefromand VALUATION
C&O the bash for
"..alleged exemption. Any violation of Section 7B11S by any OUTLETSSWITCHE&FIXTURFS S OO
applicant for a permit subjects theapplicant too civil penalty of not men,than a
E piR live hundrdviur.fthep0). - NEW RESIDENTIAL ELECTR SQ.FT. STORIES TYPE CONSTRUCTION
G05 .n ❑I,as owmr of the property,or my employees with wages r their sole
0 compensation,will dess and work Pr andthe s Cde:Th Contraet Intended License d for
Law
O ssle(Sec 7044 Business and Professions Code:The Contradofa License Law
�,I B does net apply to an owner of property,who builds or Improves thereon,and - OCC.GROUIs RES UNITS
who deessuch work himself orthrough his own employees,provided that such
Improvements are not intended proffered fcrsa)e.If,however,thebullding or TOTAL:
improvementissold within oneyearofcempletlon,theowner-bullderwill have '
to burden of proving that he did not build or Improve for purple ofsile.). QTY, PLUMBING PERMIT FEE FLOOD ZONE APN
F-1 1,ae owner of the property,am exclusively contracting wl/h Used PERMIT ISSUANCE
to construct the project(Sec.7044,Business and Prof.[..Code: -
The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA)
Wilds or Improves thereon,and who contracts for such p -
4ojads with a FEE SUMMARY
%n(fadar(s)licensed pursuant to the Contractor's Liman Law. BACK FLOW PROTECT.DEVICE
I_l l am exempt under Sec B& P C for this moon
OUTS I UP FEES
OwnerDate DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N
' - RECEPTN
WORKMAN COMPENSATION DECLARATION FIXTURES-PER TRAP SCI IDOL TAX Y N
❑1 hereby affirm that I have• Idum to of consentimAifl d pytheure,ora RECEIPT Y
3800(late.(Workere'Compewtionlmuranrn oraadi(Icd ropy thenn((Sec. GAS EA.SYSTEM-1 INC4 OUTLETS PARR PER Y N
3olic Lab G.)
Conry X RECEGAS F.A.SYSTEM-OVER 4(EA) DING Df X
Cam any BELL DING DI VISION FEES copyis hereby th t hhity GRRASE/INDUSTRL WASTEINTFRCEPTOR PLANCHECK FEE
❑
Certified espy b need with less city inspection awhmn. '
CERTIFICATE OF EXEMPTION FROM WOR KERS' GREASE TRAP PAID
COMPENSATION INSURANCE SEINER-SANITARY-STORM G.20OFT. Date Reetil tic.
Ohhsectlon need cat be completed lithe permit b(prom hundred dollars
(41 I70)oIcdify that
th WATER HEATER W/VENT/EFCTR ENERGY FEE Y. N
at In the performance oo
ounof thewk(or which this permit is bed, _
I shall not employ any person in any manner so as to become subject to the - WATER SYS77iM/TREA77NC ,
Workers'Compensation Laws of California.Date - PAID
OZ Applicant NEW RESIDENTIAL PLMB. SQFF. Date - 'Revel tR
Z NOTICE become
APPLICANT.If,titer makinWorkers'
perhis Ctiop press Exemption,you
Code,you=at
subjecilo the pty with
Comprovisinprovhiowrmit the s lab be TOTAL:
(A dececdrvoet(orthwith comply with such provisions or this permit shalt be BUILDING L
W j dmmdd revoked. -
a CONSTRUCTION LENDING AGENCY SEISMIC FEE
]hereby afnrtnthat there h a corotrudlon lending agency for the perform ELECTRIC FEE
Z aced erRhe work!or which this permit is blued(Sec.3097,Civ.C.)
TOTAL:
V O Icederb Namur PLUMBING FEE
U. F ']-end AtAdh.tl Q'Tl', MECHANICAL PERMIT FEE
O W Irect.Iareetodmply with aliatldndcoutyordinancesadmateationam _ MECHANICAL FEE
1 bcorrcct.lagrcetocomplywlthalldtyandcountyordinanmaandstatelaws PERMIT ISSUANCE FEES PAID:
relating to building comtrudion,and hereby authorlu representativesof thio
city to enlerupon the abovecremi.ned propertyforlrspedlon purposes, ALM OR ADD TO MECH. . Date , Revel IN
_ . (We)agree to save,Indemnify an d keep harmldm the City of Cupertino ..
against liabilities,rydgments,"sand expenses which may In any way accrue AIR HANDLING UNIT(T010,000 CFM) ,SUBTOTAL'
against said City In ronaequena of the granllhg o(Ihb permit. AIR HANDLING UNIT(OVER 10,000CEM) CONSTRUCTION TAX
Signature of Applicant/Contractor Data EXHAUST HOOD(W/DUCT) - CONSTRUCTION TAX PAID:
HAZA R DO US MATERIA LS UI SCLOSUR E -
Willtheappliaestorfuture building occupant store or hand In hazardous HEATING UNIT(TO t 00,000 BTU)
material as defined by the Cupertl no Municipal Code,Chapter 9.17,and the _ Date Receipt#
I ealth and Safety Code Section 8532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL:
r-1Y. No
Will the applicant oruture building occupant use equipment or devices VENTILATION PAN(SINGLE RESID) ISSUANCE DATE
which emit havrdous air contamlmmus as defined by the Bay Area Nr - '
Quality Management District?' BOMER-COMP OHPOR 100,000 BTU)
!�l rFYves read Na -
mnaterlals requlydmentsunderChapter 6.95 of BOILER-COMP(OV PR]OO,IXp BTU)
the California Health&Safety Code,Sections 8505,75533 and 25534.1 -
unddrstandthzofthebulldingdoesmtanrrentlyhaveat...et,that it b my NEW RESIDENTIAL MECH. SQ.FT. -
respomtblltry tomt the occupant of the requirements which moat be ract 't-•� ��� '�y�
priori. a Cvrtlf.te.f Occupancy.
Owner or authoric d agent DateI'1 Vim!\'s1'•�Y�i
- TOTAL: ISSUED BY,�_,
OFFICE COPY
• AA?ROVeo u
IN ACCORDANCE WITH THE CITY 0 � U
CUPERTINO CODES AND ORDINA T
ORDINANCES
DATE —S_16_CtO
E
ThON �
This set o . .
be kept on the j.: ''• catkms MUST
lawful to make "" sand it is um
on same w;Nxmr ••:,, or aterations S
the buildin ; `n Ie'mssion
8 Lep.,. C;• from
the stem,; t =pa I.
MIJ: 01, ;IJ.r; e
SHALL Nul be l,c;t ,, 'r°°` specifications
approval of the v;o;a:i. py cr to be an
Q1
any City Ora: n u° ayfi�o isionr
or St . Law.
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PLOT FLANS
CHb;�p� BY
DATE 3
LAIVNL"„� �E
• DATE T. . . - MAR 16 -1990
Br,D� DE>,r BLDG. INSPECTION DEPARTIMM
GIT�L O.E GUPERTIN4�'”
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