25434 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BITi�.'�IAf:-la-r'7;rkl CA 1, PraMrr No.
BUILDING DIVISION F_ n"PO-MECHANICAL 25434
HILDING PInIEr-r untNTDrH:Ar]Ory
BUILDING ADDRESS: 0 SANITARY NO. APPLICATIONSUBMIITALDATE
/ lA.ewc9 ,/l /4v-t_ UNIT# IAT# � 7� 0--q�
40�1OW P SNAME: PHONE: CONTRACTOR'S NAME.: LIC NO: NIC CONTROLM
eXawQLR 2S7 3ad-S
9R 1{ITIiCI/ENGINEBR: LIC NO: ADDRESS: ❑ I `
CONTACT:
LJ: lyosr-P
y"_3)ps' QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
(� ! BLDG PLU B MECH-
V` y yU p-�Z,f�^ 2LE PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL. 1011 DESCRIPTION
mwz Inewyaflicm that lam licensed andorprnvisinnsorChapter9(convnencingwith / r
Poo❑ Section 70100)or Division 3 of the Business and Professions Code,and my license is in PANELS
mtE I'.Armcat leffecr
<zm LittUP TD 2W AMPSnsaClase Lic.#'
rrs<y Da, Commcmr 201-1000 AMPS
70vNice ARCHITECTS DECLARATION OVER 1000 AMPS SQ.FT.FLOOR ARBA $/SQ.FT.
CZ-F❑.❑ lundentnnd my plans shall b,used as public records. ��� D �e >�
r y d;. SIGNS ELECTRICAL J
�5d 1 Licensed Professional
C)CQ OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
Ni p. 1 hereby uffinn that I con exempt from the Contmcme,License Law for the
W3aN following revs.a(Samion 7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE.INST.
�•O¢ which requims a Permian construct.alter,arouse.demolish,or repair any&tmcture
�Is,}� )dor to its iswancnalw requites TheapplicantI...chpermiuoftl...ignedmmmem POWER DEVICES
MOthat he is licensed pumamno the provisions of the Conrracmrs License Law(Chapter - /
LLo4 K 9(commSWIMMING POOL ELECTRIC VALUATION
Mo, encing with Section 7")of Division 3 of the Business and Professions Code) AL l(F
W , or ban
e is exempt therefrom d to basis for Ne all exemption.Any vialationof OUTLETS-$WITCfIES-FIXTURES �' �// O ZS L
[_ZQ Section 7031.5 by any applicant for a permit subjects the upplicat ksacivil penalty of I
as0 not mote then five hundred dollars($50o).
y .
5o ❑ I,asowarof theprnpeny,ormyemployees with wagesastheirsolecompensution, NEW RESIDT:NTIAI.ELEGTk SQFT. STORIES YPE,CONSTRUCTION
�villd.thewerk,mdthestmctureisn.tintendedorofferedforsale(Sec.7(4 ,Business
and Promsaons Code:The Contractor's License Law does not apply to an owner of
jamiscrty who builds(it balances thereon,and whereas steel]work himself fie thnngh his OCC.GROUT' RHS.UNITS
own employees,provide)that such imprevcmeetsare not alendedoroifered locale.If,
however,the building or improvement is sold within one yearorcompktion,theowner-
builder will have the harden of proving that he did not build or improve for purpose of
nwnen+f to prnpeny,emeaelvalvelywntmating with licensed conwmers m QTY. PLUMBING PE EMIT FEE FLOOD ZONE APN
mswns the projee0(Sec.7(114,Business end Professions CtdeJ The Conlmemr'e - ,�
.ittnse law deesnot apply teas ovenerofpresm,who builds or improves hereon,end PERMIT ISSUANCE
whocnnlmets fmsuch projectswithaconunctogs)licneseci panuauo to Commemra PETER-DRAIN&VENT-WATER(EA) ITE SUMMARY
License law.
❑ 1 am exempt under Sec. ,B&P C fur this mown BACK FLOW PROTECT.DEVICE SANTTARY OUTSIDEY_N
Owner Dam RECEIPT#
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF,AREA,COND. SCHOOLTAX YN
❑ Ihercby vffirm rhetlhave acerti0ca¢of conxnno xlhinsum.cru ttni0eme of RECEIPT)
oorkcn'Cnm fIXTURFS-PERrtmn
pensmion lnsuren<eorattnifiedcopy tere.f(Sec.3#OQIab421which I"- EE Y N
en all employee'&under this permit. GAS-EA.SYSTEM-II C.4 pLrfLETSr u°.. DIVISION
Policy p BUILpING UIVI$ION PEES
I company❑ Cenifialutpylshuchyfbmished., GAS-EA.SYSTEM-O rR#( )/ 1. N IECKPEI 3S'63
❑ Ceniflal copy is RlcJ with the city inspection Jiviaim. - GRRASEANDUSLWASHINPHRCEPTOR 1 I .FEi
CI?k'1'IPICATIi OF EXEMPTION FROM WORKL>HS' GREASETRAP $ t7 - �(J
COMPENSATION INSURANCE. — �A
(This 1
smiion need not be completed if the permit is fortune hundred dollars($100) SEWER-SANITARY-STORM EA.200Ff. ENERGY FEL?
or lo( x ,00
I certify that in the perfommum.1'the work for which this permit is issued.Ishall WATER HEATER W/VENTELIUM1t --�/
not employ any Pers.. in any mance(so as to become subject to the WorkersPAID I
COmpensationlaweof Califrrom Date WATER SYSTE14TREATING Date Recciptp .r•p3
0 z Applicant
z0 NOTICE TO APPLICANT:IL after making this Cafifmme O(Exemption.you should NEW RESIDENTIAL PLMB. SQ.FT. OTAL
r � n
(q became subject 10 Workers Compensation provisions of the labor Code,you must 'I s�forthwith comply wit such provisions or this permit shall be BUILDING FE deemed revoked. 6�l
LIa [] CONSTRUCTION LENDING AGENCY SEISMIC 4 a/
I hemby.ff0rm tot tem is a construction leperformanceengagency funds performance of 3� ELF, IC E
U 0 the work for which this permit is issued IS",3097,Civ.C,I '
Ldera Name O
U Lender's ,UMB GFEC Address QTY. MECIIANICAL PERMIT FTE
V I certify that I have read this upplicnrion and slam that the above information is
correct. I agree to comply with all city and county ordinances and state lawn relatingto PERMIT ISSUANCE. MECHANICAL,FE
building constrnnion,and hereby authorize representatives of ria city mercer urx
pon the CONSTRUCTION'(
U z above-mentioned property for inaNclion purposes. ALTER OR ADD TO MECII.
.^. (We)agree to save,indemnify and keep hamdess the City of Cupertino against
hadilities,judgments,musts vndexpenses which may in any way accrue against said City AIR HANDLING UNIT(10 10.000 CFM)
in consm, fm gramingoftis N(n ''y
�/�Y� AIR HANDLING UNIT LOVER III,WOCPM)
Statute
of npNicants7ontram Data EXHAUST HOOD(W/DUCn PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,0110 BTU) Date RmaipiN
Will the applicant or future building aempam store or handle hvrardous material HEATING UNIT(OVER 100,000 PTU) TOTA
as thermal by the C.,ftino Municipal Code,Chapter 9.12,and the Health and Safety
CMe,Section 23372(e)7
04
❑Ya ❑No VENTILATION FAN(SINGLE REBID)
BOILER-COMP DHP OR 100,000 BTU) ISSUANCE DATE
Will theapplicam or(owns builJingoc<upant useequipmemordevi<ea whichemit '
hazardous air conWmiaams es defined by to Bay Area Air Quality Mtmagement BOILER-COMP(OVER IOr,"BTU)
�
lDisdcfl
❑Yea ❑No NEW RESIDENTIAL MECH.—SQ.fel'. P p '
I have and the humm
rdous aterials requiremenn under Chvpmr 6.95 of rhe Nsi
Odifmniu l itNth&Sultry Cudq Section;&25505,25533 and 23334. 1 undemand that pa
ly the huiidingdoes not currently have a meant,that it is my resparsdility t S
nobly the r# t ��•,/
nccupnnt n(ta reyulremcros which must he met prior ro issuance of a CeniOcam of (�'�//��/)
Occupancy. Cl 'U
Owner Or alldm ed agent - Da, ISSUED BY: -`
OFFICE
t' IA.J1 .1 _if' 1 r I
b ,.ld r I
�I l r 1 • i _ ,
I nr1 • • • -
f: r
II
n"I1 1
—
,I 11
I
it °T
t r
n '
Zai I,+ati.' Head And TrackMust Be Level
And Straight
ROOM
'i.
V
ADDITION
I
11 tl"I J�
UZ
1115
„r }
I� 1
J
�4�li�d J 1
a
,
AVENUE
CUPERTINO
APN
OF il I':I I
I rF 1 'i
btf p�
11
IVIt M1j It _._._ _ _ _ _ _ _�� G'Yr'S�.Si'•T..�.E . �% r
Is YAI►MFI�M
rY4 5s'�' I •
I �
1,yYul"il ' • . • •ri , ��
I � I T IENT UE /
ERTINO
Y r I
. : -
/ it
r
• 4: )(A�#LiER GRILLO (408) 257-3285
' c
�Ay 1115 ENTWOOD AVE , CUPERTINO, CA, 95014-580
/
Or
j t,ItPt'{I
ybdlzY4
I'iA It �' 1p1 � is .. � r •,
t� � SII i,y}� t � I I I � � � •
Illk 5 5 I d� , I � ��, 1777777 5
t
I il'II II, 4
r tr t , f 4l, I,rl 1 r l Y r.
S4 tlt11 f 1 1+ ! It {
, -�
, !
A+ t t 1 t )
llM IpV zK
h}I4tdl}t t 1 11 I lr�a 'ja r1 nl i I r l I' t 1 I I. i' 1'A
AfW,( 4141( 4 T r _ 5 ''I 1 rl
61 V�Am It} UII f tJl� 1 � tl'I �5if hl. IIID
, , 2 d I I? f I � I ,u' n 1 i � l,• ri
Al Itilr I :: nr .. 1,1 I f 1 r
4:
'I Y
hf I ,r1 d s " J 5 I �5 . 4� 1 e � •1 r " ."�� 1
Yr. }. 1C, V•o ! ° II d f ' , 5 ( 9 •:f.L,�Irr 1 r' ,l rl n. 111 li �'l nY .0 r,4 I 1 �I_ I. Ar u .... _.:
n Grn....:. ur _ , 'r•