26692APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OFCUPERTINO BUILDI G-ELMIHI AL
BUILDING DIVISION APPLICATION/PERMIT PLUMBING -MECHANICAL
BUILDING PROJECT IDENTIFICATION
PERMIT NO.
26692
BUILDING ADDRESS:
SANITARY NO. A^PPLICATIONSUBMITTALDAIE
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C5 1,40 UNIT# LOT#
� —
1
- N/C CONTROL#
O
F: P E:
CO RAC 'S NAM LIC NpQ:
3 Y1 �0,3
R TECT/ENGINEER: LIC NO:
DRESS:.
CONTACT: PHONE:
QTY. ELECTRIC PERMIT PEE
BUILDING PERMIT INFO
BLDG ELECT LUMB MECH
PERMIT ISSUANCE ��
LICENSED ParlaCON underp R'SDECLARATION
amliceeBusinderprovisiooli of..Coer encise with
Ih7000)
APPLIANCES - RESIDENTIAL
JOB DEV r'rv�
x�(\)�,•L•`
PANELS
ofrision
Section 7000) of Division 3.f the Business antl Professions Code, and my license is in
anon,
1 6�;O_
full force and offer,,
eClass Lic.#
UP T0200 AMPS
'
Date Conrctor
ARCHITECT'S DECLARATION
I understand my plans shall Int used as public records.
261 - IOW AMPS'
OVER 1000 AMPS
SQ. FT. FLOOR AREA
$/SQ. FT.
SIGNS ELECTRICAL
Licensed Professional
OWNER-BUILDERON
SPECIALCIRCUIT/MISC.
empt frmEC Contra
1 hereby nffir that 1 am exempt from the Contra License Law for the
TEMP. METER OR POLE INST.
following meson.(Section 9031.5, Business and Professions Cede: Any city or county
which requires a peril to construct, alter, improve, demolish, or repair any structure
Prior to its issuance, also requires the applicant for such Permit to file a signed statement
POWER DEVICES
that he is licensed Portland to the Provisions of the Contractor's License Law (Chapter
9(commencing with Section 7000)of Division 3 ofthe Business and Profeseio ode)
or chat he iv exempt Nerefr.m andthe basis for the alleged exemption An olati ofOUTLETS-SWITCHES-FIXTURES
Section 7031.5 by any applicant for a permit subjects the applicant to vil penalt of
SWIMMING POOL ELECTRIC
VALUATION
' 6 df�
V
not mom than Eve hundred dollars ($500).
❑ I,asowneroftheproperty,ormyemployeeswithwages eirsolecompensation
NEW RESIDENHALELECTR SQ, FT.
STORIES
TYPECONSTRUCTION
willdothework,eadthe structure is not intandedorof ms.le(Sec.7044,Busmvss
end Professions Cade: The Contractors Licen ew does not apply to an owner of
Property who builds or improves thereon,end 0 eessm workhimselfmthroughhis
a
own employees, providedthatsuchimpmv ems are notimendetloroffered forsale.If.
OCG GROUP
RES. UNITS
T
however, the building crimprovemem is dwithin one yearofcompletion, the owner-
builder will have the burdenofpowin athe did notbuildor improve forpurpose of
Sala).
❑ Lanowneroftheproperty, exclusivelyeantracting with licensed r m
QTY. PLUMBING PERMIT PEE
FLOOD ZONE
APN
.meas[ the pmje.t (See.7n4 Business and Professions Cod , a
ore
License Lawdoes not apply to an w rofpropenywhobuilde est ,and
P61,11T ISSUANCE
whuenntractsforsuchprojects 'thacontrectot(s)licansedpu t tors
License Law.
ALTER (PA)
FEE SUMMARY
❑ I am exempt under Sec. B P t is reason
BACK FLOW PROTECT, DEVICE
OUTSIDE FEES
SANITARY YN
RECEIPT'#
Owner to
DRAINS- FLOOR, ROOF, AREA, COND.
WORKMAN COMP ATION DEC 10
SCHOOL TAX YN
❑ l hereby affirthat l have. certifies fconp,;nl al urc,.race oudeof
Workers'ComPensation lnsurena ora certif opy therco((Sec.3S00, CJwhich
FIXTURES - PER TRAP
RECEIPT is
PARK FEE YN
GAS INCA OUTLETS
covers all em Joyce's under this t.
p pert
Policy #
RECGIPI'#
BUILDING DIVISION FEES
Company
GAS - EA. SYSTEM -OVER 4 (EA)
PLANCHECK FEE
❑ Cenifiedcopyis hereby famished.
GREASPONDUSTRL WASTE INTERCEPTOR
GRADING FEE
❑ Cerifiedcopyis fled with the city inspection divis
CERTIFICATE OF EXEMPTION FROM WORKERS'
GREASETRAP
SOILS PEE
COMPENSATION INSURANCE
SEWER - SANITARY - STORM EA. 200FT.
ENERGY FEE
This section need notbe completed iftheperit is for one hundred dollarsHIVE)
.nese.)
WATER HEATER W/VENT/ELECTR
I cenify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so ser to be fics, Wr
pensatr
PAID
Data Receipt#
WATER SYSTEMUREVONG
VLfTeifname.
Applicant t
NEW RESIDENTIAL PLACE. SQ. FT.
TOTAL:
NOTICE TO APPLI eer making this Cenificate W92rptaxn, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
BUILDING FEE
SEISMIC FEE ^�
CONSTRUCTION LENDING AGENCY
1 hereby affix that there is a construction lending agenoy for the perf.i.,x, of
the work for which this permit is issued (Sec. 3097, Civ. C.)
T
ELECTRIC PEE
Lender's Name
QTY. MECHANICAL PERMIT FEE
PLUMBING FEE
Lender's Address
I cenify that I have read this application and state that the above information is
rrour. l agree to comply with all city tied county ordinancesand state laws relating to
PERMIT ISSUANCE 7
MECHANICAL FEE
building construction, and hereby authorize representatives of this city manner upon the
above-mentim ed property for inspection purposes.
ALTER OR ADD TO MECH.
CONSTRUCTION TAX
(We) agree to save, indemnify and keep harmless the City of Cupertino against
IiaElf ie,judgments, costs and expenses which may in any way accrue against said City
AIR HANDLING UNIT (`FO 10,000 CFM)
inc quencepfthe gren[ing his permit. I )
AIR HANDLING UNIT(OVER 10,000 CFM)
Signature of Applican .ntmctor Dale
EXHAUST HOOD OVIDUCT)
PAID
BEATING UNIT (TO 100,000 BTU)
HAZARDOUS MATERIALS DISCLOSURE
Dom Receipt #
HEATING UNIT (OVER U)L" BTU)
IEAL:
al
Will the the Cupnt or ertino Mu building C re, C occupied store or hanand to Health at and Safety
as defined by the Cupertino Municipal Code, Chapter 9.12, end the Health end Safety
Code, Section 25532(a)7
❑ Yes ❑ No
VENTILATION PAN (SINGLE RBSID)
w A
S U AT
BOILER- COME GHP OR 100,000 BTU)
Will the upplicantorfhturcbuilding.ccuperm use equipment.rdevienwhichemit
BOILER IOQWO BTU)
bazWous air contaminants as defined by the Bay Arca Air Quality Management
District,
12 1994
JUL
NEW RESIDENTIAL MECH.—SQ, FT.
❑ Yes ❑ No
I have read the hazerdous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that
oill ,T 4T
Bthe building does not currently have a tenant, that it is my responsibility to notify the
_
occupant of the roquirturacce, which most be met prior to issuance of a Certificate of
Occupancy.
ISSUEDBY: !
Owner or authorized a gent Data
T
OFFICE
=ERMIT#
APN:
SITUS STREET:
SITUS NO#:
AVE.CT,ST,RD:
N.S,E.W. '
NOM
CITY:
ZIP:
L0T#:
ID:
OWNER:
OWNER
ADDRESS:
"Y.STREETZIP:
PHONE:
CONTRACTOR:
LIC#
26692
10000
TONNA
10596
7/12/1994
SUBDATE: 7/7/1994
0
PF IFER
PFEIFER
LATE CODE:
DESCRIPTION: BATH REMODEL
BLDGDEPT:
.
•
•
ARCHITECT: I
VALUATION:
10000
LICENSE #:
ISSDATE:
7/12/1994
SUBDATE: 7/7/1994
PLCHKDONE:
TYPE: RS%
LATE CODE:
DESCRIPTION: BATH REMODEL
BLDGDEPT:
1
ENGDEPT:
PLANDEPT:
RLCHKREO:
CMA
CATEGORY: 1
CTRFlRE:
DATED UE: 7/11/1994
SANDIST:
Commercial
HLTHDEPT:
CAsq#It#
STRCTENG:
CE-sq#It#:
TOTAL
CNsq#fl#:
INSPHOLD:
Residential
RN:sq#IL#:
REaq#II#:
RUSsq#fl#'.
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