20613 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN,ONLY.
BuRdin Pr 'en Idemi(IcaUon P' r NO.
Bussing Address:
roof o 57- 20613
wnere ams: one: A A
7 CITY OF CUPERTINO-BUILDING DIVISION
c-no -
ctos me Lm.No: APPLICATION /PERMIT — 2-b—�
' ArcMtect/Engtaeer. 7 BUILDING-aECTRICALPLUMBING-MECHAMCAL CATEGORY CONTROL p
Lie.No:
QTY ELECTRIC,PERMIT FEE BUILDING PERMIT INFO
Address:/Q 35- a1A17'01V16 ae• -
PERMITISSUANCE. - ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION
Ihereby affirm that fDim Bi.3dh.Brpio...dso(ChapteCd( ,..eno • APPLIANCES-RESIDENTIAL ]pg DESCRQ'I10N
Ingwlth5ection7(100)o(Dlvislon3o(the Busineseand Pm(eselone Code,and my ��/y ��_CRI
license ill fullf " and effLieect. PANES 1\ �I•U V El r
LDIcenseC ® Contractor Z 3 L g /'fj/� ,I� !�
ARCHITECTS DECLARATION 301-1000 AMPS- I✓'-/0- 3710
µQ!Ore ZOO I understand my pious aluB be used as public remrdw OVER 1000 AMPS SQ.Ff.FLOOR AREA S/$Q.p('.
Ebu Licensed Prolesslowl SIGNSELEW
GH a 4 OWNER-BUILDEReptinn DECLARATION SPECIALCI
Z t. � Iherebya(ftrmthatlam exempt(romthe Contractor's License Law for the
O 9L F. (ogowing reason.(Section 7031.5,Business and Professions Code:Any city or
county which requiresa permltmcorstroct,alter,Improve,demolish,or repair TEMP.MET
$ aystmmmpAortoibissuance,alsomquimstheappllantforsuchpermitlo POWER DE /
�w fl-le a signed statement that he Is licensed pursuant to the provisions of the
3w� Contractors LlcsrseLaw(Chapmr9(mmmencingwithSectbn7W0)offhvl-
H�O - slon3 of the Business and Professions Code)orthat he is exempt therefromand SSo'�MINVALUAOthe basis for the alleged exemption. Any violation of Section 7031.5 by anyOUTLETS gF�D
appguntfor a permit subjects the applicant to a civil penalty of not morethan❑ve huntlred dollrs($500). NEW RESID� owof the properly,or my employees with wages as their soleQTL TYPE CONSTRUCTION
compensation,will do the work,and the structure is not Intended or offered for
n sale(Sec 7064,Business and Profemlors Code:The Contractors License LaPat
w
,32 does not apply to an owner of property who Wilds or improves thereon,and
who doessuch work himself w through his own employees,provided that such RES.UNITS
improvements are not intended oroffered foraale.If,however,thebuilding or TOTAL:
Improvement lssold withnoneyearofcompletiorytheowner-bullderwlll have
tF(g�urden of proving that he did not build or Improve for purpose of sale.). QTY, PLUMBING PERMIT FEEu Las owner of the property,am exclusively=trading with lirensedAPN
centractme to mustruct the project(Sec 7064,Business and Professions Code: PERMIT ISSUANCE
The Cmarector.License law don no apply to an owner of property who -
Wilda or Improves thereon,and who contncte for such p(ojects with a ALTER-DRAIN&VENT.WATER BLU
on LI{actor(s)licensed pursuant to the Contractor'sLicense Law. FEE SUMMARY
L�I am exempt under Sec.' B&P C for this reason BACK FLOW PROTECT.DEVICE
OUTSIDP
Owner Data DRAINS FLOOR ROOF,AREA,CONTI. . SANITARY Y N
WORKMAN COMPENSATION DECLARATION RECEIPTN
QI hereby affirm that I have'. lmum to of consent to pythemo ora PICTURES PFR TRAP SCHOOL TAK .Y_ N
3800,ab of Worken'Compersatlon Inuunnceora arti(led copythereo((Sec. RFOEB'F M
Policy ab C.) GAS F.A.SYSTEM-1 INC.40UTLETS PARK EFT: Y N
Policy p RECEIPT p
Com any - - GAS EA.SYSTEM-OVER 4(EA) BUILDING DIVISION FEES
ECertlBed copy is hereby the cid. GREA5EANDUMI,WASTE INTERCEPTOR PLANCHECK FEE
Certified copy V filed with the sty Inspection division. -
CERTIFICATEOFEXEMPTION FROM WORKERS' GREASR TRAP PAID ,.
COMPENSATION INSURANCE
(TMasectbnneed not Wcompleted lfthepermB lsforonehundreddollam SEWER-SANITARY-STORM EA.200FT. Date Recei of
($1 I omiNla
less.) WATER HEATER W/VENT/ELECTR ENERGY FEE Y N
Icertl(ythat the performance o(thework forwhlch this permit la mued, —
I shall not employ any person In an nner so as to b 7 su 'act to the
Worken'Co .tion Lawson
Ifo .Date G 2.C, WATER SYSTEM/TREATING PAID .
O Z Applicant L a ���
Z 0 NOITCE TO AAppPPLICANT:I/,aftaaFFrrrr��king this CertlfMto of Exemption,you NEWRESIDENTIALPLMB. SOFT, Date Recei tM
should becorusfsubject to the WaEWrS'Compenaatlon provlalols otthe Labor TOTAL:
W Code,you at forthwith comply with such provisions or this permit shall be -
W.> dnmedrevoked. - .BUILDING ELE p'
d p CONSTRUCTION LENDING AGENCYSEISMIC FEE
I hereby afflrmthat there Is a construction lending agency for the perform-
D.Z ance ofthe work for which this permit E ELECTRIC FEE'
Issued(Ser.3097,Civ.C.) TOTAL: _
U O Lender.Name PLUMBING FEE
LL F Lender.Addim. QTY, MECHANICAL PERMIT FEE MECHANICAL FEE
O W Iadllythatl have read thisappliationand statethartheabovalmormation
C lscomod.I agreeto complywlth all cltyand county ordinances and nate laws PERMIT ISSUANCE FEES PAID:
F_ N relating to building construction,and hereby authorize representatives o(this
F Z city to enter upon the above-mentioned
property for inspection purpose. ALTER OR ADD TO MECH. `
z (We)agree to save,indemnify an d keep harmless the City of Cupertino Date ReeeiptN
against liabilities,judgments,ommana expenses which may In anyway accrue AIR HANDLING UNIT(TO 10,00 CFM) SUBTOTAL:
agai III,In consequ naP.pf t ruing of this permit '
qp AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
'[ Sgwtpre of App�j ntr for Date EXHAUST HOOD(w/DUCT) CONSTRUCTION TAX PAID:
RDD S MATERIALS DISCLOSURE
Illtheappli to building occupant store or handle hazardous HFA TING UNIT(TO 100,000 BTU) Date Recei ttY
material as defined by the C. rtino Municipal Code,Chapter 9.12,and the
Health and Safety Cade Section 7S532WT HEATING UNIT(OVER 100,000 BTU) - TOTAL:
F1 Yet No
Will the applicant or(umrebuilding occupant use equipmentordevices VENTILATION FAN(SINGLE RESID) - I$$U(C"(��TE
which emit hares minus aircontaminants.,defined by the Bay Area Air
Quality Management District? BOILER-COMP O 'OR 100,000 BTU)
❑Yes ❑No
I M1ave read the hazardous materials requirements under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU)
t, the California Health&Safety Code,Sections 25505,25533 and 25536.1 ,
understand that if the building does not currently have a tenant,that It E my NEW RESIDENTIAL MECH. SQ.FT.
f responsibilityto notify the occupant of the requirements which must be met h .
prior to Issuance of a Certificate of Occupancy. a4-
^ Owner or authorized agent Date ISSUED BY:
klrCc`
s ipTAL: �
OFFICE COPY
t-nyti y 10 5
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❑ 1 .
xxg'QF *12. Tasri
w General Contractor
�y 0•C.• Lic. # 528347
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- - - - -- 1r1041fIt
Neoprene gasket Acrylic pyramid Slepetl - !
I. gutter - - -" - -
Acrylic dome
Aluminum cap mitered ----- — _ __ _ � M�Ri•,. i__
i
and welded at corners
Weep
I Wee slits
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Tamper r j
APPRO V crews - --
10 ACCORDANCE WITH THE Cl -
CUPERTINO CODES AND ORDINAN
DATE
i 6�2b-
SIGNED CIM G
c J G
be kept on Pb 2. eat„ I!•�:�LM ' O ��y `
lawful to make any changes ort era
on same withaUt written Polmission from _
the bw d;ng Dept., Clty 0"Upe�tine. L�q�
The stamp ng of the Plan I no specif{ca
SHALL NUI be hed to pe-mit or to be an
approval of the vi:;lalion of any Provision
of any City Oldutance or State Law'.
O'KI�EFe. 14� X 36� _RMYut
JUN LY 1990
ALDO. INSPECTION DEPARTMW
CITY, DE CUPE8M.--
mbki U rW