2499 APPLICANT TO FILL IN INFORMATION.WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO PLUMBING-MECHANICAL - PERMITNO,
BUILDING DIVISION ' APPLICATIONTERMIT'
24991MOJECTID
'.:`ti`A.i?i!i.e BUILDING EMDlCAT1ON;?L I/f17 s p
BUILDING ADDRESS: SANITARY NO. APPLICATIONSUBMHTALDA
mike MAMAgo ML-ir> UNIT# LOT#AOL
WNERS NAME: PHONE: A OR'S NAME: LIC NO:
V 'I. N/C CONTROL#
s R HT'IECT/FINGINEER: LIC NO: A FSS: 1 ��
VV in I)CION Ir RG a
oNT�A,C.Jr��.r. P0.DNpE,E,� qn-- ,,,•u'+•••:r+, ' - +. MITI,+:I y.;;;• ..+--:,,^(.•, s. BUILDING PERMIT.EVFOau,`..i^., ,L�
,ze'ELECIRIC PERMIT',`-
QTY- ... .> ,j .,,•FEE
w LDG F.BPLUMB MECH
PERMIT ISSUANCE /' El ED
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JDES
_yz I hercM1y'•Jli nmhalTann icemeA unJer moviaions of Chapter9 lcommencio,.uh / a \ u` ` R
::-..0 Scctiou700(uot Division Sot the Business and l'romanew Cude.and my license is in PANELS La IiI{�rl w7 a.r
Lrcem0-(TILL p I P
arcih
ictu
FZW fullforce
Class Lic.q UPTO 20O AbIPS
y6y Dat, Cmnmctm 201-I000 AMPS
Aft-
I-n% ARCHITECTS DECLARATION OVER 1000 AMPS SQ.FT.FLOOR $/SQ.ET.
�..rn_ lundersun0 my plans shall be used upublic records.
F� SIGNS ELECTRICAL
svxQ LicensOJ Hotcsxiowl OWNER BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
KOacV. 1 hereby affirm that sum sexempt from the Contractor's License Law for the
m 3 u to following reason.(Section 7031.5.Business and Pmfessiov Cade:Any city or county TEMP.METER OR POLE INST.
1-- 2¢ which nes, es a permit to constrvcL alta,improve,demolish.or onpav any—to-
<wi}, prim to is issuance.also millions the applicant or such permit to File a signed stmerent MOWER DEVICES
i X r o that he is licensed pursuant to the provisions of the Contractors License Law(Clopar SWIMMING POOL ELECTRIC
9(commencing with Section)000)of Division 3 of the Business and Professions Code) VALUATIp�I A
w=N m that he is exempt throduom and the Dosis for the illcgW mompdOn.Any violation 0f OUTLETS-SWITCHES-FIXTURES
F Z Q Sation)031.3 by mY apPlicam for a pemmiuubjecu Ne applicmuoii em1 penalty of
o more Wan five hundred dollars]SSW). NEWRESIDENTIALELEM _SQ.FT.
sHp ❑ ateworrk,f tpso tumisnotin=d oroffe ges as Je(s .7Ompemadon. STORIES TYNE CONSTRUCTIC
r'3°= will doffewmk.aMthe he Contractor's
Law t ,tion. Iy 1.so..in
.
and Professions Cade:The Cont emon, nd.h.Law does not apply tom owner of
..employ .provifimproves Nceonmdwhodo onimendedasuchwonk rtaelfm lbrough hies OCC.GROUP RFS.UNITS
cmr,the bs,providnd grave improvemenuartrotquirofdroOffcrtdfmak.H.
however,the have
the
bur improvement is sold within one yearor improve for purpose
o-
builderwill have the burden of proving Na he did wt build or improve for puryou of -�*,� _
Ie). QTY.'£'� is:' cti."s�az.n,. Clta9 i^ep'yex
❑ I,as owrerofthe propenY•am exclusively contracting wit lionsNconmetonm -#sK l-n.�_ rPL.UMBINGPERIvfffJl l' a FEE FLOOD ZONE APN
construct the project(Sec.7044,Business it Professions Cock)The Contractors PERMIT ISSUANCE
License Law daces not apply m an ownerof property who bur'lds rr improves theeon,and
Whoconoacufmsuchprojauwith aeonrmoss)licensed pursoun to the Comnerora
License
Law. ALTER-DRA &VENT-WATER(EA) s'''p+ e_aaT..2'. 'y FEE SUMMARYrjj ,gp.-cti
❑ 1 am exempt under See .B&P C fie Nis reason BACK FLOW PROTECT.DEVICE S
SANITARY Y-N
—
Owner Da¢ DRAINS-FLOOR,ROOF,AREA,COND. RECEIPT'#
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ Thereby affirm that]haveacenificue ofconuntmsel(-imam.ora anificare of FIX'IVRFS- TRAP RECEIPT'#
N
.,Vorken'Compensation lmurano macmified ropy theuof(Sa.38W.lab C.)which PARK FEE #
v rsvil emPloYe25 under Nia permitEASY "' E?A� 7 ION FEES
Policy p
Co y GAS-EA SYSTEM IAd1EAI
Cnified copy is hereby famished.
he '
C] Ceertified copy is filed with
the city inspection division. GREASFJINDUSTRL NTE INTERCEPTOR t ,
CERTIFICATE OF EXEMPTION FROM WORKERS GREASE TRAf /Q2 SOUS
COMPENSATION INSURANCE
(Thissatimnee mtm mmpletedif Nopamilisfmo hmd dollana(5100) SEWER-S Y-STORM FA.]WFT. GY E
or less.)
I certify that in the performance of the work for which this Perot is issued,I shut] WATER HEATER W/VENTIELECfR
not employ any person in any manner so as in become subject to the WorkersPAID
Z Compensatiou L.wsaf Califomu. Dare WATER SYSTEMAKEATING Dam Receipt
Appliecm
0Q NOTICE TO APPLICANT:If.after making this Cenificate of Exemption.you should NEW RESIDENTIAL FILMS. SQ.IT. TOTAL:
F ` become subject to the Worker's Compensation Provisions of the Isbor Cade,you mor
forthwith comply with such provisions or this permit moll be domed revoked. BUILDING FEE
1 Q CONSTRUCTIONLENDINGAGENCY SEISMIC FEE Is L
O
Z Ihereby off Nat them is a constriction lending agem,for the performanceof TOTAL ELECTRLC FEE
O
U the work for which NPermit is Peit is issued(SIL.3097.Co.C.)
Lender's Name yn vsntwsrdvtvrus#A:�rx.'+sa ;y'}+' s'ii{r-res?}sly. PLUMBING FEE
LenderSA ,18 MECFIAMCAI:PERMRr; kd4PEE•11""
O U 1 certify dor I love read Nis app]icimen and sus dust the above information is ""ILD "3fi •ru x..s ^'" 4aru"--+ht MECHANICAL FEE
correct.lugme mcomply with all city and county oNinmces and sate lawn mlatingm PERMITISSUANCE
building conxtroction.mdhereby authOriu repounudvesofNiscirymcnrr upon tM CONSTRUCTION TAX
U Z above-r tumoral property for inspection pury0sn. ALTER OR ADD TO MECH.
/(W e)agree o save,indemnify and k barmlraa the City of Cupertino agaimt
lia�j'Iitics.jud nu,cosumd ex ma yinmywayaccme0gainm vid City AIRHANDLING UNIT(TO 10,00t
in sort u<nc s Ne eontin6 of x
11 AIR HANDLING UNIT IOVFtt IO.IXp CFM)
ignaL0 plCHA7,
'Arm a Dara EXHAUST HOOD(W/DUCT) PAID
RDOUS MATE IA DISCLOSURE HEATING UNTT OTO 100.000 BTU7 Date Raelpt0
will the fuwrebuilding 'cu mtsme.,handle h.dous contend HEATINGUNITIOVERIW.O0OBTU1 TOTAL
as ddinmed by ohe no Municipal C Pott 9.12,and the Health and Safety
Cade.Section 25532tq? VENTILATION FAN(SINGLE RESID)
❑Yea ❑ No
ISSUANCE DATE
Will tJ fupplicvnorfuurebuilding mcupantune uipnentmdeviceswhichemir BOILER-COMP(3HP OR 100.000 BTU)
baeardous- contaminant,as defined by the Bay Arta Air Quality MmagememP A I D
BOILER-COMP(OVER IW,00OBTU)
District?
❑Yn ❑No NEW RFSIDENTIALMECH. SQ.FT. JIINI 1D ,r
1 have read'he ha.ardoun materials requirements under Chapter 6.95 of the IJJ 4 i99 S
Gliln us Health&Salmy Cute.Sections:3505,25533 md'3534. I undenund Nut
ifdo:building dues not currently have a tenant.that it is my respon,%toity to notify the CITY Ur wrolI
cupem of he rt4uimmems which mow Fu met Ado,10 isumce of a Certificate of
Occupancy.
Ownermamhorited,ent Due TOTAL: ISSUED BY: �
-0-F PC
Ai PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• BU LDI NG PROJECT 1 DENTI FICATI ON PERM T N
RVILOiND yva o ooms - 73 APPLICATION & PERMIT 499
,0204 y
20900 Marianni BUILDING - ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME CITY. ELECTRIC PERMIT FEE
Berg & Berg PHONE 725-0700
NAVE croRs OUTLETS-SWITCHES-RECEP 5.00/1.00
NAME
Ervin Engineeringc.,G. 150751 LIGHTING FIXTURES 5.00/1.00
CONTRACTOR'S Santa Clara, CA APPLIANCES-RESIDENTIAL 4.00
ADDRESS
3271 Kifer Rd. eHONE732-2192 PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO,
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENO. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
zip TEMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 10.00
oo LICENSED CONTRACTORS DECLARATION FAID /% L
W. I heechy uttino that I um licensed under Provisions of Chapter 9 ISSUANCE DATE
w < $ (commencing with Section 7000)of Division 3 it the Business and I 7L�G, T_ PLG. MECH.
r o Z Professions Code nd yylicense is in full force 9rµI y{Ce� "111,"��NN•911��
Licensy('I .sSy���1yl�q-Lic.Number.0151_L�_1
o Z F o ])are��L�.JS2G_Cont rador_VV_11 LL13
Q E
It Ic w sr OWNER-BUILDER DECLARATION Of Cupp GING PERMIT
w 3 u- 1 hereby oil that I am exempt from the Contractor's License MISC.-
REFER TO ORD IORMATION
following PERMIT ISSUANCE vALunrloN s/FT.
F LL O j Law for city
orc reason. Professions 6.00
Cope:Any city nr county which requirespermit to construct,ulna,
rt ¢o im Flruve,demolish,or repair any structuree,prior to its issuauance,also ELEC.CONTE. LIC.NO. ELEO 2 698.80
O I[ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w$" be is licensed pursuant to the provisions ol'the Contractor's License
HZi
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
2 Business and Professions Code)or that he is exempt therefrom and QTY, PLUMBING PERMIT FEE Fire S rinklerS
¢ o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ;m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 4.00
of not more than five hundred dollar,(SSBtO:
❑ I,as than
of the property,or my employee's with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure Is not
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code.The Contractor's License Law does not apply loam owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 4,00 SO,IT,FLOOR AREA TOTAL ACREAGE
himself re through his own employees,forts provided that such improve-
memsarrthrouOut ghhis or offered ees,provided
that suhebuildirig Roc- GAS-EA.SYSTEM-1INC.40UTLETS 4,00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.( 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 RES IND CON PB ower
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed emamclors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or inhproves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a conaucmAs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/8.00 TRACT N0, PARCEL NO.
the Contractor's License Law.
❑ I am exempt under Sc,.-,B&PC.Iln this WATER HEATER W/VENT 4.00
reason
Dare Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKERS'CO.MPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby uttirm Ihul I have a cert ificute of consent(11 sell ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a cerlitied
copy tiler- 3g .C.
N�Y2- . y 0096 Araonau
O ❑ Ce,ific a hyi,herelly'fumishcd. FIRESPRINK ENERGY-24
Z 2 %I�(Certih opY is ill / ins ec un division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
O Appli"o, s v N v N
W 'r ICATIi OF-IiSE.M I'1'ION s bl N'ORRERS, PERMIT ISSUANCE 6.00 FLooD ZONE A.L.U.C.
LU > COMPF-NSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
1 0 IThis action need not be completed if the pennit is tin one TOTAL Y❑ N❑ Y❑ N❑
Z) Z hundred dollars IS 100)or less.)
U O 1 certify that in the pertormance of the work or which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P ..sit is issued,1 shall not employ any Person in any manner us as In
U become subject to Ore Workers'Compensation Laws of California.
O i Dat APPEcart ALTER OR ADD TO MECH. 4.00 BUILDING 38.50
} N NOTICE TO APPLICANT: IL after making this Certificate of Ex-
F_ ? emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, You must fortheolh cotmPly with FEE 2rj Q3
U such provisions or this permit shall be decnhed revoked. AIR HANDLING UNIT(TO 10,OMC.F.M.) 3.00
CONS'I'RUCI ION LENDING AGENCY AIRHANDLING UNIT(OVER 10A00C.EM.) 5.00 SEISMIC FEE
I hereby affirm that there is a corotruction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097'CI".C.). None HEATING UNIT(TO 100,000 B.T.U.) 4,00
Lender's Name
Lender's Add HEATI NG UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
ress
I certify that l havereud tdsappllcauon and state ural lire above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and county' PLUMBING
ordinances and state lows relating to budding convnmtion, and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city P enter upon the BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indcmmify'and keep harmless IIIc City of MISC.- REFER TO ORD.
Cupertino again I liabilities,judgments, is and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way acco a against said - in consequence of the
grmIWI thif permit. MECH,CONT. LIC.NO. T-MECH
ETAL
23/aTOTAL $63.53
Si a r nlp,lieanl Contr e o Dalc
James W. McGreuXor,liVice President OFFICE COPY
APPLICANT TO FILL IN INFORMATION.WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO PLUMBING-MECHANICAL - PERMITNO,
BUILDING DIVISION ' APPLICATIONTERMIT'
24991MOJECTID
'.:`ti`A.i?i!i.e BUILDING EMDlCAT1ON;?L I/f17 s p
BUILDING ADDRESS: SANITARY NO. APPLICATIONSUBMHTALDA
mike MAMAgo ML-ir> UNIT# LOT#AOL
WNERS NAME: PHONE: A OR'S NAME: LIC NO:
V 'I. N/C CONTROL#
s R HT'IECT/FINGINEER: LIC NO: A FSS: 1 ��
VV in I)CION Ir RG a
oNT�A,C.Jr��.r. P0.DNpE,E,� qn-- ,,,•u'+•••:r+, ' - +. MITI,+:I y.;;;• ..+--:,,^(.•, s. BUILDING PERMIT.EVFOau,`..i^., ,L�
,ze'ELECIRIC PERMIT',`-
QTY- ... .> ,j .,,•FEE
w LDG F.BPLUMB MECH
PERMIT ISSUANCE /' El ED
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JDES
_yz I hercM1y'•Jli nmhalTann icemeA unJer moviaions of Chapter9 lcommencio,.uh / a \ u` ` R
::-..0 Scctiou700(uot Division Sot the Business and l'romanew Cude.and my license is in PANELS La IiI{�rl w7 a.r
Lrcem0-(TILL p I P
arcih
ictu
FZW fullforce
Class Lic.q UPTO 20O AbIPS
y6y Dat, Cmnmctm 201-I000 AMPS
Aft-
I-n% ARCHITECTS DECLARATION OVER 1000 AMPS SQ.FT.FLOOR $/SQ.ET.
�..rn_ lundersun0 my plans shall be used upublic records.
F� SIGNS ELECTRICAL
svxQ LicensOJ Hotcsxiowl OWNER BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
KOacV. 1 hereby affirm that sum sexempt from the Contractor's License Law for the
m 3 u to following reason.(Section 7031.5.Business and Pmfessiov Cade:Any city or county TEMP.METER OR POLE INST.
1-- 2¢ which nes, es a permit to constrvcL alta,improve,demolish.or onpav any—to-
<wi}, prim to is issuance.also millions the applicant or such permit to File a signed stmerent MOWER DEVICES
i X r o that he is licensed pursuant to the provisions of the Contractors License Law(Clopar SWIMMING POOL ELECTRIC
9(commencing with Section)000)of Division 3 of the Business and Professions Code) VALUATIp�I A
w=N m that he is exempt throduom and the Dosis for the illcgW mompdOn.Any violation 0f OUTLETS-SWITCHES-FIXTURES
F Z Q Sation)031.3 by mY apPlicam for a pemmiuubjecu Ne applicmuoii em1 penalty of
o more Wan five hundred dollars]SSW). NEWRESIDENTIALELEM _SQ.FT.
sHp ❑ ateworrk,f tpso tumisnotin=d oroffe ges as Je(s .7Ompemadon. STORIES TYNE CONSTRUCTIC
r'3°= will doffewmk.aMthe he Contractor's
Law t ,tion. Iy 1.so..in
.
and Professions Cade:The Cont emon, nd.h.Law does not apply tom owner of
..employ .provifimproves Nceonmdwhodo onimendedasuchwonk rtaelfm lbrough hies OCC.GROUP RFS.UNITS
cmr,the bs,providnd grave improvemenuartrotquirofdroOffcrtdfmak.H.
however,the have
the
bur improvement is sold within one yearor improve for purpose
o-
builderwill have the burden of proving Na he did wt build or improve for puryou of -�*,� _
Ie). QTY.'£'� is:' cti."s�az.n,. Clta9 i^ep'yex
❑ I,as owrerofthe propenY•am exclusively contracting wit lionsNconmetonm -#sK l-n.�_ rPL.UMBINGPERIvfffJl l' a FEE FLOOD ZONE APN
construct the project(Sec.7044,Business it Professions Cock)The Contractors PERMIT ISSUANCE
License Law daces not apply m an ownerof property who bur'lds rr improves theeon,and
Whoconoacufmsuchprojauwith aeonrmoss)licensed pursoun to the Comnerora
License
Law. ALTER-DRA &VENT-WATER(EA) s'''p+ e_aaT..2'. 'y FEE SUMMARYrjj ,gp.-cti
❑ 1 am exempt under See .B&P C fie Nis reason BACK FLOW PROTECT.DEVICE S
SANITARY Y-N
—
Owner Da¢ DRAINS-FLOOR,ROOF,AREA,COND. RECEIPT'#
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ Thereby affirm that]haveacenificue ofconuntmsel(-imam.ora anificare of FIX'IVRFS- TRAP RECEIPT'#
N
.,Vorken'Compensation lmurano macmified ropy theuof(Sa.38W.lab C.)which PARK FEE #
v rsvil emPloYe25 under Nia permitEASY "' E?A� 7 ION FEES
Policy p
Co y GAS-EA SYSTEM IAd1EAI
Cnified copy is hereby famished.
he '
C] Ceertified copy is filed with
the city inspection division. GREASFJINDUSTRL NTE INTERCEPTOR t ,
CERTIFICATE OF EXEMPTION FROM WORKERS GREASE TRAf /Q2 SOUS
COMPENSATION INSURANCE
(Thissatimnee mtm mmpletedif Nopamilisfmo hmd dollana(5100) SEWER-S Y-STORM FA.]WFT. GY E
or less.)
I certify that in the performance of the work for which this Perot is issued,I shut] WATER HEATER W/VENTIELECfR
not employ any person in any manner so as in become subject to the WorkersPAID
Z Compensatiou L.wsaf Califomu. Dare WATER SYSTEMAKEATING Dam Receipt
Appliecm
0Q NOTICE TO APPLICANT:If.after making this Cenificate of Exemption.you should NEW RESIDENTIAL FILMS. SQ.IT. TOTAL:
F ` become subject to the Worker's Compensation Provisions of the Isbor Cade,you mor
forthwith comply with such provisions or this permit moll be domed revoked. BUILDING FEE
1 Q CONSTRUCTIONLENDINGAGENCY SEISMIC FEE Is L
O
Z Ihereby off Nat them is a constriction lending agem,for the performanceof TOTAL ELECTRLC FEE
O
U the work for which NPermit is Peit is issued(SIL.3097.Co.C.)
Lender's Name yn vsntwsrdvtvrus#A:�rx.'+sa ;y'}+' s'ii{r-res?}sly. PLUMBING FEE
LenderSA ,18 MECFIAMCAI:PERMRr; kd4PEE•11""
O U 1 certify dor I love read Nis app]icimen and sus dust the above information is ""ILD "3fi •ru x..s ^'" 4aru"--+ht MECHANICAL FEE
correct.lugme mcomply with all city and county oNinmces and sate lawn mlatingm PERMITISSUANCE
building conxtroction.mdhereby authOriu repounudvesofNiscirymcnrr upon tM CONSTRUCTION TAX
U Z above-r tumoral property for inspection pury0sn. ALTER OR ADD TO MECH.
/(W e)agree o save,indemnify and k barmlraa the City of Cupertino agaimt
lia�j'Iitics.jud nu,cosumd ex ma yinmywayaccme0gainm vid City AIRHANDLING UNIT(TO 10,00t
in sort u<nc s Ne eontin6 of x
11 AIR HANDLING UNIT IOVFtt IO.IXp CFM)
ignaL0 plCHA7,
'Arm a Dara EXHAUST HOOD(W/DUCT) PAID
RDOUS MATE IA DISCLOSURE HEATING UNTT OTO 100.000 BTU7 Date Raelpt0
will the fuwrebuilding 'cu mtsme.,handle h.dous contend HEATINGUNITIOVERIW.O0OBTU1 TOTAL
as ddinmed by ohe no Municipal C Pott 9.12,and the Health and Safety
Cade.Section 25532tq? VENTILATION FAN(SINGLE RESID)
❑Yea ❑ No
ISSUANCE DATE
Will tJ fupplicvnorfuurebuilding mcupantune uipnentmdeviceswhichemir BOILER-COMP(3HP OR 100.000 BTU)
baeardous- contaminant,as defined by the Bay Arta Air Quality MmagememP A I D
BOILER-COMP(OVER IW,00OBTU)
District?
❑Yn ❑No NEW RFSIDENTIALMECH. SQ.FT. JIINI 1D ,r
1 have read'he ha.ardoun materials requirements under Chapter 6.95 of the IJJ 4 i99 S
Gliln us Health&Salmy Cute.Sections:3505,25533 md'3534. I undenund Nut
ifdo:building dues not currently have a tenant.that it is my respon,%toity to notify the CITY Ur wrolI
cupem of he rt4uimmems which mow Fu met Ado,10 isumce of a Certificate of
Occupancy.
Ownermamhorited,ent Due TOTAL: ISSUED BY: �
-0-F PC
Ai PLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
• BU LDI NG PROJECT 1 DENTI FICATI ON PERM T N
RVILOiND yva o ooms - 73 APPLICATION & PERMIT 499
,0204 y
20900 Marianni BUILDING - ELECTRICAL-PLUMBING -MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME CITY. ELECTRIC PERMIT FEE
Berg & Berg PHONE 725-0700
NAVE croRs OUTLETS-SWITCHES-RECEP 5.00/1.00
NAME
Ervin Engineeringc.,G. 150751 LIGHTING FIXTURES 5.00/1.00
CONTRACTOR'S Santa Clara, CA APPLIANCES-RESIDENTIAL 4.00
ADDRESS
3271 Kifer Rd. eHONE732-2192 PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO,
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENO. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION
ADDRESS
zip TEMP.METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 10.00
oo LICENSED CONTRACTORS DECLARATION FAID /% L
W. I heechy uttino that I um licensed under Provisions of Chapter 9 ISSUANCE DATE
w < $ (commencing with Section 7000)of Division 3 it the Business and I 7L�G, T_ PLG. MECH.
r o Z Professions Code nd yylicense is in full force 9rµI y{Ce� "111,"��NN•911��
Licensy('I .sSy���1yl�q-Lic.Number.0151_L�_1
o Z F o ])are��L�.JS2G_Cont rador_VV_11 LL13
Q E
It Ic w sr OWNER-BUILDER DECLARATION Of Cupp GING PERMIT
w 3 u- 1 hereby oil that I am exempt from the Contractor's License MISC.-
REFER TO ORD IORMATION
following PERMIT ISSUANCE vALunrloN s/FT.
F LL O j Law for city
orc reason. Professions 6.00
Cope:Any city nr county which requirespermit to construct,ulna,
rt ¢o im Flruve,demolish,or repair any structuree,prior to its issuauance,also ELEC.CONTE. LIC.NO. ELEO 2 698.80
O I[ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
w$" be is licensed pursuant to the provisions ol'the Contractor's License
HZi
Law(Chapter 9(commencing with Section 7000)of Division 3 of the
2 Business and Professions Code)or that he is exempt therefrom and QTY, PLUMBING PERMIT FEE Fire S rinklerS
¢ o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a ;m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 4.00
of not more than five hundred dollar,(SSBtO:
❑ I,as than
of the property,or my employee's with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure Is not
intended or offered for sale (Sec. 7044. Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code.The Contractor's License Law does not apply loam owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 4,00 SO,IT,FLOOR AREA TOTAL ACREAGE
himself re through his own employees,forts provided that such improve-
memsarrthrouOut ghhis or offered ees,provided
that suhebuildirig Roc- GAS-EA.SYSTEM-1INC.40UTLETS 4,00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.( 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 RES IND CON PB ower
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed emamclors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs not apply
to an owner of property who builds or inhproves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a conaucmAs)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/8.00 TRACT N0, PARCEL NO.
the Contractor's License Law.
❑ I am exempt under Sc,.-,B&PC.Iln this WATER HEATER W/VENT 4.00
reason
Dare Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKERS'CO.MPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby uttirm Ihul I have a cert ificute of consent(11 sell ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a cerlitied
copy tiler- 3g .C.
N�Y2- . y 0096 Araonau
O ❑ Ce,ific a hyi,herelly'fumishcd. FIRESPRINK ENERGY-24
Z 2 %I�(Certih opY is ill / ins ec un division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
O Appli"o, s v N v N
W 'r ICATIi OF-IiSE.M I'1'ION s bl N'ORRERS, PERMIT ISSUANCE 6.00 FLooD ZONE A.L.U.C.
LU > COMPF-NSATION INSURANCE PLG.CONTE. LIC.NO. PLG.
1 0 IThis action need not be completed if the pennit is tin one TOTAL Y❑ N❑ Y❑ N❑
Z) Z hundred dollars IS 100)or less.)
U O 1 certify that in the pertormance of the work or which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL P ..sit is issued,1 shall not employ any Person in any manner us as In
U become subject to Ore Workers'Compensation Laws of California.
O i Dat APPEcart ALTER OR ADD TO MECH. 4.00 BUILDING 38.50
} N NOTICE TO APPLICANT: IL after making this Certificate of Ex-
F_ ? emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, You must fortheolh cotmPly with FEE 2rj Q3
U such provisions or this permit shall be decnhed revoked. AIR HANDLING UNIT(TO 10,OMC.F.M.) 3.00
CONS'I'RUCI ION LENDING AGENCY AIRHANDLING UNIT(OVER 10A00C.EM.) 5.00 SEISMIC FEE
I hereby affirm that there is a corotruction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097'CI".C.). None HEATING UNIT(TO 100,000 B.T.U.) 4,00
Lender's Name
Lender's Add HEATI NG UNIT(OVER 100,000 B.T.U.)7.50 ELECTRIC
ress
I certify that l havereud tdsappllcauon and state ural lire above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and county' PLUMBING
ordinances and state lows relating to budding convnmtion, and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city P enter upon the BOI LER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indcmmify'and keep harmless IIIc City of MISC.- REFER TO ORD.
Cupertino again I liabilities,judgments, is and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way acco a against said - in consequence of the
grmIWI thif permit. MECH,CONT. LIC.NO. T-MECH
ETAL
23/aTOTAL $63.53
Si a r nlp,lieanl Contr e o Dalc
James W. McGreuXor,liVice President OFFICE COPY