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31344APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING - ELECTRICAL. PERMIT NO. 4-4 /I BUILDING DIVISION APPLICATION/PIdRMIT 1'LUMBINC-M111:CHANICAL LF L� OFFICE G It22e" OWNER'S NAME: PHONE: CONTRACTOR'S NAME: LIC NO: N/C�� _\ ❑ II��CONTRO^L# UEE ARCHITECNGINEER: LIC NO: ADDRESS: 4k0 i4n•1 CR- M✓7C CONTACT. PHONE: BUILDING PERMIT INFO '� 1 A _ — _ �L �Z ❑ Consultant Fees Paid by Applicant (Initial) }a( } V+oav BLVD ELECT PLUMB MECH '(W ❑ ❑ ❑ OCZ �� y.m— QVU Q F D m Z -Z LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Secran mXNp nrDivision3nfine easiness and lkofeadons cmde.aw my license i. PIiRMI'T ISSUANCIi in lull force and cffed. License Class Liv. APPLIANCES - RESIDENTIAL Dam Contractor JOB DESCRIPTION RESIDENTIAL: ❑$FOWL ❑KI'T'CHEN RIiMOUIiL -(]ADDITION [IPLUMBING R,PIPE ❑MULTI -UNIT []STRUCTURAL MODIFICATION ARCHITECTS DECLAHAI'[ON PANELS 1 understand my plana shall be used as public records CZ -0 a�f-J �Ya-J W Q X 3 d F- UPT02WAMPS []INTERIOR LI CHIMNEY REPAIR IMPROVEMENT ❑ BATH REMODELTEPAIR El DEMOLITION ❑OTHER Limnttd Professional 201 -IOW AMPS OWNER -BUILDER DECLARATION Con, ON OVER 1000 AMPS 1 naso . (Sect that I Lou exempt from the Contractor's Any c Law for the following reason. (Section 9onstru Business and Cede: Any city county SIGNS ELECTRICAL uu77 0 y I�"LL�q y} improve, demob structure which "Latest n peanut to core,o me alter, i t for su. demolish, or a sig any statement me of for mchpe.miuoievou, Law prior mits cense pursuant (Catement SPECIALGIRGDITMI$D. that he is licensed pursunnnothe provisions rel the Contractor's f.icense Law fChapter9 COMMERCIAL: ❑ NEW BLDG/AUDITION ❑ DEMOLITION ���0� e.6 c �' (cwmunencing with Section 70o))of Di vision 3 of the nosiness and Pmession Code) or 'TE MR MUTER OR 1101.1? INST'. that he is exempt therefrom and the basis for the alleged mce nption. Any violation of _ m �Q f 0 Scetion 703 1.5 by any applicant for a permit subjects the applicant m a civil penalty of POWER DEVICES out more than five hundred dollars 0300). C] 1. as ow. net property, or my anployccs with wages as thdru)Icp)mp.)sauun, SWIMMING POOL. I.LF,CTRIC is for We 9B1J, Business sc ❑TF,PROVNANT ❑FOODSERVICE IMPROVEMENT El OTHER Le3 $ will doth,work.and the ctmctum u.1mendcdmmfired (Set. and Professions Code: The Contractors License Law docs not apply to an owner of OUTLETS - S W ITCHES - FIXTURES property who builds or improves thereon, and who does such work himself or through his own mn,loycc , pnmided that such Inlpnrvemcros are not Intended m offered for NEW RESIDENTIAL ELECTR SQ FT. sale. Ifhowever, the huilJing or improvement is sold within one Year or completion,the tuner -builder will have the burden of proving than he did not build or improve far par- l SQ. IT. FLOOR AREA P A 6 D s/SQ, T. pave of sale J. 1, as owner of the property, am exclusively contracting with licensed contractors to TOTAL: strud the project (Sec. Business and Prafestions Coal, The -...tractor's mLi-cense MAR 1 [n��Cn re Law does not apply an owner of property who builds or improves thereon. and QTY, PLUMBING PERMIT FEE ISG.Ua who contracts for such projects with a Contractors) Invnud inm mm 10 the Contractors License Law. PERMIT ISSUANCE E]I am exempt matter Set. ,B& P C for this mason CITY UrNU IN ALTER -DRAIN & VENT -WATER (EA) Owner Date VALUATION WORKER'S COMPENSATION DECLARATION BACK FLOW YROTCCf. DEVICE 1 Hereby affirm under penalty relperjury one of the following Worker's Co forte Worker's Compere- DRAINS - FLOOR, ROOF, AREA, CONK cation. a> provided for by Section 3000 of the Labor Cute, for the performance of the ❑rm, as and maintain eCeni37M of GmLbor Craft STORIES '1'VI'Ii CONSTRUCTION wank for which this is ism. FIXTVRFS- PER'TRAP ainti h required by Section 1 have and will maintain Workers Compensation Insurance,work 391X1 of the Luh) Code, fiat the performance of the work for which thispennit is issued. GAS - F.A.SYSTEM-I INC. YOUTLET which OCC GROUP APN My Workers Compensation Insurance varier and Policy mummer ore: Cartier: Policy No.: GAS - FA. SYSTEM -OVER 4(E CERTIFICATE OF EXEMPTION FROM WORKERS' GRIiASFJINDUSTRL WASTR COMPENSATION INSURANCE BUILDING DIVISION IT (This section need not be completed if the permit is for one hundred dollars is 100) GHIiASETRAP or Ices.) PLANCHECK FEE Icenifythatinde perforrunceofthe work forwhich this pemtitis issued.I shall SEWER- SANITARY - STORM FT. not employ any person in any manner so as to became subject m) the Workers' Compen- EHG E . 6 1— QZ 0 a ,r, a� Z V QIhereby D" H V >>I Fr Nrr V Z salion laws of California. Date GRADING FEE WA1'ERHEATIeRWNEN'1'/IiLECT Applicant NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should WATER SYSTEM/IREATINC become subject ladWorker's Compensation provision of the Lmhor Cade, you must fonhwith comply with. such provisions or this pemtit shall be deemed mvood. WATER SERVICE CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PCMB. SQ. FL affirm that there is a construction lending agency for the performance of the weak for which this panni( is icsuul (Sec. 3099. Cie C) Lcmh,es Num. SOILS FEE PAID Date TOTAL: Lenders AJdtess TOTAL: BUILDIN certify that 1 have real this applicaion and state that Ne above information is correct. I agree to comply with all city and county onfinances and state laws relating m QTY. Mr:CHANICAL PERMIT FEC bulldingconsunction. and hereby authorize representatives ofthiscity to enterupon the ahrve-mentioned properly far inspection purposes. PERMIT ISSUANCE ( We) agree to save, indemnify and keep harness the City of Cupertino against SEISMICFEE ELECTRIC Plili PLUMBING FEE liabilities, judgments, costs and expenses which may in any way accrue against said City AI.TF.RORADDTOMECH. in nsequcnce of the granting of this permit. MECHANICAL FEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT AIR HANDLING UNIT (TO W." CFM) SOURCE REGULATIONS. CONSTRUCDONTAX AIR HANDLING UNIT (OVER 10.0(0 CFM) Signature of Applican,Conoactor - Dole EX HA UST HOLD(W/DUCO HA]ARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION PEE Will the applicant or future building occupmn store or handle hazardous material HEATING UNIT (TO 100,1000 BTU) us defined by the Cupenim Municipal Code. Chapter 9.12, and the Heeltb and Stn cry Code, Scatoo 25532m)? IIuATING UNIT (OVER UX),T00 BTU) C] Yes []No VENUH ATIONFAN(SINGLERESID) Will the applicant of future building occupant use equipment or devices which r, it hazardous air eonmminunts as delineJ by the Buy Arca Air Quality Mana,ruent BOILER - COMP (3HP OR 100.000 ITT U) PAID Duro Receipt# TOTAL: Oisvin? ❑Ya ❑No BOILER -COMP (OVER 100.010 BTU) I have read the hazardous maerluls requlrcmvnts under Chapter 6,95 of the Cull. AIR CONDITIONER ISSUANCE DATE tomia Heahh & Safety Code, Sections 25505, 850 and 25534. 1 undemamd that if the NEW RESMEN'1'IAL MECH. SQ. FT. building does nm cvrremly have a tenant. Nat it is my ni passibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy.//� ISSUED BY �L Owner r authorized agent Date TOTAL: OFFICE ITY OF CUPERTINC BUILDING DEPARTMENT S Certificate ®f Occupancy No. ____5.74 -------- THIS - 574 -------- THIS IS TO CERTIFY that the (description of building or structure). --------------------------------------------------------- M 3LAKI--OFk19k--b-tIIJJPIN .................................................. SHELL ONLY --------------- ---------------- --- ------- ----- ------------ -------------------------------------------------------------..............----------- --------------------------------------------••--•--•---•-------------•--- --------------•---....-----..-..........----------------------------- Erected on Lot No. ----------- --•-•----- -------------Block No. ------------------....--....................--.....----- Addition-------------------------------------------------------- Fire Zone ........... 3........................................... Street No.----- 20525-Marian-.-Ave----------------------,Occ. Group ..... A.....--..........-------•---•------.----- - ? Owner--......... ----------------.Use Zone ........................................................ Hawley &Peterson 3000 El Camino Real-- Palo --Alto-,- Calif------- .............................. Architect - Contra ctor--- ......................... Building Permit No. ------?762---------------------- -----Plan No.. 79-4 has been inspected and the following occupancy thereof is hereby authorized. OCCUPANCIES Max. Allowable Floor Loads per sq. ft. Basement------------------------------------------------------------------ -------------------------------------------------------------- ----------------------------------------------------------------------------------- --......-....-...................---------------------...-... Slab on rade L L. st floor .---•--.................:............................. -------------------------------------------------------------------------------------------------- •----- .----------------------- ..------------- 2ndfloor -----------............. ------------------------------------------- ----- 8ok------------=--- L.. ..-L ---------------------------------------------------------------------------------- -------------------------------------•---------------•------- 3rdfloor ................................................ -------•----------------- SoN---------------- L -..L ------------------------------ -----------------------•------.--------------------------------------------------- --------•-----••-•-------....-------------------------------- 4thfloor---------------------------------•-------•-------.-----•------------- ----------------------------•---•------•--------------------- ---------------------••-•-----•-•--------------=------------...---------------------....................................----------------........ Add floors as necessary ------------------------------------------- -------------------------------------- -...................... -------------------•------------•-----------------•-------------------------------------------------------- --------------------------- Roof..:..................................................• 20 . .................................................... --------------------------------------------------------------------•--• •----------i ............................................................. City of CUPERTINO .---------- - gig -------------......I 19-p�-- 6G.r� •--- Chief Building Inspector :his certificate must be posted and permanently maintained in a conspicuous place at or close to the entrance of the building or structure referred to above. 'ITY OF CUPERTINC BUILDING DEPARTMENT 16 Certificate ®f Occupancy NO. 574 .... THIS IS TO CERTIFY that the (description of building or structure). ---------------------------------------------------------- MARIMI-QUIa-B-Iau N -----•-•-----•--------------------------•---------- -----------••------------------------------- ------------- ------- SHELL ONLY ...... -------------------------------------------------------------------------------- Erectedon Lot No. ......... --------------- ------------------ ----------------------------------------------------------- Block No. ........................................................ = Addition......................................................... Fire Zone ........... 3 ........................................... Streef No.20525 Mariani Ave.-•-------------------Occ. Group !�-g ---------------------------------------- P Owner----------Marian-i..GxouR-----------------------Use Zone -------- ----------------------------------------------- Architect------Hawley & Peterson 3000 El Camino, Real-- Palo-_Alto -,_.Calif_............................. Contractor---NzcbA]San-----Sdilson.Ln.---160f1.]Io an {dye:....$§Rt&.G7ax&...CAJzf......................... Building Permit No. ------1762-- -------------------------Plan No. --.-79-.4 ------------------------------------------------ - 79 -4 ------------------------------------------------ has has been inspected and the following occupancy thereof is hereby authorized. OCCUPANCIES Max. Allowable F oor Loads per sq. ft. Basement..-•--------------------------------------------•--•-------------- ----- ........................................................ ------=-------------•-•-------------------•------------------•--------------------- st floor -----------•-----•-----•-----•------------------------------- Slab on rade L L- ••----------------------- --------------------------- --------------------------•-•----------------------------------------------------- 2ndfloor ----------- ...................... .......... ----------------------- --•---•----••------------••---------------------------------- .....8o L :L. ----------------------------------------•------------•--------------------------- 3 rd floor------•-------------------------------------------------•-----.------ -•----------------------------------------------------------- ----- BoN-................L :L- ----•-•-------------------- ---•----•---••-------•--------------------••-•-----.....------•-------------------- 4thfloor--------------------------------•---••----------------•-----•-------- -•-----------------......................................... -------------------------------------------- ...-------------- •---------------------------------------------=--------------•-----------------------•-----•----------------------------------------------- Add floors as necessary ------------ - ------------------------------- --- ----•-....................................................... .......................................... ---------..----------------------------............-----•------------------------•----............--- Roof -- 20A. L_L. ........................... City of CUPERTINO ------------------------------------------•----•------------- ----------------------------- Chief Building Inspector •his certificate must be posted and permanently maintained in a conspicuous place at or close to the entrance of the building or structure referred to above.