Loading...
22183APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY Building Protect Identification Building Addraas: _�os3 ��l.�L �;ti�� Ll � ~►Na PERMITNO. 2218 wners NIEntes: one: LE m EtaN CITY OF CUPERTINO-BUILDING DIVISION APPLICATION / PERMIT BUILDING-ELECTRICALPLUMBING-MECHANICAL J— L Cnnd(Jy]dq irrm; Lie. N.: CATEGORY CONTROL I"'�),3(01;> Architect/Engineer. - Lie. Na QTY ELECTRICPERMIT FEE BUILD ING'PERMIT INFO 1 - `(+ Add' d S .J eepsr_a ❑ ❑ ❑ PFRMITISSUANCE LICENSED CONTRACTOR'S DECLARATION 'I hereby afflrmthat l am licensed under provlelonsofChapter 9(commene- i?gwlth Sedi.n7000)of Dlvlelan3ofthe Buslnesand ProfessionsCode,and my It... I. in full form and effect.' ya�((JJ Q LicenseClam Lle.N lOi� I Date ContnCorUP ARCHITECTS DECLARATION I understand my plane shall be used M public records. Licensed Professional - OWNER -BUILDER DECLARATION I hembysonafRrenthat I sexempt from the CDAmotor's Limnos Law for the following mons. (Section 7031S, Business and Profession, Code: Any city or e. untywhlchrequiresapemdttommt Malter,impmve,demlbh,orrepalr anysumcWro prbrto ltsbsusnce, alsorequlresthe applimetfor ouch permit to file a signed statement that he b licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(mmmencing with Section 7000) of Divi- don3 ofthe Bukrassand Pmfenlma Code) orthat he is exempt therefromand the basis for the alleged exemption. Any violation of Section 70315 by any applicant for a permit subjects the applicant to a civil peralty of net mamthan five hundred dollars($SM. - ❑ I, A. owner of the property, or my employees with wages u their sole compensation, will do the work and the structure he not intended or offered for axle (Sec. 7061, Boston. and Placed.. Code: The C.Mmewes Llcerue Law does not apply to an owner of property who builds or improves thereon,and who doessuch work himelforthrough his own employees, provided that such improvements are not intended oroffered for As. It however, thebulldleg or Improvement Insold within oneyearofcomplsiorytKeowneabuRderwill have tliq�urdcn of proving that he did nor build or Improve for purpose of ale.). u L a. owner of the property, am exclusively =trading with licensed contractors to mrahud the project (Sea 7011, Busas lneand Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improve thereon, and who mntrsds for such ploje U with s coyVador(s)licensed pursuant to the Contncine. License Law. w lLJ11 am exempt under Sec. B k P C for this rean APPLIANCES -RESIDENTIAL PANELS TO 200 AbTS JOB DESCRIPITON, 201-1000 AMPS OVER 1000 AMPS - e.4. Ff. FLOOR AREA S/SQ. FT. " SIGNSELECTRICAL SPECIALCI6CIRT/MISC - TEP METER ORPOLE INST. POWER DEVICES I ' SWIMMING POOLELECTRIC OUTLETSSWITCHESFlrTURES ys��TVALUATION NEW RESIDENTIAL ELECTR SQFT. STORIES ' TYPE CONSTRUCTION TOTAL: QTY, PLUMBING PERMIT FEE OCC.GROUP RES. UNITS FLOODTDNE APN PERMIT ISSUANCE ALTER -DRAIN kVFM • WATER (EA) FEE SUMMARY BACKPLOWI'ROTECT. DEVICE DRAINS FLOOR ROOF, ARG, COND. SANITARY Y N RECEIPT N Owner Date WORKMAN COMPENSATION DECLARATION I hereby affirm ve that I haa artifiate of consent to self-Insure,FIXIlRtFS [:]IPER or . art,lAbC W.rkemi CampenuHan lmuurana ora arti(kd copytharco(Cic. Lab CJ - ' Policy policy N TRAP SQTOOL TAX Y_ N_ RECEIPT GAS G. SYSTEM -1 INCAOUILET5 PARK FEE Y N_ RECEIPT N " GAS EA. SYSTEM -OVER 1(G) amy BUILDING DIVISION FEES "Mpertfied ropy b herebyth the city Certified mpyb Wed with the blty Inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' _ COMPENSATION INSURANCE (fhb section need not .c*bebe m completed lithe permit lefts ossa hundred dollars ($100)or lea.) I artlfy that In the performance afthewak forwhich this pemdt is blued, I shall not employ any person In any manner so u to become subject to the Workami Compensation Iaws.f Gltfamb. Data ApplicaNOTICE NOTICE TO APPLICANT: If, after making this Certificate ate of Exemption, you should become subject to the Workers''CampemaHon provisions of the Labor Code, you =at forthwith comply with such provisions or this permit shall be deemed rev.ked. -BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lendlegagency for the perform, Ince of tho work for which this permit Issued ued (Sec.3097, Civ. C.) Le.der's Name - Len omilytdreaa Information Inst. Iagrectochatl hove mad mplywapplat andcounnand ty ordinances IsmrroRlaglcetocomplywithall ndhereyAuthoordinancnandwtelaws relatingtobuilding econstruction, andhereby ori pectionUtiva ofthis city(We) to agree to saw, indemnify ind propertyharm) ss thecC t purpose. the City of Cu pecan. (We) agree to ave, Indemnify and keep es which ,gains liabilities, In co etacstsand expense which may In any way accrue agalnets Ily ince sequence .(tics granting oj„[hlepermlt., •- 'Z GREASE/INDUSIRI. WASTE INTERCEPTOR PLANCHECK FEE PAID Date Re i t# GRFASETRAP sFwnR-SANITARY-STORM EA. 200Ff. WATET'HFATFRW/VENT/EF.CT'R - ENERGY FEE Y N PAID Date Recel t# WATER SYSIFAf/TREATING RESIDENTIAL PLMB. SUFT. TOTAL: a SEISMIC FEE L TOTAL: ELECTRIC FEE QTY. MECHANICAL PERMIT -FEE PLUMBING FEE MECHANICAL FEE - - PERMIT ISSUANCE FEES PAID: ALTER OR ADDTO MECH. ALR ]iANDLINC UNIT UO 101000 CFM) Date Recei o t# SUBTOTAL: AIR HANDLING UNIT (OVER I0,000GFM) CONSTRUCTTON TAX cure. AppR t/C.ntrsd.r .. .Date HAZARDOUS MATERIALS DISCLOSURE ' L WIIl the a pplimet orfutum building occupant store or handle hazardous ilterlal as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code Section 25532(a)T - ❑ Yes No Will the applicant or lure building occupant use equipment ordevias which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? q Ya No a out nateriaedt.m 25505, underChapter6.95 6.95 of havemad Health the California Health A SafetyCode, Sedlom)5505, 75537 and 25534. I understand that lfthebulldlngdoes not currently have sterent, that It b my r¢pooslblllty to notify the occupant of the roquirements which must he and prior to Lasuance of a Cedifleate of Oaapancy. E7(HAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID: HEATING UMT(TO 100,000 BTU) Date ReCBI HEATING UNIT (OVER 100,000 BTI!) TOTAL: L VENTILATION PAN (SINGLE RESID) ISSUANCE DATE r - C �&T `r2�qv x1 1991 ISSUED BY. BOILER -COMP OHPOR 7(X1,0(10 BTU) 90ILFR-IbMP(OVER l00,OL0 BTL)) NEW RESIDENTIAL MECH. SQ.FT' E Owner or eulhmieed agmt Date I TOTAL: OFFICE COPY Lois �;TO I d r� r (• ,E�'a < , IGS ' j`` LV I IT, ,.irlplcAlf.. LAL1� X tw i r . rT... I a. IT 7 APF?Rpi4�TFI L� h'I • ACCORDANCE WITH THE C 7 �'.'. PERTlND; C015Es AND,... TTY 06 L_ L� �� iAAI �i� __.. . pA OflQINANCE,g -316A E This plans and 4 ke on the . specifications MUsit � b ul make wti at all time I ,{{ n n, Ys %11 r , ,I X �(?A =tom �`_ �•`-T �. _, wrthou — 1ha thob fr - — > 4 rasion Cr esat nng,oj Cr�paetlfi�nA �oftIOLE a royal r T. De held ¢crr be Of any Cr i 0 do f1atIN4,bf any pro si a2 eor� Law, CI�o�SYA E(�rJATA a - - - _ y�IGvU ��I n z.5c1. PLOT PLAN49 - � I?0 DULAKL,l1 i' �� ° e�� . Sar / ' • . , , III f�Kl F. MA��6' a - I PT . A DO. INSPECTION D iINA,�i ���col GIR Of— �= L'.) �. '' ;; � ,;:.; 134 - ., .'. �• �� �> ,.-' � _ �, ,,- �';.� F 1. ll�� `, ;t� � • �` ` �' �L� STS �: i r^..5� l �--- -----� �� 54. _ SIA-�-t � r•l u M .. ' �, • . >< p FOOT, lIA � ce► / I r i q 5::...�a�sYA 11 4 !] 1 a � Y .3- 5 011 tI &r. �X(o- PogTs- .......... � wig • r Lo7- l - loS$S M/I 9p, % LOT LUT 9- I D 537 M 1 LLEK�. • _ q�,gma.s ll�xl� xP�Ro� I`P LoT l - loSF3S M/Ls-e P. LOT \ L.OT `�- — I O 537 M 3 - 5�' "L, n Cr.S 6 X ip . Po STS .........._. P, Wil