19824 Mrr LII,MI\f I V rill_ rel\ sl.rvnnlMl lmJ ltl vee nm na.s+ metes — vv� ua+a.r r vu.r r �.. .. �.
Building Protect Identification PERMITNQ. 9824
Build Ing Add rens: 1
1061 M I AMoNTf, (ZD
w . .me: one:
.L-69Y61Z,,krT0N 251#M CITYOPCUPERTINO-BUILDING DIVISION � � `7 �O
Cmlractor's Name: LIc.N. APPLICATION 1 PERMIT /
�Fnt, BUILDINGELECMCALI'LUMBING.MECI IAMCAL CATEGORY CO IA�
— Q' V�r ;$,,;;y,)„,'BUILDING PERMIT,INFO
Add.. M-I ITISSUANCE ,��V ❑ ❑ El
LICENSED CONTRACTOR'S DECLARATION u
IM1ertby dllrm dust lam Seemed underprovbinna olChapter9(commenc APPLIANCES-RESIDENTIAL 108 DRSCRII-110N
Ingwilh Sedlon7000)ol Dlvlsion3ollhe BuWmsand Pro(enlonsCode,and my
license Is in full force and cried. PANES
License Class Lie/ LJ (J
Date Corlrado 12PSQ2MAMPS
ARe""Tt 4DECLARATION 201-OOOAMPS
ceZ �undenUn e'0' Ism Mil be sed upubllc rcc 3 OVERI000AMIS [SQ.FT.FLOOR AREA S/SQ.FT.
Deslbti SIGNSELECTRICAL 7 74(' 7�• 7�
Licensed rossioca (7
OWNER- IL ER DhL/ARATION /
Ihercly alOrm l0FINE aempHromlhe IA RAT or'e License Law for the SPECIALCItCUIT/MISC
ZO fallowing reason.(Sectim 7031S,Business and Professions Code:Any city or TEdP,MEH➢LORPOLEINST. O 0 7
county which requires a permit tocomtroci,aber,Improve,demolish,orrepair
as anystmmmpriortults L+wane,.lsorequlmiheappllnnt(wsuchperMtto POWER DEVICES
y�
tG file a signed statement that he Is licensed pursuant to the provisions of the
Contrador's License Low(Chapter 9(commencing with Section 7000)of Divi. SWIMMING POOL ELECTRIC VALUATION -) /
BOJ doo3orlhe Bm
uslnessd ProkealmaCb ade)mthal he exempt therelromand d' i .CO
< the basis for the alleged exemption. Any violation of Section 7011S by any OUTLETSSWITCI 1139-FIXTURES
applicant fora permit sub)ecta the applicant to a dull penalty of cad more than
/IvLj1,a sr owner onhe B.
pro NEW RFDFNTIAL ELFLTR SQ.PF. STORIES TYPECONSIRLCTION
ue s owner of the pwill do the roperty,a or my employees not In wage r thele wk
CC < romp5cc.70 ,Business and kandthes Code:
rche Contractors
se Law
❑ d for
dole(Sec.apply to Business of property
Cnde:The or ImpciaJs License law — ^
Q whoddoes ossuch torn ImselolpmpntywhobemploimproovIded eoryand I ,G ^'I" RLy1JNl
whodaessnts.re khimeeldedmuttered
mgh hlsowne.If,hoes, er,thedlhatauch I' 9 IIIA
Improvementsmwtlntendneyearfcompl calm theowever,tilderwdingm TOTAL: "• ""
Improvement prb.os gthin be did rut
build
improve
furp purpose
of saill l.). \ _
Ii�R�ardenolprovingthatkdid not Wlldarlmprove fru purpose oink.). (j'y. PL�JPNBING FERINIT o-�.. � ' �—i—
I_I L.owner of the properly,am ecWslvely conlnding with Ilnnssd PERMIT ISSUANCE
contract.to construct the project(Sec 7044,Business and Proksslona Code:
The Contndor's License law don no apply to an owner of property who
Wilds or impros;thereon, and who contracts for such paojeds with a ALTER-DRAIN VENT-WATER(FA)
171
midaictor0)licensed pursuant to the Contractor's License Law. .1,1,;44"-',% FEE SUI /LR.
-AC/IT BACK FLOW PROTECT.DEVICE
am aemp Ina Sec 0 A P C for this reason SANITARY Y N
f DRAINS FLOOR,ROOF,AREA,GOND.
Owmr 4� Dat T/ RECEE'T 1
PI fAN CO f S ION DECLARATION ��LL pp(,NRES MR TRAP Sp{OOL TAX Y N
QI hartTb�yy 1111 that I hrvt a cestiflce/e o!cmssm to ulf-Inwrc,ora BBC=�
cedlflateo(Wmium,'Compemaiian lmurmee ora certified ropy thereo((Set.
3800,Lab C.) CAS)RQd-
A.SYST11NC.{OIJFLE75 PARK FEE Y N
Policy,1 CAS FA. R RECEIPT I
Cam any BUILDING DIVISION FEES
cc
copy is hereby furnished. GREASE/ W I PLANCIIECK FEE
o CertlBed copy b filed with the city Inspection division.
CREASE
CERTIFICATE OF EXEMPTION FROM WORKERS' P DPb-I^QO
COMPENSATION INSURANCE S, :R-SANIYbITM J DBIC RCcei I8 G a
(Thls sedlon need not be complded lithe permit b for one hundred dollars
(g100)mleu.) • ERGYFEE Y N
Icedlfythat lntheperfor asomofthework forwhich/hia permit Is laaued, WA TEATETW/VENT/ELECTR . —
Ishall not employ my person in my manner o u to become subjM to the WATIR SYSTEM/TREATING PAID
Wmk.re Ccmperudh n laws o(C.IIf.la.Date r'jnY�p
O Z ApplicantNEW RESIDENTIAL PLIAS. SQ.ET. Date RCceI lH D"TW
Z NOTICE TO APPLICANT-.ILaRermnaking this Cedllluteol Eaempllon,you
0 should berme subjM to the Workvn'Compenaallon pmvbkmolthel.abor TOTAL:
a N remed
rev
muel lodhwith comply with such proWalona orthb permit Mll be -Q�ILDINC a
ILj drerrr:d rooked. C
IL C CONSTRUCTION LENDING AGENCY SEISMIC PGE at
Thereby dorm that thercbacomWdlonkndingagency forlhe pedorrry TOTAL ELECTRIC FE G r
M Z ante ofthe wmkfar which this permit b heated(Sec.3(197,Civ.CJ
V O Lender'.None PLUMBING PEE
LL F Lenders Addrcas I
' '0 fadifylhatL uvereadihbappllotlonandkatethallheabovelnfortmllon MECHANICAL FEEa bcornat.l agree to comply with dl cityand county ordinances and pate lawsPERMIT ISSUANCE PEES PAID:
relating to building construction,and hereby autharUe reprcssntatives of this
Zcity to enter u pon the above-mentioned pproperty lar inapedion PUT—. ALTFRORADDTOMECH. DBIC RCCCIrTTI
(We)ague to save,Indemnl fy an d krep harmless the City of Cu pedlno
V against liabilities,Pcigmenls,cost and..per.which may lnany my... NR I IANDLING UNIT(TO 10,OW CFM) SUBTOTAL:
against said City In consequence of the granting of this permit.
AIRIANDWNC UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Signature of
ApplicDate IX—
IIAUSTIIOOD(W/DICD CONST�LU �ION(y�TAX{PAID:
�
D
:
HAZARDOUS MATERIALS DISCLOSURE
WItheappllutuubui occupal.t.reandle haurdous IILATINGUMi(TOIO0,0000TU) File RCClPN
1.laadeldbytheCupedi..Munidp.]C.d,Ch.pter9.13andthe
IIsalthand Safety Code SMlonLS93Hd7
HEATING UNIT(OVER IW,OW BTU) TOTAL: a d
811111 ptu VENTILATION FAN RFSID) ISSUANC DATE
Illmt ha.,d u.. ulurc mina t,occupant by the Say Arx.devices Fj
which eMt..genx.t air'fot7 arab.dented by the Bay Arca At, R mw.
• QualOy Management Dbl rkt7 BOILF.RCOMP OlII'DR IOILpq BTU)
qYn nN.
have read the hazardous materials uquiumenb u ceder Chapter.1 a1 BOI,ER-COMP(OVOi 100,0008111) 0AY 31 1991
the California II ealih k building
Code, of cumt.flyh have.
and3:534.I
understand that if the bulldingdoes not arrenlly hsveelenanl,the llbmy NEW RESIDENTIAL.MIiCiI._ SQ.Ef.
rnponsibillty to nalfytheoccvpant olthercqulrrmenlewhkh mull be met ��20fcuperf
JiB^ I
prior it nceol kaleal parry.
Owner cath rlud gentDale IgsUEp e
IOTA L:
OFFICE COPY