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24253 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY Building Pm ect Identification PERMIT N Building Addrev: � � cc ` Y 2 4 2 5 3 "��ts2_ are. W L s one. CITY OF CUPERTINO-BUILDING DIVISION le Gn ra r%� _]}� Lic.No: APPLICATION / PERMIT LjdlaBUILDING-ELFCTRICAI.PLUMBINC.MECHANICAL CATEGORY VV CONI�Isd� Architect/Engineer. Lie.N. QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO A�.� Add. PERMITISSUAtNCE i� MI I'Llell 1 11 LICENSED CONTRALTOR'S DECLARATION �ON L-R Ihereby ion70that lamsion3 Theunder Busiessand provisions ofChapter9(mmmm AIsIsIlANCESRE9DENTIAL �p!� Ing with Section 7000)0/Division 3 o(the Buelneasand Pro/nslonsCode,and my Isome Is 1. Limosecims force and effect PANELS Is Date- Clave it.p T 1 Y�/ •'r►�iii Date Conlmctor UP TO 200 AMPS ARCHITECTS DECLARATION 201-IODOAMPS µQ�9O zz I understand my plata shall be used as public records. OVERIIDOAMIS SQ.FT.FLOOR AREA $/SQ./FT�. E ly Licensed Professional SIGNS ELECTRICAL -X/�ara<� �3sYi «<< OWNER-BUILDER DECLARATION SPECNLCIRCUIT/MLSC VVVV VV ��VV zF. I hereby affirm that l am exempt fromthe Contractors License Law for the p following reason.lSecHon 7031.5,Buatess and Pro(essiona Code:My ctty or FZ H TEMP.METER OR POLE INST. ceuntywhich requlreaa permit to mrutmcL alter,Improve,demolish,orrepair enystructure prlorto Its Wuance.alm repulreatheappllcant forsuch permitto t �g�d Ofib a signed statement that he b licensed pursuant to the provisions of the TOWER DEVICES µ,l• Contractor's License law(Chapter 9(mmnnnc itwithSection700D)ofDivl- Blon3oftheBusinescandProfesseonsCole)orthat he la exempttherefromand SWIdMINC POOL ELECTRIC VALUATION the basis for the alleged exemption. Any violation of Section 70315 by any Lo !1 A UTLETSStVITCFtESFIX'IURESco applicant fora permltsubjerotslheapplicmttoa civil peoaltyo/nat nn.than div ` five 1,a.o ne,dolof he W). NEW RESIDENTIAL ELECTR SQFF. STORIES TYPECONSIRUCTION �n ❑Lasownerll otproperty,or my employeeswith wages a their sole compensation,CSoc.7Kwill Bothe work and the structure Th no Intended or License for O vie(notapply to an ow and Proopert oCode:The Contracture thereon law does$$ whodot such loan owner ofporthropertyo builds owneporees,prvided thereon,and OCC.GROUP RES.UMTS whodoements am not himself Intended reoffered Neow or ale.lf employees,provided that such Improvement.red within pleb the o nveg deer ilingoe 7 L: 1 Improvementbwld wltFln orwyearo(completlorytheawnerbullderwlllhave ljZIIuBm of pmvlog that he did nabuBdorlmpmveforpurpoeeofsale.). QTY, PLUMBING PERMIT ]SEEFT.OpD ZONE APN a. or of the property,am eachWvely mntrecting with licensed PERMIT ISSUANCE s� foot on to construct the project(Sm 70K Business and Professions Code: The Contractors License Lw does not apply to an owner of property who ALTER-DRAIN 4 VENT WATER(EV builds or Impresses thereon,and who contra /or such plojeR - • s with a .1114actor(s)licensed pursuant to the Contradoei License Law. FEE SUMMARY lJ I am exempt under Sec. B 6 P C for this reason BACK FLOW PROTECT.DEVICE 00TRIDE FEES DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N • Owner Date RECEIPT N WORKMAN COMPENSATION DECLARATION FIXTURES.PER TRAP �r SCHOOLTAX Y N_ [31 hereby affirm that I have a certificate of consent to Belfdneure,or a RECEIPT 9 certificate ofWorkeri Comperuatlon Insurance ora certified mpythereof OSec. 3810,LbCJ S FA.CASYSTEM-1 INCA OUTLETS PARKFEE Y_ N_ Policy Y GAS EA.SYSFEM-0VER a(EA) RECEIPT 0 Com any BUILDING DIVISIO FEES CCeAMM copy t herebyth the city CREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE ed Cedllled copy b(Ikd with the city inspection division. as � CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID_ gi.r I COMPBNSATONINSURANCE ' (Thleeection need CnotO be eompl COMPENSATION epermit t/or am hundred dollen SEWER-SANITARY-S'NRM F.A.200Ff. Datetjt ems # ($10D)or ler.) WATER HEATER W/VIiNC/Q.GCTR ENERGY Y N I cert)/ythat In the performance o/the work forwhlch this permit is Issued, O �� I.hall not employ my person In any no Bo yJp b�, (rye su�tet�toyhe 1 WA.I.PR SYS.IFA1/.IRFA•DNC Workers icam_mp ...jr E�t�'�j(I(o�i ia. atelim_y_7 R p\B PAID O Z Applicant 4 / '\\ IC ISJ�6 V NEWREADENITAL PLMB._SQ.FF. Date Re i _ 2 O NODCETO APPLICANT.If A mating ap. �if qpI IAB; U H ahouldbemmesubje.z.Warken'C°m4tfAn fyov b 'BAh@L'$ol 1 W Code,you must(wish mmplywithsukh pro Mid-ort t a 1 W > deemed revoked. cONsrI�47{qI LEND A� —/ SEISMIC FEE 0. Iherebyat(Irmthattherllfi Mise form, ELECTRIC FEE Z ,..fthc work torwhich this permit t issued(Sm.3097,Clv.CJ T V O Iandere Name PLUMBING FEE Q LL F Lender'BAddresa QTY. MECHANICAL PERMIT FEE MECHANICAL FEE OW Imdi/ythatlhavereadthlsappRrati°nand Btatethattheabovelnfomutlon �w 1 boome%.Iagreetocomplywethallcityand muntyordi.mccamd smteiaws PERMIT ISSUANCE FEES PAID: } relating tobuildingmtutructiory and herebyautherhompre ,...xs of this w ' I— Z citytnenterupontheabove-mentioned prerperty for pectlen purposes. I ALTERORADDTOMECH. aa� lWe)agree to Inde a d ken ss the City o/CupertNo Date Reeci t# V ag.,utllab Bit. d ex vee ithmaylnanywayaccrue RHANDLINcuNrrcT010,ODOCFM) I" SUBTOTAL' agal aid Cl 1 the gr tin o/thbpennit. / AIRHANDLING UNIT(OVER I0,000CPM) CONSTRUCTION TAX S sea reofA� cant/Contnctm Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID: Hk R USMATERTAIKIDISCLUSUILE Will the plcantorfutumbulldlogpant Blomor handle hazardous HEATING UNIT(TO 100,!00 BM r' Date i terblas eflmd by the Cupertino Mu tlpal Code,Chapter 9.12,and the Health and Safety Code Section 25532(a)7 HEATING UNIT(OVER 100,!100 BTU) ❑Yee No Will the applicant Rome building occupant use equipment or devices VENITLATIONFAN(SINGLE RESID) r ISSUANCE DATE which emit haaardous air contaminants v defined by the By Area Air Quality Management District? BOILER-COMP DHP OR 100,01'0 BTU) 4 Yee rl No havereadthe th&SSi ouematedab requirements under Chapler6.95 of BOILER-COMP(OVER 100,000 BTU) thecmta ndtatifthAildin Code, otcure2tly have a tend,that (A p p nepontandthat notify the ocupard of t erequire encs tcnanl,ihal It try NEW RESIDENTIAL MECH. SQ.FT Y'• G9 (I rnporolissu to notifytheoccupanto/the requirement which must be met prior to issuance of a CertlBcatc of Occupancy. R Owner or authorlacd agent Date ISSUED B OFFICE COPY CITY OF CUPERTINO INSPECTION DIVISION m WW < _ = m D D D D f f m D D Z D D T 9 D m ; m v N N D v r C �^� �'n C 0 4 2 D D 2 2 a c y y 1 y f `* O m m y D O -/ m O m 0 O 2 -,E 0 H l m m H H H D D �^ m m m m Z Z y c Jc m < O ? n uZi H m - ti r N ,V O a D r Z Z c D m m m a a w m i �^ m a m y A a ; D H rn D y 1 h D O O y 0 2 0 H y = H 9 a_ D D m r 0 m m m r a Z 2 y Z O ti c C o a m < m D m m y y y r O a n H O D m 0 '�[�. O C 2 m y 2 D < �e D 9 m - T_ u V 9 3 O Z Z_ pj D m m D 2 Z r < y v 2 a 2 m �3 m 9 Z p Cl D 'I H y Jc JC y H m 9 Z r D a 0 m X r 9 2 H m m D r r * H m a a C Z O c a H m O Q u m H H O Z C O D 9 m a m m D M O 0 F. O a m C n m m s y D 0 -1 i HZH H Z Z < a a m 3 H a H < m m H m a = H " ,' O Z < O f O O y m H a g m m '� m m T v H $ y a o i m< O m O m O O 2 O Z 9 T v m 2 y N e ( O C7 Eq O GZl O p D O = m v -ZI 3 m 0 m A > a m D a Z � m 9 2 y m r O g c o 12 m a a O m < H ; N D 0 m n ppppp Li m my y )> m m r m o O H m m 1 -� n T 3 D m < y 'c-1 O m m H m v < C n .0 p C m0 Id I J� C - y _ i m N m m m 17 H m v m m my m C7 V O C m m; C CI1 C m 9 O ij Z a O = Z m c z z < Q= � APPLICANT TO FILL IN IN FON MAI ION Al If II HED LINES-USE IIALL POINT PEN ONLY _ 4o.o.o1FCTTT,T1PRX'(iT— PERMIT NO, CITY Ur,CUPERTINO APPLICA'T'ION/PERMIT PLUMING.MIrCIANICAL BUILDING DIVISION BUILDING PROIRCT IDENTIFICATION -9 BUILDING ADDRESS: SANITARY NO. I APPLICATION SUBMIT TALUATE i ONO I LOT If OWNITIS NAME; PHONE, I'ON'I RACI OR:S NA Mli: LIC NO: NC CYINIROLX ARlllfll!CIJUNGINEER: LIC NO: ADDRESS: ri C— FOIACT: PHONE: ' Y J"ffl fCf)INd FLiiMrt INFO N Q'tr9i , eLLsf,li �fliikl" 1. �. din a1 DLDG CLEM PLUMB MLCII PERMIT ISSUANCE -(Ju 0 O ❑ E LICENSEDCONTRACI'ORlS DECLARATION APPLIANCES-RESIDENTIAL IOD DESCRIP'T'ION Oyy fberehyaffrrmHis,on'ReenaeJ rrnd<rinuvisimnnfrhans,9(cammencing will, L300 $alien 7000)n1 Division Sof @c 0nsineas sed Profession.,Carle,eMmy license Iain PANELS lywC full(maned drat. '-Zw I.1,c cClass Lief UP TO 200 AMPS H7. Date Cnmmmor 201-IWO AMPS 50.IT.MOOR AREA SISQ M. r I"'Z ARCBITECl-S DECLARATION OVER 1000 AMPS Dorn— I mndersundmy Plan I'allheusnl as p^hliemrmda. �� [{3 �L.. 3� 04-0l �_rnkw SIGNS CLECIRICAL 120, 3y i0 Livnrnvl l`rnfusiannl OWNER-OUILDr:R UI!CLARAIiON SPECIAL CIRCUR/MISC. _ 3is,-u I hereby arrant nrnl I mar escmrl front;lire camra<m,n noose Law ror me p 20_b� W LL~N fnllnwingrcrinn.(Scc(iorr2O)LS,Uusine%antull`rnfessinr+s Cmlc:Mnycityorennrrry IRMP.MLTRRORPOLE INST. F_sy ON which m9mirea n prmnh to tonins,miler,intparve,do oolieh,or rePnir any auadure 5§> prinro;lelaen:nme.nlxnm then rJicanl fur such nnfilenni reed mmenent POWER DEVICES 7 J u{�� t 9nlms tI pcmJ p wpy 0 Thal he It Ocnrseel Terminal to]fit p rrovia^^.a or oro Contractor's License Law ill da0y, 9lSWIMMING POOL ELECTRIC VALUATION YC mm�nrndng wide Strikes nn ROfglnf Division)olihc nminean and l`rnresions Cml<) pI_y orlhallieBrernnn@erehomandlliebasisforlheRllegnlriemptinn.An,sialntionoT OmanSWITCIIPS PIXTURPS a 73 k Set Ilan 71115 hynity applicant for a Penangn mO anhjeclire applieo n civil Penshy of nil meal 11rnn Bvelmmlr<d ddl...(3{1X1). O � ❑ I,mnwnermftlreprnprny,nrmy nnpiny<uwillswnpemnstmirsolealnrpnnmlrnq NEW RESIDENTIAL ELECIR SQ.17. ��O- � .'OlS "YI'iCUNS1N IC-1 IIN iwill Jo lire wank.rod lie sbncmreis not Intended looferml for male(Sec.Ill4,Onslneaa and Professions Caste Un,Cnmracmr'n License Law does not artily to an owner lir proMoy who hmildam hoposea daemon,and whodoem ench work mmaelror ennui,his OCC.TillOtll' TUIS.UNI lS hoerermieen,Tmai or that nveloarTmvmnnreart rrm hear ided orcmpicilod for owner wevrw IT havedinenrlcinof mein imhsaid wilid lo(oild or for mnawnaa" TOTAL: Innun<r wIu haat fire hrnden lir Ina„erg arm Int girl rent I+sun lir hrnpnnve ren prrrpann ar sale.). ❑ ) a.00nzG I: nrN LmnwnernrmeT.sled,,.erearwa1.clyranvacmrgwhhuerm.nemroortarilt, Qr . I,mnaect she Project(Sec.70,14,Business and Prefmsiona Cnum,1 lot Cantrmer's pERMI'r ISSUANCE icenvel iwdorvmtapplymnn^wncrnfprnperiywlinhoilntnrimprmcalhcrc^n,n^d who Oanmms for sedh pmjecln with nc larc us)licernalpmamanI mthe Corns,no's I Idcrese Law. ALTER-BRAIN k VENT WA WIT(RA) FEE SUMMARY ❑ 1 ass evmpl inner Sec. ,R A P C for this reamer GO I- TUE vmutP' BACK FLOW PROI ECT.O11 SANITARY Y_N • Owns Dmc RECIiIPI X _ UItA1N5 FLOOR,ROOF,AREA,COND. WORKMAN COMI'CNSATION UECLAIIATDN SCHOOLTAX Y_N ❑ Ilicrclnymff'rorlhmllmveacemi0entenlemnsreitti sd roominncarilicnle til RECEIITX Workrrd Umar flan losarancanr a testified urn rhrrrof S<c.igal l.ah CJwhidr PI%'I'I)It ES PER'IRAP PARK PER Y N Prmo I Y 4 awon all rrnpinyrc'n rrrWcr thi.pvrnJl, GAS EA,SYSTEMI INC,4oil TLET3 RECEIVI0 Policy N BUILDING DIVISION ITIS / cI CmnP^r0' GAS.PA.SYSTEM-OVER4 THAI PLANCIIECK MIT �V,O6 L) Citified copy is herehy furnished. _ ❑ Ccllnrncnpy ie filed with theclly innpcc0ondiv6Inn. OREASPgNDUSTRLWA3'rEINTERCEPfOR GRADING R!II S15-:OF CrITIPICATE OP EXEMPTION FROM WORKERSORHASEIRAP SOILS FEE to 00 COMPENSATION INSURANCE OLla xaian seminal lc cornplNcJ ifthc lxsmit is ler not adreldoll—Itllo) SEWER-SANI TAR Y-S I OR M IIA,2mrr. ENERGY THE 3 0 mlcsmd I artily Char in the perfommnce of rhe work far which this permit is lsamu(I short WA'I FR DEA PER WIVENTR!LEMIT nil mnpinY any Person in tiny manner so as to baleen subject In the Withers' PAID Z Cnmlennntinn lawn ler Cnlirnrnin. Dote WATER SYS"11!M/EREI'IING On. Recdpi4 7 nririenrn 0 NOT ICE 10 APPLICANT:It, fit,nutria,do,Certificate of T:ncorl+llan,yn^mcohl NEW RESIDENTIAL PLmn. SQ.Ter. TO FAL: 21$nab' .Q V) Tern(sobjecl to he Worker's Cannpensarian lnnvlsimrs of Tic Labor Cane,ynoor I '— � , fnnhwirh cmnply will moll provldonsmlldn to..n0'half hedveneal rrvnkcA, BUILDING FFEi W CONSI'RlICT10N hI!NOINU AGENCY SHISMIC TRE Q J z I lrachy affirm don there is R construction lnulieg agency lm the Trdnrnnnrr til UO the work for which this permit is issued(Sec.J042.Cly.C.) TOTAL: yD r:1.ECTRICFGE J, It W.None lir r a U.. PLUMBING FRE t� 1<mltdnndnre,a 7ev. . . , t.�ciinNi'cnLncnf�ii: `: ��:' ' SIO _ 0 V 1 ccdiry That I hove read thin it,liemimr and notle rho the almva infennmirm it A1E:CI IANICAL FET- 0d ?e w carrel,Iagree incarplywmrnndlyold eoaalyordinances and state lawardmdngtn PimmirISSUANCE bs' h”' MrilAinp anran¢rian,and hereby Rmhndae mpremenmOvo of Chia eirymonv nrym de CONSTRUCTION TA% U z alxwemenlioned propcmy row no irelian purposes, ALTER Oft ADDTO MECII. (Wei stare In nave,inde neify Rod keep Innmlcss the rhy lir Conciliar ngvimr Iiuhiliri,,joar.rncnis.rom,ralcolon"'wlrlrinmry inonywnyarro..y;ninnt said Cir, A Ill I IA NDLING ON II'U O 1 ItNXI Cl M) ;."r e.npenre of tfit gmndng of this permit Alit IIA N DIA NO UNIT(OVER 10,000 CI'M) Sq,mdnre or ATTnerrm/Comramnr Dae EXnAUST I GOD(WIDUC) _ rn1O IIAZAR0O0S MATERIALS DISCLOSURE BEATING UNIT(TO 101L07IfI TITO) Date Receipl0 Will toe apir or hnnre huilAinp acctrpanl more or lonelle bacndova inalerlald as denied by tan Op Linn Mi ieipal Cod'.Chnper 9,12,nod the IIi and Safety BEATING UNIT(OVER IIMI,gp Ill U) TOI AL: Q Coil'.Seellmt25512(,)? VENT I LA'I'ION PAN ISI NOTE Il a g 1)Y" 0 No ISSUANCE DATE Will0enpplicnrnne hnnrc hnilAingampamuaupriprncmar Jcvicn wlrichnnit DOILRR-COMF(lllp OR IIXI,(XIO TITO) Immnlom ole rmunlaintm,m defined Ey the Rory Alta Air Qealily Maavpemrnt BOILER.COMP(OVER Iflq(%10 IT TO) Dtmien ` ❑Yen ❑No NEW RESIDEN'T'IAL MECII, SQ.PL ' I have maul lire hmmaloos amtmlala rcgnlronm6s trader Chvpler 0.95 of lire Collfmnla l lerllhRSnfely Code,SeOImB25505,25511 a 12551d. Itrndemund that if file 1,01,14orelne1 nal cnrrcmly Imve rr mmol,ellen h ix my remlvnaihillly In notify the rnpanl of It "non"which nrnsI Iv are Prior In lean.....of o Ce rifirme or —_ O"oP.mty. eTvrwnm aaluni'd.'r l Onaa IOTM: ISSUFO DY: