22368 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
building Project Identification PERMIT NO.
Build Ing Add res,: 22368_
Do 2 c 253 a
/ one: A A
10 G s CITY OF CUPERTINO BUILDING DIVISION h
c aao • tante: Lic.No: APPLICATION if PERMIT / 07 ` /
Sc -6'16qBUILDINGELECTRICAIPLUMBING-MECHANICAL CATEGORY CONTROLX
Architect/Engineer. Lk.No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
AdaM9A3</L 91 AU/ u�� Exr1. SA
m PFRMITISSUANCE ❑
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9(comment APPLIANCESRESIDENTIAL JOB DE50ZRIPTION
Ingwfthnkn T)ondivofthcBu,ine,sandProfessionsCode,and my
license
IIn rumformaeffect. PANELS S �L ,
LimmoCksi
�
LIc.8 T
Date �L�j r,
Contractor 201-1000AMPS L so ce-, �
ARCHITECPS DECLARATION OVERIMOAMPS SQ RAR $/SQ.FT.
9
0 O I understand my plan dull be used u public records. L �N
Licensed ProfessionalSIGNS ELECTRICAL --F I-rib III
Q OWNER-BUILDER DECLARATION P T E R
�n SPECIAL C]RCNT/MISC
fo' � Ihereby affirm that l am exempt from the Contractor's Limme Law for the
O Z ti 8 following reason.(Semon 7¢115,Business and Proleabm Code:My tlty or TEMP METIER OR POLE INST.
�p county which requires a permit to construct,alter,improve,demolish,or repair /O
anystmnum priorto its Wuance,atso requlmthe applicant forsuch pertNt to POWER DEVICES ass
E r4 W� file a signed statement that he Ls licom e t pursuant to the provisiom of the
Contractors License Law(Cha
pter9(commencing with Section 7000)of Divi- SWIMMING POOL ELECTRIC VALUATION
Oe skm"ofthcBuss's,and ProfemlonsCode)orthat hesexemptthercfromand
�
the basis for the alleged exemption. Any violation of Section 7031.5 by any OUILETSSWITC FD('IURES err
applicant fora permit subpnsthe applicant to a civil penalty of net merethan E3-0 ID,L(J
cc five hundred dollars(SM.� NEW RESIDENTIAL ELECTR❑I,as owner of the property,or my employees with wages as their sok SQ.FT. STORIES TYPE CONSTRUCTION
compensation,wllldothe work andthe structure snot intended or offered for
S O ale(See 7014,Business and Professions Code:The Contractors License Law
C� $ does not apply to an owner of property who builds or improves tMrson,and OCGGROUP RES.UNITS
E who does such work himself orthrough his own employees,provided that such
bmprovemens arenot letended...ffered!..sale.If,howevep thebuilding or TOTAL:
improvementssold withinoneyearofcompletion,the owner-bullderw111 have
t e rden of proving that he did not bund or improve for purpose of sak.). QTY. PLUMBING PERMIT FEE F DPANE APN
L as owner of the property,am exclusively contracting with limmed PERMITISSUANCE
contractors to constad the project(Sec.70"Business and Professions Code:
The Contractors Llmnse Law does rad apply to an..or of property who ALTER-DRAIN VENT-WATER(EA)
builds or Improves,thereon, and who mstram, for such p of is with a FEE SUMMARY
c�j➢I�a&or(,)licensed pursuant to the Contractors License Law. BACK FLOW PROTECT.DEVICE
IJ I am exempt under Sec B 4 P C for this reason
• Owne Dau DRAINS FLOOR ROOF,AREA,GOND. SANITARY RECEIPT
ORKMAN COMPENSATIONDECLA R TIS-O�� FIXTURES.PER.TRAP SCHOOLTAX Y_ N_
111 hereby affirm that 1 have a certificate of mnsent to self-tnare,or a RECEI'T M
certificate ofWorkers'Compensation Insurance or a unified ropy thereof(Sec. GAS EA.SYSTEM-1 INCA OUTLETS PARK RS Y N
MM.Lab C.) RFCFJPf M
Polity p GAS EA.SYSTEM.OVER 4(EA)
Com[rany BUIL DING DI VISION Fr.ES
Ccrtfiled copy Is hereby furnished. GREASE/MDUSML WASTE INTERCEPTOR PLANCHECKFEE
r-lCenlfied copy Is filed with the city inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-SFORM EA 200FT Date Recei [#
(TMs MRlon need not be completed If the permit s for one hundred dollars
($1000mless.) WATER HEATER W/VFM/f].ECTR ENERGY FEE Y_ N_
I ormlythat in the performance of the work for which this permit is issued,
I shall not employ any person In any manner so as to rre u 'eci to the WATIR SYSTEM/TREATING
Workcrs'Compp�9ppee��yy hwre of C�Bfema- ate�q PAID
O Z Applicant >i(fC.iLi✓(1a[Xi NE}y RE4OENT1Al I'f.M B. SQ.Ff. Date RCCCI [#
Z O NOTICE TO APPL NT:IL after making the Ccrtlflmteof Exemption,you
FN should bemne subject to the Workers'Compensation pro,is t.fthe Labor TOTAL:
K — Code,you must forthwith comply with such provisl.ns or this permit shall be BUILDING FEE
r�emed revoked.
l!J - •m CONSTRUCTION LENDING AGENCY SEISMIC FEB 74
Il C Ihereby afflrmthat there Is a construction lending agency for the perform ELECTRIC FEE
D Z ..Inof the wmk for which this permit s kssued(Sec.3097,Civ.C.) TOTAL:
00 McfereName PLUMBING FEE
LL F- �Lumicr',Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
I rertlfythat l have maithsappmeatlon and statethatthe above Information
O W
M scomo.I agree tocomply with am city and county ordinances and state laws PERMIT ISSUANCE FEES PAID:
>_ relating tubuliding coatanlon,and hcrebyauthorlocrepresentativesofths
F
Z city to enter upon the above.mentioned property for IR
inspection purposes. ALTORADDTOMECH. Date ROCCIPt#
- (We)agree to save,Indemnify an d keep harmless the City of Cupertino MR HANDLING UNIT(f0 tO,OW CFM)
against liabilities,pdgneens,coseand expenses which may in anywayaceme SUBTOTAL:
agai By in covequen f the grant ing of this it.
AIR HANDLING IINR(OVER 10,000 CFT1I CONSTRUCTION TAX
gnau Appmmnt/Con tact EXHAUST AUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant orfimme building occupant store or handle hazardous HEATING UMT(TO100,WOBTU) Date ReCel t#
material a,defined by the Cupertino Murdcip.l Code Chapter 9.12,and the -
I1ealthandSafetyC.de n25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL:
nYes
Will the applicant orfumm building occupant useequipmemt ordevices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area Air
• Quality Management DistrictBOILER-COMP OFR'OR 100,000 BTU) (taw I
��
YYeao /i'a�t��
Ihave madthehaza ousmateriasrequirementsunderChapter6.9iof BOILER-COMP(OVER 103,"BTU)
the California Ilealth k Safety Code,Section 25505,75533 and 255M. 1 11 s f. aT .arsea�
understand that ifthebuilding dues not currently have a tenant,that it my NEWRESIDENTIALMECIL SQ-FT. x't0 M re�!
responsibility to notify the ocmpant of the requircrrcnts which must be met
prkutossofaCcrtlficatc of Ocmpan
i � � zAy9
Ovvnerorofilhorizcd agent I Date TOTAL: ISSUED BY:
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Ilis
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Curb Nl o u n t Size Inside outside
-�77 7 Model (Modular Wood Curb Wood Curb
• I 1 o r i z o n Li to' Over 4' X 6' Skylights NumberDimension) Dimensions Dimensions
Lifetime WaLel-Lile'M Warranty MODULAR 11 2052 16x48 141/2x461/2 171/2x49'/2
: EXTRN
•NERED ED 2828 24x24 221/2x22'/2 251/2x251/2
O wLLDCD AT CORNERS �, r-
T"'
2836 24x32 221/2x301/2 251/2x331/2
_� ttIG
NEDP4ENr cA$K[1 DWELL ACRGLA7INC (OPTIONAL)
A:o LONG ACRYLIC COME OR P.R.MID 2640 24x36 221/2%341/2 251/2071/21APERPROOF R00( TEKS O
SCR(w AT
2: DN CCI+TCR BEDDING TAPE
(AVAILABLE rROM O'KEEFFC'S) 2852 24x48 22'/zx46'/x 25'/zx49�/f 1
wIIP NOLCS — w000 CURB
FRA ALUMINUM SILL III \ I 2868 24x64 22'/2x62'/2 251/2x651/2
ILDI M'1[R[D AND
wCLJEJ •: CORNERS
NAILS AT 2: (AVAILABLE _ /— 2876 24x72 22'/2x701/2 251/2x731/2
rROM O'KECrrE's)
28100 2496 22'/2x94'/2 251/2x971/2
ROOTING INSIDE w000 CURB DIMENSION
GALVANIZED SADDLE 3636 3202 30'/2x301/2 331/2031/2
rLASNmG (AVMLABL[
TROM O'KCCr(E'S) OUTSIDE wW0 CURB DIMENSION
3652 32x48 30'/2x46'/2 331/2x491/2
3668 32x64 301/2x621/2 33'/2x65'/2
3676 32x72 301/2x701/2 331/2031/2
36100 32x96 30'/2x941/2 331/2x971/2
4040 3606 341/2x341/2 37'/2x371/2
•,Curb Mpt n
— _�-- 4052 36x48 341/2x46'/2 371/2x491/2
( H qri I o ne iN uP eD 4' X B Skyligt L�
L 5252 48x48 461/2 x461/2 491/2x491/2
Lifetime Walertilen Warranty MDWL•R DIMENSION
5268 48x64 46'/2x62'/2 49'/2x65'/2
-21 EATRUDED
ALUMINUM
.LM ELDE Ai CORNERS CAP MITERED
AND w5276 48x72 461/2x701/2 491/2x731/2
__ _
Imo- ---�'
- -
DOUBLE ACRYLIC
$2100 48x96 461/2x941/2 491/2x971/2
NEOPRENE GASKET GLAZING (CFRONAL)
p0 x 5/8'POO, LONG Acer¢ DOME OR PYRAMID 52124 48x120 46/2x118/2 49/2x121 /2
1n#10 RPROO' 1[KS — 1 / 1 1
SCRCw AT 24' ON CENTER BEDDING TAPE
(AVAILABLE FROM OKEE((E'S)
ML-20 UTRUDCD ALUMINUM I V'UW CURB 6868 6464 621/2x621/2 651/2x651/2
SILL FRAME MITERED AND
w[LDED AT CORNERS
1 6876 6402 621/2x701/2 65'/2x73'/2
PAILS AT }: (AVAILABLE .
FROM O'KE[SIC'S)
ROOTING 3/ 3/ 68100 64x96 621/2x941/2 651/2x971/2
INSIDE WDOD CURB DIMENSION 7676 72x72 701/2x701/2 731/2x731/2
GALVANIZED SADDLE
(LASHING (AVAILABLE 76100 72x96 701/2x941/2 731/2x971/2
FROM (AVAILABLE
WigOC WCCO CURB DIMENSION
76124 72x120 701/2x118'/z 731/2x1211/2
100100 96x96 941/2x941/2 971/2x971/2
88124 84020 821/2x1181/: 851/2x1211/2
all us for your skylight needs. Distributed by.
w. =� I 75 Williams Avenue
San Francisco, California 94124
(`„/Y
(415) 822-4222
Alul linum Building Products Telex #278927
FAX 8225222
j3LgNEct STREET
s 2'11"ON C
RULTEcJ COJLII J9
DOWN
IsLof a of Roof
X 8" o DoME
BRONZE PRA
J`IMNUAL OP�NlNQ
Roof Rid-9E.
SLOPE of Goof
Do w ry
NoR-FipoitJ I` 6JEL Ff TowNhousE
_20o y.2 NoRT4CgF-5T Sc�
COPERTi-No Cq , gSOlzl