23710 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
BuildingProject Identification PERMIT NO.
Building AOddgmY: o^� �/� -c.. -. 23710
Low, a one:
J, 6tece PA CITY OF CUPERTINO-BUILDING DIVISION
con a or.Name: I1hfGV �jZXJ /D1 APPLICATION / PERMIT L�L Li
AmMtect/En BUILDINGELECTRICAL-PLUMBING-MECFiAMCAL CATEGORY CONTROL of
glneeq r Lk.No:
N QW ELECTRICPERMIT FEE BUILDING PERMIT INFO
Address PFRMITISSUANCE ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION
I Mreby al 7000)o DmisIon3ofthc usmA; alonsof Chains 9(mmmm APPLIANCESRESfDENTAl JOB DESCItB'770N
ingwith Section 7000)of Dlvialon3of[hegusin+saa dProleslonsCade,and my
license Is In full fo and effect PANELS
I'ANEIS ri1 —) SK-j L41 as
Llcense�Co Y C� (1J L L- ' F_jv�
Date
Contractor UP TO 2DOAMPS
2011000ANPS
ARCHITECPSDECLARATION OVER 1000 AMPS SQ.PT.FLOOR AREA $/SQ.Fr.
q�v ce0 ZO
` I understand my pions shall be used s public rcmrds
U O Licensed Professional SIGNS ELECTRICAL
�
Zffi
. OWNER-BUILDER DECLARATION SPECALCIRCUIT/M15C
G Ihercbyarm that l am exempt from the Contractor's License law for the
Z0I.,`7 following reason.6ection7aIS,Busluesand Professions;Code:Any dty or TEMP.METRORFOLEINST.
0Xf'� cwntywhkh rcqulrnapertNtmmrutmct,alter,impmve,demolbh,ormpalr
11 .a anystmeture priorto its Lwnnce,also requireathe applicant for such permit to POWER DEVICES
C G(Qj file a signed statement that he b licensed pursuant to the provbiom of the
0m Contractor's License Law(Chapter 9(ecm encing with Section 7000)of Divi- SWIMMING POOL ELECTRIC
soofthe Business and ProfessionsCode)urthat he Is exempt themfmmand VALUA'1]QjS'
the basis for the alleged exemption. Any violation of Section 70115 by any OUILETSSW[TCHESHXIVRES r� ��'(J
applicant for a pernis Jtiod the applicant to a civil penalty of not more than l S�
five hundred dollars(SS0o
e. ICi NEW RESIDENTIAL ELECTR SQ.FT. STORIES IYPECONSTRUCTION'
.. ❑I,as owner of the property,or my employees iso with wage as thele sole
compensation,Bultlo sandhe Ex,+ndthe ai Cede:The
notIntended or License
ed for
Law
a O ale(Sec.7044,Business and Professions Code:TM Contractors Licensor law
W � does not apply to an owner of property,who Wilds or Imp Aos thereon,and OCCGROUP RFS.UNITS
who doessuchwork himself orthr°ugh hlsownemployees,provided that such
improvements are not Intended oroffered for sale.IL however,thebulldlog m TOTAL
i pmvement bsold within oneyearolcompletion,the owner-budderwlll have
thcyrdenof proving that he did not Wild or Improve for purpose of sleJ. QTY, PL BING PERMIT FE FLOOD ZONE MIN
[_I L as owner of the property,am exclusively motracting with licensed pER�gT155 ANCE
contncton to constmct the project(Sec.7054,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property whoroFLYER-DRAIN`&VENT-WATER(EA)
Wilds or Improves thereon, and who contracts such pLojects with a FEE SUMMARY
,,llllSSfTador(s)licensed pursuant to the Contractor's License Law. BACK FLOW PRQjFCT.!IIEVICE ceol
jJ I am exempt under Sec B Ls P C for this reason
DRAINS FLOOR ROOF,AREA,COND. SA ARY Y_ N_
Owner Date RECEIPT Y
WORKMAN COMPENSATION DECLARATION FIXTURES-PER TRAP SCHOOL TAX Y_ N_
f-11 hereby affirm that I have a certi0cate of consent to self-Insure,°r a RECEIPT Y
certificate ofWorkeni Compensatlonlnsuranm ma certified copythereof(Sec. GAS EA.SYSTEM-1 INCA OUTLETS PARK FEE Y N
3800,Lab C.) RECEE'I'N
CoPolicy It S GAFA.SYSTEM-0VER 4(EA) BUILDING DIVISION FEES
[om ay
Certified ropy is hereby furnished. GREASEANDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
❑Certified copy b filed with the city Inspection division.
CERTIFICATE OF EXF.M PrION FROM WOR KERS' GREASE TRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA.2001.1'. DaIC
(This section need not be completed If the permit bfor one hundred dollarsRCCCI t#
($100)orlen.) WATER I-IFA.I.ER W/VF1J.I./E].EC.I.R ENERGYFEE Y_ N_
Imnifythat Athe performance ofthe workf°rwhlch thio a
mot bsued,
1 shall not employ any person in any manner so s to to a WAT1R SYST.FM/TREATINC
Workers'comppyynn33�9tlon Law Callhsp,b.D to PAID
O Z Applicant G(!/ie a / - NEWRESIDENTIALPLMB. SQ FT. Date RC CI I#
Z O NOTICETOAI'PLICANT: fterm Ungt eAificateof Ex emptlon,you
should bemme eub}ct m the Workers'Compensation provisions of the Labor TOTAL:
N Code,you mus:(orthwlth comply with such provisions ar this permit shallW BUILDING LU 7 deemed revoked.
CONSTRUCTION LENDING AGENCY SEISMIC FEE
11 O Ihembyafflrenthatthem is a mnstmctlon lenciingagency forth perform TOTAL:
ELECTRIC FEE
M Z anm of Ne work for whichthb permit b Issued eiec.3097,CN.C.)
60
Lender'.Name PLUMBING FEE
LL F Lender's Addmns QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW 1cenVythat l have read thbapplica0on and statethat theabove information
1 acorns.l agree to comply with all city and county ordinances and sate laws PERMIT ISSUANCE FEES PAID:
>. relating to Wilding construction,and herebyauthoriz,representativsofthis
N city to enter upon tet above-mentioned property for Wpeetlon purpasn. ALTERORADDT0MECH.
Z (We)agree to ave,Io lornAl an d har "Aja the City of Cupertino Date Reecipt#
V againstllabilidA%judgments,costsand sea which nay In any wa meme AIR HANDLING UNIT GO 10,000 CFM) SUBTOTAL:
ag.inst. in con ceo(th a tingd[hb pe
AIR HANDLING UNIT(OVER l0,000CFM) CONSTRUCTION TAX
Sign fApplkan[ Contraactor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
illthe applicant orfutum building occupant store or handle hazardous HEATING UNIT TO 10,000 BTU) Date Reedt#
tial s de0ned by tet Cupertino Munidpal Code,Chapter 9.1Z and the
IT, ith and Safety Code Section 25537(.)? HEATING UNIT(OVER 100,000 BTU) TOTAL:
Ym M No
Will the applicant or future building occupant use equipment or devices VOITILATION FAN(SINGLE RFSID) ISSUANCE DATE
which emit hazardous air contaminants as defined bythe Bay Area Airy YW STs
Quality Management District? BOILER-COMP PHPOR 100,000 BTU) 1 V
4hYin ❑No BOILER-COMP(OVER 100,000 BTU)
aeereadthe h ardousmtedalsrequlremnbuntlerChaper6.95u(
• the California Health&SafetyCode,Sections 25505,25533 and 755M. 1 MAY 19 i99C
understand that if the building dos not cormotly have tenant,that it Is my NEW RESI DENTIAL MECH. S'Q.FT
raporaibllity to oalify the ocm pa cat of the rcqu kemcnts which must M met CI I Y Ur
prior to Issuance of a Certificate of Occupancy. V CUrL- 1 Hk.
Owner or authorized agent Date TOTAL: ISSUED BY'_y,aL/'" R—S
OFFICE COPY
INSTALL NO 2X4 GLASS FIXED TEMPERED OVER LAMINATED OBSCURE
I,C,B4O,# 4257 �5
C,J,
2X6 �T
HEADER
HEADER TO BE INSTALLED WITH L-50 HANGERS
SKYLIGHT TO BE INSTALLED BETWEEN C,J,
CURB 2X6
IN A '4F PROSE
CCORDA VCE WITH TI1D•,�„
�nNO C)DES
DAT A"1QB>iSITtE: 10892 NORTHFIELD SQUARE
SIGN. �CUPERTINO CALF❑ '1
This set of plane 9J014
�awfulbe poon the job at alt ticllicationSmus
On make any changes es and it is un
he same without written , or alterations
the building De p, n
IN, ,.ssio
The stampm8of Ch' ," c,rpat,non from
SHALL NOT Ihistor;n n, specifications
approval of the vol-, p �,d cr b
to
If ar,Y Oify' O,d.n •, a ci; Provisi an I
ons
ECE§ VED
• MAY 19 1992
BLDG- INSPECTION D OFFICE COPY
CII' OF CUp6 PI RTMENP