24605APPLICANT TO FILL IN INFORMATION WITHIN RED LINES • USE SALL POINT PEN ONLY
CITY OFCUPERTINO BUILD '- EC CAL
BUILDING DIVISION APPLICATION/FERMI'! )INGPROj CT II)KNFIICA
RUII. IND ROJP,CTI RN'TIFIC TIUN
r1:RMrrND'
2 /1605
L �L1I v J
RUII.UINUADI ESS ..
J11,'J UNIT 1.0'fN
SANHARYNf I.
AI'PLII'A'IIUNSItliklll'IAI.UAIIi
nYV
OW !RSNAME: — s PH NE'
—Z
✓✓
OM
NIC
El
C(IN '1'R111.N
FCT/bNGINEER: I.ICNO:
ADD : S✓
J
S�yc
J
Corr11TACT: PHONE.'
/, 1QTY,
I�1 V
-'', ' ?fs)^"' ,.u'r
IT SUAN,ICPB . I{,,:�y.S;
ILDING PERMIT INFO
E0 ELECT PLUMB V
� AI`[-jr
PER
/ PERMIT ISSUANCE
I.1-ENSEDCONTRACfOR'SDECLARATION
I hemby elfirm that l ata licensed under pmvisionsof LTepler9(cmnmencing wish
Scdinn lll(1,)n DiviSS��n111oI IM1e Rusinea Pmfgs C elMmyli«nubin
full force eon ,�ceYG6
Lirenu Cl x\e Viii Lica
APPLIANCES.RESIDENTIAL
/may 10R DIi$f'.WP` IN
IDl/�c Ir'�L�C
CiNV j�
PANELS
UP TO 200 AMPS
DvteConv«mr�_
ARCIIITtiCTS OE A
1 makentend my,thma,holl he umd ea public r«mda.
2D1-IgMIAMPS
SQ. IT. H2OOR AREA
S/SQ. IT.
OVER IOM AMPS
SIGNS EI.ECTRICN,
-LianuA Profcssimnl
OWNER BUILDER UF; be CmImION
I hereby M. that 1 em eacmpt from the Comnctor'a License Lew farco the
lo)11. Rminemand
obi Co de: Any city., munly
SPECIAL CIRCUIT/MISC. x
TEMP. MUTES OR POLE INST.
whichficillinwingumna(Smion
rve,de
which r I. i. s o Permit y),anima, ,her, improve, demolish, t ar repair any smctnre
RlmmaI.(Chaterredimmicard.
pdmmiuicealFmmand.amunce, at. che
POWER DEVICES
proi,mermfor, Comrrmino
thathe nsis IicenseJpumction the provisiamal the Convectors Ldd Porlaw(.Leper
9(cammencing with Semina llN),rol Division Jofine Reines, end PmfessionsCode)
SWIMMING POOL ELFCIRIC
vALUAItUN
or thin he in aminuthmefirmumd IM1e basis for lhealleged exempnbn. Any vichili or
Section 7031.5 byanyapplieam for a permit subjecd the applicant ins civil penalty of
7 (J
3•/ �, %1
OUTLETS -SWITCHES- I>I%TURPS
nil mom than rove hundred dollars ($50B.
❑ I,a,ownerofinepmp rry,mmyempryemwlthwagoauheinoleconlocnsation.
NEW RFS I01iNllALf:1.ECTR —SQ, FT.
,'TURIIS
TVVI'L CONSIR CI'ION
will do the work, and IM1e structure is not in rodnlorolfered for al 7044. Milne.,
and PonfieVinm Codc, Me Commucom'a [lanae Low does not apply to an owner of
property who builder improver themnn, end whodoes such work himaell m @rough his
nployces,pmvidedthauuchimpmvenentsemnwlntadsdoroffeMformle If.
awever,
OCC GROUP
Rli. NITS
TOTAL:
hothe building or improvement is sold wimmone yearof completion, the owner.
builder will have the burden of proving thxt he did clot build or improve for purpose of
- ;:�.1••' a
QTY. ''PLUMBING PERMIT'�,..5, (. ';��'F,'FEE
FLOOD ZONE
APN
Ic.1.
❑ I,armorerofihe Property, emexclurivelyconlnning withli«n,edcontnaton to
construct thpmjsa (Sar. 7044. Rusinms and Profeasions Code:) The Cmir—or'a
Licenm Lnwdoes not npply loan ownerof properywho hi ilds «improves thme m, end
PERMIT ISSUANCE
whocnmmct, Ln such projects .11h. ennrnemb.) firemen pammam a the Contractors
Umme I.W.
ALTER- DRAIN &VPN(-WAI'EDIDA)
FEESUMMARY
❑ I em escmp under Sec. , E & P C for this maim
RACK 19.0 W PROTECT. DEV ICE)
1
SANITARY Y _N
Owner Data
WORKMAN COMrFNSATIONDECLARATION
or
I hosiery affirm that I have. or certificate oremnm a w<I(Sm.39, 0. a ab C.) which
rken'Cnmpen,atinn Insurance ropy thereof (Sm. 3900. C.l which
coven allcminy Vn M1' iy
x 2i�3�_r
Policy N
DRAINS - FLOOR. HIIOP, ARI?A. .OND.
RECEIPT N
SCII00I. TAX Y N
RECEIIT N
FIXTURES - PER TRA!'
PARK FF.Ii YN
OAS-EA.RYSTIiM-1 INC.40N1.1iTS
REcrmrN
BIILDIN(IDIVISION PETS
Cmnpony a M8`�
GAS - EA. SYSTEM IiR A)1 rl �, I
IS.A ''K M,
t
❑ nified copy 1, here /y famished.
GREASEINDUSTRI, ASI .•IND!RCEPfOR
Certified copy is Filed with the tiny Imperious division.
CERTIPICAT E OF EXEMPTION TROM WORKERS*
GREASE TRAPISFEIi
'
COMPENSATION INSURANCE
(Ibis,«lion need not he completed ifthe permit is for one hundred dollars(SIM)
SEWER - SANITARY!TORME 2(X
lir lest.)
I certify that in the performance of the work For which this permit is issued, l rhxll
WATER If EATER W/VI T/E1XCTR
m to becomes sub*l to the Worked
am employ any Person is any manner an, or
Compemdionlawsaf Celifsmie. Data
WATER SYST11W RPAT ING
PAID
PAID
late Receipt
Applicmn
NOI ICE TO APPIACANT:ILuhcr making this Cmincme of Exemption, you shnnId
NEW RE9IDEN'rIAI. PLMR. SQ. 1T.
TOTAL:
bentne subject to the Worker's Compensation provi,lona of the Lalxs Coda, you must
Forthwith comply with such MovNion, i, permit shell he record! revoked.
Forthwithm th
RIMMING PEI?
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
1 hereby affirm that here Is e construction lending agency for the performance of
the work for which this permit is Issued (See .)Wl. Civ. C.)
TOTAL:
Fl, FMR IC FTEs
landers Name
QTY. MECHANICAL PERMIT '.FEE"
I'hUMRING FEE:nder,
laAndrea,
I cemy nett I have mad this application and .slate that the above information is
tr«L I agree in comply with all ciyend county nrddnmces and state laws mAlins to
FERMI'IISSUANCE '
MECHANICAL PEE
CONSTRUCTION 1'AX
building conitmction. and hemby amMriu mpmmnutive,af this city mater urym the
id nve-memonerl properly for inspection purp,tsrn.
-J
ALTER OR ADD TO MECII.
We) agree m Bove, inns If and keep ha lea nh M Cupertino ngnin.at
Ilebiliti juJgmnna, cases J penes whicway.. ago suoid City
AIR BANDUNG UNIT(IO;0.0 !CFM)
AIR HANDLING UNIT (OVER 10,000 CFM)
In [am eam AA of I BMI f !his Farm
Atka il.hm.
EXEAUS'I' i IOGDOVIDIlM)
PAID
Signarm of Applican erector I Dem
DMIING UNITGO 1(x1,(1(1(1 BTU)
IIA]ARUOUS MATERIALS DISCLOSURE
Data deceits
BEATING UNIT (OYER 100,00 9'I'U)
TOTAL:
Will the apFlicem or firms huilding occupant nom lir handle bsaarzra, material
m defined by the Cupertino Municipal Code, Chapter 9.12, and the Ileabb and Safety
VENTILATION PAN !SINGLE RISIDI
UANCF, DA 'E
Code. Section 255321gP
❑ Ya ❑ No
BOILER-COMPp11POR 1(0.1x10RTU) /
Will ghee Iicaner fulumbuilnin fuseequipment mJeviceswhichemil
pp g«ahem_
�tmaMom aim comominemn as defined by the flay Arta Air Onnlily Menngemea
ilidrinl
21993
SEP
BOILER-COMP(OVER 100.00n BTU)
NEWRESIDENTIAL MECII. SQ. R.
❑ yen No
I have man ole baanrmat, matemml.e reRaimtmOla setae iper rtte
liifry
UIQ
+ UT �
cmdmmiGalin&Sar,rtle,r255,5,2dvJ ani25sJs4n
C11y
m6.93
fasidtyfhe building Joe,nmcureatly Fars. board, that ithmy re,ier.. h
emulate of the or,imm,nd, which nun be net prior m iammes n! • Cenifiene of
Overpancy.
ISSUEDIII':
Ownamorroll imd agent Data
'I(OAI.:
OFFICE