26414 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO HUI LI1 N�-KLLC I R[CAL PERMITNO.
I1UILDI!NG DIVISION APPLICATION/PERMIT PLUMB;NG.MECHANICAL
-TF
BUILDINGPROJECTuHREvrIFIFA ON 26414
BUILDINGADDRESS: SANITARY NO, APPLICATI N SUE MITTAI,DATE
UNIT# LOT#
146
LACTOR S NAME. IICND NIC CONTROL#
RES,
ARC]I1TFCT/FNGINIdoC. LICNO: �3+
CONTACT i PHONE: ELECT RIC PERMIT' FEE BUILDING PFRMITINFO
"'Ey ELECT PLUMB MUCH
PERMIT PSSU�C[i
LICENSED CONTRACTORS DECLARATION APPLIANCES-RESIDENTIAL KEI DpjCqIPG0N
0=z I hereby affirm that I con fircused ander provisionsof0hapterr)(commencing with
�02 Section 700(h),dDishuo.3.f the Has,.
res,and Pordessams(;We, it my license ban PANELS &ynXeq
UP TO 200 AMPS
MPS
72 W A
SQ.ptr�FLOOR AREA TO.
ARCHITECICS DECLAIIIiIii" OVFR I"AMPS I;/SQ.
load,,
Z-0
pt"i-ec; I SIGNS ELECTRICAL
<x Licensed Professional
%= OWNER-BUTLDER DECLARAI ION SPECIAL CIRCUITIMISC.
N Hu I hereby aff=that I
EI- sun exempt from the Contractor's Licers,Law for the —
following mason.(Sectioni Businessand Professions Code:Any city occounty TEMP.IM FR OR PEOLE INST.
which requires a permit in comintict,idar,improve,deralish,or repair any sunicatem, —
�W�7 prior to its issuance,also requires the applicant ficirsuch Forea to file a signed statement POWER DEVICES
We5�0 that he is licensed pursuent to the Provisions of the Communes License Law(Chapter —
9(cmicamoca,with Sciahat 70m)of Diemen 3of the Btisimes,and ProRoicas C...lit SWIMMING POOL ELECTRIC VALUA ON
orihat he is exempt therefrom and de basis for the alleged exemption.Any violation of —
OUTI-17S.SWITCHES-Fim/rs
0 I.mownerofihepro�ny,ormyemployetswi�wU�uiheirsolecom�nsation, NEWRESIDFNTIALELL SQ.ff. STORIES IYPECONSTRU ION
and VoifirSidilas Code:The Contractor N License Law does not loply To an owner of i
RA90A1
ownernployces,provicial that such improvencentsime not intendedoroffered firsele.If, OCC,GROUP ITS,UNITS
builder will have the burden ofpsonving that he did no,build or improve for purpose,of
however,the thaddingor improvement is sold within one ycarrofcourpletion,the owner- TOTAL
suds.).
[] 1.as owneroftlic property.ancesclusively contracting with licensed contractors to Ql�y- Ir/h/I BINGPERMIT FEE APN
construct'he MEW(See 70,t4.Business and Prodfassics, -..... ....C..........s
License PERMITTSSUANCE
WhOcentructS ho such projects with accouractorris)licunissed moment in the Contractor's —— - -7-.
License Law. ALTER-DRAIN&VEDIT-WATER(EA) 17EESUMMARY
0 lannextumptunderSee.—,B&PC forthis mason BACK FLOW PROTECT.DEVICE OUTSIDE FEES
y SANITARY Y—N—
Owen- Due 'ECEIFT 4
WORKMAN COMPENSTTION—GLC�RATITO-N— DRAINS-FLOOR.ROOKARE�A,C�ND I 'STI�L Y—N—
EI ......c."Ficium of TIN RUCEIFF#
Workers'Cturperiatim finstrouracem.cuntified!cap,Elsocref(Sce.3800.Lab C.)which r1XTUfpgl PFR TRAP P Y.
(�Ovcrs all empil GAS-EA.SYSTEM-1 IN -11 1- 10 RECEIPT 9
101111?n&4 - n TIDING DIVISION FEES
clic,# C.4 OUTITE0%
C..,.Y— GAS-EA.SYSTFA-OVER4HV ""` �Au
0 Fa i
>R Ciatifed copy is Tied with the city inspection division. GRFASMNDUSI RL WASATHRcEFDAT
CERTIFICATE OF FEMPTION MOM WORKERS' GREASETRAP SOILS FILE
COMPENSA FION INSURANCE
(Hibiaelion need mis becompleted!if the Permit is for one hundred dollars LS I(A) SHAER-SANITARY-STORM PA.2041 FFIPRGY ITE
or lano.)
hall 11fpcial rmwo.1.1.,ij%i,occed,I Is.[] WATCH 1112ATE 1VREh1T/EjI.MrTR
I eirml,an, .(a lrmc,' PAID
Compensation L at sh WATERSYS MG7REATING Date Receipt#
zA—c".., s_s cll�
C N6TICETOAPj ANT afudaking this Certificate of Exemption,you Isould NEWRES ENGIALPI-MB.—SQ.17T. TOTAL
becoractubjec, EWor6e C� nsation�ovisionsofthel��rC�e.yos�.��t
to,a
furthwim comply with such provisions or this Permit shall be deemed evoked, BUILDING THE
CONSTRUCTION LENDING AGENCY SEISMIC FEE
z I hereby aftion that them is a construction lending Bgency for The Performance of
U o the work for which this Permit is issued(Sce.30?7,Cis,C.) TOTAL: ELECTRIC FEE
. Leader's Name
C) Lemb,r'sAddoess qryi ME61ANICALPERMIT FEE PLUMBING PEM
U I crunify that I have it'his application and state that the shove informal.is
correct. I agree to comply with all city and county ordinances and state laws relming to PERMIT ISSUANCE MIECIIA,NICALFEE
EA building construction,and hereby autherice representaticm ofthis city[center upon the — CONSTRUCTTONTAX
U z ALTER OR ADD TO MICH.
C Marc aguin't —
r,`cv`(zm -yh--CybY.f - mill AIR HANDLING UNIT(TO 10,00)CFM)
AIR HANDLING UNIT(OVEA TO."CFvU
Signar� lieso'Com"p D4m EXHAUST HOOD(WIDUCT) PAID
"It IIAZA11D SM US DISCLOSURE Iffik TING UNIT(TO PXL0p0 BTU) Lane Receipt#
Will the applicant or future occupant store or handle hatemadous material
as derated by the CtFaurvarm Marocipal Code.Chapter 9 12,and the Thai ad Safe,, HEATING UNGF(OVER 100.000,W) TOTALI i f--cy
Code,Section 25532m)l
Cl Yes 0 No VINTILATION PAN(SINGLY4 HSID)
Wilitheappliertmourfutumbuilding occupant use quipmeni orderices whichench BOILER-COMP(ITT coll BTU) ISSUANCE DATF
be,ardmis I,rimummusim,its defirad by the Bsy A.Am Quality Mebagcoricat P A I D
District? BOILER-COMP(0�4 Hit BTU)
0 Yc, 0 No NEW RESID F/L VERCIL-SQ'Mr. A
] have...d the luccourrous crimedid,on,itioureals order Chapter 6.95 of the JUN 0 1q!j14
Cali mor a ca Ili rifil coll herb�505.25533 and 255M.I understand that
"Um hufal id it cumen hav a tenant,that it is my responsibility to notify the CI I Y Ur vwrrn I jjqU
occup e re to conj is I must be met prim to issuance of a Certificate of
Occup nay
ney
Oucasum rcan�r H.d ,at Date TOTAL:I ISSUED BY: )N:L4!)IA-U CC I;K
I OFFICE
FROM Blase Const. ' - PHONE NO. 97?1948 May. 31 1994'-10:00RM P03
ATTACHMENT "A" . .
I
SMOKE DETECTOR CERTIFICATE OF COMPLIANCE
I understand and comply with Section 121 a of the Uniform Building Code.
Section 1210a requires when repairs are done to an It Occupancy, a smoke detector
will be Installed, mounted on the coiling or wall In each sleeping room and at a
point centrally located in the corridor or arca giving access to rooms used for
sleeping purposes. If existing smoke detectors comply, no now detector shall be
required.
I
I understand the above requirement and certify that we now have smoke detectors
installed and do comply.
•
ADDRESS:
PERMIT NO.: G ��
HOMA:OWNER SIGNATURE: - �✓ " ��a A, � �
DATE: 17-S- 9 -