28017 CPPLICANT TO ITY OF CU FILL IN
NO FORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
BUIL" PERMIT NO. 0
PLUMBIN MECII RIUAL.
BUILDING DIVISION APPLICATION/PERMIT fit'
F. ";BUILDING PR(JF,CT IDRNTIFICA'i ION.. .
17
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
UNIT# LOT If 71 �
OWNERS NAME: PHONE: CONI RACTOR'S NAMENO: N/C CONTROL»
ARCH]I EC /ENGINEER: ��
TLIC NO: ADDRESS E M ❑
FA .SLWK)'i
CONTACT: PHONE: 11c
° P#v .,f111, E3a9CRIYCRM ; ; T x '
yHUIIDINC"PERMIT INFO
� `'gA '-
$LDCs EL PLUMB MP.CII
PERMIT ISSUANCE / ♦I.alA/`.
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
cawz I hereby affirmthat i amlicensed underprovislons of Chapter9(commencing with JOB DESCRIPTION
�00 Section 7"h of Division 3 of the Business and Professions Code,and my license is in PANELS
ass'W full force and effect
G Z License Class Lie.#_-� IIP TO 200 AMPS • • `#`'\/Y •�r"r�V
rFii]y Uatc 5_tCuntractor ^ 201.I000AMPS
zc-74 ARCHITECTS DECLARATI N OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.IT.
OZ-0 I understand my plans shalt be used as public records.
Pm0SIGNS ELECTRICAL
,� Licensed Professional
�tYWV OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
OyF 1 hereby affirm that 1 am om exempt frthe Contractor's License Law for the
'30m followir,omeon.(Some.7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST.
�b m l which requires a permit to consumer,alter,improve,demolish,nr repair any imuctam
"sY� Prior to its issuance,also requires the applicant for such Permit o file a signed statement POWER DEVICES
y1 Q0 that he is licensed pursuant in the provisions of the Contractor's License Law(Chaptau _
C IyoS 9(commencing with Section 7")of Division 3 of the Business and professions Code) SWIMMING POOL ELECTRIC VALUATION
XW ern or that he is exempt therefrom and the basis for the alleged exemption.Ad's.)in ationf
�4O Section'/03LS by any upplicom fora pem
tit subjects the applicorn tnueivil penahy of TLEIS-SWITCHES-FIXTURES
notmore than five hundred dollars($5f0). 70
OyV�
—
❑
I.asowneroftheWoprly,ormyemployeeswithwagesmtheirsolecompensation, NEWRESIDENTIALELECTR _SQ.FT. STORIES TYPE CONSTRUCTION
y will dothework,and the structureis not intended reoffered forsale(Sec.7044,13usiness
and Professions Code The Contractor's License Law does nut apply 0 ad,owner of
propedy wh.b.ildaorimp...esdiduan.and whrdnessich work himselforthronghhis
own employees.provided neat suchimpmvements aremanotendedorofferedfarsale.If, OCC GROUP RES.UNITS
how egillhav l the burden
int ofprovn,that he(lidnot build ofImprovtion,purpose
of
builder will have the burden of proving that he(lid not build or improve for purpose of uto �-
sle., ;1111
#4Ab.
s ) fi JPLUMAING PERh1IT« r y{
❑ Ins he ,.ja,t(properly,,Business
Pogrn uC.licensed a +`- ,g -{£ ' f CEH*. PLDOD ZONE qpN
License
et the project(See]044,Business and Professions Code)The thenramadd
License Lawdt,s�ch pplymanownerofpvurs)who
sed pamimptothe thereon,andMIT ISSUANCE n /
whence Lacus f.rsuch projects whhacontma[or(e)liceneadpureuanuotha Cnn¢acmr'sALTER EA
License Law, <' ) = FEE SUMMARY
❑ I em exempt under Sec. ,B&PC for this reasonCK FLOW PROTECT.DEVICE. a 0111 STOP FEES
Owner Date SANITARY YN
AMS-FLOOR.ROOF,AREA,COND. RFCEIPI'#
WORKMANCO _�, ,., ' .m SCHOOLTAX YN_
❑ I hereby affirm that l have.; did
r�(c(nse:T!If-insure,macenificamofTURES-PER TRAP �' RECEIPT#Wirkers'Comperettion Insurance.,amdifi pyt reof(Sec.3800,Lab C.))which PARK FEE Ybawars all employee's under Nis permit. o C II I /\ I �. -1 INC.4 O LETS RECEIPT»
comp licy# BUILDING DIVISION FEES
Company I^� �' GAS-EA.9YS OVER4( ) PLANCHECK ME
Cl Certified cagy is hereby famished.
C3I /'1
Cenlfied copy is filed wit the city inspection divlsio fLJGRJASC&D fS,WASTE INTERCEPTOR GRADING FEE
CERTIFICATEOFEXEMPryQN FR MWOR ERS' G SOILS FEC
coMPENswTION7rt cE ATE
(This section neeJ no[be completed iftls�permi[ �ronehundreddollers E - AR ORM ' .2U(IFT. ENERGY FEE
or lees.) Ak
I comfy that in Ne perfomnana of[he woe fq��uch Wspe_[(,,nh,i�sis_ssuW,labe11 WATER IIEATER W/VF.Nb/�+1. CTR
not employ any person in any manner so as to bem'4"SLBjEEfT "' `` PAID
z Compensation laws of California. Date WATERSYSMIATRFATING Date Receipt
»
Applicant
z 0 NOTICE TO APPLICANT:If,ofter making this Certificate of Exemption,you should NEW RESIDENTIAL.PLMB. SQ.I,C "CONSTRU�JONTAX
TOTAL,:
� became subject to the Workers Compensation provisions of to Labor Code,you must
forthwith comply wit such Provisions or this permltshall be deemed revoked. E
Q CONSTRUCTIONLENDINGAGENCY
Vz I hereby affirm that is a construction lending agency for the performance of
O uhe work for which this penial is issued(See.3119],Civ.C) T �� E \ LO
Lenders Name `tel
Ow Laidler',Address Q7Y � ,� MPAHANICALPF3RMIT' I ' - {�FCFEE
U 1 cenify that 1 have lead this application end curve that to above mfornation rs r ¢ n: , u .,:. i .e , a
comet,i agree to comply with a 11 city and county ordinances and statelaws relatiug o PERMITISSUANCE LFEE
�! building construction,and hereby authorize representatives ofthie city toentero a b
U 7 aMve-mentioned property for inspection purposes. ALTER OR ADD TO MECH. ON TAX
rte— (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgmenis,costs andexpenses which may in any way accrue against said City AIR HAN DLING UNIT(TO 10,000 CFM)
in c
qucncc�ih t ft 'e permit
l.$; �, o 6�14.#r,� AIR HANDLING UNIT(OVER I L"CFM)
Sigmnure fApplieff on m, Onte `ILq EXHAUSTHOOD(W/DUCf) v
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Dote Receipt#
Will the applicam or future building occupant store or handle hazardous material
as defineal by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEATING"IT(OVER IBLOW BTI) TOTAL:
Code,Section 25532(a)P
❑Yes El No VENTILATION FAN(SINGLE RFSID)
BOILER-COMP(3HP OR IOO,UW BTU) ISSUANCE DATE
Will 1heepplicanlnefircurebullding occupant use equlpmentordavicee welch emit P p B
hazardous air contaminants m defined by the Bay Area Air Quality Management BOILER-COMP(OVER IIIU,000 BTU) M
Dlsirict9
❑Yes ❑No NEW RESIDENTIAL.MECH. SQ,PC
I have read the hazardous materials requirements under Chapter 6.95 of the �AY 1 'gg�
Culifomia Health&Safety Code,Sections 25505,25533 and 25534. I understand that
tithe building does not currently have atenanq that It lsmy responsibility to notify the
occupant of the examinants whmt W met prior t.issue.¢of a CeHEvua of Y
Occupancy.
Owner m anlhorized age- Date '
ISSUED BY:
ich m
OFFICE
LA r'+v
WM 405V97-0
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MAY 11 D
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BLDG. INSPECTION DEPARTIIEHI
Qe CITY OF CUPERTINO
nn nl4e a b q a,G�`-. ..�� +- ID
tuiid�g to w �'ange,^ es -
stns fi -
r�'��t f ,•E d`�5 n .` 3✓1� bran _f \ r , L '
ndOf°T RY �� S \ \ / ti [lam �� s Y DRAWING i JOB NAME: EUETTF CiL4SSON
! I have studied this sketch and complete)
r - t �' _ understand its contents. Arty changes or
additions will be billed as an extra. Z— 1Z3�53 tC7E DK_ G.tpuzct o 4�iU
SIGN: SCALE
&IFICE
\ . INTERNATIONAL
—`Z7��
F COP
DATE:Y I tF , ^� Perspective Drawings ars Artistic renderings and
APPROVALS DATE ITCi����VA
should not be considered as drawn to scams Because DRAWN
ICL UfF4k15
\- ` \ _ - - • ,.�/ of must distortion in forced perspective drawings and
cy�acED
possiWe flan charges these drawings should not be -
o .r ♦ considered contractual. REVISED
DESIGNER• niii � YJIt^15 1
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In v
lie,
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3A1 c.Ds f£4�v6 � F�dld�c� _ _ (S[FtJI• _
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KItt6EtJ = �mrmat; mtrOa! _ L60
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dice LAN CA - - - fFJ 6LL 4ECJ2U61etSk -
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aw.mra.4ae € arab. alat.>vSif -- � _ - - _ LiL ULW
C�rvarE��u�t��
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F•m.w ax,fr,.m -
Gf'l 4S t,JtcE 54 aL�
a.amF Frm. 46 cruse m.r
DRAWING Y JOB NAME: ELl�is�Tf k C�IdSSo r l .
- - - s3ocE .si�� - � M C� C`4"Ntr uoifsl vr� - - - - � _ 1 have studied this ketch and completely � .
- - _ _ - e�rU WKU t1v samara cows - - understand iq contents. Arty changes or e -
oma wi fdt y.Na so.K additions will be Watt as an extra. 2 a� ` Zz353 �tU RSIflC �r?. 1f?C�t3 Iib
t reolmcTre,J
SIGN: X15DC� -
SCALE INTERNATIONAL
8 - - - - - - - - - - - - - - - - - - - - - -
E _ DATE: ITCHEN&PAT
Perspective Drawings an Artistic reand
APPROVALS DATE
o - = should root scale.
t be considered an drawn to scala. BaBe dusa DaAwul kk.. I Fr sS
of visual distortion in forced perspective drawings and
- - - - - - - - - - - - - - - - - - - - - possible plan changes#was drawings should not be cr�acED
e
0
considered contractual. aEvSED L q DESIGNER 'IJ SD