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I 5 _ CITY OF CUPERTINO-BUILDING DIVISION Q� _ r,
u D� 2a Lk.Na APPLICATION I pthMIT v Ga�LF6�7Z
�"-ewe's Nere� • -- CATFfARY
1 Y - BUILDING-ELECTRICALpLUMBINGMDCIIAMCAL
,,R T BUILDING;
n/Ggi neer C614n nR A u5idll Ali, ly CF1� -p iTpti r„ YI NL_'b,IS
-11
Addms:40 e ( I '
PERMIT)SSUANCE #. ) LN ❑ ❑
LICENSED CONTRACTOR'S DECLARATION MPI3ANCESRESIDENML ,^ OR CF 'TIO-�,`CZ V4
Ihrrchy affirm that lam licensed under prwlslen.ofke.l.r C(aommrmc V`
IngwuhSeNon7lt0lgol Dlvlelonlo(Ihe Buelneeeend ProleealomC^de, Y PANELS
��e� e V
license la In full force and effect. ���jjj.���
Llcru.Claae Llr.P� LWJQ,2IDA
Dale Contractor 911._100DAMPS SO.Fr.FLOOR AREA $/SO.FT.
ARC"TE SDECLARATION OVER 1000 AMP5
y iun land 1 1 usrdu bllcrcmrd.. SIGNS ELECTRICAL
Lim o I
L� OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MISC
G owing yafOrmlhatlameaemptlmmthesa Cmur.and
LlCenx Lay city he TEMP.Mum OR POLE INST. •'sem -T�
IollOwingrrawlent on 70115,Buelnem end Pmferbn.Code:Any
repair
Im cove,demolish, pa
wnly whkh requlmaperMtlomrotruct.aper, P �r POWER DEVICES
nyetrucwrcpdortolt.lssuance,.lso rtqulm lhuppllanl(onuch Mt10 _
if...igned statement that he ls licensed pursuant to the Pmvi0ons of the yWU1MING FOOL F]-ECfRIC p�VALUAIIO%A
r Certractor',Licc.Law(Chapter9(commencingwllh Section 7000)Of Dlvi- �D/ O O c\ VI1
J don J orhe Bovine„and ProleabroCoda)Or that hels.aempt lherefrvnman� OUTLEISSWITCI IISfl7(NRFS ll
the fuels for the alleged exemption. Any violation of Stolon 70115 an TYPE CONSTRUCTION
'X appllcantfora perMtsubknelhe applkanl to,civil penalty^f fid more than NEW RESIDENTIAL ELECTR SQ'Pf' 91 RIES
Ilv�un1O nolo.hePr1.
0 I,a owner will
of Property,R or my employesr with wages a heir a01<
A comPcnsatlon,wllldothe work.and the structure lsran Intended Or, for «a O p RFS.IINTB
Lpd,&r.7dl Business and Proffered”Code:The Cee tractor a Llce Uw
does not ePPly t......er d pmpecty who LIZ Or/mpr rovided hat such -
�$^ whodceemchwork himnell Orhrwgh hlaownerdPlOO�yen,p T L:
Improvrmenb are not Intended or of/seed for Bale.11,howevep thebullding m
Improvcrrcnlls.old wllhin ormyearofcomplClbn,rhe owner-l,ullderwlll have 4,.y;.', (sLUMBI�G r�RM� ,ft "� AOD TPNE
1F",1 �rl�i',� {14 FI
tlRj rdenof Frew that he did not am aldudv,lor y mntrartrove for res ith lkeneed PERMIT ISSUANCE
u 1,as Owner Of 1h0 Property,
contractors 10 Construct Use pmlen(See.70dd,Busluess and Pin Parkes ode: ALTDLDRAIN 4 VFM-WATER(FN !'~
who c�',V,' t: ;k:FEC 9'UMMARY
The Contactor i License Law does not apply to f owner d r° •with a �o. I I build,or Improve. hereon,and who co.nN 1m eacense h p(okct BACK FLOW PROTGCT.DEVICE ..
cgB1[sa.,(,)licensed i u.uanl to the Contractor. Bk•P C for this raven SAMTARY
LJ 1 am caempt under Sec DRAINS FLOOR,ROOF,AREA.GOND. RECF]Pf II
Data IDOL TA%
WOR KMAN COMPENSATION DECLARATION FIX
NRFS PFR TRAPRFLFRcra
`.•�i h.aly allben that I have.certificate of consent to aell-,nererol". ' RK F� n_ N
ttdilirate of worken'CompensatIn.Insurance a.certlfled copy GAS EA.SYSTEM-I INCA OUTLETS RECPR7P_,_
33W,Lab C) CAS-EA.SYsTEhi-OVER{(EA) _ BUILDING DI VISIONFT:ES
Paltry P
Co. PLANCIIECK FEE ^'2
.Allied copy lshettby furnished. GRGSE/INDUSTRL WASTE INTPRCQ'lOR
OCertmed copy ls filed with live city inspection division. GREAsETRAP PAID
CT.RTIFTCATE OF EXEMMION FROM WORKERS' Date Real I
COMPENSATION INSURANCE SEWER-SANITARY-STORM E"ReFE ENERGY FEE Y_ N_
(rhl..dlonneed fid be Completed 11 the permit ls for One hundred doll.. WATTRIIFATIAW/VENT/EL`CTR
Bil W)or leo)
I molly hat N the Performance or the work rot which this permit 1,nlssuri. WATER PAID
I shall fid employ any person In any norm er.o.s to become sub 1m the Data RCecl IR
Worker COmPr --Ibm Laws of Cdllmel"Date NEW RESIDENTIAL PLMEL SQFE
I Z AppBa^t__ TOTAL_
NOTICE TO APPLICANT:If,.Rer making"Ced'"caue^foes of the
Lata �� •w,
0 sh,uldbe..subFdlolheWorkersCompra""I"PmvlelomolheLabor ��RI��r•
w Gdgyeumo.tl.ohwlthmmplyMthmchp.o L,l nsorthlsperMtehallbe SEISMICFEE -'t-
• j deemed revoked. ELECTRIC FEE
J
CONSTRUCTION his ON LVd DING AGFN�Y TOTAL'
I hescby affirm that there ls•construction lending agbnq for the Perform PLUMBING PEE
j C Z sere Of the work(.1 which this permit is Issued(Sec.3097,C1vC.) Q7'i! ; I'MECFIAN� ALyP�1�MIT }r""�"a�lx E%�l MECHANICAL FEE
O tender's Name
):• I.ceder.AddressFEES PAID:
L U 1crdifytk'.tl have read tole applkatlnn and Artethatthe elmve Informal- PERMIT ISSUANCE
W lscurren.lagree tocomply with dl^editheRb Cmrt„oyr!e rcu^c madilveet1 laws
olhb ALTT3(OR ADD 10MIiCH. Dore RCCCIp14
(I• rA.0ng lm building construction,. Y'
~ W rvy to rnterupon the abovementlonedpp perry for Inspection purports. SUBTOTAL:
- Z (We)agrer in vr,,.dc.Ify.ed keeph.mlea the e.nyity of Cupertino AIR IIANDLING UNIT U010,000CFM).
D _ agewillsbllllla,Ndgmenl.,met.sedeapenseawhlchmay In myway.come DDo el'nb CONSTRUCTION TAX
against uld Clty In co^anprena of the granting of this Permit. AIR HANDI)NG UNIT(OV ED 10,
CONSTRUCTION TAX PAID:
Data EXITAUSr HO
OO (W/DICT)
synsterrel Appuanl/COntrecter RDEDI IN t
11 A TAR DOUS MAT FR IALS UISCLOSU RE I MATING UNIT(TO I W,WO BTL) DR(C
Will hr.ppllanlur f.t."bulldl^gg occupant 11.1.or hand havAoua __ TOTAL!
mamrlal.e defined M1y the CuPerttne Mu nirtP.ICcdr,Chep'.9.12.ocihr I IPATING UNIT(OVER 100,000 BTU)
I i,.Ilh and S,
Yee ley Code Secton 755374)7 VNntA1ION FAN(SINCLF RESID) ISSUANCEDATE
tlnleU�eNu1p"r rdevices
wV' emtharJnmdr Co�mlnsndefined by the Bay Are Air
001LERCOMPO11PORI0B0WBTVT ^-/ IP
AM, ;y hlanagenvmt Dist rid? 000 ON)
C -J,res rl No DOILER-COMP(OVIA 1001 r�O
I lave rr.d he have un ma1<rlab requlrtmcnb7ul and Z5p5Jf6B5 of r- V 199 1.
the C.11fomlalt'.1t Sally Cod.,Scciloru2550S, that 11lsm NEW itI!SIOFNIIAi.MCU i. SO Ff. - 1
u!de.nndtlui llhe bulldingdoa Out currently have.tcmel, y far ., l/`rV,Y✓-�-�
r.url.b Oy to ndlly the Occupant dl Fancy. rcranlewhkh.$I be met
Prhuto LrwncedaCedlfkale olOm,panCy.
f ISSl1F.D 0Y:
(honer or aothurbed agent
Data WIAI. -_may