24518APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BI U,DING - ELEC'TRICAL
BUILDING DIVISION APPIACATIONIPFRMIT PLUMBING - MECHANICAL
BUILDING PROJECTIDEN'TIEICATION
PERMIT NO.
24518_
BUILDING ADDRESS: �n'^ S � � Ma
37 At UNNITN LOTH
SANITARY NO.
APPLICATION SUBMITTAL DATE
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OWN SPT%R: s PHONE:
al.a't.lc O� {§'t Q. t �5- �62%'�Z %i
CON "HA C'I OR'S NAME: ('' _ .LNICpNO: -�!/
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CON '1'ROI.p
CHITI:CT/IiNGINI:I ?R: LIC NO:
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AppDr.$Ss "n � (n-�O TI%\�-qJ�Vp _Q`(-�
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CONTACT: PHONE:
GevrSe ell e. «� 204- 9�1 -29A -1
Q
ELECTRIC PERMIT
FEIi
Bl11LDINGPERMIMB
BLDG ELECT PLUMB MECIi
PERMIT ISSUANCE
/
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LICENSED CONTRACTOR'S DECLARATION
hereby of5ma Thal l am license) under provisions of Chapmf 9 (commencing with
APPLIANCES - RESIDENTIAL
LOB DESCRIPTION
Section 9( 100) of Division 3of the Bminessard Prod000ns Cade, and my license is in
fell force it c J
` C
License Class ��Lic. # J
PANELS
UP102MAMPS
%-
S/ G�
Date Continuum
201. 1" AMPS
ARCHITECTS Of LA ATI
1 turnaround my plans shall be used as public records.
OVER IOW AMPS
SQ, PT. FLOOR AREA
$/SQ. Ff.
SIGNS ELECTRICAL
! 5--(7 t7
Licensed Professional
OWNER-BUILDER
BUILD ER DECLARATION
SPECIAL CIRCUIT/MISC.
I am
I hereby affirm that I am exempt from The Contractors License Law for the
TEMP. METER OR POI.Ii INST.
following (Sermon 9o3ilmel, Business or county
Probations Coo,
wbicM1 rcyuires
c,ad... mambo to roves oc,o ini
p are sig any
alma improve, demnon
issuance. The person to aiderure
The applicant t a
prime s
POWER DEVICES
of the Co License a (CImenl
lcensed pursuant to the
that heislicensedth Section totheprovisionsof the the Business License Law (Chapter
9(commencing with Section llNNl)of Division 3rf the Business enJ rrofessionsCade)
SWIMMING POOL ELECT RTC
VALUATION
or that he is exempt Berefom and the basis for the alleged exemption. Any violation of
Section 9031.5 by any upplicnm f mli
ora Pat eubjerts the applicmo Ina civil penally of
67 O
7�(, j V
-
OUTLETS SWITCHES - FIXTURES
not more than live hundred dollars ($500).
❑ I, asnwneroftheproperty, ormyemployceswithwageeastheirsolecompnsation,
NEW RESIDENTIALELECIR_SQ, FT.
STORIES
TYPE CONSTRUCTION
will dolhework, and lhestraclureis not intended mothered outside (Sec. 9044.13miness
and Professions Cade: The Cotnmcmrs License Law does not apply to an owner of
popmty who buildsorbnpmvestharon,and who does such work himsidl m through his
employees, provided That such improvements me hot intended or offered for mic. If,
OCC. GROUP
RES. UNI'I'3
TOTAL:
/ S
however, the huiWingor improvement ssold within one year ofcompletion, the owner-
builder will have the burden of moving that be did not build m improve for propose of
QTY.
PLUMBING PERMIT
PIiE
ale.).
❑ I, ns owneroftbe property,ameaclusively crnvuctingwilh license) cnnbuaors to
n.00D ZONE
nPN
commotl the project (Sec. 71144, Business end Professions Codca The Contractor's
License law Arcs not apply In anownaofpopeny whobuildsorimproves thereon. and
PERMIT ISSUANCH
who contracts Ibrsuch projects with a contortions) licensed prsuannoThe Cummc4or's
License Law.
ALTI?R- DRAIN& ENT
' )
FEE SUMMARY
❑ 1 am exempt order Sec. , B & P C for this reason
BACK FLOW PROT :CT. , CH
n /1 -
OUTSIDE FLL.
Y RECEIPT'# N
Owner Date
DRAINS- FLOOR, OOP, ;A,COND' ✓� 6
WORKMAN COMPfiNSAT10NDECLARATION
Ira Con affirm that lhmnce or certificate eecrvenureof( ee inlaid.
Workers'Conrpansnlinn Insurance nraceni0od copy Thercnf(Sa.3gW,l . nh CJ which
F110IIIJAX Y N
RPCEIPfp
IlX'TfIRES - PERT AP _ -
w
V
A 'EG YN
GAS -FA. SYSTI? - C.40UTLEIB
Pahcy #II cropo ey /dryll myl, /_,/ ,
�/ ` l Y
RE EIPI'N
BUILDING DIVISION FE[5
.., n"
Croatian) I/� +��
GAS - 1?A. SYSTEM.OVER 4(HA)
PI.ANCI I DCK FEE
,jarCcnified copy is hereby famished.
GRF.ASEANDUSTR, WASTE INTERCEPTOR
GRADING PER
❑ Certifiul copy is fled with Thechy inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
GREASETRAP
SOILS FEE
SEWER - SANITARY - STORM HA. 200FT.
ENERGY FEE
(This seminn need na hecompleted ifthe permit is frrisda mrdreddollsrs( §loo)
or less.)
WATER HEATER W/VI?NT/ELHCTR
I ccnify that in the pedommrce ofthe work for which this permit is issued. )shall
ant employ any person in any manner so as o become subject to the Workers
PAID
WAI RR SYSTEM /TRFA1 'ING
Data Ittsseiptp
Compansationlawsof Celifonam. Data
Applicant
NOTICE TO APPLICANT: IL aRCr making this Carifcmcof Eachadon, yonuhould
NEW RESIDENTIAL PLMB. SQ. FT.
TOTAL:
become srbjat to the Worke /s Compermlion provisions nhrhe Labor Cade. you must
forthwith comply with such provisions or Ibis permit shall M1e deemed revoked.
BUILDING FEE
99• °`
CONSTRUCTION LENDING AGENCY
SHISMIC PEE
`6d
P O
I hereby affirm that then is u construction lendingagency for the peromicance nl'
TOTAL:
ELECTRIC FEE
L _ 00
tb #w ask for which This permit is issued (Sec. 3097, Ci, C.)
Lender's Name
Leader s Address
QTY.
MF.CIIANICAL PERMIT
FEE
PLUMBING FEE
1 ccnify that I have mad Bois application end start that the above infonnetime is
correct. I agree to comply wish all city and county ordinances and state laws rcbning to
PERMIT ISSUANCE
MIiCHANICAL
huildingconswctivir it herebyaohorimrepresemative.ofthis citymeater upon the
.hove - mentioned property for inspection proposes.
AUIBR OR ADD TO MECH.
CONSTRUCTION TAX
(We) agree o wve, indemnify and kap h.rmless The City of Cupertino against
liabilitieajudgments.costs.rd ex Pansy a man wayaccmeafida,lmid City
AIRHANDLING UNIT (TO IQWO CFM)
inccmiv, ncc Ibagmnti g II ( -nhi
�����
AIR HANDLING UNIT (OVER IILWO CPM)
Si reof pp MComrrefor / / Data
EXHAUST 11001)(WNUCq
rnLD
HEATING UNIT (TO I W,000 BTU)
Date Receipt#
IIAZARDOUS MATERIALS DISCLOSURE
Will The applicant or future building acupnnT more ar handle htuansos noeflid
tied by the Cupcnino Municipal Ca le, Chapter 9.12, and the Health and Safety
TING ON
HG TT (QVER IW,OW BTU)
IT
TOTAL:
/d/s -- GY
VP.NTILA'1'ION PAN (SINGLE RESID)
Crude. Section 25532(.)'
0 Yes NN.
Will Iheapplicientorfulnrebuilding occupanl meeyuipmentnrdeviceswhich emit
BOILER -COMP (31IP OR 100,000 B'llp
ISSUANCE DATE
BOILER - COMP (OVER ImROb0 BTU)
hazatdnus air contaminants as defined by the Bay Area Air Quality Management
District!
P
❑ Yes )$ZNo
NEW RESIDENTIAL MECH. SQ. FT.
L have teed the hazmdous materials mquiremetns under Chapter 6.95 of The
DEC 21992
California Health & Safety Code, Sections 25505, 25533 an 534. I understand that
ifthebuildingdrcsr toothilyhaveat lung lu 'spy ponsibilityto nmify The
Occupant of the memo w s ad p Of ranee of a Ertir ate nr
Occupmmy. / Z
�{
C11 Y VI- Cut'tn nlrV
T
ISSUED BY: rO Z A/170 — CC
Ow r muhnrimd ens Doc
TOTAL:
OFFICE