25212to
AI'1'LICAW1 10 DILL. HI HI1011111A 11011 Vv IJ1IJJJ If LJ) LII IL.;. - U:;_- UAILL VIA II IPGIA ONLY LJ eL VN
- ----_. --------- __._.. `. -__- - _-_--IItBLrll:r:.r I,T:CtIMCdL -
( I I Y Ulr? CUP RTINU /Y Ia I'I,I I. /Y,I,r(, MLI, 1'LIIn1111NO-nICUTANICAI,
IIHILOINI: DIVISION RIIILDINGPROJCC I IDGNTIFICAIIOr
I'GIRMIT NO.
F
' 25211
11UII.IIINUAI ,R ES,S:
SANII'ARYNO, APPLICATION SUBMIT! Al. DA'
/ M `V `_ ` S C—P-4 UNIT LOT
IVVJ
NIC CONIROLX
❑ "Y'� ti X
\r,J Vy1:lES NAhII:
WISNA/tDl,IC NO:
a YMIi'/<�. Y �'�
MICU II( III'NCINI ru: I.IC Nrn
1(:y' A �/-- ..
U,.V✓
(aN rncr: \�^ �.
��.,
LJ L
Q1 -Y.
t
L,ECLRICPERMI PHH"pLDa
I`rRhlW SSCA ' !
HUILDING PERMIT INFO
ELECT .UMIt
r 11
LIC'CNSP.n CnIlORACHORS OI!CLARAI ION
vidun ,nen
'Ihcrdrynlfinn Jen Bun, HIreled nrdrr pa, =nf Charter 9(11 ing will,
AI'I'LIANC S RESID •N'
_
)R DCSC IPTION
r NO
OPgA `S
201 It
tit 1'S
lal
Scnlon]Ixxp of Uivi=inn dnf 1111 131.1111111 011,1 rmf dnnn CnJc, nnA In,, llrcmrl. in
hnllrnmenndrl'fm1.
Llcn„a UI: n= LT— Lic. X
❑:nr C-• f Cnnlrncrnr=ARA
ARCIII'II CIS OFO
I rod"lland n,y pInn, e1m116e r1od n= p
SQ, Fr. FLOOR ARCA
VSQ. Fr.
Sir N.
ECB' CAI,
� �
,
jLiarrr,nl Pnd'rminn'II
S OWNER BUILDER DIX LARANON
�_ I herrhy nfririn Bill I ren eaen,rt rrnm the Cnntrnnni, Li,,rse Lnw for t e
SPC 111. CIIRC'UII/MISE. 1
I 17 MET ER Oil POUR INST.
L,Iliru ingm n(Sm9inn]n)Ly,linelnr<= Ind Pmfc=rinn, Cmle Am,,hynr v pity
( oblrh rcgninry n ill la..nndrnrl, nhec Invr, dcnudlxh, nn rq,dB In fin,
pr'? Intxie Prnnilm
Ill nrrgnirr"<Ihrnprlienh fret, n(Chrl"
-
I'01VF,R DI(VICILS
j-
LBit,ien"Trill
III
Bran hr Ill inadll'S"'nnntlm)ofC=inn.nflhr O,nanchn(, Ll
C
Iv.n..nw(Chsplrr
e 9(rnnmmuring wish tirrBmr 70m) of felt, for)oflhellnsinOnpli l.Any lieT l of
nrllr:lrhrl=r.rn,l rny"'pnrnalr t the enfi,farl lelllrprd cnanptim,.Aoyvinlnlion of
$rcrinBJWISeY mry npplicnth..Gpcnnil ml,jcd, the nPPlicmn lnncivil prnnlly of
r; 11111 marc rem, Ivc hnndrnl Aullnrf (SS(q).
� rcnwnvrnflpe npor n,Idr(S,,r ron,perra
❑ "rake.
—
SNIMMIN(1 POOh IiLGC'IRIC
VALUATION +
1 O
111.1515-SWIICIIGS-FIX1URf:S
NIr.W RI;SIDIiNT1A1. CLI:CTR S FT.
Q
STORIES
'1 YI'r CONSIIRUC'llOi
unonnon ol,nyerInrnfF
x911 d,r rhe wnd, an111"'I nruBrr ix 11111 htivNlr,l nntlfarnl fm,alr Ltim. 111Jd, Ilnnlnr„
in,,,
nJ Ile& n 04, the Cowl -I'll,, 1111 '1,, Lnw dor, nor :q,ly In nn of
properly% in hnilik nr inrrrne,lhmrnr, end will) duce snch wahn
l k lm r1o1n..10ti,
mnpinym,,providoltenuimeln,Frnvanrmsure nntinlrndrJ l)roffcrOl for,nln If,
OCC. CROUP
RESUNIIS -
en.c r. Thr hallA np or impo,ve cap,nidmolocne yennrenn,Plcti9n,Iho uwnrr-
I I I,, will l,me,er I I,n of rrovin, Ihnl he did nor heild or impmve for prnFe,O.f
T
QTY.
PLUMOINGPERMIT ;7 '' Pt13
wJr).
❑ Ln,n,rnrrnnlrr p,,I,rny,nm<,rnn,imdy rmm�nrnnp wm, urrn,emm�hnrmnm
I1.000ZON1!
MIN
nr,nnrl Ihr prniod (See, IDJd, In=inr-„ pled Prrfr,don, 00,) 'Ihr Cnntrnnor,
PliIt MII'LS.SOANCLr
l.nwdr,ry nor apply mlrrnwum afpn,rrny wlrverrll:ly ar innpnwre dmr<ngnml
,,ircna
o9nnonr I,—wo,for xud+pmjrrB,wilharnno-:mon{gllrrn,rvlpnc,n:mnnthe ConhncmF,
1 Icrnw Lnv.
ALTER -DRAIN AVPNT.WA1RRFA /^
( )
r . •.,U '
PEHSUMMARY'
[I I inn ,.rnrrr nndrr Scc. , 11 h P C for tlri, er,m,
RACK FLOW PROI'rCT. DEVICE
SID VVE
SANITARY Y N
RCCCIff
Owner Dam
DRAINS- FLOOR. ROOF, AREACOND.
WORKMAN COMPENSATION DECLARATION
❑ Ihmaey nl Bmnem l have a ern 0role of I on,enua self inmre, or a Roti fcale of
Well ... ('..o..lillian lnananrenrnrolihcAoopy Bhmrnff5rc. ix(XI, Lae C.)weirh
cnvrrsnll rnploycl, anderlhi, lrnni(.
SCIIOOLTAX Y__N
RrG1iI1'rp
19X'rURFS-PIIR TRAP
_
PARK FITC Y__N
RECLIP JI
(IAS" CA.SYS'IVIU111,117.4OUILCTS
BUILDING DIVISION ICES
GAS . EA, SYS 'I PIT OVER AICA)
PLANCIIRCK FCR
(i'r1i11rJ ropy is hrrdp Inrni=hrd.
vL ('anilird ropy i, Ilial will the oily Ion divi.dnrr,
ORI!ASI'/INDIIS'I'RI.WASTEINIIiRCITI'TOR
GRADING FEC
07111 (FICA I IT OI EXUMP'I'ION I' ROM WORKERS'
COMPIIN.SA ZION INSURANCE
GREASE IRM'
SOILS FEE
(Ibis verlinn nerd nor he r spieled i ft he pennil i, for mre hundred dollies 1$ l nn)
Ic".)
SEWER "SAN] TARY-S FORM EA. 200F,
ENERGY 1
�.w•.
Ir,ffy Bell in lire P,ifnnn:nwrnI the work Ile MJoh lei, pc.... it i.v ia.rcd, 1,101
WA ITR I II!AICR WHEN r/rrrCrR
Inn <n...loy nny prr.on In nary nemnm In m h+ firronre ,rnlfcrl In Irr Wnrlevel
('oop,rr..all nn l:u,nf('r?B.... r. D;nc
Algdir°°t
PAID
Unle Rc<��_
�M
WAIER.SYSIRM/IRRAI'ING
NOIICC"IOAPPLI('ANT: IL nOcr mnkinp Ibis COtiOc,m of li,anp,inn, ynv,InnrlJ
Ir ne.erl,JrdmtheW... kcr', Cnrn rr,all.. .... .=im,eof Ohl, L.I ICorr, yon Bmml
NEW RP.51DIiN'IIAI, PLMI1. SQ, Fr,
InIAL
BUILDING FIEF,
fin dnvilh cnonply wiBh finch prnvi,ion, nr lel, pennil shill he deaoalr<voked.
(ffINS I'R11(II ION LfiNO1N0 AN,NCY
SEISMIC FCC
Ihr¢hy ufrnm rhul There
1iI,mmullnp nrfnm¢c of
Poi,aned (Soc. 3197, Ci,,. C.)
LrllTell Nall,r
RCIRIChr,mlrnroOl=pevJr
IR!B
PLUMBING PEC
I�
Irn1,,,Add:e,=
QTY.
MECHANICAL PERMIT .'pHH
rrrliry Brnl I Immo rmd Bhi.. nppll<:ninrr 11111 xmlc Iha1 Jm rinwr ioron..;.If iv
—
PI REMIT ISSUANCIi ✓'
MECIIANICAI, PEC
all. Inprm In co.....ly wiOnnllrhy nn I r t,ordinm¢e,nud,eue lows r<I:ninp us
I,nd.inpee"I uarinn,mrdhe'd,ritill i<e,pre enlellve, nrIhl,lily n,r„rerBryn, IIle
nhavmnmminnnl pn,Perly rnr inq+mlim, pnrpn=ee
nl.l'IiN OR A OO TO M ECII. !^
Vb
CONSTRUCTION TAX
(We) ngrri, m rrrv<, indan..ify mrd kerp Irnrml<,x the city nr Cnprnien npnin,t
lieeiliric,, judpamnm. coir, n Irsarnmawhidunny in nny wry nrrne."fill" aid City
A I R I IANDLI NO UNIT TO I o.mo CFM)
in anis lir rorrhnpmntinp Blit' PrnniI
��7v
1pnt7e
AIR HANDLING ON[[ (OVER B)BWCFM)
-
.tiipBmmrr of ApplicmNCmrhnclor
C%IIAUSi Il0001W/DUCq
—
PAID
HEA I TNI r(rO InRBW BOB
Date RoO,IFtp
IIA$ARDOUS MAILRIM.S DISCLO.SUld;
Will lee a,,Fh,:ndm home huildinpnn'apnnr,lorenr In Ile hm:nrinnsn rtainl
u, drliar I by lire O',,Iiun MnnrI,ipal Prxle, Cepnrr 9. 17. nn I the l lruldr n lS:drly
I'wlr, Srcdanl :5512(:..)7
IIrA'I I NO DNI I'(OV Fit 100.I0110'I[I)
VCN'I'II.APION PAN (SINGLE RRSID)
F1(�f
1'r, ❑ Nn
14ill Bhr lrpplirurnm fnurrehvilAinp 9n'np:nnm:c cglBlpnrcm nnlrrlra rvlricb cnlil
Room Jrrm nlr rnnmminnm, Bn AerneA by Ill, Bay Arc, A'n Qnn[it, Mrrmprmnd
ROIIkaEC'OMI'plIPUR 10(1,111111 R'rUl
ISSUTA DAT
/$
\
pal LliN"COMI'(OVlilt 1001000RIC)F
ri ❑Na
1993
NEWRFSIDRNi'IALMECIL. SQ, IT.
;nd
1 Lave lend nor Imran Jon, n,:dill,a 5101,Ile I25'ilI noA,5 Clr.gnrr 1..95 nl the
[nde. SrdionaJ..... }5511 :urd 25514 Innda,hnnl nun
AUGKit O
if 111, I Infrly
Il dm lmilAinp. .....olc....1,o h:wrmm�:vr(ninl ill, Buy 'u"I ,l bililymin9iify nor
vgnnBl or lie rnpreonnnv whldr mins In � Bnr1 pri n e, hm:nur of a ('ref lirme nr
( L�L'111ju
tall C I.Ir liUi
—_
BY: v ���• 1
O,�nrn in Ord,
t,l.: ISSURD
lll'1-Ii`f:_ _
APPLICANT TO FILL IN INFORMATIOV WITHIN RED LINES -USE BALL POINT PEN ONLY 8' Zl' V AJ
CITY OF CUPERTINO Buu,DIrvG . ELLU I 1CAL
APPLICATION/PERMIT PLUMBING -MECHANICAL
]BUILDING DIVISION BUILDING PROJECT IDEA I IPICATION
FERMI NO.
�i C �i eI �i
G J G 1 G
BUILDINGA(RESS: ��
xIV/y��Y. 2 UNIT It LOTH
SANITARY NO.
APPLICA'DON SUBMITTAL DA'Z'E
VVV
W ERS NAME: /� ONE::
��./.
Y�
CO CIOk'S NAM TIC NO:
��I
N/C
❑
CGNTRGI.M
,RCH ELUENGINEIiR: LIC NO.
��
'ONTACI':
(�.•\7
QTY ECPRIC PERMI PEE
BUILDING PERMIT INFO
BLDG ELECT UMB i H
QO ��
PFRMIPTSSUA
nmz
0
Z W
mQy
F-yZ
OZ - C
LICENSED CONTRACTOR'S DECLARATION
IM1creby affirm thou am licensed untlerprovisionxof Chepter9(commencing with
Section fDivision 3af the Business and Professions Code, and my license
full forcerceand eeffect.
License Class Lie. a
Date Corruptor
APPLIANC RESID M
p N
O 200 A 5
201 I
O PS
)p pESC IPE'ION
ARCHITECTSDECLARATION
1 understand my plans shall be used as public records.
SQ. FT. FLODR AREA
$/SQ. FT.
SI N E CAI.
qqmYt�.4
Licensed Professional
is Q
OWNER -BUILDER DECLARATION
1 hereby of rat that 1 an exempt from the Contractors License Law far e
YPFVI L CIRCUIT/MISC, 1
TEM MEER OR POLE INST.
fl3arn
N}�
6CC Op
Xe�
W _,y
tKQ
W-0
y3—
follawingreasnn.(Section 7031.5, Business and Professions Code:A^ycit,mmumy
which retainers permit to construct, slow, m
improve, deolish, of repair any structure
prior in its issuance, also requites the applicant for such permit to file asigned statement
the, he is lict,mrdpunuum m the provisions fthe Contractors Liomse Liov(Chapter
9(manamm6ng with Section IIl00)of Division 3o1fthe Business and Professions Code)
or that baspennotortheallegedexempnt to Any violation of
exempt.1yan applicrefrom ant for
Section 703
Section?0315 by any applicant fora permit subjects the applicant macivil pennluy of
nt mom than five hundred dollars ($500).
❑ 1,asownerofthepropery,ormyemployeeswitbwageaustheitaolecompensutimv,
will dothework, Business
is
POWER DEVICES
SWIMMING POOI. ELEC'T'RIC
VALUATION
'1.ErS-SWITCHES-FIXTURES
NEWRESIDPNT3ALELCCIR _SQ.FT.
STORIES
TYPE CONSTRUCTION
and omm
ns Code: The Contmc
Coale: he CommitteesLicense
License Law does not apply tom owner of
Lip, does of Plly town
ds
ort, wh is
add
such
an.
propemploy b,pmvir ffiatssthimpmvemenma mount wdr oroseemdfro le.I,
wn employees, provided mm such improvements sere not intended oraffered forsale. If,
OCC GROUT'
RES. UNITS
T
bwo,ukle, ,mebve hegoriarp en.1'p evrt
pidishathwithin oneyam of improve fortlu,som of
builder will have the burden of proving that he did tat build or improv<for purynu of
QTY. PLUMBING PERMIT
'
ole.).
❑ I,mowner ofthe property, am exclusively contracting with licensed eontremorsm
� rf E
KI
At sl
construct the project (Sm. 7044, Business and Professions CWe:) The Contractor's
hiceraeiaw Voce not apply to nn ownerofpmpery who bulldn or improves t"mon.,end
t `
PERMIT ISSUANCE
who contracts fix such majmts with ammunitions) licensed purxuanuothe Commctar's
License Law.
ALTER - DRAIN & VENT - WATER (HA) /
y
❑ lam exempt under Sec. , B & PC far this reason
BACK FLOW PROTECT, DEVICE
gA NR1 R1� N
RECEIPT#
Owner Date
GRAINS - FLOOR, ROLE, ARCA, COND.
WORKMAN COMPENSATION DECLARATION
,❑ I hereby affirm that l have a certificate ofcomm�t to self-insum, or a certificate of
Workers'Compensmlon lnmrumceora modified copy thoomf(Sec.7gW,Leb CJ which
SCII001. TAX YN
R[CEIPrp
FIXTURES-PE,R'I'RAP
PARK THE Y N
GAS - EA. SYSTEM -1 INC. 4OUTLEI'S
coversemployee's
all under this permit.
,cy N
RECEIPT' p
BUILDING DIVISION FF is
o ra ^y
GAS - EA. SYSTEM -OVER 4 (EA)
PLANCHECK FEE
Certified copy is hereby famished.
GRHASFIINDUS'I'RL WASTE INTERCEPTOR
GRADING PER.
Cer6fed copy is filed with the city inspection division.
CERTIIBCAT'I! OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
GREASE'I RAP
SOILS FEE
SEWER - SANITARY - STORM EA. 2(1
ENERGY FEE
(This section need not be completed ifthe permit is for one hundred dollars ($Elf)
m Tess.)
WATER HEATER W/VENT/ELECIR
PAID tp
I certify that in theperfortnsinceofthe work for which this permit is issued, I shall
not employ any perwm in any manner so as to hecmmt subject to the Workers
C) z
z 0
r V1
Ciari'mationlawsof Califomia. Dara
Applicant
NOTICE TO APPLICANT:If. afar, making this Cenificeteof Exemption, y..should
become subject to the Workers Compensaion provisions of the Labor Code, you must
WATER SYSTEM/TREATING
NEW RESIDENTIAL PLMIL SQ. FT.
Du¢ Recei 7
'TOTAL:
lorhwitb comply with such provisions or this permit shell he deemed revoked.
BUILDING FEE. —t
SEISMIC FEE
0.Q
CONSTRUCTION LENDING AGENCY
Z
U O
0
IM1creby affirm that hem is a construchonkriding agency for the Performance of
the work for which this permit is issued (Sm. 3097, Civ. CJ
Lenders Name
FlELTRIC FI?L•
Lemlers Address
QT'Y. MECIIANICALPERMI'r FEE
PLUMBING FEE
I cerhfy that 1 have read this application and sure that the abova infornminn is
correct. l agree m comply with all city and county ordinances and state Taws relntingm
huilding<onshuction and hereby authorize upresentativesafthis city to enter upon the
ahove-mentioned properly for inspection purposes.
U
U
7" a
U Z
MfCE IANICAL FEE Is'
PEkMIT ISSUANCE !
AL'T'ER OR ADD TO MUCH.
CONSTRUCTION TAX
(We) agree to save, indemnify and keep harmless the City of Cupertino against
Iiabilities,judgnmms,consand expenses which may in any wit,mcme".last said City
AIR HANDLING UNIT (TO 10,000 CPM)
in e of the gmating of I permit.
i 91,
AIR HANDLING UNR(OVER 10,0110CFM)
Signature of Applicant/Contractor Date
EXI IAUST HOOD(WNUCI)
PAID
HEATING UNIT (TO 100.000 BTU)
I IAZARDOUS MATERIALS DISCLOSUR'
Date Receiptk
Will the upplicum or fmure building occupant stow or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
T Al,
HEATING UNI 'p(OVER 100,1100 BTU)
Code, Section 25532(e)?
13 Yes ❑ No
VENTILATION PAN (SINGLE. RESID)
Will the applicantbuilding u Air
BOILER - COMP (3HP OR 100,000 BTU)
ISSUANCE DATE
PAID
BOILER -COMP (OVEN 100,0110 BTU)
conca contaminants
hazadous air mmeminants m defined by the Buy Arcu Air Quality Management
s by the Bay A Quality Muragennom
District?
r W
❑ Yes ❑ No
!1 .OO tI
NEW RESIDENTIAL MECH.—SQ. Pf,
I have mai the hazardous materials requirement under Chapter 6.95 of the
.L J
N 1��Q
AUG
California Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that
if the building does not currently have a mount, that it is my msponsibility to notify the
Cl 1',I, Ur Qul'
occupant of the requlremmts which most M met prior to issuance of a Certificate or
Occupant,
I^or,
ISSUED BY:
Owner orauthorized agmt Dem
T L:
OFFICE