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24929 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO B HM NU-ELEcfRICAL PERMITNO. APPLICATION/PERMIT PLUMBER;-MECHANICAL. A A (]n (� BUILDING DIVISION BUILDING PROJE4 J G JCT IDENI IFICATION G NIIWz�R�OS Se �V UNIt'# IDT# SANITARY NO. APPLICATION SUBMITTAL DME OW SNA P NE: CONTRACCIfI �r N LIC NO: L {♦V7Vw NIC CONTROL# ARCHI F. /ENGIN. LIC O', ADDRESq 6 ❑ CON PHONE C •Na�a b �,I QTY. ELECTRIC PERMIT zr UQjW BUILDING PERMIT INFO BLDG "Da"PERMIT ISSUANCE _N 1 El ❑ LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL ON IIPSCRI'ION qmz Ihereby ofrimaded lam liceroed undcrpmvisinnsofChap¢r9(commencing with �Uoo Section900(Ool Division Sof the Bu,mr,umd Professions Codamdmy license is in PANEM 1 , C full force and effect �B � � � © I 1a,ZW License ass �' Cl Lic.p UPT02W AMPS �I ,,<0- Date Cnnwctor 201-IOW AMPS z ONz; ARCHITF.CI'S DECLARATION r lOOR AREA S/SQ.Ff. O z—O I damI, OVER 1000 AMPS and my plans shall be used as public records. E t..Lo FW SIGNS ELECTRICAL ��• ••• � DATE �Q Licensed Professional OWNF.&BUILOHR DECLARATION SP[CIAL CIRCUIT/MISC. 0.OyF 1 hereby affirm that I um exempt from dte Contractor's License Law for the tn3aN following reason.(Section 9031.5,Business and Professions Code:Any city or county TEMP.METER OR POLI:INST. tS which d require a permit to construct,ghee improve,demolish,or repair any swcmm Y� priorto its issuance,also requires the applicant forsuch permitto file a signed statement POWER DEVICES p OK ]hit he is licensed pursuant o the provisions of the C'ontmctnr's License Low(Chapter cte 9(commencing with Section]000)of Division 3 of he Business and Profusions Code) SWIMMING POOL ELECTRIC VALUATION or that he is exempt herefrom and the basis for the alleged exemption.Any vurmionof OUTLETS-SWITCHES-FIXTURES 4 Section 9031.5 by any applicant for a permit subjects the applicant to a civil penalty of \ not unme,ft live hundred dollar,($500). . be p w ❑ Lasoterefthepropm erty,myemployees with wages nms stheirsolecompeation, NEW RESIDRNTIAL ELECTR 3 QFf. STORIES TYPE CONSTRUCTION 1 will do the work,and the structure is not intended or officoned!for sale(Sec.7044.Business and Professions Code:The Contractor's License Law does not apply an an owner of property win builds or improves thereon,and win does such work himselfor through his employees,providesdthatsachimprovementsarenothttendMorofferedforxale.Jr. OCC.GROUP RES.LINITIS however,the building or improvement is sold within oneyearofcompletion,the owner- Oi. builder will have the burden of proving that he did not build or improve for purpose of [ ❑ I,asnwnerrofthe property.amexclusively comromingwith licenseA conhucmrsm QTY. PLUMBING PERMIT FEL; NhOOD ZONC AI'N construct the project(Sec.TDM,Business and Professions Code:)The Contmetors License Law does not apply toanownerofpropenywhobuildsorimpmves thereon,and PERMIT ISSUANCE who controls far such projects withacommete(s)licensed pursuant tithe Cnntmcmr's License Law. ALTER (HA) FCC SUMMARY ❑ 1 am exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICE SANITARY Y N Owner Data RECEIPT N DRAINS-Fl.00R,ROOF,AREA,CONp. WORKMAN COMPENSATION DBCLARAT'ION SCII001.TAX Y N_ ❑ Ihercbyaffirmthat lhave rance anicamm�f cosent to py thenof(Semre,or. Lab C.)c which RECEIPT# Wmkcrs Compensation lnsurancemaunificd copy thereof(Sec.38W,Lab CJwhich FlXTURES-PIER TRAP PARK FEE YN covers all employee's under this permit. GAS-FA.SYSTEM- INC. GOTLEfS RECEIPT# Policy 0 BUILDING DIVISION FEES Company GAS-EA.SYSTHIM OVER 4(EA) PLANCHECK FEE ❑ Certified copy is hereby famished. ❑ Certified copy is riled with the city inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF 13XFMPTION FROM WORKERS' GRRASE'I'RAP SOILS FEE COMPENSATION INSURANCE (This soedonneodnot be completed ifthe permit is forone headrest dollars($100) SEWER-SANITARY-STORM EA.201FT. IiNERGY RIi or less.) I certify that in the performance of the work for which this permit is Named,l shall WATER IIEA'I ER W/VEN URLECTR am employ any person in any manner so as to become subject to the WorkersPAID z Compertatinnlawsof California. Date WNJERSYSTE•M/TREATING Date Receipt If Applicant 0 NOTICE TO APPLICANTI':If,after making this Cenificareof Exemption,you should N RW RESIDEN'T'IAL.PLMB. SQ.FT. TOTAL: ybecome subject to the Workers Compensation provisions of the Labor Code,you must � ? forthwith comply with such provisions or this Permit shall be deemed FR revnkol. BUILDING E LkI Q CONSTRUCTION LENDING AGENCY SEISMIC FBF, Z Ihechy affirm that there is a crnsmation lending agency for the Performance Of L) 0 the work for which this permit is issued(Sec.3091.Civ.C.) TOTAL: ELECTRIC FINE Isandet's Name PLUMBING IgiG F Lender's Address QTY. M.v CHANICALPERMIT PEE A "ittititN U I certify that I have read this application and store that the shove information i, ' context.l agree to comply with all city and county cninaaces and state laws relating to PERMIT ISSUANCE /i MIiCHANICAI.FEE lO buildingconstrumion,and hereby authorize representatives mfthis city to enter upon the CONSTRUCTION TAX L) 7 shove-mentioned progeny for inspection purposes. ALTER OR ADD TO MECII. F7 (We)ngreo to save,indemnify and keep harmless the City of Cupertino against liabilities,judgmrtnts,coxa wdexpc seswNclt may in any wayoccrue against said City AIR HANDLING UNI'I'(10 I 0,001 CPM) incur eog ft nmm IN qN-- AIRHANDLINGIT(OVER10,"CIM) Signature �� UN pplicant Con�ireemr 1 �D.Ic'� EXIIAUSTHOOD(W/DUC'1) PAID HAl RDOUS MATERIALS DISCLOSURE BEATING UNIT(TO 100,000 BTIU) Date Rcccipt N Will the applicant or future building occupant stow or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety I]RATING UNIT(OVER 100,000[11 U) 'TOTAL: Code,Section 25532(a)P 11 Y. ❑No VENTILATION FAN(SINGLE RPSID) Will the applicant nrfumrehuildingoccupant use equipment rdeviceswhich emit BOILER-COMP EHP OR 100,000 BTU) ISSUANCE DAT f hanudnus air contaminants as defined by the Bay Area Air Quality Management BOILER-COME(OVER 100,000 BTU) District? ❑ PAID Yes 11. No NEW RESIDENTIAL MIiCH. SQ.Ff. I have read the hazmdous materials requirements ander Chapter 6.95 of the •,aAR V 1 California Ileahh&Safety Code,Sections 25505,23533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the IN Q ccapam of the requirements which nnrsI be met prior to issmmce of a Cenilicate of Occupancy. Owner m inthoriaed agent Date O /� ISSUED BY: OFFICE CUPERTINO SANITARY DISTRICT SANTA CLARA COUNTY DISTRICT MANAGER-ENGINEER 20085 STEVENS CREEK BOULEVARD,BLDG.0 BOARD OF DIRECTORS MARK THOMAS ! CO. INC. CUPERTINO,CA 85014.2385 ROY M.RUSHTON.. PHONE MM)253-7071 . FAX(4OB)253-5173 WENDELL H.KERR,JR.,urn. DISTRICT COUNSEL CURTIS B.HARRISON PHILIP O. ASSAF OF DR.JOSEPH F.BROWN STURGIS. NESS. BRUNSELL A RICHARD A.FELLOWS SPERRY March 31, 1993 File: CuSD - MOP Building Department (Cupertino ) RECEIVED, Mr. Jerry Brager Building Department APR I City of Cupertino 10300 Torre Ave Lily OF C DEM OF. CUPERTINO Cupertino, CA 95014-3202 Re: Retail Building Remodel, 20387 Stevens Creek Blvd. , Cupertino "Over the Counter" (APN 316-26-090) Dear Mr. Brager: Based on the proposed improvements, as shown on the plan submitted to this office on March 31, 1993, no additional fees or permits are required by the. Cupertino Sanitary District. The condensate from any air conditioning equipment, surface water or irrigation water shall not be discharged to the sanitary sewer. Yours very truly, MARK THOMAS & CO. INC. District Manager-Engineer by Carl H. Beckham CHB:lw SUPPLYING SANITARY SEWERAGE SERVICES FOR: CITY OF CUPERTINO. PORTIONS OF THE CITIES OF SARATOGA. SUNNYVALE AND LOS ALTOS AND SURROUNDING UNINCORPORATED AREAS