16754 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY
^ BUILDING PROJECTPERMIT NUMBER
BUILDING
APPLICATION $l PERMIT � � r
ADDRESS 1 C C'n
ADOREss BUILDING=ELECTRICAL—PLUMBING—MECHANICAL I U 5
_
-22638 'Stevens "Creek B1.
Y- OWrvr: 1 PLAN CHECK VALIDATION
N=UTnternational Baptist Ch . OTY. ELECTRIC PERMIT - FEE I
International ` r.ONE253-7590 rD
CONTRACTOR'S- - c� pp
NAME tJTLYJS.,SWITCHES-RECEP 10.00/1.00 W
George b k C No. • LIGHTING FIXTURES , 1400/1.00
_ u41
.. -- C,ONTRACTOR'sp APPLIANCES-RESIDENTIAL - ,4.00 4114.1%
ADDRESS : . O. BOX 64 (619) •� (
• elendale CA' 92342HONE 2 PANELS , 0,00 DAT of 'z44010101;
ARCIIITECrH K P -.-P.C.1NO.
oR.. yL PANELS (OVER 200 AMP) 20.00 Vf F
-� ENGINEER
LIC.ND. 8 aNsoRROlp is. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5,01) PERMIT VALIDATION
:Ib TEMP.METER OR POLE INS. • 20.00
APPLICANTS 22638 Stevens Creek Bl d , MOTORS ' SEE FEE SCH.
ADDRESS l
Cupertino . - CA 95014 SERVICE CHANGE 2400 J �,
O o LICENSED CON'IRACTONS DECLARATION W
a v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
y G w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
n.i Professions Cade,and my license is in full fo((c•upp I eCject.. - ,
Lice nsy ala¢ / Lie.Numbery�µ.4->i$.51 -
9 w r Da1cLL(-4-(_�.8—Contractor U Q I ❑ ❑ ❑.
BUILDING PERMIT
.¢ ¢ a OWN ERBUILDF.R DECLARATION
a ¢ a v - - INFORMATION. 30A ,' 1 hereby affirm that I am exempt from the Contractor's License • MISC.— REFER TC D
uo J Law far the following reason.(Sec.7031.5,Busicc,,md I'rol'essions - VALUATION $/FT.
H _ PERMIT ISSUANCE
•
Code.Any euros county which structure p riot t o eonsuance,also
- -
Q ¢ ¢ p improve,demolish,or repair any structure,prior to its issuance,alto ELEC.CONTR. LIC.NO. ELEC. '
aa
C ¢ requires the applicant for such permit to file o signed statement that TOTAL
¢ he is licensed ptvsuanl to the provisions of the Contractors License PERMIT TO
Law(Chapter 9(commencing with Section 7000)of Division 3 of the \ _ t '
1 4 o Business and Professions Code)or that he is exempt therefrom and O PLUMBING PERMIT '+ FEE,
¢ I-$., the basis for lire alleged exemptleft.Any violation oflection 7031.5 i \ STORIES TYPE CONSTR.
d3 — by any applicant(.,a permit subjects the upplicvnnoa civil pcnity TER-DRAIN&VENT-WATER X5.00 "
of not more than five hundy0 colors(S500),I: -
❑ I,as owner of the property,or my employees with wages as BA FLOW PROTECT.DEVI 0.0
their sole compensation,will do n1C work,and the structure is ml OCC.GROUP RES.UNITS
Intended or offered forkle (Sec. 7044, Business and Professions DflAI -FLOOR,ROOF,AREA,CON D.\.
Code:The Contractor's License Law does not apply to an owner of
property who builds o�.mproves thereon,and who does'such work FIXTUR PER TRAP 5.00 , SO.FT.FLOOR AREA TOTAL ACREAGE•
himself or through his own employees,provided eve such improve-
hulloing _ GAS-EA.S TEM-1INC.40UTLE \ _�
or iinprovemenl is sold within one year of completion,the owner- GAS'EA.SV EM-OV ER`4 (EA.)builder will have the burden of loaning thin hedid not huild or int- ` BUILDING USE
P
rove for purpose of sale.). INDUSTRIA TE INTER. Mn� ' ' RES. IND coN, PB Omer
O I,as owner of the properly,am exclusively contracting with -E]� �.0 ❑. ❑ ❑-
licensed contractors to construct tire project(Sec,7044,Business LAWN SPRINKLER -1 INC 5 V . '6 00 'ASSESSORS PARCEL NO.
and Professions Codc'.'The Contractors License Law dots not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS- VER 5(EA.) 1.00'
contracts for such projects with a contractoo( Ilcensod p.1...o a' SEWER-SANITARY-STD EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ I anoexempt under Seo—,BAP.C.for this WATER HEATER W/VENT 6.00 -
reason
Owner 11xte WATER SYSTEM 5.00
ACC:DATE ACC,FILE NO.
WORK ERS'COMPENiSA'I'ION-DECLARATION WATER TREATING EQUIP. 5.00
1 harchy affirm that 1 have a certificate of consent to sell-insure, ZONING ENG.SITE NO.
-- _ or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lah,C.l. -
Policy No. Company
0 0 Certified copy is hereby furnished. FIRE BPRINK ENERGY T90
Z Z ' ❑ Certified copy is filed with the city iuspcetiou division. - -
-.� 0 " Applicant - MISC.- _ REF• TO ORD. Y N� Y ❑ NE3
T ' PERMIT ISSUANCE '00
cc — CFR'I'IFICATE OF EXEMPTION 1'NOM WORKP-RS' FLOOD 20NE A.L.U.C.
LU -COMPI:NSATION INSURANCE PLG.CONTH. I.C.NO. PLG.
` 0" Ot (This action sstd not he conlplmeJ if lire pant il'is for ort ��(�f 4U)' V❑ .N CE] V ❑' NC]
Z hundred dollars(S 100)or less.) N
- - -
.0 O I-eertily that in the performance of'.me work for which this per- O MECHANICAL PERMIT FEE FEE SUMMARY
LL I— not is issued,I shall not employ any person in any manner so As to -
U bccomcsubjcct to the Woskers'CompcoS.lion Laws of California.
mayUILDING
, Date Applicant AlAL ER OR ADD TO MECH. 5.00
>--,wNOl'ICI: TO APPLICANT, If,after making this Certificne of fix-
i F 2 elption,you should become subject To the Workers'Compensation gppL CE 5.00 PLAN CHECK
provisions,of the Labor Code, you must forthwith comply with
(� such provisions or this permit shall be deemed revoked AIR HAN NG UNIT(TO 10=11F.M.) 4.00 FEE
f CONSTRUCTION LENDING AGENCY AIR HANDLIN NIT(OVER 10,000 C.EM.) 6.00 SEISMIC FEE
L•
" 1.1 hereby affirm that there is a construction lending agency for EXHAUST HOOWITH DUCT) 5.00 . '
the performance of life work for which this permit is issued(Sec. MICROFILM.
3097,Civ.C.): HEATING UNIT IT N00,000 B.T.U.)- 8.00
Lender's Address
HEATING UNIT IDV ER 0,000 B.T.U.19.50
' Lender's Address ELECTRIC ,
`I certify that I have read this application and state that the above VENTILATION FAN (SING 1 4.00
olbrmalion is correct. I agree to comply with all city and county PLUMBING
ordinances and stale laws refining to building construction, and BOILER-COMP(3 H.P.Or 100,00U.)' 6.00
h erehy.authorim representatives of this.city lo.en ler upon 0 T.
the BOILER-COMP (Over 188,008 PTU)SENE SCH. MECHANICAL
�„ ,'♦ � i above-mcnlioscd property for inspection purposes.
1 -:'TWe) agree-to save; indemnify and keep harmless the City of MISC.- REFER TO D.-
Cupertino against liabilities,judgrnenls, costs and expenses which PERMIT ISSUANCE 10, CONST.TAX
mny-in any way accrue against Sri Cit .in consequence of the
xra igof this per nil. MECH.CONT. LIC.NO. - MECH. 1
TOTALI TOTAL -
.. ie acus f ices / ractor Datta - -
7 OFFICE COPY
IrrrMNAaiONAI BAPn9r CHURCH'
22638 Siciens Creek DIVA., Cupertino • (408) 253-7590
putor. Greg Dawn
We, International Baptist Church, as your neighbor, would like
your permission to have two sodium vapor parking lot lights to
be used during church use hours in the evenings . These lights
are equipped with visors to reduce light and glare into neighboring
properties . These lights will be turned off after people have exited
the church property after use in the evenings .
If you approve of these lights please indicate your approval by
signing your name and address below.
THANK YOU `'.
Pastor , International Baptist Church
r � �
• 1 ) ta!Z i � (�i 3 Cupertino
Cupertino
3 ) R�/11 � 0 .{� , ' i. l \ (� /o Cupertino
4) V
o 7tt, Cupertino
5 )— Cupertino
JUN,19
1995
BLDG;C N�ErCUP T1Na M&MI
Nt'}r;,V
22638 Steivcn3 Creek Slyd., Cupertino • (408) 253-7590
Pastor. Greg Dawn
We, International Baptist Church, as your neighbor, would like
your permission to have two sodium vapor parking lot lights to
be used during church use hours in the evenings . These lights
are equipped with visors to reduce light and glare into neighboring
properties . These lights will be turned off after people have exited
the church property after use in the evenings .
If you approve of these lights please indicate your approval by
signing your nam d address below.
THANK YOU !
"I astor , International Baptist Church
r v_ Cupertino
2 )
_, Cupertino
3 )
Cupertino
4 )
Cupertino
5 )
Cupertino