20424APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Buildin Pm en Identification
Building Addmea:
PERIvITNO.
20424
Ave. Unit 224 A1.2
,�A�RQ_:Tqrge
ane.
�rt�er� Properties
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
UIBLDINGELECTRICAL-PLUMBINC.MECHANICAL
5/10/90
Contractors Name: Lic. No:
738-4444
CATEGORY
CONTROLX
rchltect/Engineer. Lia. Na
QTY ELECTRICPERMIT FEE
BUILDING PERMIT INFO
Addres>
PERMITI:SUANCE12
nLTJ Ln Ln
LnXJ
LIC ENS EOCONTRACTOR'S DECA RATION
[herebythat aivscunder p Chapter
inion7Dof Division3oftheBusiness and Professions Code, and my
license is In force and ffect
LlanxCWsss
Cmdr
Date GHITECr
ARCHITECTS DECLARATION
lunden/and my phruahall be used g; public records.
APPEANCESRESIDENML
JOB DESCRIPTION
�G`A r
"V
PANELS
PS
OVERIWO AMPS
OVER0000 AM
SQ. FT. hT,ODR AREA
5/SQ. FT.
SIGNS ELECTRICAL
Licensed Professional
SPECIALCI(CUIT/MISC
OWNER -BUILDER DECLARATION
I hereby affirm that l mnexempt from the Contractor's License Law fee
followingreason. (Section 7011.5, Business and Professions Code: An d or
county which requires permit to emeneelf, alter, improve, demolish,.
or repair
1,115
'
74.92
TEMP. OR POLE INS(.
Ws
any structure prior to its uance, also requires the applicant for such permit to
ilk a signed statement that he V llramad pursuant to the provisims of the
Contracmen License Law (Chapler9(mmmendng with Section 7000).( Divi.
slon3 of the Business and Pro(essiora Code) mthat he is exempt there(romand
POWER DEVICES
SWASMINGIWL ELECTRIC
VALUATION
the basis for the alleged exemption. Any violation at Stolon 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
five hundred dollars (ISM.
[:11, as owner of the property, or my employees with wages as their sole
OUTLETSSWITCHMFIXTURES
$83 536.00
s
NEW RESIDENTIAL ELF.CTR SQ9E.
STORIES
TYPE CONSTRUCTION
compensation, will do the work and the structure is not Intended or offered for
.to (Sec 7614, Busbmsaand Profaed.m Cade: The Contractors Llame Law
V—N
don not apply to an owner of property who builds or Improves there.e, and
wWdoessuchworkhmagIfmth.gh hinownempleyees, provided that such
OCC.GROUP
RFS. UNITS
Improvements are not Intended or offered for sale. If, however, the building or
Improvement bsold within onoyw
carofcnpletion, the owner-huaderwlll have
ft.4urden of proving that he did ent build or Improve for purpose of age.).
"4 as owner of the property, am exclusively contracting with Beensed
contractors to construct the project (See. 70K Badnessand Prodigal.. Code:
The Contractors License law does not apply to an owner of property who
Wilds or Improve thereon, and who contracts for such p(oleds with a
cjEB4adm(s) licensed pursuant to the Contractor's License Law.
LII am exempt under Sec B & P C for thls reason
TOTAL:
PLUMBING PERMIT FEE
R-3
.
/
QTY,
PERMIT ISSUANCE
ALTER &VENT -WATER (FA)
FLOOD ZONE
APN
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y_ N_
RECEIPT M
Owner Date
WORKMAN COMPENSATION DECLARATION
01 hereby affirm that I have a certificate of consent to self-Inwre, or a
anlllcete of Worken'Compematlon lmunna ora adifled copythemof (Soc.
3800, Lab C.)
Polity Y
FIXTURES' PER TRAP
SCI IDOL TAX Y N
RECEIT M
GAS EA. SYSTEM -1 INCA OUTLETS
PARK FEE Y_ N_
RECEIPT M
Com any
GAS G. SYSTEM -OVER d (FA)
BUILDING DIVISION FEES
CC led copy is hereby furnished.
eni0ed copy E filed with the city Inspection division.
GREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF EXEMPT ION FROM WORKERS'
PAID
COMPENSATION INSURANCE
(This wdion need not be compldedif the permit b faom hundred dollars
Date Recel t#
SEWER.SANITARY-STORM EA. 810FT.
WATER HEATER W/VENT/dECTR
ENERGYFEE Y N
PAID
(510porless.)
I artl(y that In the performanri of the work forwhlch this permit is Issued,
1 shall not employ any person m any manner so a to become subject m the
Workers Compevaadon Lawso(Callfornu. Date
WATEt SYSTEM/TREATING
Applicant
NOTICETO APPLICANT: a earl making this Compensation is Exemption, you
the Labor
should become subject tothe Work nit Compmentionprovhis
Date Recel t#
NEW RESIDENTIAL PLMIE._SQFI.
TOTAL:
Code, dyou per
re =at lonhwl/h comply with such provisbru orthb permit shall h
deemed revoked.
567.50
SEISMIC FEE
CONSTRUCTION LENDING AGENCY
Iherebyafflrm that there is a corutruction lending agency for the perform,
dna of the work for which this permit Is issued (Sec. 3097, Civ. C.)
fenders Name
Under's Address
Iartlfylhel I havereadthls appilationand Oatethattheabovelnformatlon
Incorrect. I agreelo comply with all city and countymcitrancesand statelaws
TOTAL
ELECTRIC FEE
19 RA
PLUMBING FEE
MECHANICAL FEE
QTY. MECHANICAL PERMIT FEE
PERMIT ISSUANCE 12
FEES PAID:
39.88
relating tobulMing construction, and hereby authodae representatives of this
city to enter upon the above reentioned property, for Inspection purposes.
(We) agree to save, Indemnify an d keep harmless the City of Cupertino
against lbblW4ro,judgments, costs and expenses which may in any wayamue
ALTER OR ADD TO MFCH.
Date Recel t#
AIR HANDLING UNIT (TO IO,ODO CFM)
SUBTOTAL:
.Q
againstsald IBiposs once th anti ofthlspereelt
` j '�4/f�B��
/\ to
Signature b(ApplHAZA
AIR HANDLING UNIT (OVER I01000CFM)
CONSTRUCTION TAX
EXHAUST HOOD (W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS
HAZA RDOUS MATER $DISCLOSURE
Will the api.adby futum fti. gompanlstore h.ptnrle hssardous
material as defined by the Cupertino Mu Ndpal Code Chapter 9.]Z, and the
Health and SafetyCode Section 25532(a)7
❑ Yes r] No
HEATING UMT(TO 100,000 BTU)
Date RCCeI [#
HEATING UNIT (OVER 100,000 BTU)
TOTAL:
. 0
VENTILATION FAN (SINGLE RFSID)
ISJUMDATE
Will the applicant orfuturebulldlegoccapant use equipment ordevices
which emit hazardous air contaminants as defined by the Bay Area Air
Quality Management Dktrid7
Yes❑ No
have read the hazardous materials requirements u nder Cha pier 6.95 of
the California Health & Safety Code, Sections 25505, 75533 and 75534. 1
understand that if the building does not arrently have a tenant, that It b my
1
I 1kv 1 j 1990- '
'
BOILER -COMP OHIP OR 100,000 BTU)
BOILER -COMP (OVER 100,000 BTU)
NEW REFI DENIIAL MECIL SQ.FT.
responsibility to notify the occupant of the requirements which at be red
prior to Issuance M a Certificate of Occupancy.
^IL- of �IIQC�IO7P
City
1- e
ISSUEDBY:4kV IAU GL1
•'--���ii--
Owner or authorized agent Date
TOTAL
OFFICE COPY