27848 Permit APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO FGILVJNG DUCAL PERMII'NO.
BUILDING.DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. O 2 7 8 4 8
BUILDING PROJECT IDEMI'IFICATION Gy 4 o
❑UILpING ADDRESS: err�CE lYId$
SANITARY NO. APPLICATION SUBMIITAL DATE
UNITp Vh� I"aA/ .r/QLOT# 40 90
rO�q
OWNF AMP' W,5--
HONECONTRACT'OR'S NAME: LIC NO: N/C CONTROLX
i a bion omes ,5= pr
•ARCHIgIiCfryNGINF.ER: LIC NO: ADDRESS: ❑
CONTACT: PHONE: QTY ELECTRIC PERMIT PEE BUILDING PERMIT INFO
gq Cooper
p. //I BLDG ELECT' PLUMB MECH
`e A.-Wo Qr �p -6o Y(/ PERMIT ISSUANCE. / II�Sy CK 09 Ile
LICENSED CONIRACTOWS DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
QWZ I hereby afpnn that l am licensed toderpmvisions ofatipter9(commencing with
=a E Section 70001 of Division J of the Business and Professions Code,end my license is in PANELS r)� s� l
y00 Secion7000Ieffect. `\) U �/'1
FZm Licence Class Lic.# UPT02MAMPS
yQy Date Contractor 201-IMAMPS
2.OI,,Z ARCHITECTS DECLARATION OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT.
O{o,•O T undersand my plvns shall be,used as public records.
P''4 m SIGNS ELECTRICAL.
6Licenced Professional 4T IS'7
VJ yd�'6 OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. •�O
4x�('060 I hereby affum that 1 am exempt from the Contractor's License Law A
for the _
LL13LLy¢ following reason.(Section 70315,Business and Professions Code:Any city or county TEMP.METER OR POLE INST.
ua ON J which requires a permit to construct,alta,improve,demolish,or repair any structure
WY7 Prim to its issuance,also requires theapplicant forsuch loort1.file avigned,neement POWER DEVICES
oaf
WC) that he is licensed pursuunuo the provisions of the Commcmrs License Law(Chapter
4• m 9(commencin with Section 7")of Division 3 ofthe Busineasand Professions Code SWIMMING POOL P.LECIRIC
ols, (commencing ) VALUATION
W,W ,�, or that he isexempuherefromand the basis for the alleged exemption.Myviolation of FI%TURFS 997 7y�•
FZ_p• Section 7031.5 by any applicant for a permit subjects the applicant m u civil penalty of OUTLETS-SWITCHES- /
�S¢ t more than five hundred dellen($500). .�
�Cm n❑ I,asowneroftheproped NEW RESIDFNTIAI.ELECIR _SQ.FT. I D ` STORIES TYPECONSTRUCIIUN
y,mrmyempluyeea withwngesusthcirsolecompensatimn,
44)„-�� will do 0e work,nnd the structure isnot in¢ndeA oroRemJ forsale(Sm.TN4,Busmxn
and Pmfessimns Code:The Contractor's License Law dims not apply or an owner of
propenywyees,president
hiroffennhrmughhis OCC.GROUP RES.UNITS
ownemployees,providedthatsuchintpmvcmentsamnot earrtdedmplltaed the owner-
builder If,
billhathe vltheburdenofpmentishatbe arald idbut yrnrorimproefortheof TOTAL: l7' 6
will have the harden of proving that he did not build or improve for Aargau of
sale.).
❑ I,as ownerofthe progeny,amadosively<ontmctingwithlicenud conrrectorsto QTY. PLUMBING PERMIT FEE FLOOD LONE pPN
cin swct the project(Sec.7044,Business vad Professions Coded The Contractor's
License Luwdmsnutapplylo nowncrofptnpenywhoboildsorimMnvathcrem,end FERMI'1ISSUANCE
who convects forsuch projects with o comaradods)licensed pursuuuo the Councou's
License Law. ALTER (EA)) FEESUMMARY
❑ I am exempt under Sa. ,B&P C for this reason BACK FLOW PROTECT.DEVICE SANITARY ou I SIDE 1,80 N
Owner Date RECEIPT#
ROOF,
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR, AREA,COND. SCHOOL TAX YN
❑ en Cerr fenardhatlhavea iarace ifie copyt mselsee.re,m Lab C.)c hi of RECEIPI'p
Workers'Com copy FI%TURFS-PER TRAP
pensm]onderdanc permit. nified co thereof(Sec.Jg00,Lab CJ which PARK FIiE Y N
coven all employee's under Chia permit. GAS-EA.SYSTEM-1 INC.4 OUTLETS RECEIPT N
Policy p BUILDING DIVISION FEES
Compniy GAS-FA.SYSTEM-OVER 4(EA) CK FEE n
❑
Certified copy is hereby famished. .20•
❑ Certified copy is fled with the city inspection Jivi.ion. GREASPJINDUSTRI,WASTE INTERCEPTOR GRADIN
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This section and not be complemd H dr,per mit is Forane hundrddm11an($100) SEWER-SANITARY-STORM EA.200F7. ENERGY FEE
or leas.)
I minty that in the performance of the work for which this permit is issued,l shall WATER HEATER W/VENT/ELECIR
not employ my person in any manner so as tu become subject to the Workers PAID
Comparrationleawsof California. Date WATER SYSTEMITREATING Date Receipt#
O 7-. Applicant
C) NOTICE TO APPLICANT:If. fill making this Certificate of Exemption,you should NEW RES]DENTAL PLMIL SQ,FT. TOTAL:
V) become subject to the Worker's Compensation provisions of the Labor Code.you must 5 BUILDING FEE �Q�•forthwith comply with such provisions or this permit shall he deemm
ed vaked.
Q CONSTRUCTION LENDING AGENCY SEISMIC FEE Q
I hereby affirm that there is a construction lending agency for the perfmmsuce of
V 0 the work for which this permit is issued(Sm.3097.Civ.C.) TOTAL: ELF.Cf1I1C FEE 7 • 6
Lender's Name PLUMBING FEE
0 U 1.enaer:neemaa QTY. MECHANICAL PIiRMIT FEE O
I certify,that 1 have read this application and sum that an eMve information is
correct.caner mon,complyand with
yauthriz county ordinances osund sura laws ruporsgto PERMIT ISSUANCE MECHANICALFEE
UZ building construction,andherebyauthorizeoRhiacity menmrupomhe CONSTRUCTIONTAX 6
L) Z above-mentioned property for inspection keep
ALTER OR ADD TO MSCI I. V
(Wu)egmc m save.indemnify and keep hnnnless the City of Cupertino against 77
~ IiabUnies,juJ nts,costsandexpenses which mayin my wayacentengainst said City AIR HANDLING UNIT(TO IO,WII CFM) S'/
in
conuqu of the grartt' #yfthis permit. �/9 /��
/ AIR HANDLING UNIT(OVER 10,030 CFM)
Sigum onAfLam/ComuactmrN IDate EXHAUST FOOD ONMUCI PAID
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT(TO 100,0VO BTU) Date Receipt is
Will the applicant or future building receptor store or handle hazardous material IiIiATWG UNI(OVER 100,11(10 BTU) TOTAL.
as dc0ned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cale,Section23532(e)?
0Yes ❑No VENTILATION FAN(SWGLE RFSID)
ISSUANCE DATE
Will the applicanmrfuumbuildingottupantuu aluipmcntordeviceswhich mdt BOILER-COMP(3HP OR 100,00OBTU) Rfi A
• barudom air contaminants as defined by the Be,Arca Air Quality Management BOILER-COMP(OVER 100,0(10 BTU) 1�
District?
❑Yes ❑No NEW RESIDENTIAL MECH.-SQ.IT. OCT 9 1995
1 have mad the hazardous materials requirements under Chapter 6.95 of the
California HCAth&Safety Code,Sections 25505.25533 end 25534. I mulennnd that IYy z s
iflhebuildm ors mm currently have a tenant,that it is myresImmibility to notify the CITY Ur VUYCHII^'
occupant he requimm hick must be met prim to lssuance f v C tifim¢of
mer or authorized agent /rte Dam TOTAL: ISSUED BY:
OFFICE
COO gdt ykw Insert Format gemrds cods gkidow Uelp
IMM111111II ®' Q .
r'
PERMIT#: 2781 ARCHITECT. Input Permit Numbe VALUATION; 9874
D
nryd tfi: i LICENSE tltT.;
APN: ISSDATE: 10/9
,I ` y'y,,,• SITUS STREET: VIA PALAMOS SUBDATE: 10/9/95
PL
SITUS NOU: 20349
AVE.CT,ST,RD. TYPE: SFDWL LATE CODE:
N.S.E.W: DESCRIPTION: SNG.FMI.DWELL BLDGDEPT:
NO#. ENGDEPT:
CITY: PLANDEPT:
'i. PLCHKREDI CMA:
ZIP. CATEGORY: LTRFlRE: 1 > d
g
LOTp: O DATEDUE: SANDIST:
HLTHDEPT:
ID'. CITATION HOMES Commercial : ?'•.
STRCTENG:
OWNER. gTATION HOMES CAegtlltp:
0TAL:
OWNER CE-sgllllp:
INSPHOLD: 6
ADDRESS'. CN-sggllD:
CITY,STREETZIP. f 4. iFre,
PHONE: Raaidential
RN tgtllttl. 2157 I`✓— ',h " gni
CONTRACTOR: OWNER REagpftp
LIC#, RUSagIXltil, Seatch by Addtea
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