S 0376 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATIONIFERMIT NGPROD PLUMBING. T IDIIANIFIC S 0376
BUILDING PROJECT 1118NTIFICA'1'IUN
SANIIANY NU. At"PLICAI'ION SUHMI'PfAI.DATE
BUILDING ADDRESS:
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ONEk/NACONTRACT COVfHpNICGfWaA J
ARCH ECT/ENGINEER: LIC NO: AD RESS' N C ❑
�7� 9, 7ion
CONTnCf: P�H[ONE: BUILDING PERMITINFO
��I V/(�` �� x{'�O �/d I/ /Z ❑ Consultant Fees Paid by Applicanl(Initial) BLDG ELECTPLUMB MECII
LICENSED CONTRACT DR'S UECIARAIION QTY ELECTRIC PERMIT FLE JOB DESCRIPTION
1 hereby affirm that I am licensed under provisions of Chapter 9(oomusheing R AU
WOO .QaZ with Sntion llXNB ill l3ivisiunJof the Buxinus unJ Pro fusion'Coda and my hcenaln PERMIT ISSUANCE. —
WOOx full location cOea. ❑SPDWI, ❑KITCHEN REMODEL
m icene Cass Lic.p Tf L o 9 7
la-�Z{Ui],Datc Contra APPLIANCES-HfSIDENTIAI. []ADDITION' ❑PLUMBING RE-11111E
m 6 a ARCHITECTS DECLARATION PANELS ❑MHLI'1-UNIT ❑MOLTSTROCTURAO
~oA y� I understand my plans shall to used as public records MODIFICATION
YQIp,� UI"T021XIAMYS [D INTERIOR ❑SWIM SWIMMING
PUIR
OZ—r
F-4l"„{y hiccnaJ Professional 201-IIXIBAh/P5 IMPROVEMENT SWIMMING POOLS
g OWNER-BUILDER DECLARATION OVER ISMAMPS ❑BATH REMOUEIIREPAIR ❑DEMOLITION
C C Q 1 hereby nffimt Thal 1 am carbon from he Contractor's License Law for the UIDER
WO ha.U Inllowin6 return.(Section 7031.5.Businrn and Pn#essions Code:Any city or cnun1Y SIGNS ELECTRICAL
which requires a perms to conauuet.alter,improve,demolish,or repair any labo nme
prior,noxissumbe.ono squirestheapplicantfarsuchpemtinofileosignedxtatebent SPECIALCIRCUIT/MISC.
ytent he is licensedpurmannI, hebo,siemunheContractor's License Law(Chaptcr9 COMMERCIAL:
�yQp (commencing with Sections 700 )of Division oflbc nosiness and Professions Code)nr q UMP.MITER OR POLE INS'1'. ❑NEW BLUGIADDI'1'IUN ❑UEMOLI'1'ION
Q. a than he is exempt namfmm and she basis for the alleged exemption.Any violation of
sow Section l(D 1.5 by any ap,th,in for a permit subjects thevpplictonoa civil Penalty'If POWER DLVICILS ❑TENANT [:J FOOD SERVICE,
nor mom than five handled dollars(start). IMPROVEMENT
E00I.as owner of the Property,or my employees with wages on thcirsilc compensation. SWIM MING POOL ELECTRIC BOTHER
will do the work,and the stmdure is not inenJCJ orallercd for sale(Sur.7(HL Businesv / `
G 3 m and Professions Gale:The Crmmm
cr's License law dres not apply to an owner rd OUnFIS-SWITCHES-FIXTURES J 11 /1 ,t
property who builds or iimproves thereon,and who does such work himself or thnmgh NVW RIiSIDENN IAL ELECTR SO 14. `—
his
his own employees,Provided that such improvements am no'intended rr named for / yyQ.FIT 19.00R ARLA/ S/SQ.Ff.
,aide.If.hawevrr,me budding or impmvemcm is sold within one Year ofcomplmion,ler V4 �C /.' D.
twou,-builder wall Town the bunion of proving that he did not build or improve for put-
pubs,
ut- ^
pMneofsals.). IYn'AL: v`UV. / /f P 99�
I f the Property, exclusivelycontracting with f sed contracts.to
construct th p l el(Sc 1(111 Easiness IP Professions I )Use Contractors(.
cruise la doe. tapply t ownerofp PertY h build: P :thereon.and QTY PLUMBING PER I FEFI`/r .F�'T/pyv
whocontracts f such projects with c t t ds)licensed p tt theContractors /+/� p[�
License la IIERMI'1'ISSUANCE Cut
License
O I am exempt under Sec. .B&P C frr this b awn C
ALTER-DRAIN&VISNI'-WAT :AI VALUATION
Done
thvncn - following
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE
� 1 hereby affirm under Ponolly ill pujury me of the following dcdamdum:
haveand will maintain aCenificateof Consem malt inturks-Worker's Compen- DRAINS-FLOOR,ROOP.AREA.COND. gTpµBiS 'l'YI'Ii CONSTRUC'TIOt
xvtiun,as Pro nfial for by Section 31(X)of the Labor Cmlc,for the porfmmance of he
stork lin which this Penna is issued. 1'I%TUkliS-PER TRAP
1 have and will anu man Worker's Compensation Insurance,as rtquired by Section GAS-EA.SYSTEM.I INC.4 OUTLITS
3700or the labor Code.fortbe perfunnanceor the work far which this pontic is issued.
My
UCC GROUP APN
My workers�sn�inn In �A yt' Pal YNcy:� � � GAS-EA.SYSTEM-OVER4 EA)
Currier: r+ (L l�J
CLRIIFICAI'1i OFFXEMPI'ION IBOM WORKERS' GREASIVINUUSTRL WAST Ii INTERCEPTOR
COMPENSATION INSURANCE. BUILDING DIVISION PEES
T,rissu'tio need oat he com,eted if M1e permit is furore hundred dollan(SI BE GREASE TRAP PLANCHECK 1910
or kss.)
Toy airy
hot performance o(thewo.kforwbicht,I permit isissuN,l shall SEWER-SANITARY-STORM EA.200 Fr. IiNERU1'PEIi
not employ vny parson in m a murmur no ns h:M1cmnm suhlut ht rbc Wnrkcrp Compon-
Z union Llxs of Calilnmia.Dore WATER HEAI'Ek W/VIiN"I'/1[LEC 1'R (:RAVING FET[
zApplicant
iNO]ICE TO APPLICANT:IC atter making this Certifcale of Exemption,you should WAl'IiN SYS'I'IiM(rkIiATING SOI1.5 I Pili
become subject to the workers Compewtlon pmvisiom of the Lalwn Conde.you must
:;nhwith comply with such pmvisinns or this permit shall he deemed revoked. WATER SERVICE
a 0 PAID
CONSTRUCTION LENDING AGENCY NEW RCSIDENTIAL PLMn, SQ.F1'. D:nr Receipt X
UQl hcbban yanion thhere inn construction leading agency b,rtbc perfomancaof
the weak for which this permit is issued(Sec.3091.civ.C.) TOTAL:
OF- LcnJers Nance TOTAL:
r Lende,,AJdraoi HUILDING FEE
1 certify shat 1 have ad,hi,applicmium and tam thio the rrobust,infomloomb is
a
.H. h control.I agmen comply with all city and county ordinances and slate laws relating to QTY. MECHANICAL PERMIT FEE $Ii1SMIC PEE
U Z bulldingcomuuaIrn,and larcby outhodoe rcpr"llosaivu of this city on anter upn"hc
sMrvcmuntioned proparl,fill inxivtion p olowel PERMIT ISSUANCE ELECTRIC hili
(We)agrcu to savu,amenmlfy and keep Iwnnle, the City of Cupertino against
liabililiu.judgmenn.costs and expenses which may in any way name against said City ALTER OR ADD TO MECII. p[.UMBING FHE
I. nscyncnce of the granting o(this permit.
APPLICANT ON UERSI'ANDS AND WILT.COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFM) MECHANICAL 1£E
SOURCE RE UL"TIONS.
� AIR IIANDhING UNTI'(OVCR IB,(XXICFh) CONSTRUCTION TAX
5 na Pelican r or Dam F,XHAUSTH000(W/DUCT) DOUSING MI'I'IGAI!ON FEE
e IIAZARDOL'MA'I'IiR1AI.I Upa"(35URIi
Will thanPPhrant rrfmumhudolusbare pantxmrtrrhordbehvuNan motorial HEA'T'ING UNIT('rO IIXI,INXI PTUI
as Aefncd by
the
Cupeninn Municipal Gde.go;c,4.12,and rhe Healrh and Safely HEATING UNIT(OVER[00.00)BTU)
Gde,Section 255120)1 I'AIU
❑Ycs ❑Nu VENTILATION FAN(SINGLF RI?SID) Dae Rccciptp
Will the applicant or future building occupant use equipmcm or devices which BOILER-COMP QHP OR 100,1100 BTU)
emit herardous oar contaminants as defined by the Bay Area Air Quality Manogemrnl TOTAL: r,_
District.' BOILER-COMP(OVER B0,(1(NIRTU) I
Fl Yea; 0N
AIR CONDITIONER ISSUANCE DATE I
I hove real the h ode,Sections
2ls 5.225533 an under2553 L 1 and 695 0l the Cal
build Health.@ Safety Code,have
Saatinns 23505.is bly and 25531.1 to noblandy th thin if the NEW RFSIDLNTIAL MIICIi. SQ.PII
building fres nal cunontly haunt trnvnt,that's is any rcspmsibiliq to nobly the nccupum
rI he nquilemrnts which moa be'net 111111 no issuance of a Cendicsm"I orceumm y.
Uwool or ouNori, agent
Date TOTAL: ISSUED BY:
OFFICE
- -
X7
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"AEI above sign designs&art works are belong to SIGNS EXPRESS NIFG.CO., Any duplication is prohibited. ALL RIGrrl'RESERVED."
10837 N WOLFE BLVD. CUI'ERTINO
Scale Noted Drawn
mcm CXp�Ci-N mi:G. co. Date : 7 997 Drawing# :#
4446 MERGED AVE.,SOUTH EL MONTE,CA 91733
:
878-443-3333 ' 818-443-1615(FAX) APPROVED BY :
u STATE LIC.#552097 ' U.L APPROVED#E-119586
FROPI JUL-30 '97 =in:3hPl'1 NIKKO CRF T L CC�PP.-lff 34406=.c7ar� ccoc "` F.3--
CEJ C'UPERTINO VILLAGE ASSOCIATES
10767 N. Wolfe Road, Cupertino, CA 95014
Tel, 408.873.11992 Fax. 408.873.2032
•
CI:PERTINO VILLAGE SHOPPING CENTER
SIGNAGE APPROVAL
TENANTTRADENAME:
UNIT NO.: °
ADDRESS NO.: L .831 A-) . W o( Uct�Q
SIGN CONTRACTOR:
ADDRESS:
TELEPHONE:
J
APPROVED _._ DEMED
COMMENTS: •
APPROVED By
DATE: h
Pet au
FROM CUPSPT1140 QILLAGE PHONE NO. : 408 873 2022 Jul. 30 1997 03:slpm
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