S0046 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL. PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PING PROD -MECHANICALFN
- ? n na FRUILUING PHOJE6T IDFNTIFICA'f (�APPLICATION SUBh1HTAL DALEBUILDING ADDDRSRESSOWN :NA2M'E: PHONE: CONTRACTOR'S NAME: CCONTROL#
ARCiII'1',,rVENGINHF.R: LIC NO: ADDRESS:CONIACf, PHONE: LDING PERMIT INFO
Consultant Fees Pal by Applicant(InitiaI?L1'(T PLUMB MECH
TJ 0
LICENSED CONTRACTOR'S DECLARATION QTY ELECFRIC PERMIT B DESCRIPTION
I hereby ofnn Na I am licensed under previsions Of Chapter 9(mmmewing
2 with secdan]ap)of Division 3onnc Badnevs end Professions Cone.andmylmcnwis PERMIT ISSUANCE?��2 in full farecaml cfmaL ❑KITCHEN REMODEL
aVU License Class Lien APPLIANCES-RESIDHSHI'[At, El ADDITION C]PLUMBING RE-PIPE
0<i Dam Comraetor
ARCHI'1IiCTti OIiC1.ARATION PANELS []MULTI-UNIT QMODIFIURN.
Fy1 w unde,oard m plans nhnll be used ao I' d MODIFICATION
OZ-L— Y poste rcwrs UPTO 200AMPS ❑INTERIOR ❑CHIMNEY REPAIR
'3�W I.iansed Pmfe"I'mal 201-I0XEAMPS IMPROVF.MhN'f SWIMMING POOLS
�s1 N, OWNER-BUILDER DECLARATION OVER IBIIfEAMYg ❑BATH REMODI?IJREPAIR ❑DEMOLITION
C C Q 1 hereby affirm that 1 am exempt from the Contractor's License Law fur the []OTHER
�=O W t-1 following reason.(Section 7831.5.Rosiness and Professions Code:Any city or county SIGNS HLECrRICAI.
1+13 0 to¢ which requires a permit to cons ruet,altar,improve,demolish,or repair"Y suunure
F 0J prior u)in issuance.also requires the applicant for such Permit to File a signed statement SPECIAL CIRCUIT/M ISC.
Ythat he is licensed pursuant the provisions of the Cmuctictora License Law(Chapter 9 COMMERCIAL:
W roto (commencing with Section 7")of Division 3 of the Business and Professinns Ctde)ar TEMP.METEOR OR POLH 1NST
d a y Chill he is exnnpl Iberefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
W2to Section70315 by any applicant for aperinit subjects the applicant)u civil penalty of MQTYPLUMBING
WR DEVICES ❑TEND��LL ❑FOOD SERVICE
nl more than five hundred Jnllurs 185108, IMPRIpJF.
SSC1.as owner at'he propetY•nnny cmployac with wages as their.cnlc almpensnlinn, LECTRIC �"1
(.. will Au the work,and the ntmc¢oe it not innmdeJ nr nliered total.(Sec.7014.Business ❑OTHIiR
W L J I 1 '. . Cal '[heC t :I' 1 d I'pply t Owner ofES-F URES
la,
WA
his O property h Wallis p . thereon, J h J h k himself Intmgh
wle.il.bmvm'm lbe building that such
is mldwobinone yeaam not ra[completion.the d forNEW RESIDENTIAL I:LL SQ lel'. ry/1 SG FT IID 95Q.lel'.
wnerte ilder will have the burden of proving that he did nm Wild or improve for our- Ur L•yJ.)L .1�
,arse of Ilde.f C�nry�
1,ac owner of me propety,ma exclusively contracting with licensed condoemrs m
mswcl the Iraq.,(Sec.Iatt.Business and Professions Code:)The Convenor's Li-
censeLaw does no(apply to an owner of Imlay who builds or improves thcmon.and ING PE FEE
who contracts for such pmjecls with a a nmatur,)licensed puccuam to the Commnar.c
License late. PERMIT ISSUANCH
❑ Intl exempt under Sec. ,B&P C for this reason
AL'I ER-DRAIN&VENT-WATTin IEA) VALUAJ'ION
Owner Data
• WORKER'S COMPENSATION DECLARATION BACK FLOW Playl'ECI'.DEVICE
I hereby affirm under penally of perjury one of the following declarations
I havcand will oninmmaCelificmc of Conscm m-n-insure for Worke,Compel- DRAINS-FLOOR.ROOII.AREA.COND. S'IORIIS TYPECONSTRUCf105
sation,as provided for by Section 3700 of the LabUI Code,for the performance Of the
work for which this permit is issued. FIXTURES-PER TRAP
O 1 have and will maintain Workers Compensation Lawrance,as required by Section GAS-EA.SYSTEM- INC.J OUTLETS
3]1X1 of the Labor Code,for the perfonnanm of the work for which this permit is issued. OCC.GROUT' APN
My Wnrke tion Iso J Policy num
Cartier. olicy No.: f] �� Z GAS-F.A.SYSTIiMOVF.R4(G)
oCB nIFICAI'I F�iMITION FROM WORKERS' GREASI%INUUS'IRh WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISIONFI-ES
1'I lik,evtin amama he ennlplemd if'ill laturn is haute hundred dollars l SHXH GREASE'I'RAI'or las.) I'LANCIII IIiIi �~
I certify that in the perfamlwme oflhe work forwhich thispennit is issucd.I shall SEWER-SANITARY-STORM P.A"28819. ENERGY FEE
not employ any person in any manner so as n1 become subject to the Worker:Compere
OvAaEll,d^'s of California.Dara WATER NEATIiR W/vENf/ELECfR GRADING PEE
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SYSTEMOREAfING SOILS FEE
become subject to the waders eomlKnmdon Permit
ofoethe IwMY Cute.. most
� ..� forthwith romply with such previsions nnhis permit shellMdecmN revoked. RNSEWRMIDENM*IA
6PAID
CONSTRUCTION LENDING AGENCY SQ.ET Dam ReceiptU ZO F he ware for which this permit is issued(See.38119.Civ.C)L) 1,dular's Name TOTAL:ULender,Address BUILDING IIEI7I ccnily That I have read do,applicmion and,tate m nthe rintwa information is
s rrect.l agree to comply with ail city and county ordinances and state laws ranting toRMIT FEC gEISMIC 1'Ii1i
U ,7, building constrvetion.and hereby authorize reprcsematives ofdlis city m enter upon the
Abtw-comma anal property for inspection famproes. PERMIT ISSUANCE ELECTRIC ItiE
Wed anile to sue,indemnify and cep harmless me City of Cupertino against
liabilities.judgments mstsande nsesw ch lrmyinanywayacerueagainslmid City ALTER OR ADD TO MECH. PLUMBING FEET
ificimsinuenceoddlegationfifigo hisperm
CANTUNDERSTANI AN V .COMPLY WITH ALL NON-POINT AIR HANDLING UNIT LTO 10.000 CRID MECHANICAL hiliCE REGULATION
� AIR HANDLING UNIT(OVEH 10,1180 CF-.MI CONSTRUCTION TAF
' Slgnnwrc of Applicurmcurn n Dma EXHAUST HOOD(WT II HOUSING MITIGATION FEE
HAZAH )US NIX]HRIALS DISCLOSURE
Will the applicant,,fumed huilding occupant store or handle hazardou,ratelial HEA'HNGUNH(I O IaI,)(q BTU)
a
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
BTU)
Cala Section 25532(a)? HEATING 11Nl'r 1 OVER fin"
C]Yd, [3 NO VENTILATION FAN(SINGLE RESIDE PAID
Doc Rc<ciptM
Will the applicant or future building occupam use equipment or devices which BOILER-COMPOHP OR HMO XE BTU)
Wemit hazardnuh air contaminants as defined by the Hay Area Air Quality Management TOTAL:
E Its hill? BOILER-COME(OVER 100,000 BTU)
N ❑Yes LJ No
I have read the kauNous materials rcquirementa under Chapter ls95 of the Cali-
AIR CONDITIONER ISSUANCE DATE
famlalbruill&Safety Colic,Sections 259115.25533 and 25534.1 understand that it the NEW RESIDIiNI'I AL MECH. SQ.Fr
'nullAing oliYs nal allrrcmly has a itmnanl,lbw It is my relleco dud v1 notify Inc ncaupI I
of'mc rcqu Ucments which must be owl prior m issuance Ona Cctilien,of Occupwmy.
1 TOTAL-: SSUED HY:
sUwner ur amhnnaed agent -Data
OFFICE
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-*All above sign designs&artworks are belong to SIGNS EXPRESS bIPG.CO., Any duplication is prohibited. ALL RIGHT RESERVED."
10925 N. WOLFE RD. CUPERTINO
ICI n I� C np.% mn. (0. Scale : Noted Drawn by:
2446 MERCED AVE.,SOUTH EL MONTE,CA 91733 Date : 5-21-97 Drawing.#
818-443-3333 . 818.443-1615(FAX) APPROVED BY :
STATE LIC.#552097 • U.L.APPROVED#E-119586
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**AU above sip desl gm&at works am belong b SIGNS EXPRESS MFG.Co.. Any&W icalion is probib&d. Ail.MUHT RESERVED.•
1 siGni iAPRLU nt FG. co. Scale : Noted Drawn by:
4446 M1l®Y AVj6 t0tIM1 tL M0=,CA 91777 Date : 5-21-97 Drawing#
**�qg M-4W7777 a$10.443-1611MAX) APPROVED BY :
�•n� 7TAUUC.,osn097 a QLA7'MWIDM11Vte6
CUPERTINO VILLAGE SHOPPING CENTER
SIGNAGE APPROVAL
TENANT TRADENAME: CLje
UNIT NO.: -,0
ADDRESS NO.: 101o2-5-- N. 000(AL lea", ��n0
SIGN CONTRACTOR: /J �7 p
NAME: J �E7�S ��CY
ADDRESS: >,w- u,"61 M 7l M:t> S�
TELEPHONE: 6e
APPROVED V/,� DENIED
COMMENTS: y gwY6 �rZG� L*y
cz
APPROVED BY" ���� DATE:
EUNI CHANFOR •
CUP RTINO VILLAGE ASSOCIATES