22158 f-�jo.,!limit�L'EVTEI�'F.'F-V•rlcm.ngrRCVamrs.'rvr�•..a.asrr. nuv rn.rv—•vvr ve+rr r- -r.. .er e� --•.---�-�. _._.
Building Pro ed l tllbtion PERMIT NO.
Bafldi.S 44rtsen
1V 02.: oc.F ROAD . 22158
rs ame: JJv. one:
BREADOar g:.al•r'�✓,i. CITY OF CUPERTINO-BUILDING DIVISION p
APPLICATION /PERMIT
t , V A PLUA4 BINq4r
BURRINO-ELBZ7MCALMUMBING-MECHANTCAL CATEGORY CONTROLS
/i
jjNCrZNe. Co << ,. a.,..�,t
NA
gL C ICP,dhl�•1Ff fi - .��'st'a�'BUILDINC PERMIT-INFO�r;;'-T4�
Add— a D6djapj6WW PERMIT ISSUANCE �� ❑ ❑ ❑
LICENS EO C'ONTRACTOR'S DEC RATION 1/�
Ihembyefflrmthat leen licensed ardor provWon.ofChaptet9(comrrunc APPLIANCESRESIDENTAL JOB DESC O
Ingwllh Sedion7000)of IIIV W on3oflh Butlner.nd Pm(eulon.Code,.nd my
license I.1.fu dfect. PANELS
LbnrC �LIe1
Dab Contracto `
ARCHITE O1-IDAL MPS SQ.FT.FLOOR AREA F/9Q.FT.
oy Iurderstard my plans shall be used As public records
{{((t�py����d�t7t7; Licensed Professional AGNS ELECTRICAL
ZOWNER-BUILDER DECLARATION SPECIALCIRCUiT/1,119C '
Z lhert dBrmtlutlemexem (menthe Contractor's Ll¢rue Law/orlhe
lolbwing rtason.(Secllon 78115,Business and Professions L E D ns Code:Any cior TEMP.METER OR POLE INST.
Flt cauntywhkArsqubesapertdttowvmLt,alter,lmpmve,demolbh,ormpalr p u T E R
Syy anystrudurt Orb to lblwarce,abo rtqubestheappgant!¢such permit to POWER DEVICES
PS pts !fie•dgned statement that he b Ikensed pursuant to the provblons of the
6O0µI1�� Contndor's License Law(Chapter9(mmorendng with Section 7009)of Divi- SWIMMi NG POOL ELECTRIC VALUATION
30J tlan3ofthe BusInesa andPMerlonsCode)arthat hebettmptihemlromand P��
.•77 the baste for the alleged eaemptbn. Any Wdatbn of Section 7m15 6y any OUTUETSSWITCHMFMURES DATE
applicant for a permit subjects the applic.ni toa dvll penalty of not more than
Oundned dollars l+Ml. NEW RESIDENTIAL ELECTR �Q.P1'. STORIES TYPECONSIRUCTION
veUI,a owner of the property,or my employees with wages as their sole
compensation,will do the work and the structure isnot Intended or offered for
sal.bee7011 Basbess.d Pmlesioru Cade:The Contndoe.Lim.Lw
K $ don .pplytoan rdpmpedywhobuiklsorimprwn UNFrR
re
theon,and OCC.GROUP R
C� whodoessu6.nichinseB¢ w
thgh hbownemplyers,provided that such
Improvements arc not Intended orolfemd fonee.If,however,thebulMing or TOTAL.
Impmvemerd bold withlnoneyearofcanplebNthe w er-bullderwlll have
IT1714-
urd en ofpm wing the he did rut build or Improve!¢purpose o/eele.). Q'iy:PY SFI ELUIt'N$IN6 YB MLI •• 4 v!°FE6 i�' FLOOD7DNE APN
T17LJ L as owner of the property,.m esluevey mending with Ilnnrtd pp�R RSUANCII
tto cot truct the project(Sm 7061 Bushe e.nd Pr faAAlo N Cade: I la-0
The Contradoe.License Law dm one appy to.n at of property who ALTER-DRAIN k VENT•WATER ffN
build.or Impmees lhertm,and who contracts for such p(olacta with.cqaqeu�w �'� Y ..k" ,.° ~"} 'v.nT'^7•"'i
a Ikenaedpur.uanttotheeonendoe.LkemeLw.
1 am oempt anter gee - B k P C !or this rtmn BACK FLAW PROTECT.DEVICE >V � Us) -b. '
DRAINS.FLOOR ROOF,A ODNU Q� SANITARY Y_ N_
J- Owner Data `e•y D RECEIPT I
WORK MAN COMPENSATION DECLARATION FIXSCHOOLTAX Y N
\ ❑I
her7b;%affirm that 1 hen.¢rtl0ate of consent to.elf-Insure,or• N�'PER TRAP RECER'T 1
¢dlOcate of Workers Compenrsadrmimnn¢aaartUled eopythereo!(Sec. GAS.EA.SYS-pp�t-I WG60Ilf1.Ef5 PARK FEE Y N
3800,111,C) Jo3Q RECE4rTI
PoIIyP J GAS EA.SYSTEM-OVER 4(EA) BUILDING DTVI SION FEES
Com any
�CertNed b ° Ir, CREASE/INDUSTRL WASTE INTERCE7'1OR PLANCIIECK FEE
Ceded copy b(Ikd wllh the dry inspection division.
CERTIFICATE OF EXEMPTION FROM WORK ERS GREASE TRAP PAID
COMPENSATION INSURANCE SLIVER-SANITARY-STORM EA pgFE DaIC RCceI lit
(EMs section need not be completed Uthe permit b for..hundred dollars ENERGY FEE Y N
(5100),eles.) WATER FiFikTIR W/VENT/ELECM .Q —
I¢d0ythat In the performance of the work(orw dch this permit b bored,
I shag nor employ any person In any manner so u to become subject to the WATER SYSTEM/TREATING PAID
Workers Compensation Laws of California.Data
Q Z Applicant NEW "a._SOFT. Date Recel IR
Z O NOTICE TO APPLICANT:If,after making l his Cedglate of Exemption,you
— should bemme.ubject k<n
to the Wor 'Compensation provisions of the Labor - TOTAL:
f N Cade,you must forthwith mmpywlth such provblu s or this permit shall be I -V-1LDJ
> deemed 1eYOW. SEISMIC FEE
LU CONSTRUCTION LENDING AGENCY
CL IherebydRrtnth+tthertbsmmrudbnkMingagemyfor the perform- TOTAL UO ELECTRIC FEE O
7 Z Arm ofthe work forwhkhthb permit b tv ed(Sec.3097,CIv.C.) PLUMBING PEE p•Qj
VO Lend.,'.Name }' "e ^'
LL I- I<nder.Addrtr (IIT!. 3'.rW M6i:F7A1JIGAG PBi�bilT� ;`� I;".FEfi;t MECFIANICAL FEE
O I¢rllythatlhawmadthbsppllatbnandtlaterhetheabovelnlormatlon FEES PAID:
O W bcorrM.I sgreetocomply wkh seg cityand many ordInanm and state laws PERMIT ISSUANCE
O• relating tobullding construction,and lemby authorlre mpmenMlva ofthis
y d to entero n the sbovamentbned pp for lns ion ALTERORADDTOMECH.
? y(We)agrte upon
save,WemNty and keersp hamderN CIy oI Cupertino
Date Rotel lit
V .gaWt WblUtLi,'�t�dg^ma�kW.t �0�tsadeximnsnwhkhmsylnanyw.yacvud AIR HANDLING UNIT(TO 10,ODOCFM) SUBTOTAL:
said
.gel
a g o(t - anung dl Ma permit. CONSTRUCTION TAX
R HANDLING IRJTr(OVER IQWOCFM)
SI Appant/C—1onrad¢ Date EXHAUST HOOD(W/DUCn CONSTRUCTION TAX PAID:
HAZARDOUS MATERIAL. ISCLOSURE HEATING UNIT IOO,WO BLV)
Will theappgaM or future building oo:upantetme or he M le harvrdous Date Recel tit
material as defined by the Cupertino Municipal Code,Chapter 9.12,and the pp�
Ilea ,�FErani Safety Code SMlon 25532(+)7 HEATING UNIT(OVER 100,0008"M TOTAL: p•v�
Yes No VENTILATION FAN(SINGLE RPM) ISSUANDDATE
�I the Applicant re(saran building occupant use equipment or cl,Am l''!/•.��g
which emit h..,dous air omtambants a defined by the Bay Area Ala
�ijlu Maio emeM 7 BOILER-COMP pEE'ORIOQIXU BTUI
\• L R
No Q(�
� .h• `and theh ou.rnstedab tequltemenhundeT Chapter 6,95 of BORER-CVMP(OVITt 100,000BN) MAY 14199
I x,4-yrla healthkSifey Code,SMlom25505,25533and25536. 1 ITS^
�r.+"e hallllhebullding does nM cumnlly hive.tenanl,Ihatlthmy NEW RESIDTIALMECH. SQFT e
FN
vn•a:'h: to.dlythe occupant of the requirementswhich must be met N11e )t who
Itt�Wamc Ce of +Maty. MV
Sri �
a
��•-!" . 9edagen I Dot, TOTAL: ISSUED BY_ 'Ii&�-V _
OFFICE COPY __