25936 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CI7"Y�P CUPERTINOB ILDIN,�F,LF.CTRI Ah PERMIT NO.
I T APPLICATION/PERMIT PLUMBING m MECHANICAL. L/� C /�
3
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION J Vh
BUILDING ADDRESS: ..\\ /\/ SANITARY NO. APPLICATION SUBMITTAL DATE
W10 E/ �D J ✓* UNIT# LOTIt 2� 1
t
.,*MRS Nr1M-Er: 6 PHONE CON R]' ACTOR'SN/IpGHI /� LIC NO: ✓—L'
eAS N O LpJ�C 0 �V,J'L,� N/C CONTROL M
1, LIC LIC NO: ADDRESS: ❑
FCO�A� PHONE: QTY. ELECTRIC PERMIIT FEE BUELECT PLUMB MECH
PERMD'ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
Qdizrtnthvt lam licensed uniaTmeisime.fChapmr9(commencingwith JOB DESCRIPTION
�00 Division 3 of the Busiue,sand Professions Code,and my license is in PANELS
feet. �hie# UPT02WAMPS Contractor 201-1000 AMPS
Fy{ ARCHITECT'S DECLARATION OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT.
ZOOZ`:_O (undersand myplansshall be used as pchfr records, x
P., sal I SIGNS ELECTRICAL
6 Licensed Professional x
�a6 OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MIS
XO p,V 1 hereby affirm that i am exempt from the Contractor's License law for the
F3Oa
following reason.(Section7031.5,BusinessandProfessionsCode:Anycity«county THMP.METEROR'POLEIN ATE
�y which requires u permit to construct,alter,improve,demolish,or repair any structure
E Y� prior to its issuance,also requires the applicant for such permit file a signed statement POWER DEVICES
ha <p that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter
LMa9(commencing with Section 7000)of Division 30fthe Business and Professions Code) SWIMMING POOL ELECTRIC VALUA"TJ(yF
X�my or that he is exempt therefrom and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES-FIXTLRES 2�A/�
F.7a Section 7031.5 try any applicant for aponnit subjects the applicant to a civil penalty of Co
ore than Eve hundred dollars($500). NEW RESIDENTIAL ELECTR SQ.FT.
IyIrv]]F� Las
owe
with wagesastheirsolecompensalion, STORIES TYPE CONSTRUCTION
will he work,and Nc structure isnot intended orof[ered fnrsale(SecA044,Business
and Pro nssirins Code:The Contractors License hew does not apply to an owner of
property whobuilds orimproves @ereomand whodoessuchwork himselfonhrough his
own employees,provided that such improvements arc notimeadedoreffered forsele.If, DEC.GROUP RES.UNITS
however,the building or improvement is sold within one yearofcomplcilon,the owner- TOTAL'
builder will have IM1e burden of proving that he did not build or improve for purpose of
sale.).
❑ Las owner oflhe property,amexclusively contracting with licensed eonueausto QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
construct the project(Sec.7044.Business and Professions Code:)The Contractors
License Law doesnot apply to an wenerofpropeny whobuilds orimproves thereon,and PERMIT ISSUANCE
who contracts fersuch projects with acnntrector(s)licensed pursuant to the Contractor's
License Law. ALTER (EA)) FEESUMMARY
❑ I um exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICE OUTSIDE FEES
SANITARY Y N
Owner Date RECEIPT#
DRAINS-FLOOR,ROOF.AREA,COND.
WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN
❑Workers
Coyzffn tion( hrance or do'ni rdon'enu.od(Snsure,0,Lim C.)win(of RHCEIPI'p
FIXTURES-PER TRAP
Workers Compensation Insurance oraceniBW copy rheic.f(Sec.3ft00,LabCJ which PARK FEE Y N
es all employee's under this permit GAS-EA.SYSTEM-I INCA OUTLETS RECEIPT#
Policy# BUILDING DIVISION FEES w�
Company GAS-HA.SYSTEM-OVER 4BEA) PLANCHECKFHE V
❑ Certified.,pyis hereby furnished.
❑ Certified copy is fled with the city inspection division. GREASETxDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERSGREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This section need not be completed lRhepermh is forace hundred dollars(SIM) SEWER-SANITARY-STORM EA.200PT. ENERGY ME
ata less.)
I cenif din,in the performarrof he work for whichthis pe man is issued,Ishall WATER HEATER WNENTMLECTR
not employ any person in any m as to became subject m the Workers' PAID
O z Applicant tion Laws of Calil'omia. Dale so WATER SYSTEMTREATING Date Receipt#
PP
Z NOTICE
subject
APP LICWorkr's Compensation
this
ovisiosofTh Exemption,youshould
most NEW RESIDENTIAL PLMB. SQ.IT. TOTAL:
F' >
become campy the such provisions
or this Permit
be eLabor
evoked. mull
� � fonM1wilM1 comply with such provisions or this permit shell be deemed revoked. BUILDING FEE �.
CONSTRUCTION LENDING AGENCY SEISMICFEE
I hereby affirm that there is a construction lending agency for the performance of
U O the work for which this P.rmit is issued(Sec,3097,Civ.C.) TOTAL: ELECTRIC FEE
Laurier',Name
O U lenders Address QTY. MECHANICAL PERMIT FEE PLUMBING ME
I certify that 1 have read this application and state that the above information is� MECHANICAL FEE"
Cs correct.I agree ata comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE
,,, building construction,and hereby ambiance representatives ofihis city reenter upon he CONSTRUCTION TAX
U z vMvo-mentirined properly for insprelion purposes. ALTER OR ADD TO MECH.
�-^ (We)agree m save,Indemnify and keep harmle,s the City of Cupertino against
liabilities,judgments.crisis and expenses which may in any way accrue against said City AIR HANDLING UNIT(TO 10,000 CFM)
mrnseyue ce of the graining of this paned,
AIR HANDLING UNIT(OVER 10,000 CFM)
&gu reof APPlic.m/Contender Dam EXHAUST HOOD(W/DUCD
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNI'T(TO 100,000 BTU) Date Receipt#
Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(OVER 100,001)BTU) TOTAL:
as defined by the Cupertino Municipal Calc,Chapter 9.12,and the Health and Safety
Gide,Section 25532(a)1
0Yes 171 No VENTILATION FAN(SINGLE RFSID)
ISSUANCE DATE
Will the u licanmrfmurc buildm BOILER-COMP(3HP OR 100,000 BTU)
pp g«cupanBay Arica Acn Quality
.hazardous air contaminants as defined by @e Bay Arca Air Quality Management BOILER-COMP(OVER 100.000 BTU) 4�
District? 0v q
11 Yes ❑No NEW RESIDENTIAL MUCH. SQ.FT.
1 have read the hazardous materials requirements under Chapter 6.95 of the s�Q
California Health&Safety Cut ,Sections 25505.25533 and 25534. 1 imdetstaad that /��44// 2 I���
ifcupanbei lofthe rdue,nomurzeniIhave
ust IN,teeth is my reuance of
Certifica of /
he
occupant of Nc requirements which mull he mel prior 1.issuance.f a Cenificare of
occupancy. h L'C/r ,
Owner or authorized agent Data TOTAL: ISSUED BY:
OFFICE
t;;
J. THOMAS JAKABY JOB
Civil Engineer SHEET NO. OF
13206 Kevin Street T l DATE
SARATOGA, CA 95070 CALCULATED BY
O (408) 374-6149 CHECKED BY DATE
SCALE
_... ..... .. ... �Q ��
FEB 22
1994 t
_... ......
gLOG. INSPECTION O
n, OF CUp
DEP
Ci
_ ptTjRlp
........ .
TETE I,AMAY F.SIDFNCE
1101 ELMSFORD AVENUE
CUPERTINO, CALIFORNIA
IN AMOANCE WITH THE CITY 06
PI WONO CODES AND ORDINANCE$
Ate-_ BAY WINDOW DETAIL
�Et of plans and specifications MUS1L
4 an tho ►oh at all times and it is una -DATE: .FEBRUARY 11, 1994
#1F�CY ho MOO oily Changes oc alterations
:�fe;� without written permisskirt from
bilding Dep.t., city.of Cupertino, ....: _ .
ricg`ttbf itld'Of this plan and specifications
e
MALL.NOT-he held to permit at to be aN
Votaval of ttro violation„of,any..'provisioe9
er tiY Cty Ordinance or.State, Lam
..... ,
o Q�pFfSSlp
. . No 42317
EXP. 3/31/ 96
. .
OF CA11E04
.................. ............ ..................................... .......
........ OF
FICA -C���
.
J. THOMAS JAKABY doe 1 I o I L nZ i=oQt-;�P
Civil Engineer SHEET NO. y OF
13206 Kevin Street
SARATOGA, CA 95070 CALCULATED BY JTJ DATE
• (408) 374.6149
CHECKED BY DATE
SCALE
12
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