22602 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Irmteet
`I4mlfkalonµw / / Ie, PERMIT NO.
•/A/I^� -//1/
Bu Wing Addmaa:/O 6 / F// Zi 0�� ✓� ' yYVOLJ
vis ams: /' ane:
CITY OF CUPERTINO-BUILDING DIVISION
°^t . . : m m APPLICATION / PERMIT
BLfLDINGELECIRKALPLUMBING-MFGHANICAL CATEGORY CONTROL
ArchBet Englreen Lb. a
/�+J��� Q ELECTRIC PERM IT FEE BUILD�r�I�Nc�IG PERMIT INFO
Address a � �L-R—a-Gv`� b• PFRMITISSUANCE (� ❑ L-^ ❑ 1:1TUIRB V=
LICENSED CONTRAOR5 DECLARATION
I hereby aH70 that I lc 3nffiMR.M Waeaa(Cha.0(comm. APFl]ANCESRESIDENIIAL BD6CR�TION
Ingwlth infullf.me.fDlvlJan3ofthe BuJrcu.nd Pm/edovCade,and my C•-� l \�
Iimnee la th fail torte and erred. PANELS
Glance Clan Licit
Date CoMnaor JIe�
ARCHITECTS ECLARATIO 1-1000 AMPS
reO Z2 I understa my plans w
shall he ed n public recordERs. OVIODO AMPS SQ.FT.FLOOR AREA $/SQ.FT.
0 Licensed Pmfenbvl SIGNSELBCTRICAI,
Q Lbyi OWNER-BUILDER DECLARATION -
t.., Ihereby alarm that l am e.empt I.the Contractor's Llarue Taw fee the SI'ECIALCItCUIT/MBSC
{) folbwing teoo.ISeetlm MI5,Bush.am Pmfenbn,Code:My city or
0G�uy muntywhlahreTl aperrNtromrotrtMJter,Mpmve,deno h,ormpalr TEMP.P.METER OR POLE INST. I �
`47,�X77 any strutlure prior to its lnwrce,alw require the a ppU.t fmauch permit to
D
E S Bla•signed wtemem the he b licensed put m
rant to the pm taro.of the POWER DEVICES
Qw� Contntor's Licenaelaw(Ch,pter9(mmrcncingwhh Section 70(D)ol Dlvl- S'WBdMfNGP0OLF1.ECLRIC
TPQ
F, O Jon3of the Busmen and PrdenbroCode)orthJ hebeeempttherelmm.nd -
'S the ii sla for tha alleged exemption. My violation of Se tion 70115 by any .�j �( /♦'
�� -SWITCHES-
applicant permit sub*ts the.ppllcant too civil penalty N not men, han /` OUTLETSSW17CHESFIXTURFS DATEO Q�
Bvf hun,ed owner ars of
peo NEW RFSTDEMIALE ECR #QFE. BTORlm TYPE O NSIRUCTION
I,as ower o!tM pmperty,or my empbyen with wages.,their sole
pewlon,wBldothe work,andthe wumurebnot LteMed or offered for
sale(Sec 7061,Bwimss and Pmfessbv Cade:The Cmdraccrs Llaroe law
(;j$$
dm"apply town owner of property,who WiNs or lmpvrvtherem,and
0. whodoneuchwork hlmselforthmugh Memploye,provided employeprovided that sock OCC.GItO(JI' RES.UNITS
imlmvemrw am not Intended oroffered fmsale.If,havever,thebuilding or TOTAL
improvementlawdwlthinovyearofer plmtb thever-buWl wllllave
tEl he burden of pvving that he did not Wild or Improve for purpose ofsale.). QTY, PLUMBING PERMIT FEE FLOOD ZONE MWS an owner Of the property,am e:<hulvely contracting whin Ik..d
conu.tm to mvtmd the pm}et(See_706/.,Business and Prdmlov Code: PFRMTTLSS'UANCE
The Contractor'.Lbws Law doe not apply to an owner a property who ALTER-DRAIN A VENT-WATER(EA)
builds or Improve thereon,and who contach, for each ptp)r t with,
o�fatOK.)IkevN nt pursuato the Cwtntns
oe.License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY
L�I am exempt under See B k P C for this recon
DRAINS FLOOR ROOF,AREA,NND. SANITARY Y N_
• Owner Date BBC=N
WORKMAN COMPENSATION of
FDCTURES.PER TRAP SCHOOL TA% Y_ N_
❑1 hereby.(form that I have o atifkate of couent to oy-thetro ora RECEIPT,N
c ,ateof Worken'CmperoaHonlmunntt oraartBkd coPYthrmrf(Sec GAS EA.SYSTEM-I IN'Ct OUTLETS PARKFEE Y_ N
3800,lab C.I
Com N GASFA.SYSTEId-0VFRI(FA) RECEIPT DIV
Y BUILDING DIVISION 1910th FF.E9
Policy Certified copy la herebyfumla GREASE/INDIISTRL WASTE IM'FRCFPIOR PLANCHECK FEE
Ceti/ied copy la filet!with the city
ty Inspetlon dlvlJan.
CERTIFICATE OF EXEM PFION FROM WOR KERS' CREASE TRAP PAID
COMPoomple ONINSURANCE SEWEILSANII'ARYSTORM FA 200FT Date Reccl t#
(TMs I.) need
not Wcanple4d 0th,permit bImorchundred dollar
(D40)410') WATER HEATER W/VENT/ELC7R ENERCYFEE Y N
Iatlfy that it, performnreaf the work forwNch thla pe Ishaed, —
I shag wt empty any on In er n u m �o the WA,l.k7I 51,SfEa1/fAFA,tINC
Workers Compensaua yv p u) PAID
O Z Appgont /b 10Ac-! / NEWRNy DFN77ALPLh(B. SQFT. Date Remi t#
Z N.IId hero.xub eW11, lo, Coon p,eof FsempteLyou
N shmid become mb}eet to the Warknrs'Co�pevrtbn pmvhbns of the Labor TOTAL
LU _ Cadgyoumleeci, wth comply with ach proWabv orthla pemat shall be
�j deemed revoked. BUILDING FEE
SG CONSTRLCTIO.N'LENDING AGENCY SEISMIC FEE
Z Iheneby.fBrmthatthem h,conaomtlonkMingagenty forth,petortry TOTn1_ ELECTRIC FEE t
and of the work!or which thial;m It la owned(See 3097,C1v.G)
LL0 Lender',Name
r Lerder,Add. QTY. MECHANICAL PERMIT FEE MECHA-FLUMBINICAL FEE
O W Iartifythatlh,veradthisappllatbnandpatethJthe, einfor ons,
L+mrmt.lyreemcmplywkh.Bdty,ndaountyoNln.nmand ole laws PERMIT ISSUANCE FEES PAID.
U) rating to Wilding constructoo,and hereby authoJm representative ofthb
Z city to enter upon the.Wvo-menJonied property for inspection purpose. ALTERORADDTOMFLH. Date RCCCI t#
_ (We)agree to save,bde an d keep ha mless the City of Cup rtlw
.gg'IvtRabitit , gnroui mss, �nnsn which ya AIR HANDLING UNIT CIO 10,000CFM)
a Trot old SUBTOTAL•
ATRHANDLLNG UNIT(OVER 10,f1f10CFM) CONSTRUCTIONTAX
SignaturefAppuant/Contractor Date EXHAUST HOOD(W/DLC-T) CONSTRUCTION TAX PAID:
HA]ARDOUSMAFER SDISCIASU E
WWthe appll=or future Wilding pantstoreor handle havrdcus HEATING UNIT(to 10,000 BTU) Date Revel t#
material as deRrcd by the Cupertlm Murdtpal Code,Chapoar 9.1 Z.nd the
iirlhh and Safety Cade Sedan 2432(,)7 HATING UNIT(OVER 10,000 BTU) TAC: 7
WYe ��
Blthc appBantofuture M:Oding otvpant use trylpment ordevima VENTILATION FAN(SINGI.E RFSID) ISSUA CE DATE
Mich eMt havrdous,ir mntamlnants n depot byline Bay Area Air. t
.® Bty Management DlatrM7 - BOILER-NMP PIE'OR 10,0(0 WM Hit 3 � 1S9D
Ye No �Ia sT•F.I
a have read the b....mneriala mqulrcmenb under Chapter 6.95 of BOE OOMP(OVER 100,000 BTU)
the CaBfomla Heahh k Safety Code,Setbro 25505,75573 and 255M.I
understand that lithe building dm not cumently have a tenant that It la my NEW RESIDENTIAL MEAL SQFT.
mpovibBBy to notify the occupant of the requlremrNs which most be met
Price tot uarue a a Certificate of Octup.ncy.
Owner or aulhodud agant Date ISSUED
TOTAL BYC\\j�
OFFICE COPY