23692 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO.
I
g Address: r 23692 3^ 9
�Qr nlSpU N� �t• G31V, 1�•11G
Owne . � one:0 2tO a'%yJ U lC/E in c. I"-1 G~j 1 CITY OF CUPERTINO-BUILDING DIVISIONaL
Contranm.Name:a Lie.No: APPLICATION /PERMIT
BLILDING-nE TRICALPLUMBINGMECHAMCAL CATEGORY CONTROL N
Archlte /Engineer. LIc.N«
QTY ELECTRICPERMIT FEE BUILDING PERMITINFO
Adtlrev: PERMITISSUANCE ❑ 11 ❑
LICENSED CONTRACTOR'S DECLARATION
I herebyaffbm that l am licensed under provisions of Chapter9(mmmere. APPEANCESRESIDEMIAL JOB DISC ON
IngwlthSetlon force
affecn3o(the Buslrtevand ProlesalonaC-tote,and my /E '
license le a fun force and affect. PANELS (v�
License Class Lie#
Date Contractor UP TO 2DO ANTS
ARCHITECTS DECLARATION 201-1000 AMPS
Oot z I understand my plans shall be used as public recurds. OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT.
O
C 6 0 Licensed Professional SIGNSELECTRICAL
4600 OWNER-BUILDER DECLARATION SPECIALCERCUIT/MISC
71-�;' Thereby affirm that l am exempt from the Contractor's License law for the
following reason.(Section 7031.5,Business and Professions Code:Ancityor
F. gu9 ceuntywhichrequimsapermittommtmd,altepimpmve,dennl6h,orreair TEMP.ME['FR OR POLE INST.
$51ap G anystm=mpdortoiWs wancca6 mmluirestheappBsntfmsuchpermitto POWER DEVICES
O file a signed statement that he 6licensed pursuant to the provislom of the
3 w to Contractors License Law(Chapter 9(commencing with Section 7000)of Divi- SWIMMING POOL ELECTRIC
O Bion3ofthe Buslnevand Professions CodOmthat he beam therefromand VALUATR�_V,
H Yd 5 the basis for the alleged exemption. Any violation of Section 7WIS by any OUTLETSSWITCHESFIXTURBS ��''ff
X aPphcanl for a permit subjects the applicant toa civil penalty of not more than 7yT J
a five hundred dollars(S500). NEW RESIDENTIAL ELECTft
?�n ❑1,as owner of the property,or my employees with waSea as their sole SQ.FE STORIES TYPE CONSTRUCTION
Q
pe ton,will do the wmk and the structure 6 not intended or offered for
$ O vie(Sec.764y Business and Professions Code:The Contractors License Law
does not apply to an owner M property who builds or improves thereon,and OCC.GROUP RFS.11NTfS
Fes^ who does such work himself or through his own employees,provided that such
Improvements are not Intended oroffcmd forsale.If,howeveq thebuilding or TOTAL:
Impmvement 6mld withnoneyearofcompinbn,theownef-bugderwilluw
an of proving that he did not build or improve for purpose ofvle3. QTY, PLUMBING PERMIT FEE FLOOD ZONE APN
as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
c tractors to construct the project(Sec.7044,Business and Professions Code:
Contactors License Law does nor apply to an owner of property who ALTER-DRAIN&VENT-WATER(EN
Wilds,or improve thereon,and who mousers for such In jects with a
o'jdt ctor(s)Banxd pusuant to the Contractors License Law. FEE SUMMARY
IJ I am exempt urWer Sec B k P C for this reason BACK FLOW PROTECT.DEVICE
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N
OUTSIDE
Owner Dace
WORKMAN COMPENSATION DECLARATION RE=N
❑I hereby affirm that I have o cemOcate of consent to copy
ora FIXTURES-PER TRAP SCIdOOL TAX Y N
mni(Isb of Workers'Compensation Insusnaora certified copy therm((Sec. RECID'I N
3800,lab CJ GAS F.A.SYSTEM-1 INC40UTLEfS PARK FEE YN
Policyp RE=#
Com any GAEA.SYSTEM-OVER V4(FA)
�CS crtl(led copy 6 hereby furnished. BUILDING DIVISION FEES
❑Ccnified copy 6 filed with the city inspection division. GRFASE/WDUSTRL WASTE INTERCEPTOR PLANCHECKFEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
COMPENSATION INSURANCE
(Thlssectionneed not becompine ifthepermit isforons hundred dollars SEWER-SANITARY-STORM EA,2001T. Date Recei t#
($1 W)or Iev3
Icertify that In the perfmorsoeofthe work forwhich this permit le Issue, WATER HEATER W/VENT/E.FCTR ENERGY FEE Y_ N—
I shall not employ any person In any manner so as to become subject to the WATER SYSTEM/TREATING
O Workers'Compensation Laws of California.Date PAID
Applicant
Z o NOTICE TO APPLICANT:If,ager making this CenBkate o(Exemptlon,you '�T's'RES[OFSJIIAL PLMB.__SQ,FT. DagID"'
cej t#
HN should become subject to the Workers'Compensation provisions ofthe Labor AL'
Code,you must forthwith comply with such provisions orth6 permit shall be
LU > deemed revoke. BUILDING
Il p CONSTRUCTION LENDING AGENCY SEISMIC FE
I hereby affirmthat there 6 a ecrutrualon lending agency for the perform TOTAL: ELECTRIC F
Z anmoftheworkforwhichthlspermit66sued(Sec.3097,CIv.C3
V O Lender.Name PLUMBING
U. F- Lenders Address QTY. MECHANICAL PERMIT FEE MECHANIC
O W Imrtifythatlhavemadth6applisttonandstatethattheaboveinformation -
(1. Iscnrret.l agree to comply withal)city and reunty,mmances and state laws PERMIT ISSUANCE FEES PAID:
N relating to building construction,and hereby authorize representatives ofthIs
(— Z city to enter upon the above-mentioned property for inspection purposes, ALTERORADDTOMECH.
V — (We)agree to save,Indemnify an d keep harmless the City of Cupeerino Datet#
against llabllities,judgments,emtsandexpenses which°y .J�� RIiANDENG UNIT(f010,000 CFM) AL:
uga a d City In consequence ofthe gran ti this
AIR HANDLING UNIT(OVER 10,0D0CFM) CONSTRUC
Signa re of Applicant/Contsnor Date EXHAIIS'r HOOD(W/DUCT) CONSTRUCAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applica nt or future building—pant store or handle hazardous HEATING UNIT(TO 100,ODO BTU)
materials.defined by the Cupertino Municipal Code,Chapter 9.17,and the Datet#Ile❑althandSafetyCade,S1,11.2S532(a)? HEATING UNIT(OVER 100N. ,000 BTU!) L'
Will the applicant or future building oavpant uaeequipment ordevices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hazardous ab coniaminanta as dented by the Bay Area Air
Quality Management District? BOILFR-COMP(311POR lffl OM BTU)
M Ya 1.No
have read the haze us materials requlrem,nts under Chapter 6.95 of BOILER-COMP(OVER100,000 BN) PAID the California Health&SafestyCode,Sectlons75505,75S33and 25534. 1 #W Y
understand that if the building does not currently have a tenant,that it 6 my NEW RESIDENTIAL MECH. SQ.IT.
responsibility to notify the oavpant of the requirements which must be met per rt� a
prior to issuance of a Caniflcate of Occupancy. IVIH 1 19�
Owner or authorized agent Date 1111
TOTAL: ISSUED BY: 'I 1 4 f t � V
OFFICE COPY
J�
LV
Lr to
ICIO
cA
•
L
J
:1
I�
I.�
•
L
� b
i � y
y
m :
i
i
qc
Vex
i
7i
i,
%% . Pw�Vh, t\C�joaNAe
-_ Q\'18L 114aaa\spev.�
CuP g4'c\t+o�
• CP '\Se14.
pef;e a��► \qaa
'To TME L\Z4 OF t\ApQ0.t1N0 ,
LOP zyv kwew •k r.,�
�ee� �n1e,\. �twe.. ptie' tticd fwk We 10w�►
�vwwwiiQeel �f'we.� Oww.-0 � �vf�ew wa
S4�M�we. �IOQw.
GOoMnaf
CNq�e!\w CA Aso14.
MONTA VISTAHIGH SCHOOL
21840 McClellan Road
Cupertino, CA 95014
M-19091, (408) 366-7600
April 23, 1992
City of Cupertino
Cupertino, CA
To Whom It May Concern:
Mrs. Julie Fiala, who owns property at 21765 Hyanisport Drive, adjacent to Monta Vista
High School has informed me that she would like to build an eight foot high fence which
will separate her property from that of the school. I support her decision to build a fence of
that height.
Sincerely,
Jim Warren
Principal
bao