25007 (2)APPLICANT TO FILL IN INFORMATION WITHIN RED LINES • USE BALL POINT PEN ONLY
CITY OF CUPERTINOUILMN(i EL.ECTRrfai.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING MECHANICAL
BUILDING PROJEO'I' IDENTIFICATION
PERMI'I'NO. 25007_ � 0 O
BUILDING ADDRESS:
SANITARY NO.
APPLICATION SUBma FrAI. DATE
UNIT# LOT# -
OW S NAME:IIONF:'�j ��
ILL
CONTRACfO 'S NAME: I'1
N/C
❑
CONTROL
'4NCHITECf/ENGINEER: LIC NO:
ADDSr - JT�
: ' a0.
CONTACT: PHONE:
QTY. µµ7-r�,``, VELECIRIC PERMIT FEE
+s,
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
w4r'
PERMIT ISSUANCE
El ❑ K 0
LICENSED CONTRACTORS DECLARATION
I hcmby uffinn shut 1 am Ilcensed underprovisinnsofChupter9(cnmmencingwith
APPLIANCES -RESIDENTIAL
JOB DESCRIPTION '
Section 70)(d of Division 3 of the Business and Professions Code. and my license is in
full forte and e #n'n X`�%,]/
J Licence Class �� ic.#� •w
PANELS t
UI'T02(NIAMPS III ILII J ,' ,
'
201-It11p AMPS - d \ r, 3 q ,.—,
hate Cnmrautor F
ARCHITECTS DECLARATION
mn
1 deratmtd my plans shall be usod m Public rewNs.
OVER I" AMPS amu )
M SQ. FT. FLOOR AREA
$lSQ. FT.
SIGNS ELECTRICAL
-
1 Licensed Professiusul
OWNER -BUILDER DECLARATION
1 hereby aft(Se that 1 u eusin from the Compactors License Lew for the
SPECIAL CIR SC.
TEMP. METER OR POLE INST.
following reusaa (Section 703 Business Professional Code: Any city at county
which consumer, i pr
I which reconswm,nhcpimprove,demolish, orrepair any smucure
or to iguisesnposit
the file a statement
untto
POWER DEVICES
that hesliensed pursuantthe prvisios of the Contractor's License
the be Business License Law (Chapter
La
j Natheis licensedpursuant tothe) of Division
- 9(rommcncin with Section ]q)0 of be Business end Profasiow Cede
6's'i Ira )
oradain Section 703exemprahcmfromand Ne basisforof
by any subjeasogedexemption. civiny l
subjects the oPPlicenunncivilpenalty of
lore
SWIMMO40 POOL ELECTRIC
VALUATION,.
-
%�D• ePR')
OUTLETS -SWITCHCS-FI%TURES
not than hundredollars($Permit
1 not mLassoonfvehd, propdollaa(SSW).
❑ Lmownk withwages mthei(See. cW,Buadon,
J
NEWRESIDENTIALELECIR_SQ.FT.
STORIES
'TYPE CONSTRUCHON
will dothewons and the
and ed Business
is
to
and Professions Cele: The Commdor's License Lnw dna not apply to an owner of
he Contractor's License Law does not apply to an
propcnywhnbuildsorimprovev Hereon, nndwhoNesauchwurk himulforthmughhf,
D,
oweeer, wilding
OCC. GROUP
RES. UNITS
TOTAL:
le, ri improvement isman
howee,will avec a ard.ilfementisold he id am
builder will have the burden of that he did nm build err ire
,improleiogthrpmai-
peeving prove for puryose or
QTY. PLUMBING PERMIT FIFE
sal
❑ I, avuwneraftheproperty, are exclusively convecting with licenced commnom to
C3 1
FLOOD ZONE
- APN
Lstruct the project (Sec. 70,14, Business and Professions Cade,) The Contractor's
icense Lew does not apply ban ownerof property who bui Ids or improves thereon, end
PERMIT ISSUANCE O
who contracts for such projects with a centmetorts) licensed pursuanuo the Contractor's
License Law.
ALTP.R-DRAIN&VIiNT-WATGR FA
( )
PEE SUMMARY
❑ 1 am exempt under Sm. , B & PC for this ressan
BACK FLOW PROTECT. DEVICE
OUTSMEFEI:.
SANITARY Y N
RECEIVE#
Owner Dom
DRAINS - FLOORROOTARFACONU
, , ,.
WORKMAN COMPENSATION DECLARATION
❑ thereby affirm that l have acenificataofconsennoseLGinsure, ommidiftcateof
Wnrkers'Cnmpcnsatinn lnsumnce oracmified copy thereo((Sec.3g00, Luh C.)which
SCHOOLTAX YN
RECEIPT#
FIXTURES -PER TRAP
PARK FEE Y N
GAS - EA. SYSTEM -1 INC. .
covers all emplo se's under 's arm'.
Policy p b
RECEIPT
BUILDING DIVISION FEES
Company <Ogg A 9, PC
GAS - EA. SYSTEM -OVER 4EA)
1'LANCIIIiCK FEL?
❑-CcntOcB copyu fere yf rmshed:
m Certified copy is filed with the city inspection division.
/�•
GRfASEANDUSTRL WASTE INTERCEPTOR
GRADING FE -E
CCRTIPICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
GRLASLTRAP
SOILS FEB
SOWER - SANITARY - STORM HA. 200F1'.
ENERGY ME
(Thisseetion coolant becampletcl lithe permit is forms hundred dollersIgloo)
or las.) I
WA'1"ER HEA PER W/VFNT/ELIiCPR S"
' I cenify that in the pecon... se f.he work far which tide pemsit is Issued, la hall
not employ any person in any rammer in as b become subject to the Workers'
PAID
Cmapsom tienlswsof Cmifenia. Data
Applicant
WATER SYSTEMORIATING
Date Receipt#
NOTICE'I'O APPLICANT: IL after making this Cenifcate of Exemption, you should
thescrounc subject to Ne Wadda Compensationprorrns of the Labor Card,. you mon
NEW RESIDENTIAL PLMB. SQ. FT.
TOTAL:
forthwith comply with such provisions m this pennitsholl he deemed revoked.
BUILDING FEL
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
I hereby offira that them is n rn vas a ion lending agency for the performance of
the work fur which this permit is issued (Sec. 3097, Civ. C.)
landcr's Name
TOTAL: rS
ELECTRIC FEE
Lendefv Address
QTY, MIECHANICALPERMIT FIEIE
PLUMBING FEE S
I cenify that I have read this application and state that the above information is
correct I agree to comply with all city and county ordinances and state laws relating to
PERMIT ISSUANCE
MECHANICAL FEE
buildingconstrucuon, and hereby southern repressedulvesof Nis city be enterepon the
above mentioned property for inspection purpraba.
ALTHR OR ADU TO MECH.
CONSTRUCDONTAX
(We) agree to save, indemnify and keep humorless the City of Cupertino against
liabilities,judgments, emaiandexpema which may in tiny waynccrueagaiostsaid City
AIR HANDLING UNIT(I'O 10.000 CFM)
nnsequenceof Negrenf goI th's parer.
/D_,
AIR HANDLING UNIT (OVER 10,000 CFM)
EXHAUST HOOD(W/DUCI)
PAID
namreof ApplicenVContmaor Data
HEATING UNI'NTO 100,1)00 BTU)
HAZARDOUS MAl'ERIAIS DISCLOSURE
Data Receipt #
Will the applicant or future building actuarial amen or handle hazardous mtihim.)
as dcbncl by the Cupertino Municipal Code, Chapter 9.12, and the Hovlth and Safety
HEATING UNIT (OVER IW,INIB BTU) -
(�
TOTAL .l
VENTILATION PAN (SINGLE RHSLD)
Code, Section 25532(e)?
13 Yes C1 No
Will theapplicamorfutumbuilding occupant use equipmentordeviceswhich etnit
BOILER - COMP (]HP OR 100.00) BTU)
ISSUANCE DATE
bortudnus it contumacious s as seined by the Bay Area Air Quality Management
s issrict?
BOILER - COMP (OVER 100,000 BTU)
'
❑ Ya 13 No
NEW RESIDENTIAL MECH. SQ. FT.
mations requirtments under Chapter 695 of the
I have mad the Invarifelt'
Code.
Code,Smtioleman. but b ill and 25534. 1u, to dednd that
that
if
if the Wilding encs not
Wilding ]h& at,' ly hove o mount, e,m it is my responsibility to notify the
A'
menta
net-landan of the requirements which most M met prim to issuance of a Cenif¢nm of
Occupancy.
ISSUED BY:
Owner or authorized agent Date
TOTAL:
urrlL t Cllr ser laurrnwiw
•
40
10300 Torre Avenue
Cupertino, California 95014
Telephone: (408) 252-4505
Cit -4 of Cuperti"o
DEPARTMENT OF PLANNING AND,DEVELOPMENT
PE= #: -2 S 0(> ;7
ADDRESS: 7 e 3 E /c��r
DATE: 3 -1?` -`/y
To Whom It May Concern:
P.O. Box 580
Cupertino, California 95015
You are hereby notified that your permit has expired. Due to the
requirements of Section 303D of the Building Code, a building permit shall
become null and void if work on the project has not commenced within 180
days from the date the permit was issued.
If we do not hear from you within three (3) working days, your building
permit and file will be considered void, and it will be forwarded to the
City Clerk's office for destruction.
j—C'.i�i� h � 71• S .�iu171xY
LTR-PMT(BT 92/1)
AODI IrAMT Tn FII I IN INFnRMATIOld WITHIN RFn I INF$ - IISF BALL POINT PEN ONLY
—1 llascxu
CITY OR CUPENO rLUMBINO MECHANICAL
BUILDING DIVISION APPLICATION/PERMIT .UILDINO YROJFCT;H)ENTIBICATIONdr _ T
PERMIT NO.
25007
BUILDING ADDRINS:
SANI'1'ARYNO.
LOTN(�
&APILICATIONRUBPETALDATIiUNITI
OW . SNAME: 'l10NE:_ `j ��
J
CONIRACTO'S NAME: Li
N/C
El
CONTROLN
'I
ARCI IHTCT/VNGINER: LIC NO:
I?
ADDRESS:
CONTACT: PHONE:
F %W
•...
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE
❑ TK '
LICENSED CON' TRACTOR'S DECLARATION
I lemby affem lhm turn li<ensai under provisions of Chnptu9 (commencing with
APPLIANCES - RESIDENTIAL
JOB DESCRIPTION
-
Section 70IXgnfDivision 3oftheBusineasend Profusion Code, and my license is in
PANELS
full fora and a Na. f
Licensell c.N 0
UP TO 1fq AMPS
'
0q 't0-41,111
Date Contractor'1 viaea !
ARC] IITECTS DECLARATION
WI - IM AMPS
SQ. FT. fLOOR AREA
SISQ. PI'.
OVER 1000 AMPS
I tmderxmnd my plans shall Ire used m Public rtenxds.
SIGNS ELECTRICAL
LicensedI'rofueienal
OWNER BUILDERDECLARATIONthe
SPECIAL CIRCUIT/MISC.
CoATION
1 hereby affirm that I am cacmpt from the Committees License Isw for the
i.eard
following reason.(Scdion 7031.5, Business end Professions Code: Any city or coumy
TEMP. METER OR POLE MST.
which requlres u permit to construct, alter, improve, demolish, of repair any structure
prior to its Issuance, also requires the applicant for such permluofile. aloedrameneat
POWER DEVICES
that he is licensed pursuant m the provisions of the Contractor's License Law (Chapter
9(commencing with Section VUW) of Division J addle Business and Profusions Cale)
or that he is ucmpt therefrom and the 6esia for the allegM uemptien Anyvidialonof
Section 7031.5 by any applicant far a permit mbjecls the opplicenuo a civil penalty of
SWIMMING POOL ELECTRIC
VALUATIONS
(eTa•�)
S� D
- FI
OUTLETS - SWITCHESXTURES
.or more than Eve hundred Jo1drs(5500).
❑ Loanwrk,anbepmp<ny.nrm tle(Ser. eampcnsiness
NEWRESIDENTIALELECTR _SQ.IT.
STORIES
TYPBCONSTRUMION
of areayeeawifferedor Business
will dm the work, and the is sot's o fn
he Conctructure
Law Ams not apply to en owner of
and Professions Cale: The Contractor's License w do not apply to son
ndwho
owneywhes, proorimproveaah improandwhodnenauchwmk himselfonhmugbhis
provided nulde carr dcrmoffercd ferule.
impis
err.
OCC GROUP
RFS. UNITS
TOTAL:
prtech
r-
the slid within
however, the have bur improvement is sold within one year or impreetion, theownar-
builderwill have IM1e burden attracting that he did not build nr improm far purpose of
the
od")'
Lasowneroftbeprnpeny,anmaclnsivclyconvactingwithlicenaedemmocmrsto
convtruct the project (Sm. 7044, Business and Professions C(deQ'Me Contract—
License Lowden not apply tonnowncrofproperty who buildsor improves therea land
n.00D zo E
"N❑
a,
v a
'aaovr�Tr'sada
i PLUMAING PERMIT
�.Rnv Sa:uvar.7geivaxuml: !Ld
Ffi
tY
PERMIT ISSUANCE
who commits for such projmu with acomunor(s)licensed pursuant to Ctuntreaors
License Law.
ALTER -DRAINVENT- WATER(EA, _
&
�� y��,rzzptg F$E$UMMARY
ll�P
❑ 1 am eacmpt under Sec. , B & PC for this tenon
BACK FLAW PROTECT. DEVICE
T 1
SANITARY Y N
RECEIPT' N
Owner Date
DRAINS - FLOOR, AREA,, , GOND.
SCHOOL TAX YN_ '
RECEIPTN
WORKMAN COMPENSATION DECLARATION�
❑ I herehynffitm that l bavencenificam ofeometn to self -insure, macertificateof
Worlorm'Compenmtion Insurance or a certified copy thereof (Sm. 3910, Lab C.) which
arvemsall empin se's under 's eon'.
Policy q
19XTURES-PGRTRAP
PARK FEE Y N_
RECEIPTN
GAS -EA. SYSTEM. INCA OUTLETS �
BUILDING DIVISION FE
Company a
GAS - EA. SYS'LHM-OVER 4IRA)
PLANCIIECK TEE
❑ CenificJanpy is hcrehy tarnished.
OREASrANDUS'IRL WASTE INTERCEPTOR
GRADING FEE
Vl Ccnified copy is Bled with Nadhi, inspection division.
K.
Cf:RTI1ICATEOFEXEMPION MOM WORKERS'
GREASETRAP
SOILS ME
COMPENSATION INSURANCE
SEWER - SANITARY - STORM EA. 301FT.
ENERGY FEE
(Husacauld accrued be completed ifthe pemdt is fortune hundred dollars ($INE
nr less.
Ittiti fy that in the performance of the work fm which this permit la iamed, Ishail
WATER PRATER WIVE NT/LLEMR
ata employ any person in any manner w u to became subject m the Workm'
PAID
Currartionlan Lawsof Celdmirds. Data
WATER SYSTEM/TREA'DNO
Data RaccildN
Applicam
NEW RESIDENTIAL PLMB. SQ, PT.
TOTAL:
NOTICE TO APPLICANT: If. it,, making this Canificate of Exemption. you should
become aubjem do the Workers Ctumpe alumn proviaiona of the Labor Cnde, you must
fonhwitln comply with such p ... Winds or this permit shall be decreed revoked.
BUILDING ME
SEISMICFEE
CONSTRUCTION LENDING AGENCY
I hereby affirm that hem is. conswction lending gency for the padormance of
it is ised(Sec. 3097, Civ. C.)
the work for which this permm
TOTAL: r5
ELECTRIC FEL•
o 'ti yylNNpa'LY..tW
l ME HANJCAL.!PER
') " trr.�.L
ti h HSalt 1
tljl `I.By
NEW
PLUMBING IL8 s
Ledder'a Nome
Lender's Address
I certify that I have read this application end state that the above information is
Correa. I agree to comply with all city mrd county ordinances and stale laws relating to
MECHANICAL PCE
PERMIT ISSUANCE
building construction, and hereby mihoriu representatives of thiscity, to enter upon the
abov-memionW pmpeny far inspection Purposes.
ALTER OR ADD TO MECUL
CONSTRUCTION TAX
AIR I IANDLING UNIT (TO 10,OW CPM)
'
(We) agree to save, indemnify end keep brocades, the City of Caper inn against
liabili l its,judgments, costs and expenses which may In any way accrue against aid City
nscqurnccmflbegmn. gmflti a pcnnit. 2
/a_�
AIR HANDLING UNIT (OVER 10,00(l CFM)
EXHAUSTHOOD(WMUCD
PAID
:' nmuro of ApplicandsCanbanm Dam
HEATING UNIT CTO 100,01)(1 BTU)
IIAZARDOUS MATERIALS DISCLOSURE
Date Receipt M
IICATINO UNIT (OVER I00,000 PTU)
TOTAL: 2
Will the applicam or futerc building ..,.at score or handle hazardous memorial
as defined by the Capenino Mnnielpal Code, Chapter 9.12, end the Health and Safety
VENTILATION PAN (SINGLE RMID)
Code, Secllen 33532(a)7
❑ Yes ❑ No
ISSUANCE DATE
Will lhcapplkarn or future buildingmcupant uuequipmentordevicu which emit
DOILBR-COMP(311POR Irn"BTU)
BOILER -COMP (OVER I W.000 BTU)
hazardous air mmaminants as dcra,d by the Bay Ams Air Quality Management
District?
NEW RESIDENTIAL MECII. SQ. IT.
❑ Yea ❑ No
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Heallb&Safety Code, Sections 35505,25533 and 35534. lundcolondthat
jP I
currently have a nd, that his my responsibility to notify the
if the building does not Rn
4A DM
occupant of the requirements which most the met prior to issuance of a Certificate of
Occupancy,
ISSUED BY:
Owner or nnthorimd agent Data
TOTAL:
OFFIGt 011r Ur L.U"t,%t mgr