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24982 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY CITY OF CUPEPERMIT NO. NO APPLICATION/PERMIT PLUMBING.MECHANICAL BUILDING DIVISION BUILDING PROJECT IDENTIFICATION 24982 BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMI'ITAL DATE ��4© I' �1 NpSA`�' ��/. Cv6�IUNIT# OT0� , c� 4 OWNERS NAME (''� `1 PHONE: CONTRACTOR'S NAME: LIC NO: JgM�S ,t $J A Y),� J^A Y N/C CONTROL# AR STECT/EIJrG=INEER�O�— LIC NO: ADDRESS El CONTACT:V PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO PERMIT ISSUANCE LDG ELECT PLUMB MECH ❑ 1:1 ❑ LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL Msez I herehyaffrm thatt am licensed underprovisions of Chaprer9(commencing with OR DFS til 00 Section 9000)Of Division 3 of the Business and Professions Code,and my license is in PANELS S �Zfullndeffect. License GQ Licensense ClClass I,ic.tt UP TO 2M AMPS c, Date Contmcror. 201-IOW AMPS Z8-4ARCHITECT'5 DECLARATION OVER 1000 AMPS SQ.PT.FLOOR AREA $/$Q.FT. Oz..rt:� I understand my plans shall be used as public records. yr SIGNS ELECTRICAL "i LmenseJ Pmfesetonal a OWNER-BUILDER DECLARATION SPECIAL CIRCDIT/MISC. O a U 1 hereby aT'f(Se that 1 am exempt ar ss an the Contractor's License Law Por he W y following reason(Section 7031.5,Business and Professions Cale:Any city or county TEMP.METER OR POLE INST. � rn which requires a petmit to construct,ulcer,improve,demolish,or repair any strvcwre rn¢� priorto its issuance,also requires the applicantfor such permit to file esigned statemcm POWER DEVICES ti0 a that he is licensed pursuant m the provieinns of the Contrmtute License Ixw, up( ap Wp 9((commencing exempt therefrom and the Division Soflle Business and Professions Code) SWIMMING POOL ELECTRIC AL iW CK or 9(cmheicing wittherefmmandthebasiefor 3 offfic ed Business .Anssionstioaof e) `' [-.Z 6 Section T03 L5 by any applicant for a permit subjects the applicant m e civil penalty of OUTLETS 1 S FIN $ mnot more than five hundred dollen($50% ❑ I,atnwneroftheproperty,ormyemplOyeeswifiwagesastheireoleciai'madar. NEWRES EN A STORIES TYPE CON$TRUCf10N W will do the work,and the structure isnatimendedmoffered firmade(Sec.901 Bushes, and Professions Cade:The COmmnia,License Law does not apply to an owner of properly whobuilds orimproves Nereun,and whodoes such workhimselforthrough his ownemployees,provided fiatsuch improvements monatintended confirmed hassle.If. OCC.GROUP RES.UNITS however,the building or improvement is sold wiNinoneyemofcompletion,the owner- builder will have the human of proving that he did not build or improve for purpose of sale.). ❑ I,as weacrufihe properly,amexclusively contracting with licensed contractors to QTY. PLUMBING PERMIT FEE FLOOD ZONE APN construct the project(Sec.7044,Business and Professions Code:)The Commetars License Law does not apply to sur Owner ofpropeny who builds or improves thereon,and PERMIT ISSUANCE who contracts fmiwh projects with-emancou(s)liermsedpursoant to the Contractors Lie no,Law. ALTER-DRAIN&V ENT-WATER(PA) FAH SUMMARY ❑ I ant exempt under Sec. ,B&P C for fiis reason BACK FLOW PROTECT.DEVICE O SIDE FEES Owner SANITARY Y N Date DRAINS FLOORROOF,AREA,COND. RECEIPT# - , WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N ❑ Ihercby affirm Nmlhave ecerificale of consent to self-insure,oreccnificam of FIXTUR -PER TRAP RECEIPT# ES Workers Compensation lnsumnce oracenified copy fiereof(Sec.38W,lab CJ which PARK FEE Y—N — covers all employee's under this permit. GAS-EA.SYSTEM.]INC. OUTLETS RECEIPT# Policy M BUILDING DIVISION FEES Company ❑ Cercifed copy is hereby furnished. GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE ❑ Certified copy is filed with the city inspection division GREASEIINDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP 3PAID S FEE COMPENSATION INSURANCE (This section need not be completed lithe permit is for one hundred dollan($IW) SEWER SANITARY-STORM EA.2WFT. GY FEE orless.) I certify that in the performance of the work for which this permit is issued,I shall WATERHEATERWNENT/ELECTR tot employ any person in any manner so as to become subject to the Workers'zACuipensationLowsofCalifornia. Date WATER SYSTEM/HtEATING Date Receipt# Oicant — NOTICE TO APPLICANT:If,after muking this Ceni ficaln of Exemption,you should NEW RESIDENTIAL PLMB. SQ.PT. TOTALbecome subjectto the Worker's Compensation provisions mf the Labor Code,you mustforthwith comply with such provisions or this Permit shall be deemedrevokod. DING FEEa Q CONSTRUCTION LENDING AGENCY MIC REE 7 Z I hereby affirm that there is a construction lending agency for the performance of L) O the work far which this permit is issued(Sec.3099,Civ.C.) TOTAL: ELECTRIC FEE O �y Lender's Name Cry Leaders Address QTY, MECHANICAL PERMIT FEE PLUMBING FEE I certify that I have read this application and state that the above information is acorrect,I agree to comply with all city and county ominouns and state laws relatingmPERMIT ISSUANCE MECHANICAL PEE building construction,and hereby authurt.representativesof this city to enter upon the V `J abuse-mentioned property for inspection proposes. ALTERORADDTOMECH. CONSTRUCTION TAX •^� (We)agree to save.Indemnify and keep harmless the City of Cupertino against liabilities,judgmems,costsandexp may in any way accrues against said City AIR HANDLING UNIT GO 10,(100 CFM) in consequence of the grunting L/ AIR HANDLING UNIT(OVER 10,01 CFM) tS encs oFApplicanUComraz — Ban, EXHAUST HOOD(W/DUCT) PAID HAZARDOUS MATERIALS DISCLOSUREHEATING UNIT(TO Hat"BTU) Dare Receipt# Will the applicant or future building occupant store or handle hanarrlous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 1 SO BTU) TO Code,Section 25532(x)? EI Yes IJ No VENTILATION FAN(SINGLE RESID) Will the applicanmrfumrchuildingoecupant useequipmentordeviceswhichemit BOILER-COMP(HIP OR 100,000 BTU) ' ISSUANCE DATE azarlous air contaminants as definod by the Bay Am Air Quality Management istrl100,000 BOILER-COMP(OVER lO0, 0 BTU) ❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FT. 1 have read the hazardous materials requirements under Chapter 0.95 of the P Lk9 00 COlifomia Health&Safory Code,Sections 25505,25533 nod 25534. I understand fiat /'1 Y ifthebuildingdoesnotments lyhaveasena,.Nato is my reietweiofla tonotify of occupant of Nc requirements which must be met prior to issuance of a Certificate of Occupancy. -APR 1 Owner m mahomed egem Data TOTAL: ISSUED BY: CA4cu LATED By - STEVEN A. ARNOLD JOB ND33 - 73 Civil Engineer . CHECKED BY SAN1The lameda JOSEACALIFORNSAite 305 95 26 DATE /10 i�e,d J3 IGNED BY RCE NO. 22301 // PAGE_�OF �- PROJECT -S�t4 �h� 'S p�aiT 7' Ur :,: f, rr1 Del V !f t;tr r;;. _r A �� �✓ _ _.. c%14� IUNO/ LinoWso7 {{A� Q,•. b� +<;\¢ Vn'✓ A/ `tJL �. � t�. CLf1�✓7 /✓t O� as 222C3 3 3o k9S APR 19 1993 �tx0 BLDG. INSPECTION II��EPART�dEM 0 CITY 1? 1�LD 11 / ekl 1p A 2A y wood no SS e'f l� av/1o.� , � X1:51 s2c Tim^ r CA�CUI_AtED BY ,STEVEN A. ARNOLD JOB No. 3 3- 93 Civil Engineer Q— CHECKED BY 1671 The Alameda Suite 305 DATE 14 ' 2. f 3 WIGNED BY SAN JOSE, CALIFORNIA 95126 'IGNED 8Y RCE NO. 22301 w7.f `� 11 /.L PAGE--L--OF 2 PROJECT J !'// 2Xts"� cor+��o rucl 2x 1 per 12 t2ew 5«�Z- C) sky IIgH�• new Al .G/on9 - np,/ �G -1-rUf5 pew Zx� �ols� 2n '4 p�i� � •. 7 Loklerer exlsi 2 ,Kq r06 } ru5SX _ = Z x ti wo i t h�/ncu / 1 4 S� YJ� ( LO ur"v\ SUP.,nerr7 epi Z x l� • tya l l