20841 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
Building Project Identification - ., - PERNUT NO.
Building Add mac
z 20841
arae: one:
CITY OF CUPERTINO-BUILDING DIVISION 0
�
Ce •Name' Lie.No: APPLICATION I PERMIT v V
r BUILDINGELECTRICAIPLUMBING-MECHANICAL CATEGORY CONTROL N
Arch ect/En seer, Lle No:
- QTY ELECTRICPERMFF FEE BUILDING PERMIT INFO
Add. PFRh9TISSUANCE Rr � ❑ - ❑
LICENSEDthat Ia CONTRACTOR'SDECLARATION
I herecdion7 thatlamlken3ofthe order provW dPmf hamaCo(a,and APPWANGESRESIDENML JOB DESCNB'ITON
Inane l.edlon )of Dldied 3oltheaualussand ProfesslonsCode,and my
license ie In(rel ddfed PANELS �l VVr"a�
Llan Lk Y
Date Cantndor_
ARCHITECT'S E TION 201-I000AMPS
cc0 ZO 1 understand my plans slug be used an records.cords. OVER 1000 AMPS - SQ.Fr.FLOOR AREA $/SQ.Fr.
iK Licensed Pro(eatimul SIGNS ELECTRICAL
6^g WNER-BUILDER DECLARATION
I..,< Ihereby affirm lam exempt from the Contndoes License Law for the SPECIALCE(CUIT/MRX:
FMrx following reawn.(Section 7031.5,Businemand Professions Code:Any city or �OL�
µ^�-� county which requires a permit to muWd,alter,Improve,demoWh,or repair TF.MPMEFER ORPOLE INS'.
anystrudurcprlortoltsbasnce,Xa h ®
nrequlrea/heappRntforsuchpermlttoµ file a signed stsm.mant that he h lksoud pursuant to the provisions of the POWER DEVICES
3µ Contradorb License Law(ChapterI(commencingwlthSedWn7000)afDlvl-
t�n SWIMMING POOL ELECTRIC
El 01 a(an3ofthe evslneasand ProfeulonsCode)orthd heheumptthercfromand VALUATION
O the bash for the alleged exemptlon. Any vidatlon o(Section 7011.5 by any OUTLETSSWITCHESFIXI'URFS
applicant for a permit subjects the applicant to a doll penalty of not more than
liv6undred dollars($5M. NEW RESIDENTIAL ELECTR__SQ.Fr. STORIES TYPECONSTRUCTION
�n I,as owner of the property,or my employees with wages as their ah
compensation,will do the work and Ihertadure h not Intended or offered for
pIn(Sec.7074,Business and Prard lou Code:The Contractors License Law I--
' ' � does not apply to an owner of property who Wilda or Improves thereon,and OCC.GROUP RES.UNITS
who does work himself orthmugh his own employees,provided that such
improvemcntsare not intended oro!(ered formle.11,howeveythebulldingor _ TOTAL:
improvement hsaldwlthlnoneyeamfcocopletlon,the ownerbullderwlll have '
t})iI.Ilurdenofpmving that he did out build or improve for purpose ofule.), QTY, PLUMBING PERMIT FEE FLOOD ZONE APN ,
u L as owner of the property,am exclusively=trading with licensed - pg 4,p�gUANCE.
contractors to construct the project(Sec.7074,Business and Professlwu Code:
The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN&VENT.WATER(EA)
Wilds or Improves thereon, and who contracts for such ptc)ects with a
ogNractw( rcu
0)Rmnsed pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY
LJ I am exempt under Sec. B &P C for this an FEES
Owur DRAINS.FLOOR ROOF,AREA,COND. SANITARY Y N�
.• Date RECEIPT p
WORKMAN COMPENSATION DECLARATION FIXTURES PER TRAP SCHOOLTAX Y N
❑I hereby orkem that 1 have o lmum to of consent to opytharc,ora RECEB'r N
38WLamnifl�teofWorken'Campensatlonlnsunnoewa certllkd ropythnreaf6ec. GAS EA.SYSf'EM.I BJC.YOUTLETS PARK FEE Y N
Pollry Y GAS EA.SYSFFM-OVER 4(FA) RECEIPT M
Com any BUIL DING DIVISION FEES
0 Certified ropy b herebyth thead CREASE/PIDUSIRL WASTE INTERCEPTOR PLANCHECKFEE
�CertNed copy h(Red with the city inspection division.
CERTIFICATE OF FXEM PTION FROM WORK ERS' GREASE TRAP PAID
COMPENSATION INSURANCE SEWER-SANITARY-STORM PA 200FT Date Recei t#
rrhlasection need net W complded If the pemdt h fw aro hundred dollars
(f100)orfy that
WATERFEATERW/VENT/ELECTR ENERGYFEE Y - N—
I
not thatlnanypethe omrInanynce of ework.astobeco for which permitishoed,
I shall not employ any pears In any manner w u to become abject to the WATER SYSTEM/TREATING
WorApplica Compensation Laws of California. Date PAID
Z Z NOTICE TO - Date Recei t#
Z NOTICEco APPLIGM:U,•gems Compensation
omhnCtion poisons ofte Lyons
NEW RESIDENTIAL PLMB. SQ.FT.
FCode, become subject it the ply wia'Comp rovisinprovhionsrmit s Lab be - TOTAL:
fA
Code,you=at forthwith comply with such provisions orlhh permit shall be
j deemed revoked. 13UILDING FEE
aCONSTRUCTION LENDING AGENCY - SEISMIC FEE
Z Ihercbyoffirm/hat there h a construction lending agency for the perform- TOTAL: ELECTRIC FEE Z
once of the work for which this permit is Issued(Sec.3097,Civ.C.)
•V O lender's Name PLUMBING FEE -
LL i- Lender.Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
OW• Icenlfythal l have mad thisappRolionand siatethattheabovelnforondion
1 Iscorred.I agree m complywith all city and county ordinances and state laws PERMITISSUANCE - FEES PAID-.—
Mating to building construction,and hourly authorize representatives oflhis
F Z city to enlerupon the abovementloned property for inspection purposes. ALTER OR ADD TO MECH. Date Recei t#
— (We)agree to uve,Indemmiy an d keep harndess the City of Cupertlno
against babllitl judg cwts xpenses which cosy lnanywayam AIR HANDLING UNIT CIO 10,000 CFM) SUBTOTAL:
against uidC In • nce th granting of thio permit
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
S tureo AppR nt/Cant dor D e EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAlARDOUSMATERI LSDISCLOSURE -
Wllltheapplicantorfuture building occupant store or handle hazardous HEATING UNIT(TO 100,000 BTU) Date Recei t#
material an defined by the Cupertino Municipal Code,Chapter 9AZ and the
Health a ad Safety C c ton 25532(•)7 HEATING UNIT 100,000 BTU) TOTAL:
❑Yes a
Wlllthc appllant tore building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
whichemithavrdous Ircontamlruntsasde(Ined bythe Bay Area Air
QualP�ff�
ity Marugemen Wt d7 BOILER-COMP OR 100,000 BTU) .
4 Yea No
have reacithchaza ousmaterialsrequimmnhunderChapter6.95of BOILER-COMP(OVER100,000 BTU)
the California Health& fety Code,Sections 25505,25533 and 25534.1
understand that if the building does not currently have a tenant,that It is my NEW RESIDENTIAL MECH. SQ.Fr AUG 2 1990
raponsiblll tonotlfylheoccvpa o requirements which moat he met
prion.i. eofa tat, nry.
4O^Z Cli'.r re fin'?7�i0q '
Cycor—oralftfroriced agent - Data
TOTAL: ISSUED BY:
OFFICE COPY