28016 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO BUILDING-ELEU,RICA[. PERMIT NO.
BUIDIN(.DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL /� O O a�
kOf - BJ.1LDINGPROJECTIDINL
'fIFICA'rUON o 1
BUILDING ADDRESS: SANITARY NO. APPLICNOON SUBMITTAL DATE
- „ PI Ler- UNIT. LO"I'#
OWN' SNA E: PHONE: CONTRACTOR'S NAME: LIC#
' 1• W
T A e a$ 1
NPC CON'IAOLp
ARCHITECTi LL INEER: `i LIC NO: II DRESS: 1 ❑
CONTACT: PHONE: QTY. ELECTRIC PERMIT ME BELL PHRMITINFG
iiii E PLUMB ECII
I PERMIT ISSUANCE �� 'TLr
LICENSED CONTRACT'OR'S DECLARATION APPLIANCES-RESIDENTIAL
py% I herebyaffirm that l am licensed underprovisions of LTapter9(commencingwith - JQBQl O.
woo Scaion]f1001 of UivisionJnf the Business and Professions Cotle,end my licenm is in PANELS
�IyC full fora enJ effc GIN
FZu1V� Liccto Class Li<.p UP T02AMPS
rn�y Datc L'ral0fmf 201-IIXst last AMPS SQ.PT.ILOOR AREA $/SQ.FI'.
Hy% ARCHITECT'S DERRIS ON OVER 11100 AMPS
ZOvs
OZIunticused
n—O
dersnd my plumshall bv public records.
F F-W SIGNS ELECTRICAL
Qy E,j Licensed Professional '
�yne6 OWNER-BUILDER DECLARATION SPECIAL CIRCUTOMISC.
X06 V 1 Mreby Wrion that I am exempt from the Contractors License Law for the
w3LLya following reason(Section 70315,Business and Professions Code:Any city or county TEMP.METER OR POLE.INST.
F'�OJ which teyuine u pcm:it m conaran,alter,improve,demolish,m repair any stmcwre
}S prior to its issuance,also requires the applicant for such email to file a signed statement POWER DEVICES
did C Oz fou he is licensed pursuant to the pun
rsions of the Contractor's License law(Chapter
La.LpLL 9(commencing with Section 7")ofDivision]ofthe Business and Professions CadSWIMMING POOL ELECTRIC e) VALUATION--ww
ed or that be is exempuhercfrom and the basis far the alleged exemption.Any violation of
F Z>pUTLETS-SWITCHES-FlXTURSection S hy y ppI calperm: sbjec sThe pp i w oa civilpe a1y of
ENEW RESIDENT-1AL CLEM —SQ FT. STORIE59 J YPE
C
ONSTRUCTIONore,b h rsF10
did ❑ I,asownertsfthepropcny.ormyempluyecswithwagesasibeirsulecompensation,
Wy3°� will do the work,and the arucmre is not Intended ocalfered for sale(Sec.]044,Business
and Professions Code 'I he Conrnnors License Law does not apply to an owner of
property whobuilds or improves thereon,and whodoes such work himselfor through his
own employees.providW lhaLeummre
chimpv ends onot imendedurofferedforsale.If OCC GROUP RES.UNITS
however,the building or improvement is sold within one yesrofcompletion,the owner-
builder will have the burden o'proving that he did not build or improve for purpose of
sale.).
❑ L,as owner ofthe property,am exclusivelyconrachng with licensed coolracmrsm QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
instruct the project(Nes.]OdW,Burinoas and Professions Codc:)The Contractors
Llceam Law fare snou..plymanownendpo"nywhobuildsor improveslhereoganl PERMIT ISSUANCE
whocontraas for such projects with a contmetor(s)licensed pursuanuothectoractor's ALTER-DRAIN&VONT-WATER 13A)
License law. ( FEE SUMMARY
❑ 1 nm exempt under Sec. .B&P C for this reason OUTSIDI!MRS
BACK FLOW PROTECT.DEVICE.
SANITARY Y N
Owner Date DRAINS-FLOOR.ROOF,AREA,COND. RECF.IIT#
WORKMAN COMPENSATION DECLARATION SCHOOL TAX YN
�❑ Iherehy ulfmslhatl M1ave acentlicem of<'onacnt to celf-inxurc.orneenifcnm of FIXTURES-PERTRAP RECEIVE,#
Wnrkurx'Congscnxmion Insurance nr cenifrodcopy thuwf(Sec.9X(10.LabCJ which PARK FEE YN
covers all enrto ads under this permmECEIPT#
p Y GAS-EA.SVS'IIiM-I INC.INC40UT : . BUILDI DEVI, S
Policy It
-, Company GAS-EA.SYSTEM-OV E G) PLANCI C
❑ CerifieJcopyishercbyfumished.
❑ Certified copy is Bled wilbtheciry inspection division. GRF SMNDUSTR ASTE INTERCEPTOR GRADI F' -
CHR'I'IIBCATE OF EXEMPT ION FROM WORKERS' GREASF.TRAP SOILS PCE
COMPENSATION INSURANCE
Mix action need not be completed Bit,permit is for nae hundred dollars($100) SEWER-SANITARY-, ORMLA.2001-T. YI1C
or Ecss.l
I certify that inlhe performance of the work for which Ibis permit isissuW.l shall WATER HEATER WNENT ECI'R I�
not employ any person in any manner so as m become subjm m the Worker.
Coni'munionlaweof Caliramia. Date WATER SYS TEMNUREATING ate Receipt#
OApplicant
NOTICE TO APPLICANT!If,ofsr making this Certificate of Exemption.you should NEW RESIDENTIAL PLMB. SQ.FT. 'TO"IAL:
71 bamandubjcct tot he Workers CnmprnsuBon provisiomoflbu Labor Code,you most BUILD[ ,FI?E
fmmwilh comply with eucM1 pr rsi .co n,this(comil,M1all be de tra d oevoked. r
(] CONSTRUCTION LENDING AGENCY SEES CFEE
z 1 hereby affirm that there is a coraswalun lending agency for the pedormanee ofE ,CIRIC FEE
O the work for which this perms is issued(Sec.3097.Civ.C.)
Lenders Name
F
Lender's Address QTY. MECHANICALPERMIT FF,E PLUMBING ICI:
V I certify shut I have read this application and%uta that the above ofismanion is
t.1-) MECHANICAL 1;
correct.I.dFm to comply witholl cityund munlyodinancesandsune lowsrelatingm PERMIT ISSUANCE LE /
buildingimndruction,and hereby aathnfine representatives ofthis city menrtr upon the
rA above-mentionedpropertyfor ins lion ALTER OR ADD TO MECIL. CONSTRUCTION TAX
Z t pec keep bar
(We)agree m save,indemnify and keep harmless the City of Cupertino against
liabilines,judgmenin and eapenx which..,in any way accme against said City AIR HANDLING UNIT(TO IO,WO CPM)
I
ave of the 5rani g nit.
uen I' AIR HANDLING U NIT(OVER 10.000 CFM)
r'.goulure of ppbcanl/Cnntracm PAID
Pam E%HAUS"T HOOD(W/DUCT) /1
IIA LARDOU MATERIALS DISCLOSURE HEATING UNIT(TO 1W,OW BTU) Dane Raceipt#
Will the applicant or future building occupantstom or handle haasrdous material HEATING UNIT(OVER 100.00081'U) TOTAL:
as defined by the Cupertino Municipal Cade,Chapter 9.12,and the Ilealth and Safety
Code,Section 25532(s)? VENTILATION FAN(SINGLE RCSI DI
❑Yes No
ISSUANCE DATE
Wous air ci ll theapplicamorfuwre bit dingoccupant mecquipmcntnNcviceswM1icM1 emir BOILER-COMP(3HP OR 100,000 BTU) P A I D
rdontaminants as defined by the Bay Amu Air Quality Management BOILER-COMP(OVER 100,00(i BTU)
ria?
❑Yes No NEW RESIDENTIAL MECH. SQ.FT. MAY
111995 j Zak^
I have read the huardous materials requirements under Chapter 6.95 of the "'/1 a a,llC
Culifomid llcahh&Safety Code,Sectiom 25503,255]3 and 25534. lundersteadthm CITY OF J,J
dine building discs no]currently have a lcnant,that n is my responsibi0ty to nafify the GUI'EN In
cup:mt of the rcyulrcn¢ms which mull M:mm prior m isxuancc of a Ccnifcmc of
'1 Occupancy.
Owneraraathorinedagenl Date L: / ISSUED BY:
OFFICE '
1q�t°
76,,
wcr� zo-lava-tc� Ib�w'
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t.t1040 ftsftj t�- Wz13000 t�,*,CZ43o(r)
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f%MT L Ci9SOIL �t � 65SoL�'7i1 $f .
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1ca�-ro O4 F t. _0 AIRS I - 5-PC PT -
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APPROVED = _ -
M ACMRDANCE WITH THE CITY Of, - - ' -
CJPERNO CODES AND CdDINANCES v '` -
it tf
�r7
SIGNEQ -
This set of Plans and4--
it 4 ; s
be kept on the + 'p ",ii gtions MUST
bat �a 6,tres and it is tm.
lawful to make any ai; as or alterations -
on same withaat w it.:n arm
the buildingDet Cby _ C scion from
P f Cupertino.
The stamping of th to eni specifications
SdAZL NOT be ha 4 1 _ ..
A to permit a ro be an _ �Ayll
3Ppnov�l the vtdatort of any prcwisions �} _ - — +y D
any City D d;nu7re N State Law. Sjet 19.95
0
`� ~ I have studied this sketch and completely DRAWNG • JOB NAME. t KA7a N�t-tL IC46
OFFICE COPY �. _ ss� a contents. a r 3 � elL
SCALE
INTERNATIONAL
SIGN:
rkw,t�Jci 11�.-�►� - _ -- _ - DATE: 'rCj��N�BA
,u Perspective Drawings are Artistic renderings and APPROVALS DATE T
? t I should Trot be considered as drawn b scale.Because oFuwn
of visual distortion M forced perspective drawinge and -
possible plan changes these drawings should not be CHECKED .
o0n9KkW d contractual. "
� aEinSED !ll DESIGNER-
BISHOP GRAPHiCS,ACCOPFIM
PEOeOFA Na Maw_ - - F
I ir !• y 777- t
2- - _ 9 +i _ - - _ - - __ - _ -T- }- - i—',: 4 � F i-:r k F•.3 h '1 �.1 _ _ ii- i. 1 _ _ �� F _ - - _ - _ _ -
1 - _ - - - 4 - E __ - - °t -T--t�_ - i k-_ -ff-- • _ -rj _� 7E
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DRAWING s JOB NAME �lL�i VI :�f1'af'1LAiCr�
/ 1 thaw studied t o !hatch and Y
understand its contents. Any changes
yes or
addl wig be pined as an extra.
SPE-+�►f+o
�
SIGN: SCALE
{ { -INTERNATIONAL
I _ f - y i- •". DATE: b5 STI�-re o
Fr
Perspective- Drawings ant Artistic renderings, and APPROVALS DATE ITCHIMPAT
should not be mmderw a drawm!o scale.Because DRAWN
{ r of usual distortion ul forced perspective drat and
/ ! r possible plan charges theme drags winshould rot be � D -
considered contractual-
® DESIGNER-
e1SMOP CRAPwCSMCQiREM -
REDRCER ND M
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