27033 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO lawn s.-RCFcrRmA- PERM°'ND'
CAL
BUILDING DIVISION APPLICATION/PERMIT PING PROJECTBING- IDHANIFICA 27033_7 0 3
BUILDING PROJECT FDENT'IFTCA'11ON G
BUILDING ADDRESS: n .7y/J� p� /q SANITARY NO. APPLICATION SUBMITTAL UATE
O �iO '(✓ 1 �"✓W�WS / UNIT# LOT#
OWNER N MF P Ni: /J CO R' AM ICN . NIC CONTROL pVV VV
• ARCHITI -TEN (NEER: LIC NO: J ADD F. L/✓L/ ❑
CONT PHONE: ,BUILDING PERMIT INFO
/// QT,Y,i � �' ELECTRIC-PERMIT FEE
� •-.-S v A$:-s£ %ELE; BLDG ELECT PLUMB MECH
PERMIT ISSUANCE 2
LICFN ED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL / OBD CR&!:�
q.Z IhereM1y nflirm thud am licenud underprovisionsofChapmr9(commencing with
00 Sccdon]tlBlp nfl ivisinn3of the Business and e Ions�^'� limy liocnee is In PANELS -IullE '
QQ License Class Lic.# J (�(O 200AMP5
tizly 'I'm Gmunctor 201-HOOAMPS
z O,N� ARhall be LT'S DFCL OVER 1000 AMPS SQ.Ff.FLOOR AREA $/SQ.F-1'.
Oz'—q lundersund my plans shell be used as public records.
r w SIGNS ELECTRICAL
6� „y Licensed Professional
a y.C6 OWNER-BUILDER DECLARATION SPECIALCIRCUTT/Ill
�'OyU 1 hereby uffrm that 1 con exempt from the Contractors Licenu Law for the
30.N¢ following?exon.(Section 7031.5,Business and Professions Code:Any city..counry TEMP.METER OR POLE MST.
C J which rc9uires s permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also reclaims the applicant forsuch permit o file.signed statement POWER DEVICES
no MC,
titre he is licen.A putsuenuo the provisions of the Convector a Liceve Law(Chnpty
CkE M 9(commencingwiih Sntion7000)of Division3ofthe Businessand Professions Code) SWIMMRIGPOOLELECTRIC VALUATION
X_,� Sectio70or that he 31.empUhetefmmend the basasfor Neallegedeaempnt to civil
of
Fza no,nomanal bye undredicollars $500).tsobjecss the applicanno¢civilpcnehy of OUTLETS-SWRCHES-FIXTlIRFS
X=0 not marethanfive hundreddollars yemp.
C F_22 ❑ Lthe wrk,an the
is emend or ofwa forsale(Sec.cam NEW RESIDENTIAL ELECDt _SQ.FT.
Y p Y 6 lxmetion, STORIES TYPE CONSTRUCTION
a3°—° will do Professions
work,and the he Contra not intended ace do s not apply to an Business
and Professions Code:The ve thereon,
t ereons License Law does not apply tom owner of
propenywyees,providedrovesthereon,andwhodoessuch wad himselfor thrsale.Is
own employees,provided that such improvetnntsureno[intended ormffered Tarsale.If, - OCC.GROUP RES.UNITS
however.the huildingor improvement is sold within one year of completion,the owner- 'TOTAL.:
bonder will have the hunlen of Freving that he did not build or improve for pur arm of
❑ I as ownerofthe property,not exclusively contracting with teemed commuorst QT"Y ? ' PLLIMBING PERAAI'P. FEE FLOOD ZONE AI'N
construct tile project(Sec.71H4,Business and Professions Code)The Cnmmclor's
Lcense Law lines not apply to an ownerofpropeny whobuilds car improves thereomand PERMIT ISSUANCE
who contracts for such projects with a conundor(s)licensed pursuant to the Convector's
License Law. ALTER-DRAIN&VENT-WATER(BA) - FEE SUMMARY
❑ 1 um exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICE. OUTSID la:.
SANITARY Y N
Owner Dme RF.CF.IPI'p
WORKMAN COMPENSATIONDECLARATION DRAINS-FLOOR,ROOP.AREA,GOND. SCHOOLTAX V N_
• ❑ e, Co affirm thatl have ecenificate of cnnum mol(S..re.orv,d,C.)cmeof FlXTURES-PER TRAP RECEIPT#
P'"crs#'Cempensption 1pxunytce orecet{i[tM cop beyyf(gec.3900.Lob CJ which PARK FEE V N
covers all employ cJY1k'iFT'!Gi-,IpIL-�L]',T7t6// (�
GAS FA.SYSTEM-I INC.401I1'LEfS RECRIPT#
ss Iq BUILDING DIVISION FEES
Com GAS-G.SYSTENI-bVER 4(EA) PIANCHECK FEE
Cerifed copy is hereby famished.
[ICenifedcepy is filed with the city impudent division. �='OREASFJINDUSTRL WASTE INTERCEPTOR GRADING ME
CERTIFICATE OF EXEMPTION FROM WORKERS. ' GR ETRq`T SOILS FEB
COMPENSATION INSURANCE;:'ik`"
or lnMosomation need net be completed if Nepeca iiisforonehandreddollars($1}q) 1 •SEWFAk SANNITA STORM EA.1200FT. ENERGY FEE
I certify that in the performance of Ne work grwhicM1 this�.R�'pit4 tssAuWash'{.1I ERPF{p-AT[R NENT/ELF.CTR��
not employ any penton to any manner so as tblbermhe sol m'lthe Worker i PAID
Compersatienlnwael Culifomia. Date n'• t kS i A S TING b+ Dam Receipt#
p Z Applicant Yr v
NOTICI?'rO API'LICAMf:IL efmr making this Certificate fExc don,you should - T'IAL PCMB. SQ.Pf.
r
rn becomesflucti to the Worker's Cam — IOIAI-'
1 pmrthis provisi6nsofT eLabm Code, 9��rrlrtust
7 forthwith comply with such provisions or this permit stiall be reed rev�.1 C� ,tfy+S^'" BUILDING PEE
(� CONSTRUCTION LENDING AGFNC •,,p+'^'�sy SIiISMIC FEE
7 z Thereby affirm that thea iaaconswction lending egrncy or the performonreuU'- TOTAL: ELECTRIC FEE
L) O Ne work fmwhich thispermitisissued(See.309],Civ.f)„ � _^tL"%
lender's Name PLUMBING FEE
O F Lenders Address QTY; '' 'MECHANICAL PERMIT FEE �+
7UJ I certify that I have recd this application and sum Net Ne above information is MECHANICAL.FEE
” Lkl rnncct.logics to comply with all city and county ordineno and aumlawa relating.. PERMIT ISSUANCE
E' y building construe n, dhem" auNoriu mpreuntativ<sof thisciry mcmerupon the CONSTRUCTION TAX
L) z above-mention rty for inspection puryems. ALTER OR ADD TO MECH.
(We)ogre t a c, ndemnify and keep hamticss the City of Cu r inc against
ancoities"rofina os and expenus which mayiusnywaylaxorm sins id Cary AIR HANDLING UNIT(TO 10,080 CPM)
in conseyueac c h a gofthis permit. A
AIR HANDLING UNIT(OVER 10,050 CFM)
Signature of Ap cant/Cxmracmr ase EXHAUST HOOD OVDUCq
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date Receipt#
Will the applicant or future huilding occupant stere or handle hmnrdous ma c,lid
m defined by the CupeninU Mnnicipvl Code,Chapter 9.12,and the Ileahh and Surety IMATING UNIT(OVER 100,000 BTU)
Code,Section 2553200?
11 Y., 0N VENTILATION PAN(SINGLE RISID)
BOILER COMP(3HP OR 100,000 BTU) ISSUANC�-.�qTE
WilHhenpplicantorfmurc define by the Bay Areequa
Quality Manes agement
AUG U ! 1995
havtdous air contaminants as defined by the Bay Aree Air Quality Management BOILER-COMP(OVER 100,000 BTU)
DislrinP
11u
Yea NEW RESIDENTIAL MECH.—SQ.FT. CITY Uf VUPEK I IND
I have read the hfnIx
o ..rials rengaremenrs under Chapter 6.95 of the
California Henhh&Safe ode,5 tic 5505,25533 and 25534.1 understand that
of the building does nrn ctly eat nu that it is my responsibili ify the
occupant of the reclu neiIt an t me prior m izs o a Cmificam of
7 Occupancy.
%P Owner or authorixed age t Dam TOTAL: ISSUED BY:
OFFICE