26216 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINON B.DI G-LLECTRICAL PERMIT NO,
APPLICATION/PERMIT PLUMBING-MECHANICAL n C n'I C
BUILDING DIVISION BUn.DINC.PROJECT IDENTHrICATION L o G 1 v
RUILDINGG11/AD^DRE55:U J1'�` SANITARY NO. APPLICATION SUIIMITI'AI.DATE
atJJ � "O 1C+�FUO UNITN LOT#
OWNERS NAME: PHONE: T CTOR'S NAME LIC NO: 032 777�
/ I L L_ k16 S O N/C NTILl
R Hrp11i /ENGINEER: LI�IyO:o ADD ' SO C�2— ❑
/�J11ffOO__
I
\-k- CONTACT: PHONE: BUILDING PERMIT INFO
QTY. ELECTRIC P MIT FEE
BLDG H.ECT PLUMB MUCH
NIS 36 -b2 PERMIT ISSUANCE: fir� o
LICENSED CONTRA R'S DECLARATION APPLIANCES-RESIDENTIAL `—O
I here affirm Cot l um licensed under l'Chat a,Rommencin C ION DLSCRIYI'ION
❑sz br prd Protea. per gwi
ts100 futiorceandof Divisionlnf be Business and Professions Code.and my littnx is in PANELS
C fullforceGla crfcc,. UPT02MAMPS (1 .T.R/�W�y��{� � 1 �
QZ License Class I.ic.p —w+` +\F'V �'l
ti61Z DaeContracmr 201.PRO AMPS
ARCHI'FEET'S DECLARATION OVER IOfN1AMPS SQ.FT.FLOOR AREA $/SQ.FI'.
OZ-0 I understand my plans shall he used as public records.
r 1 F W SIGNS ELECTRICAL
Licenmd Pro&vdaral
OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
I hereby affirm that 1 am exempt tram Ce Commaora License Low for the
LL13�F following motor,(Section 9031.5,Baamessund Pfofcssiom Code:Any cilyorcmunty TEMP.METER OR POLE INST.
C f9 which rcqutrea u .it to construct,aper,improve,demolish,or repair any structure
pd.,o its laarance,alsmrcqulms t1m."licanl fmauchp<tmd,to file a signolmumen, POWER DEVICES
that he is licensed purauam to the provisions of the Contractor's License Law(Chapter
aax e� 9(ccommencing with Sermon 7000)of Divlslmn Sof Ce Business it Professions Code) SWIMMING POOL ELECTRIC VALUATION
W_w or he is exempt therefrom and the basis for the alleged exemption.Any violation of is
Section 7031.5 by my applicant for a permit subjects the applicant to a civil penalty of OUTLETS-SWITCHES-EIXTURBS
O not mum than five hundred dollars($500).
m ❑ 1........theprnpeny.ormyemployms wiC wegesu ...lecumparradon, NEWRESIDENTIAI.ELECB _SQ.1'f. ST RAILS 9'YPE CONSTRUCTION
will do the work.und the structure is not inerdcdoroffcred for sale(Sm.7044,Business N�
and Professions Code:The Contractors License Law does not apply to an owner of
progeny who builds orimpnwes thereon,and whodoes such work himselfur Brough his .GROUP RFS.ONE IS
own employees,providW thatsuchimpmvemenlsarenot intendedoroffradforsale.If, \
however,the building or improvement is sold wuh.ona,mir mf completion,the owner- Ol'AL:
builder will have the burden of proving that he did not build or improve for purpose of
19
ale.).
PLUMBING APN❑ LusownendlhePeo property,em exdmivel cmnpuctingwi,h licensed cmmrnctnrsm QT . ' L
p
LiGOD_ZONE
censed the project Sec.apply
9aric Businemmixsa and Pm&salons Code:)The Contrathermicturs
al PERMITISSUANCE
License Lawdoes uc app,ymwownerofprogenywhosedIdaorimprothe Cotton,and
who contents forsuch projects with ucomractorts)licensed puravanGmhe Conuxmrs ALTER-DRAIN&VENT-WATER(EA)
License Law. FF.E SUMMARY ,
❑ 1 am exempt under Sm. ,B&P C for this moron BACK FLOW PROTECT,DEVICE SANITARY DO I Y D S
N
Owner Data RFCEIP ##
DRAINS-FLOOR,ROOF.ARCA,GOND.
' WORKMAN COMPENSATION DECLARATION SCBOOLTAX YN
I hereby affirm that I have a certificate of eca sentto self-insure,or a cenifiate of RECEIPI'#
orkerr'Com tion Insurance ora candied FIXTURES-PER TRAP
Compensation copy thereof(Sec.3g00,lsh CJ which PARK FEE YN_
coven all employee's under this permit. GAS-EA.SYSTEM-1 INC.4 OUTI.ID'S
RECEIVE'#
._� Policy# BUILDING DIVISION FEES
Compuny GAS-EA.SYSTEM-OVER 4(BA) PLANCI IRCK PER
❑ Car lfiml m,y is hereby trimmed.
❑ Cmified copy is Filed with the city inspection division. GREASE/INDUSTRI.WASTE INTERCEPTOR GRADING IEE
CERTIFICATE OF EXEMPTION FROM WORKERS' CREASE'TRAP SOILS FET±
COMPENSATION INSURANCE
(This xaimi need..,be completed if,he penni,is forma,hundred dollars($100) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
calms.)
I modify,hatin lhawnfomunceof,he workforwhieh,hispvrmi,isissued,l shall WATER HEATER W/VENTIELECTR
no, employ any person in any owner so t1.,��e e s�y m1 to the Workers' PAID
Compmsaio sig fC to ti . Dare ,"�Tl WATER SYSTEM/1'RFATING Dae Receipt it
Q z Applicant
7 0 NOTICETO APPLICANT:If,after making l u nificmeof E,man,lio.,you Cmild NEW RESIDENTIAL PLMB. SQ.FIE 'TOTAL:
FV) bmmr,mbj,euolm Workers Compensalin in BtonsorCe Lubar Cide,you mus,
a > fonhwi,h comply wiC such previsions or,his Penni,shall be deemed revoked. ` BUILDING FEE
W O CONSTRUCTION LENDING AGENCY SEEis IC FE
5 1 hereby uffino lh,,here is a combustion lending agency for the performance of
the work for which,his gamut is issued(Sec.3097,Ci,CJ 141M 1W ELECTRIC FEE
�-s Larairna Name n� PLUMBING FEEW l—t Lentlers Address Q97: 'v MECHANICALPERMrri"' CEL+
U I certify Nut 1 have read this application and s,am that,he above information is
W cmrrexscounty
, l agree to comply with all city and ordinances and slam laws relating to PERMIT ISSUANCE MECHANICAL FEE
Nbuilding construction,and hereby aahunse reprcxaa,ives ofihis city manner upon the CONSTRUCTION TAX
U 7 above nominated progeny for inspection purposes. ALTERORADDTOMECH.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
hid ildies,jol,runu,costs it expenseswhich may in any wayaccrueagainst said City AI R HAN DLING UNIT(TO 11,000 CFM)
in coax ecce of the losinfing of this permit.
33d AIR HANDLING UNIT(OVER 10,0gCFM)
S namm of Applicwt/Con,mcitr Dam EXHAUST I IOOD IW/DUCI) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,080 BTU) Date Receipt#
Will the applicant or future building occupant store or handle hawdous material HEATING UNIT(OVER IGI,(Xp BTU) T
as defined by the Cupertino Municipal Code,Chapter 9.12,and,he Health and Safety
Care,Section 25532(a)'I
11 Yes EI No VENTILATION PAN(SINGLE BESIDE
eqmproca
whichrou
Winthe applicant orfurore defining by[Bemuse Area
Quality Management BOILER-COMP(311P OR 1(q,000 BTU) S EDATE
havWoua air mnaminants v defined by Ute Bay Arce Air Quality Mwagcmem
District? BOILER-COMP(OVER IOQIKE)BTU) AR
011' ❑Yes 11 No NEW RESIDENi'IAI.MEClI. SQ.FI'. 3 0'1994
I have read the Emanations materials requimmen,s under Chapter 6.95 of the 01 s,
ifthe building db&Safetyendy have Lim 2550ht it is y ms,wn4.J untotiolnd Ca, I ur VUrCnfll�l�
ifthehnilofthe xsnot csconswich mutam,Cmo ismyreuance of
Cm.ofnythe _
all onat of the rcquimmenu which mon be ran prior m issuance m(a Certificate of
Occupancy.
Owner or aulbon>cd ugem Data TOTAL: ISSUED BY:
OFFICE-