23644 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Pro'ed Identlflad°o PFIL,UT NO.
budding Address:
i c) SO, S1a01'A/c1 23644
Wwnlera bore: ne: A
ON t :7OhNSOna 446-4Jl CITY OF CUPERTINO-BUILDING DIVISION 1
CmmadormName: Uc.Na APPLICATION I PERMIT
IM S L V vn ) 319
�I q / OLnDING-E•ECTRICALPLUMBING-MECHANICAL CATEGORY CONTROL X
Architect/Enginmr. Lie Nn;
�° t t9s " . -�iBUILDING'PERMITjINFO�',�,a
II ELECTRIC PERMIT _ __ �:'
Address:4.0. B D 3 2 I gj'TQG A 7 PERMITISSUANCE ❑ ❑. _. ❑
LL—
LICENSEDCONTRAC( R'SDECIARATION
I hereby affirm that lam Bcensed under prwblonsofChapter9(mmmene N'PLIANCESRESIDENIAL 108 DESCRIPTIONingwith Sed1on7000)of DiA.i.3ofthe Busimsand Profesian.Cod.,and my
Ilanse is In(aril Farre and d(ed. PANELS
LimnsCbs C=)fy_LV_# 4'?I991 5=R
Date_e^�1_TQTp ConmaorUP TO 2DO A IS
ARCNITECI'S CLA ATION 701-1000 ANT'S
0ZO IurdergaM mypbnsehaBW used upub0crtmeda OVER l000 AMPS SQ.FT.FLOOR AREA $/50.FT.
Llm.mad Pmfeeelanal SIGNSELECTRICAL
< OWNER-BNLOU DECLARATION
I., 3 Ibenby.di.thatlam exemptlromthe CoNradore Limns law lmthe 9aFLULCIRCUIT/MLSC
JOfollowing reason. 7m0315o,Business aandlecPrlmofepsroivwcudCode.Ahn,oyrcity Wr TFMIa.MEIFtORIOLE INST.
- ^^ � �
�1 anya signed
he Is alsortd pursuant
provision,
to POWER DEVICES Y
eE � file a ggned statement that he b Ilmnaed pursuant m the proWbm of the - d \ A
266 C lutndoe.License Law Chapter 9(mmmencing with Section 7000)of Divi- . '
O don3afthe Buq m"dProte WmCode)orthel it :¢mptthenfmmand SWIMMING I'(70L ELECTRIC VALUATION
Y) tha Weis!or the allegeds.emptlon. Any ablation of Sta lo.70715 by any u. �FUTURES DATE
app0ont fora pemdt uhjam NeapplimntW acivii pensltydnd mortthan O
five hundred dollars(SM.
z�an ❑I,as owmr of the Property, vrit,Ba
Property,ar my employees wages as that, NEW RESIDENTIAL Q.ECTR—sQ•F STORIES TYPE CONSTRUCTION
Fa mmpemation,wdldo the week and the groctum is not Wended or offend for
a sale(See.70K Business and Pedes ons Code:The Contrado/a Wmme Law
does not apply to an owner of property who builds or Improves tWnrary and
who doessuch work himselfmthrough hbemployees,provided employprovided thatsuch OCC.GROUP RES UNITS
Improvement,arc not Intended orof6ered foraals.It hoxxeer,the building� T(yPA4 "
improvement badd within omyearo/mmpldioryhaowner
tWllderwW have y;p '
tlurden of proving that he did not build or bnprove for purposes of sale.). 0. �4P1119,6IIVC'PERMPP FEEw —FLpp ZONNE ApN
u I,s owner of the property,am exclusively amtnctlng with Ilmmed PERMIT ISSUANCE
eonmeetms to camtud the pmject(Sec 70K BueInes mrd Profession,Cade �
Th.Contndoe.Limns Law doe not apply to an owner of property who ALTER-DRAIN 4 VINE-WATER •_. '
builds or Imthenen,and theand who zonam for mod,p(a)eds with a .
deemed pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE FEE[$UhBY4_AY
/ I am exempt under Sec B&P C for this reason
Owner aVWM
Dom . DRAINS.FLOOR,ROOF,AREA,COND. SANITARYi. Y _ N
WORIQIAN COMPENSATION DECLARATION RECF71'T 0
❑el hereby Wirt.that I have•certificates of emacs to slf lwrs,m a FIXTURES PFR TRAP SCHOOL TAX Y -N •.. --
artlfimta al Worker'CampemadmtlnsunnmmaartBled mpytherm!(Sec. '• RFLEETPII'f _
350Q lab CAS FA SYSIFAt•1 QgC40U1LE[B N
G PARK FEE �Y •'*+
CaP.Im sly CASEA.SYS[EM-OVER4(PA) .,.. RFGFBT# r "
BUILDING DIVISION FEES
Certified mpybhereby furNehed. GREASE/INDUSHtL WASTE INTFRCOsTDR PLANCHECKFEE
•
Cum
copy b filed with the city lespec nt divWm.
CERTD7GlE OF EXEMPTION mom WORKERS GREAEFTRAP PAID
COMPENSATION INSURANCE " };
(Ihlas:dbn need nestWcompletedEtha permitb(mom hundred doBanfWA
IT'VtY-sroRM PA 810FL - Date Rece7 t# `"':
(5100)mlo.) HEATER wIVFM/E3.ecrR ENERGY_FEE Y_ N '-
I certlfytha[In the pe forounmof the work lorwhidh this permit b lasued,
I shag not employ any proton In any puma" o s to bemrrc ubjed to the SYSTEM/TREATING ' ' '2'v
O Worken'Compenstion Lawsof California.Dab PAID .:
AppH.
Z NOTICFt ESIDENTIAL PLMIL SQF[. Date - Recel t#
Z Z NOTICETD APPLICANT;If,after making this CertlfWteaf Exemptbryyou
H ehmld bemmv eub}•ct to the Workers'Compematlnn proWbm of the Labor •-e TOTAL: ".+a'•
(r N Codgyou m�n lonhwith comply with such prorIslom orthb permit"IW .•p_7r:).<,fyr-T,� .q:.F, {F ••
LU 9 deemed W. BUILDING FEE
CONSTRUCTION LENDING p G AGENCY SEISMIC FE - =t
IhercbyaffioMfor tlWmbaermtlriixm lending agency097,C fortha pexorm ELECTRICFEE
0O amde?.ewoh lorwhlrA this permit blwedl5ee 30Pl,CW.CJ s i
U I<ndOe.Norm PLUMBING FEEa'L�' 'v<:,�.' N
LL F Ierdeb Addw MIT
O W Imxlfythatl have read lhbappRaxonaM gatethatlhaabove Inlommllm MECHANICAL FEEN.=';?',7!-'u
Is caned.I agree to comply with ad By and county ordhsances and pate laws PERMIT NUANCE FEE$PAID: . . .
} N relating to building camtnuYtory and herby authorize reprmemativs ofthb
Z city to enter upon the abovcmentbmd property fo,WpeWon pup. ALTERORADDTDMECR
L.I Z (We)agree to save,IndenW fy an d keep harmles the City of Cuperthe Date
agabut liabilities,judgment;eons and apenrs which may,In any way... AIR HANDLING UNIT(TO 10,0DO CFM) $UBTLYCAL• '
against sald City In mnaaquenm of the nting of thlapemdt. '
.r AIR HANDLING UNIT(OVER IQ 0DCFM) CONSTRUC110NTAX _
tureo Appbont/Coemdos Data, E(KAUSTHOOD(W/DUCD CONSTRUCI70NTAX PAID:
HAZARDOUS MATERIALS DISCLOSURE --
Will theapp0antourt
futbuildingamvpantprt
oorhandlehazardous HFATING UNIT CID 100,ODO BTLI) Date 'R0CC1 t#
mabrial as defined by the Cupertlm Munldpal Code,Chapter 9.17,and the
He❑althand Safety Code Section 75537(a)7 HEATING UNIT(OVER 108000 BTU) - TOTAL
WWtheappli mor futumbuildingx panus equip..Ia dnl. VENTILATION PAN(SINGLE RESID) - ISSUANCEDATE
which emit hazardous air oontamhunb as defined by the Bay Area A4
Quality Management District? BOILER-NMP OHPOR 100,00D BTU)
LJ Y,. .99No P A 1 i�
have read the haza are materials requlrtment,underChapter6.95 of BOILERCOMP(OVER 100,000 BTU) i) ..
the Califomb Health&Safety Code,Sedlons 75505,75533 and 75534.1
understand that if the building dos not mmently have atenant,that It Is my NEW RESIDENTIAL MECH. 5QP7 MAY 12
spoor lantanbilirf te of ACehe OTIC Of tofthertqulremenbwhkh nest be met 1992
pdartat,suamx not Y theOCteolOavhe CY.req v7v7L
t7wneror authorized agent Data ISSUED BY:
TOTAL:
OFFICE COPY