19595 (2) APPLICANT.TO FILL.IN INFORMATION WITHIN RED LINES'— USE BALL POINT PEN ONLY '
Building project dentification' - PERMIT NO.
Building Address: -• 1 9595
90 Stokes Ave
Phone: APPLICA IION SUBMI I I AL I
Victoria Kelly 257-7465__ 'CITYOF CUPERTINO-BUILDING DIVISION -
con6ador'.xana: - u,Na: APPLICATION / PERMIT,
—
485350 .BUILDINGDECTRICALPLUMBINGMECHAMCAL CATEGORY CONTROL
Architect/Engineer. _ Lk.N.
'Q'[Y ',v' 'IELECTRIC PERMa1Ta �' ", FEE a)` " ):',BUILDING PERMIT INFO-,
mumu mt�tt
Addreas: 5390 E.Pine Fresno, CA .93727 PERAUTISSUANCE '
LICENSED CONTRACTOR'S DECLARATION ' �
Ihereby affirm that l am licensed Inter pmvlsionsofChapter9(mmmene. - APPLIANCFSRESIDENTIAL JOB DFSCRB'7TDN
Ingwlth Sedion7UW)of Division3ofthe Businessand PrefesdonsCode,and my r
license ie in tod dfect. PANELS
License Class r m LIc.N�85350
Date Contractor 1Tnh�»' '
ARCHiTECrS DECLARATION 301-1000 AMPS
pQ±
9
0 ZO 1 understand my plans shall be used as public recards. JOVERIODOAMPS SQ.FT.FLOOR AREA f/SQ.FT. '
E� Licensed Professiorul, _ SIGNSELECTRICAL ,
GGGG�j I�Cd OWNER-BUILDER DECLARATION,
zt., G Iherebyafflrmthatlamexempt from the Contractor'sLicenss Law(orthe SPECIAL CIRCUIT/MISC
:❑yip . fallowleg reason.(Senion 7031.5,Business and Professions Code:Anydty or
FG ^u{ rountywhi&requimsapemttomrutmaalteglmpmvedemolbh,orrcpalr TIME.MEHIIt OR POLE INST, - -
K� �7 anned ystmMm priorto its Issuance,alsorequiresthe applicant forsuch perrouo POWER DEVICES .
K rG Rle a dgstatement that he Is licensed pursuant to the provisions of the
Ok Conmences License Law(Chapter 9(mmmeacing with Section 7000)of Dl Vi- -
�Oa cion 3 of the Business and Professions Code)our that he 6 exempt therefrom and SWIMMING POOL ELECTRIC VALUATION
Q.•S--tt the Issas for the alleged swerpiton. Any violation of Section 7031.5 by any OUTLETS
SV✓f.fCHESF[XTUftES
applicant for a permit subjects the applicant to a civil penalty of not nnrc than
�a five hundred dallars($500). NEW RESIDENTTAh ELECIR SQ.FT. � '
. Q�^ ❑1,as owner of the property,or my employees with wages as their sole SIOg(ES- Tri'B CONS'172UCTION
X, compensait ill dothe work,andthestructure is not intended or offered for '
p saleZS '.7ZBuslnass and Professioru Code:The Contrad.e.License Law
$ does not apply to an an of property who builds or improves thereon,and
who does such work himself or through his own employees,provided that such _ OTR' RES.UNITS
Improvements are not Intended oroffered forale.i(however,the building or TOTAL: .
Improvement 6sold withinoneyearafcamplallon,theowner-bullderwlll have •�. ,,. ,. ,.,
t ben of proving that he did not build orimprove
for purpouafsa6.). QTY. ,,„I{)�•rPLUMBING PERM]TC ,';,};�-', FEE';h• FLOOD ZONE APN.
U L as owner of the property,am exclusively contracting with limned PERMITISSUANCE
mntracmrs to construct the ponied(Sec.7043,Business end Profemlons Codi
The Contractor's License Law does ml apply to an owner of property who ALTER-DRAIN&VENT-WATER MA)
builds or improve.theme., and who coir ad.far such pRojed,with a ''a i• h1 FEE SUMMARY
off,
licensed pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE ''a' i - FE A s,( -"'4•
LJ I am exempt under Sec B&P C for this rcawn -
0 UT SIDE FFSTe
• DRAINS FLOOR;ROOF,AREA,COND. SANITARY Y - N
Owner - Date - RECEIPT N
WORKMAN COMPENSATION• DECLARATION FIXTURES.PER TRAP SCHOOLTAX Y_ N_❑I hereby affirm That I have a certl0ate of content to self-snare;ora _ RECEIPT N
certificate ofWorkerJ Compewationlwurance or a certified mpytbereof(Sec.
3800,lab C.) S ST
CAEA.SYSTEM-1.1 INC.60[ID.ETS . PARK FEE Y_ N_
Policy If 713375 - : xecpsTN
Comany_ � _ GAS EA.SYSTIA/-OVER4(EA) . BUILDING DIV]SI ON FE ES
[Certified copy 6 hereby famished. ' GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK-FEE
L=,Certified ropybfiled with the city inspection division.
V1 CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP - PAID -
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA:7WFT. Date RCC21 t#
(Thissedion need out be completed If the permit 6 for one hundred dollars
($1oltorless.) I
WATER FIFA7'17t W/VENT/ELECTR. . ' ENERGYFEE Y N
I certifythat in the performance of the work forwhich this permit is Issued,
I shall not employ.any person in any manner a as to become subject to the WATBx SYSTGM/TRLA7ING
Workers'Compensation laws of California.Date - PAID ^
O Z Applicant NEW RESIDENTIAL PLMB. Q.T. Date Re e] 1#
Z O NOTICETO APPLICANT:](,after making this Certiliateof Exemption,you
should became subject to the Workers-Compensation provisions.(the Labor TOTAL:
V3 Code,you most forthwith comply with such provisions orthe,permit shall be BUILDINC
W ] deemed revoked. -
CONSTRUCTION LENDING AGENCY' - SEISMIC FEE
FEE
a O I hereby afnrmthm there 6 a construction lending agency for the perform- ELEGTRIG FEG
7 Z a..ofthe work for which this permit is Issued(Sec.3097,Civ.C.) "° TOTAL
(,) O Lender.Name PLUMBING FEE -
'LL 1= Lender.Address ` QTY. .,('' _MECHANICAL`PERMIT i ,'FEE�'�, MECHANICAL FEE
O W ]certify that l have read this applicationand Ramthat theaboveinformetwa
6rorred.I agree to comply with all dty and county ordinances and pate laws PERMIT ISSUANCE /t .vo FEES PAID:
IL
} relating to building mostruction,and hemby authorize representatives of this
(_ city to enter upon the above-mentioned property,for Inspection pu rposes. ALTFRORADDTOMECH.
U) -
(We)agree to save,indemnify an d ke harmless the City of Cupertino -Date, RCCe1Pt#
V againstpa Ilii , dgmems,costsande rases which may In anywayamae AIR HANDLING UNIT 0010,000 CFM) - SUBTOTAL:
againatYYee yl ronsaquen �-t��/�N/�k�tM�epermB. ,
d/bl/y 2ermit. AIR HANDLINGUNT(OVER10,000CFM) CONSTRUCTION TAX
Signature of AppBcant/Contractor Date EXHAUST I IOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or futumbut1dingocmpant store or handle hazardous BEATING UNIT(TO 100,000 BTU) pate RCCCj t#
nnuedal as dented by aha Cupertino Munidpal Cod,Chapter 9.17,and the
Health and SafetyCode/.�Sedlon 2S532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL:
❑ Yes u No -
Wllltheappllantorfuturebuildingoceupantuseequipmentordevims VEN'TILATIONPAN(SINGLERESID) ISSyi'l-I(}�tW'ATE
which emit haaardous air conta"nantsas defined bythe Bay Area Air �-aia
Quality Management Distridi BOILER-COMP(3HPOR 100,000 BTU) -
PYes �Na MAR 1-2 'j1991
h madthebaza ossamaterialsrequirementsunderChapter6.95of BOILER-COMP(OVER100,000BTU) 9
the Califemia Health&Safety Code,Sedlom 25505,25533 and 75534. I
understand that lithe building does not currently have a tenant,that It is my NEW RESIDF1,7TAL MEIN. SQ.FT. p
responsibility to notify the occupant of the requircments which must be met }� ITIO�)nn
prior to Issuance of a Certificate of Occupancy. Q Ya'
. .
Owner or authorised agent Date :p
OFFICE COPY