28383 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING;-ELECI RICAL I PERMIT NO. 28383
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BUILDING DIVISION APPLICATION/PERMIT PLUMB ING-MF.CIh\NICAI.
I IIIJILUINI:PRD.IF.C'I'IDEN I'IIry CATION I
NUILDINGADDRESS. I SANITARY NO APPLICATION SURMITTAL DATE
z 2 G �o L Corti
- .. 'urvrrp Lorp
OWNIiRS NAMIi PHONE: CONI RACrOR'SNAME LIC NO: N/C CONTROL q0H-A-A1 Dq�MAUMJ �2J-I' 8o yna,fc,�n�c_
RCI ILL 12C DENOINHER LIC NO ADDRESS, ❑
J CONTACT. PROBE: r BUILDING PERMIT INFO- -
/ QTY. IiLELTRIC PERMIT PEE
l FCT PLUMB MUCH
PERMIT ISSUANCE s^ y
LIC ENSED CONTRACTOR'S DECLARATION ppPLiANCGS-RESIDLNTAAI. JOB DESCRIPTION
V .
o 00 I hereby al lirimhnt join l¢mteJ Un ss land Emnmo al,Clyar9lcommcmme,with .
�i100 Section .m of rt.vmmnJnf the Businessland Pmfessimis Clyde and my hcenm is in PANELS Nti
C W full l se lass el led.
F uVZ p�j
License Cl.a Lm.p UP'1 O YUU AMPS
Qy Date Conmict- � 201-I"AMPS
,ZONZ ARCHITECTS DF.CLARKIION OVER 1000 AMPS SQ,FT,FLOOR AREA $/SQ 17.
O Z-M I i ndcmnmd my plan.shall he mcd av pubhe romird,
K-tW
Licensed l'nileesnmul SIGNS HLF,CTRICAL
a OWNER-BUILDER DECLARATION SPECIAL CIRCUI'I'/MISC i
XCwpu I hereby affirm that 1 am exempt from the Commctor'v License Low for the
ed < following rector.(Section 703 I.S.Business and Professions Code Any city or county TEMP.METER OR POLE INS 1'
4J O.] which requires a permit m commoa,alt ,improve,demolish,^r repair any succmrc
ij Tn Pnnrlmia issuance.also rcquimstheapplicam formchpermd lofileasigredstaRment POWER DEVICES
iMli�.J 60 that her,licensed pursuant m the provisions ofthe Contructors License Law(Chapter SWIM1IMING POOL ELIiCfRIC VALUATION
ca.y�r1 9lnimmencing w nh Semm�]qgq of Division 3 of the Boor,and l'mfessmm Code) U
P orthmheisexconatherefmmandthehasisf^r theallegedexempuor Aryvclaner,
tZQSection 71031.5 by any applicant for a permit subjects the uppllcanno a civil penalty of OUTLETS-SWITCHES-FIXTURES
S not more than five hundred dollars($500).
N�o ❑ hmowncrofthcpmperry,arm Ir shwa panty NEWRIS1DIiNT1ALHLECR SQ �\ STORIES TYPE CONS"IRUCION
W-y yemp yeeswi d fouahe(Sec.cmn Business
I
a3- will dethewons laid the structure Cintelem,Liceese[.useidJ forsale(SCCADIJ,Bunneaa
and Professions Cola The Cmntrercor License Law don mr apply ai ar outil is I /'
property who builds Onmprnves thermn,and whodties such worklumsclforthrough his Y /
building ri provahimprovementhin one icara carpeereJ iheow.IL / l�OCC GROUP R69.UNITS
huilder ill have the harps of pmengthatledidnoneyea or improve lot iheoose of TO rAL fff
builder will have the harden of proving that he did rim build or improve fnr purpose of
sale.).
❑ 1,nuiwnernf the property,am exclusively ennuenhng with licensed nmtmcmrsto IQTY. PLUMBING PERMIT PEIi FLOOD ZONE APN
construct the project(Sec.7614,Business and Professions Code)The Contractors
Luemel.awdoesmt apply to an(wnerofproleny who hiulds orimproves thereon,and PERMIT ISSUANCE
who contracts forsuch pmputs with acorhanmfs)licensed pursuant o me Commaors ALTER (EA)
License Law I FEESUMMARY
❑ I am exempt under Sec B&P C for this reason BACK MOW PROTECT.DEVICE'fI otriSIDE FEES
SANITARY N
h h1
/C •Owner °01° SCHOOL TAX YFC N
ill COPRNSKI'ION DEChARAON DRAINS-FLOOR,ROOT',AREA,
y, ❑ Thereby affirm that l have acertificate nf<nmmnno mlf-insure,oracemficate of FIXTURES-PER TRAP' RP lit Pl'p -.
Wnrken'Compensminn lnwrunm orutertificdcopy thercof(Sec 3X1%1,Lab C.)wh¢h (PARK FEE / N
uoma.11employee'.srndenhmpermo. GAS-I?A.SYS'IEM-ZINC 40UTLETS ..aa4CEIPTM ___
Polley# I BUMINy DI ISIO;,hLlE
Coro Cllr -- GAS-13A.SY$TIiM-OV[R 41EA) PLANCHECirF
❑ Clarified copy it hereby famished.
❑ CemfiMropy is filed wnh the city inspection division. GREASEdNDUSTRL WASI H INTERCEPTOR ORADIN /
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASEIRAP SOILS PF.f? /
COMPENSATION INSURANCE
(Oo,s,locomed not be completed B riepermit is fal hundred doll.($IN)) I SEWER-SANITARY-STORM CAN 201017 ELSE /
or less)
1 lend,that m the perficmmucof the work for which Nis permit is issued,I shall I WATER HEATER WN EN'Id LEC'IR
not employ any person in any manner sit as to become subject to the Workers pA1D
,Z nempenanbon laws of Cahm
foio Out- WATER SYSTEM/I REAL]NO D Rmeiptp
0000••
Q � NOTICE ro APPLICANT:hLiftenn.J.mgthis Cinifca¢nf ExcmptioayouthouW NEW RESIDIN'f1AL PLMB SQ FL / I TAI.
a ;pJ bcct.,thc comply he such Worker's Compensation Permit shall a the Labor evoked must
wcome subject with such pmneom ratio permitonsof t JeLabo revoked BUILDING�tEE ^
0. Q CONSTRUCTION LENDING AGENCY SEISMICIEE
I hereby affirm that there o n ninnmec 3 lending agency for the perfominnce of
VOr tlot work Iherfar whmhthis pmm�is issueJlSee3W],Cis CJ - I, TOTAL: F.LECIRfC FEE
(L F^ Lender's Nam• PLUM NO PF.E
Lender's Add.. IQTY.I Ml IANICAL PERMIT'. FEE
U 1 Certify that 1 have read this application and sure that the above inf arrato n
correct.l agreetocomply with all e^y and county nrdmmeesand smmlawsrelmmgm PIiRMI'1'ISSUANCE — AIECN [CAI.FEE
UJ budding construction,and hereby authorize representatives of this city in enter upon the
V Z above-menamodpropertylorimpec1, puiJxssn. AL&ORADDTOMECII. �CONSIR ON TAX
^i
(We) nify u d cep harmless th Qty Inn
hnhilipC t huii may in mnywaya iu again t it Ciiy AIRIIANDLINGUNIT(TO 10,000CFM1D
m ft it AIR3ANDLINO UNI'1'(OVIiR 10,000 CLAD
Signature of ApphcarUConamers, Date I EXHAUST 11001)(W/DUC) PAID
HAZARDOUS MATERIALS DISCLOSURE IIEA'ITNG UNIT(TO 100,000 BTU) Date Receipt
W JI the opphcant or forum building occupant store or handle haurdous material
at defined Flute Cupcnino hlarudpal Cnle.Chapter 9,12,ant the Ilealth and Safety HEATING UNIT(OVER 11X1,00(1 B'r(j) 10]l
• Code,Section 25532(ay VENTILATION PAN(SINGLE RESiD) 4 q
ISSl DATEi /®
Will thnyiplicum or futurehmlJingnecupanl use eyuipmemor Jeaceswhrchemit OOILIiR-COhll'(3HP OR IW,IXI(1 BTU)
'I,majors air contaminants m defined by the Bay Area Air Quality Management I BOILER-COMP(OVER 100,(110 BTU)
)i In"?
❑Yes ❑No NEW RESIDENTIAL MECII. SQ PT
c�ti. 9,S
I have run the Safety Code.motors requirements under Chapter 6.95 of the
Cahe bull ing do&of cur Code,have a R out.that 25511 and 25534. 1 ity to mm�d that `
dthehmldmgdceanaicurren iyhaveust h m etprirsmyaspnceof a to
xc upan of tic rnlnvnnand wh¢h must M ma poor 0o iwumce of a Cenifiwte of
Occupancy. I I I
Owner or authorud agent Date TOTAL: (ISSUED BY,_
OFFICE