25361APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
OUII.DIM1 CI OF CUPE NO -
BUILDING DIVISIO N APPLICATIONTERMIT PLUMBING - MECHANICAL
BUILDING PHOJECT IDENTIFICATION
PERMIT NO.
25361
BUILDING ADDRESS: L/
/087(. A/ULJ/ rAkOOAL UNIT LOT
SANI'T'ARY NO.
APPLICA ^TIONSUBMITTALDATE
OW ERS NAME: PITON}::'
CONTRACTOR'S H: LICNO:
N/C
Ar
CflN9'ROL
ARCIII'TECI' INF.F:N: I.IC O:
ADDRESS: 24711 nee F1zS �N. r5, /S V
c'[
CONTACT: PHONE:
n �
QTY.
ELECTRIC PERMIT
FEE
BUILDING PERMIT INFO
ELF:Cf PLUMB MECH
PERMIT ISSUANCE
❑
LICENSED CONTRACTOR'S DECLARA'T'ION
Thertbyaffirm that l am licensed underprovisionsofaapmr9 (eommencingwiN
APPLIANCES - RESIDENTIAL
JOB DESC IPU
7 Section700Lof Division 3n fine B.,inessand Prnfevsions Cotle, and my license is in
full force wd effect. r
d Licen CI s gi Lic.p 7J n
PANELS
UPT0200AMPS
V `) \ V ` l
,�!(�
Dam Comrc�gWt"
2a1 - IOIp AMPS
CCJJ�1 ARhall be D pub) ATIOI
a
y I understand my Plans shall be used os public records.
OVER IOfq AMPS
_ SQ.,IT. FLOOR AREA -^
E
/� _
E
g /8Q. FT.
,
SIGNS ELECTRICAL
OWNER- H(JILDER DECLARATION
4 LicenI th rrafesef ran
1 hereby affirm for i am eneasin Tram We Contractors License Law far the
SPECIAL CIRCUTUMISC.
TEMP. METER OR POLE INST.
POWER DEVICES
e following dre, . (Section 7031.5, Business and Professions , de li Code: Any city or county
which requires n pennh re conrmn, almq improve, demolish, or repair any tamnurt
prior to is Issuance, .Isom requires due such permit ese statement
. Contractor's License La
9(com encing with Section? )of provisions of the Ce Basins and Pro LsionsCde)
9(ammmencscanx Section itch, basisiondr the Business r.rsswd Professions Code)
or that he is 1.5by phertfromandr a Permitonheasegedexemptt to civil Penalty of
- Section 703 LS by nnndred cwtforepermit Subjects the applicant loacivil pcnehy of
SWIMMING POOL ELECTRIC
VALUA7Jfyy
1^ �' )
OUTLETS - SWITCHES - FIXTURES
not more thrum five hundred dollars ($S(NI).
❑ I, asowncrofthepropmy ,ormyemployeeswilh wages as theirsolecompenmtion,
` L.�xf
NEWRESIDENHALELECTR_SQ.FF.
S3'ORIES
TYPE CONSTRUCTION
will do the work, na ircndW 0044, Business
d e:
C no Comis
and Professions Code: The Commctnr's License Lew does not apply to an owner of
a Lawred s not apply
properly who builds or improves thereon, and who does such work himself or through his
OCC. GROUT'
RES. UNITS
own employees, provided )bar such improvements me not intended or offered for who. If,
however, the building or improvement is sold within one year ofcompinion, the owner.
builder will have the burden of pmving that he did not build or improve for purpose of
TOTAL:
QTY,
PLUMBING PERMIT"
IT E'
sole.).
❑ I, as ownerofthe propeny.am exclusively comrening with licensednmvecmrsro
1'LOOD LONI: APN
construct the project (Sec. 7044, Business and Professions Code:) The Canvanma
PERMIT ISSUANCE
License Lawdoes not apply to an ownerofoopeny, whobuildsorimproves Neuron ,and
whocontmns for mch projects with acormetter(s) licensed pursuant to the Correctors
license Law.
ALTER VENT PA
( )
'
PEE SUMMARY
❑ lam exempt under Sea B &PC!or this reason
BACK ROW PROTECT, DEVICE
UTSIDI. DES
SANITARY Y N
Owner Dam
DRAINS - FhOOR,RWF, AREA, COND.
RECEIPT#
WORKMAN COMPENSATION DECLARATION
`❑ Thereby affirm thntlhaveecmi0com of emunno self- insurt, oreanificeteM
Workers'Compensation lnsumncear o cenifieA copy thereof(See. 3800, Lab C.) which
real) employee's under his permit
Policy M
SCHOOT,'1'AX YN
RRCEII 'T#
FIXTURES - PER TRAP
PARK HE Y N
RECEIPT a
GAS -EA. SYSTEM- INC. 4 OUTLETS
BUILDING DIVISION FLITS
Company
GAS - EA. SYST (E
EM -OVER 4 A)
PLANCHECK PER
❑ Cenan m
ereby iEeJ copy is h famished.
fa he
❑ Certified copy is fled with the city inspection division.
GREASE /TNDUSTRI. WASTE INTERCEPTOR
GRADING HE
CERTIFICATE OF FAEMFvl]ON MOM WORKERS'
COMPENSATION INSURANCE
GREASE TRAP -
SOILS FEE
SEWER - SANITARY - STORM EA. 2MFL
ENERGY PER
(Thisseedimirod net beccmpleted ifthe pe.it is Tontine hundred dollars (AO0)
leas.)
WATER IMA HE W/VENT/ELECT'R
I certify that in the perfonnanceof the work fssr which this permit is issued, ISball
not employ any person in any manner so as m become subject ro the Workers'
Compemetinn Lawsof California. Date
Applicant
PAID
WATER SYSTEMITRP.ATING
Dote Reecipt#
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
became subject to the Worker's Compensation provisions of the Labor Cale. you must
NEW RESIDENTIAL PLMIL SQ, n,
*1 OTAL:
BUILDING FEE
i
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
SEISMIC FEE
I hereby elEtin Nat them is s,mumaction lending agency for the performance of
TOTAL:
ELECTRIC FEE
the work far which Nis Permit is issued (See . 3N7. Civ. C.)
Lenders Name
Tenders Address
QTY.
MECHANICAL PERMIT'
PEE
PLUMBING FEE
1 ecnify that I have read this application and seem Nut the above information is
PERMIT ISSUANCE
MECHANICAL FEE
correct. l agree to comply withal) city and county ordinances and sum laws adding to
gvvunion, e
nnf pmpeny Tnr inspection Ourpnsa
ALTHR OR ADD TO MCCII.
CONSTRUCTION TAX
ag mvc, indemnify and keep fear less the Ciry of Cup Gino against
dg t B, cosuandexperueswhich in any way reagai Ise' Ciry
W
AIR HANDLING UNIT(TO 10,0130 CFM)
nanthe grndng �I al it. /
L
AIR HANDLING UNIT (OVER 10,000 CFM)
w.2
It
SigroV of lice I ontDI m
EXHAUST I IOOD(W/DUCT) -
PAID
HEATING UNIT(TO 100,00() BTU)
Dam Receipt#
'.ARD U 4ATERIALS DISCLOSURE
Will theapplicant ar future building oocupam store or handle hazardous material
as defined by the Cupertino Municipal Cod, Chapter 9.12, and the Health and Safety
❑GATING UNIT (OVER 100,000 BTU)
'I'
Cale, Section 25532(d?
1:1 Yes ❑ No
VENTILATION VELATION FAN (SINGLE RPSIII)
lisso
Will the acontmiorfmart muse ordeviceswhichemit
IsO1LER - COMP OTIP OR FILM) BTU)
ISSUANCE DATE
hazardous air contaminants as defined by the Bey Area Air Quality Management
defined by the Areas Air
' nixtdc'a �
❑ Yes ❑ No
gig p D
r H
BOILER- COMP (OVER IM." BTU)
NEW RESIDENT1ALMECIL SQ. IT.
I have mad he It raiders ous materials quiremen ts under Chapter 6 .95 of he
mia & Safety Code,Sectons and 25534. 1udersne
1
'JUL
dhe irgd have u rm,that it is my rcs ei Cnmlfy the
nccupant of (lie requimments whi ch must Is, mt o or m issuance of a Cenfcam of
Occupancy.
l 1 ('
ISSUED ITV:
_
Owner nut unNorimd ngem Dane
TOTAL:
yr r 111r