27335 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO m'G-TLTETR PERMITNO.
APPLICATIONIPFRMIT PLUMBING.MECHANICAL 27335/J C
BUILDING DIVISION _ - ;BUILDING PRO,IF.C'P,IDEN9'IFICATION= G J J
BUILDING ADDRESS: 9 SANITARY NO. MPLICATION SUBMITTAL DATE
o C.•/Gv '— VUNIT# LOT#
OWN.RS EE HONFy}/T� PON A AMG. LIC NO: NIC CONTROL#
-G/J 7 7
"ARL TECUENGINEER: LIC NO; A SS' - ❑
(�1 )
CONTACT: PHONE: ELEnRICYPERMIT+ x tx°' *FhEEear.* k''"dna BUILDING PERMIT INFO -
BLDG ELECT PLUMB MEC
' PERMIT ISSUANCE
LICENSEDCONTRACTOR'SDECLARATION pppLIANCES-RESIDENTIAL
JOB DESCRIPTION
Thereby affirm thaLL em license)under provisionsofChapter9(commencing with
�00 Sectifull(oneand of Uivieian3 pubo Business and Professions Code,and my license isin PANELS
WW
ZW full forceand eHLM,e
FZW License Cl bb'' chic.# ec xx UP T0200AMPS
y]an Dale_ Cnntruc_ Gf#F'♦r 201 1000 AMPS
Z O ti Z ARCHITECTS DECLARATION OVER 1000 AMPS SQ.IT,FLOOR ARCA
O z-'a I uw
ndersnd my plans shell be used are
s public records. OVER
SIGNS ELECTRICAL
Y
LrcensW Profcserpnol
pf{WV OWNER-BUILDERDECLARATION SPECIAL CIRWIT/MISC.
DC O d F I hereby affirm Iba[1 am exempt from the Contractors License Law for the
W'30.to following person.(Section]031.5,Business and Professions Code:Any city crcounty TEMP.METER OR POLE INST.
which recants a permit m conswet,alter,improvq demolish,or repair any stmcmre
prier to its issuance,also requires the applicant for such permit to file a signed shipment POWER DEVICES
ly O
that he is licensed pursuant y the provisions of the Contraclm's License Law(Chapter
9(commencing with Section 9000)pf Don,,an 3ofthe Business and Prehssloos Code) SWIMMING POOL ELECTRIC VALUATION
or that he is exempt therefrom and the basis for the alleged exemption.Any violationof
a Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of OUTLETS-SWITCHES-FIXTURES
Wimnot mom than five hundred dollars(S500).
❑ I,as ownerofthe r orm p y g peneatlon, NEW RESIDENTIAL ELECTR _SQ.FU TYPECONSTRUCTR
correlate
yam to eon withwe forcl late
atSed.cum STORIES
a3. will dotbewonal and the shut ontractoria Liencended,Law doesn not
to 70D
puniness
and Professions Code:The Contractor's License Lew does not apply to an owner of
property who builds or improves thereon,and whe dons such work himselfor through his
own employees,providedthat such improvements arenatincendedorofreredforsale.If, OCC GROUP RES.UNITS
however,the building or Improvement is sold within c neyaar of completion,the owner- I
builderwill have the burden practicing that he did nor build or improve for purpose of
sale) FWSS'�7 -z` e°-; s❑ las ownerofthe am exclusive) QTY:tk egy)'-PLUMBING PERMIT+ - 8 x FLOODZONE APN
ProPs^tY Ycnntraetrng wuhllcenned eontraztors to fl7- flier . ar a �a�a u-iia
construct the project(Sec.7044,Business and Professions Crde:)The Counselors
License Lawdoesnotapply roan menerofprepdry whobuildsorimprovesthereon,and PERMIT ISSUANCE
who contracts for such projects with a contractors)licensed pursuant o the Conueemr s
License Law. AIN&VENT-WATER(EA) r�°=v . sPBE SUMMARY
❑ 1 am exempt under Sec. B&P C for this reason BACK FLOW PROTECT.DEVICE OU'f IDE FEES
SANITARY YN
Owner Date DRAINS-FLOOR,ROOF, REA,C RECEIPT#
WORKMAN COMPENSATION
r-m DECLARATION P SCHOOL TAX Y N
heComprfirm that)hrance Ortificayed COPY ct in mdbam (Svps re,or Lab C.)which
FIXTURES-PCR TRAP RECGIPf#
Yrs all employees undeion aaranw Or acertlBed ropy thereof(Sec.3gW,Lab CJ which ARK FL6 Y Ncove �
Policy#
Q _ AS-F.A.SYSTEM-I IN 4 El / RLCCIPTb
BUILDING DIVISION FEES
Company /�3' ry� G S-EA,SYSTE EA
❑ Certified copy is hereby famished. 'R4( PLANCHECK FEE
4`lu iricate,is filed with the city inspection division. GR SFgNDUST SMI E EPTOR GRADING FEE
T CERTIFICATE OF EXEMPTION FROM WORKERS' GREA E TRAP SOILS FEE
COMPENSATION INSURANCE
This section need not be Completed ifthe permit is foranehundred dollars(SIM)
unless) SEWER SANITARY-STORM EA.2001 ENERGY PLL
Icomfy that in the performance fthe work for which this permit is issued,I shall WATER fk.ATM W/VENT/E '
not employ any person in any manner so ss 0 become subject to the Workers' PAID
Cma,mationl.awsof California. Date WATER SY TFM/fREATING Data Receipt#
O z Applicant
ryy _0 NOTICE TO APPLICANT:If,after making this Certificate ofexemption,you should NEW RESIDENTIAL PLMB. SQ.FI'. TOTAL:
r V] becompsubjeet to the Worker's Compensation provisions fthe Labor Code,you must
forthwith comply with such provisions or this permit ahall be deemed revoked. BUILDING FEE
pW, Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
^a 1 hereby affirm chat hem is a construction lending agency for The performance of
(� O be work for whichtMs permit is joined(Six.3097,Ci,C.) TOTAL: ELECTRIC TLE
Lenders Name
'e'.1 G M1 s d h F h y e.SA d
Lenders Address QTY y'"` u SME IIANICAL t ,.PFRMITz y xx>r PEB:.a, PLUMBING ME
I certipfyythat 1 have read this applicationstationary
tabna and stain that the above information is s R CE
c building
constrInglouction,
pl,and with
yautcity and nnnsentatives ofand stay entedupongy PERMIT ISSUANCE Y MECHANICAL FEC 1
�t building Controllable,
onstaotionlendh crone tionpurnresenydvee ofthis the
U 7 abo - emined prnpeny for inspection porpases. ALTER OR ADD TO MECH. � CONSTRUCTION TAX
t� ( )agree ri save,indemnify and keep harm leas the Chy of Cupeni t said
Cityliabiliti ,judgments,costa end e. cones whic ray in any way accrue against said City AIR HANDLING UNIT(TO 10,000 CFM)
in ons qua ce ofinegrunft tis
AIR HANDLING UNIT(OVER IO,IXXI CFM)
,I of Applicant/ Dormer Date EXHAUST HOOD(W/DUCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE / HEATING UNIT(TO 100,W BTU) �// Day Receipt#
Will the apply nt or furore building occupant storey handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER IJB,600 BTU) TOTAL:
Code,SeoGon 25532(a)Y
12 yes 11 No VENTILATION FAN(SINGLCRESIO)
BOILER-COMP(3HP.OR IMBIW BTID IS DANCE DATE
Will air
aCont a manus urebuOding by the
nBay Areequa enmuality esanagemewhich nt MAR
t
hazardous air conmmimnts as defined by The pay Area Air Quality Management BOILER (OVER 100,000 BTU) ,y1ll e n
DiatrictP 11j//'R (y 1995
❑Yes ❑No NEW RESIDENTIAL MCCH. SQ.FT. /s
,Ch ha c reW the hazardous materials requiremems under Chapter 695 of the Cl Y Ur LVrtN I�I��
,.^ Calilbrm, ealth&Safety Code,Sections 25505,25533 and 25534. I understand that,
iffallim ingdocsnatmren havearenant, atitismyma,maiday o notify
rwcupe ofthorequiremer hi et prick to is
ora trip f
Occu nca
nut prized agent TOTAL: ISSUED BY:
OFFICE