22828APPLICANT TO FILL IN INFORMATION WITHIN RED LINES '= USE BALL POINT PEN ONLY
Building Project ldentlfknlon. -
Building Address: n. (p�/q
1 46 .^ lac. -.
-. 'PERMIT NO.
^ /'� /� /� ('I
- 22828
t ..
wp a :-, "�--. Veers:
CITY OF CUPERTINO-BUILDING DIVISION
... APPLICATION/ PERMIT.
BUILDING-ELECTRICAL-PLUMBING-MECHAMCAL.�
A
/ ('
cano-adora Name. - }!-. AA Lie. No: y�
�- L A COFUO.CO:.SC052
CATEGORY ,-
CONTROL J.
Architect/Engineer. Lk. N.
' ' :" , t tt a "•- ` cit t
=n 11
,•;BUILDING PRMITN9E =t�.
-.�
r
PIXhIITISSUANCE U✓
Address: O ,t (V '
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Lr
' LICENSED CONTRACTOR'S DECLARATION
I herebyaffoon that l am licensed' under provisions of Chapexr9(commenc--
Ingwith Sedion7000)of Divblon3ofthe Buslnessand PmfesstonsCode, and my
license Is in full fres and died.. -wwww' (I!
License Class Lk. p
APPLIANCES -RESIDENTIAL
JOB DESCRR'['ION ,
PANELS
Data !n —2 r_4Y Contractor
ARCHITECPS DECLARATION201-1000
I understand my plans shall be used as public records.
IT TO 209 AMPS
AMPS
_ OVER1000AMPS "
SQ. Fr. FLOOR AREA $/SQ.FT. '
SIGNSELECTRICAL
r.
Licensed Professional - " -
ALED
SPECIALCIRCUIT/MISC
OWNER -BUILDER DECLARATION
Iherebyaffirmthat lamexemptfromthe Contractor's License LawforthIr
following reason. (Section 7031.5, Business and Professions Code: Any dry or
cmtywhlchrequiresapermittommtmc,alter;impmw,demolish,orrepair
-
p /1
TEMP. METER OR POLE INST. C�O'1V/'
anystructure print toils issuance,abo requiresthe applicantfor such permit to
file a signed statement that W is licensed pursuant to the pro rlsioru of the
POWER DEVICES
0
V
�. SWIMMING POOL ELECTRIC
' OUTLETSSWITCHESHXTURES
Contreveore License Law (Chapter 9(comeencing with Section 7DOO) of Divi-
slon3oftheBusiness and ProfesslmmCode) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7N1.5 by any
applicant fora permit subjects the applicant to a civil patui of not more than
VAL A N•-
five hundred doll. ($500).
F-1 1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure Ism intended or offered for
sale (Sec. 7054 Business and Professions Code: The Conlradoes License Law
NEW RESIDENTIAL ELECIR SQFr.
STORIES
TYPE CONSTRUCTION
e
does not apply to an owner of property who builds or improves thereon, and
whodoeseuchworkMmrelforthrough hieownemployees, provided thatmch
• '
.00CGROUP
,
.
RES. UNITS ,
Improvement. are not intended oroffered forsale. If, however, thebuilding or
I TOTAL:
'
improvement issoidwilhinoneyearofcompldion,the owner-builderwill have
th• hurden of proving that he did not build or improve for purpose of sale.).
j_I Las owner of the property,'am exclusively contracting with IlcensM
mntradors to construct the project (See 7040 Business and Professions Code:
a
Q'jY; y PLUMBING'PERMIT,r'i ' TEE,"
--FTppD TANE
APN .,.
PERMIT ISSUANCE
The Contravenes License Law does not apply to an owner of property who
builds or improves thermos, and who contracts for such pieimis with a
cador(s) licensed pursuant to the Contractors License Law.
MI am exempt under Sec B & P C for Nis. reason
�' ALTER -DRAIN & VENT- WATER (FA),
t ,{ FEE SUMMI�AY
,
BACK FLAW PROTECT. DEVICEOUTS113E
FI ES
DRAINS FLOOR ROOF, AREA, COND.,
FIXTURES - PER TRAP
SAMTARY e.'m Y_N_
RECEE C p
Owner Date'-
WORKMAN COMPENSATION DECLARATION
[]I hereby affirm that I have o ]mum to of consent d apythemo, ora
3800 LabC.Workers'Compensatlon lrisurance aracertllled copy thereof (Sec.
policy ab CJ
Policy N
SCHOOL TAX Y_ N_ -
RECEIPT N -
GAS EA. SY9TEM-11NCAOUTLETS
PARK FEE Y N -
RECEIPTN
GAS EA. SYSTEM -OVER 4 (EA) '.
Com any �
BUILDING DIVISION FEES
[P Certified copy lsherebyth the city
� Certified copy is hereby fh nis city impaction division.
CREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECKFEE
-
CREASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS' -
PAID
-. COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars
SEWEWSAMTARY-STORM EA. NOFT. -
.Date ReCel 0
WATER HEATER W/VENT/ELFCTR
ENERGY FEE Y_ N_
($100)or less.)"' - •'
I certify that in the performance of the work for which this permit is issued,
WATER SYSTEM/TREATING
I shall not employ any person in any manner so as to become subject to the
Workera'Compensrtian Laws of California. Date
PAID -
NEW RESIDENTIAL PLMB, SQ.Fr.
Applica
NOTICEE TO -
NOTIAPPLICANT: ](,
Date Recei ti
-
after making this Certlfirate o(Exemption, you
should become subject to the Workers' Compensation provisions of the Labor
Code, you moat fort hwith comply with such provisoes or this permit shall W
deemed revoked. -
CONSTRUCTION LENDING AGENCY
TOTAL:
BUILDING
SEISMIC FEE'
_
I hereby afflrenthat them (. a construction lending agency for the perform
ance of the work for which this permit b Issued (Sec. 3097, Civ. CJ
LendersName •. •�
Lenders Address -
lecrifythat I have read this applicationand state thatthe above Information
ismrmd.lagreetoco lywithaltdtyand muntyordmancesand state laws
relating obulldingco dins, and hereby authiman representatives ofthis
chyme teruponthe ve-mentioned property for lnspecBon purposes.
(We agrc to sav 1 emni(y and keep harMess the City o(Cupertino.
°. - TOTAL:
-
ELEC'T'RIC FEE
PLUMBING FEE
,. , ,- t 1
Q71.1t t. ME CHANICA_G•PERMIT ',; ]t.'11, E
MECHANICAL FEE
PERMIT ISSUANCE "U✓
FEE- •S gAjp:. 6, off'
0—
ALTBRORADDTOMECH.
-
Date Receiptri
AIRHANDLINC UNIT (TO 10,000 CFM)
.SUBTOTAL:
against abill a dg b, mks and expenses whkhmaymitigwayaccrue
against old I. con ceofthe granting of this permit. p
en- 16 _0 .1 [�
!
AIR HANDLING UNIT (OVER I o,BBOCrM)
CONSTRUCTION TAX .
Ignatu pp ontmctor Date
HAZARDOUS MATERIALS DISCLOSURE -
Will the applicant orfuture building occupant store or handle havrdous
material as defined by, the Cupertino Municipal Code, Chapter 9.12, and the
Health and Safety C lion 25532(.)7
Yes NO
Willtheappllce it lure building ocevpani use equipment or devices
EXHAUST HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
'
pU
HEATING UNIT (TO 100,000 BTU) -
Date RBCeI t#
HEATING UMT(OVER 10i BTU)_
TOTAL:
VENTILATION PAN (SINGLE RESIU).
I$ T„Q�{PATE
hich cant hanrdous air contaminants as defined by the Bay Area Air
Qua lity, Management D' 7
.BOILER -COMP. QHP OR 100,000 BTU)
yo,
^
/
BOILER-COMP,(OVBR IW,OW BTU)
I have mad theh materials requirements under Chapter 6.95 of
- 9,1+ 1��JJJa
the Califo talealth&Sau Code, Sectlow 25505, 25533 and 25534.1
NEW RESIDENTIAL MECH. SQFT.
understan th 'fthebuild does not currently have a tenser, that It is my
rrsponaibi ityt nazi e c pant of the requirements, which must be cosh
(� p ,y.
City, Of{MCT/y.P4tu�rl
- - -
priortol Cert'icat of Occupancy.
IEq
sero doge Data
„
TOTAL:
OFFICE COPY