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26533 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO uirn NG-ELECTRIC. PERMrr NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. 26533 N/\F6 3�a� BUILDING PROJEIDEFIFICATION c 3 BUILDING ADDRESS: CT' SANITARY U. AFPLICATIONSUBMITALDATE V� G 4uarl N LOT# 510 O NERS NAMI?: - PHONE: CONTRACTOR'S NAME LICNO: v S N/C CONTROI.N •ARCtIITILUUNGINEER: 5 LIC NO: ❑ CONTACT: PHONE: S ^' QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO v� BL ELECT PLUMB MECH 5 PERMIT ISSGANCE ❑ ❑ ❑ LICENSED CONTRACTOR'SDns Qf Ch wr9(GON APPLIANCES-RESIDENTIAL WOOQc`z Ih70OA rf i Nin.3.at I amfcemWunder and Permission, Cole,9(m mmenc]ag with WOO Scmimn]BBB)mf Division Sof the Business and ProfasionsCore,and my license i.in PANELS V ` �� fullforca nse Cladeffact. Zztil Da cine CWss LiaN UP TO 200 AMPS /1 vi?y Date Contractor. 201-1f100AMPS g�aL•rV ARC]HTECTS DECLARATION OVER MPS SQ.FT.FLOOR AREA $/SQ.PT. O z—O I understand in,Pianissimi I be used as Public records. V' W $IG LE p pa.Ni LseascJ l'rofessmnul M.g$� V I hereby a ]OWN-in amp OWNER-BUILDER ConmemN's License Lew for Ne SPE L 1 W 3 40 vfa-i following raison.(Section 7031.5.Business and Professions Code: is eiry or coamy OR PoLE BUST. y J which reclaims a Permit m convmn.Jeer,improve,demolish,m repair any madum =W,L �xmm.f iu issuentt,atm rcquims the applicant for such pemduo fileesignW Statement RDEVICES Gp f:Rcensw parsasnt m Ne Provisiom or Ne Cono-.aora Littrue law(enaptxcncing with Section]000)of Division Sof Ne Businusend Prafessiomcea]Zeis<aempnhcufromend the beds for the JlegW caemption.Any viohtimo( �]031.5 by any applicant fmapermit subjects the apPlicanuoecivil penalty of OUTLETS.SWITONPS-FIXTURES Nan five hundred dollar(5500),Fpown<rophcpropeny,�rmycmplmyeeswiNwagesmNeimolreompenastion, IDENTIAL ELECfIt _SQ,". STORIES TYPECONSTNUCTION 20wNewark,and rhe strumum is not inundW orofferW foraale(Sec.]B44,Businessfeasions Core:The Conwcbrs License Law does not apply ro en ownerof y win huilds nr improves Iheuon,and who does such work himself or throughhie ployees,providW Nm each improvememaeunorimendedmoffcmd Tarsale.If. OCC.GROUP RES.UNITS e the builJingor improvement is sold within one yemofcompletion,theowner- will have the burden mf proving that he Jid not buil)or improve for pre xmm of TOTAL: salaJ. ❑ I,us ownerolthe Pmpcny,amexclusively contracting withlicensed csmranor.to QTY. PL MIN P R 'T -' 11 Irl FLOgD ZONE ANN Mushier the project(Sec,7044,Business and Professions Code:)The Contractor's License Lawdoex not apply loan ownerofpropeny who builds orimproves thereon,and PERMIT ISSUANICE whocnmracu forsucb projects with aconaamur(s)licensecipursuam to Ne Comreemr's License law. ALTER-DRAIN&VENT-WATER BA) ❑ 1 run exemptunder Sec. &,B PC for NuniFEE SUMMARY is on BACK FLOW P TELT. ht E SID Owner Data -- ITARY YN WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF,AREA,COND. RECEIPT# ❑ Iheub a(ftm Natlheve a<enifcabe of mnunnm ulf-i SCHOOL TAX Y N_ y mure,memAfc which FIXTURES-PER TRAP RF.CEIPTp Worker'Compenutiander On,eorettniGW copy Neuof(Sec.3881,tab CJ which PARK FEE Y N_ Policy all employee's under Nis permit Policy p NGAS-G.SYSTEM-] C.4 OUTLET'S RECEIPT# Company BUILDING DIVISION FEF ❑ Cenifedcopyisheubypend,f W. GAS-EA.SYSTEM-0VER 4(EA) PLANCHECK FEE ❑ CeniGW copy is flW with Ne eiry inspection division GREASFJINDUSTRL WASTE INTERCEPTOR GRADING FEE ` CERTIFICATE OF EXEMPTION FROM WORKERS' GRFASETRAP SOILS FEL COMPENSATION INSURANCE - (This section need not becompletW if Ne permit is bar one hunNWdollars($100) SEWER-SANITARY-STORM EA.200FT. or lENERGY FEE eas) I ecnify that in the Perfommnce of the wark for which this perms is issued,Ishall WATER HEATER W/VENTiELECTR not employ any prams in any manner so as m become subject to the Worker' PAID .Z Compemationlawsof Califomia. Dam WATER SYSTEM/I'REATING Applicant Date Receipsp NOTICE'TO APPLICANT:If,after making this Camfirma ref Exempion,you.hould NEW RESIDENTIAL PLMIL—SQ,11r. become subjectto the Workers Compensation provisions of she Labor Core,you muss TOTAL: forthwith comply with such provisions or this permit shall be domed revokW. —• Rei � BUILDING FEF. pW,r A CONSTRUCTION LENDNG AGENCY SEISMIC FEE Z I heuby affirm Nat them is a construction lending agency for the performance of Ir U Or the work for which this permit is issuW(Sec.309],Civ.C.) TOTAL: ELECTRIC FEE {2. F' Linden Nume O U Lender.Address QTY. MECHANICAL PERMIT FEF PLUMBING FEE Lit 1 ttnify that 1 have read this application and sum thin the above mrorm uM a F0. correct l ague mcamply with all city am county ordinances and state laws relating to PERMIT ISSUANCE MECHANICAL FEE y building construction.and heuby amhorim repuunudves ofdds city to Mier upon the U z above-mensionW propcny,for im cacao par,mms. ALTER OR ADD TO MECH. CONSTRUCTIONTAX (We)ague to save,indemnify and ke,hmmless Ne City of Cupammo against Nabi"s,judgmcnu,corn mJexpenxs which mayin any wayxrneageinat said City AIR HANDLING UNIT(11 10.000CFM) in on me the gynIing mf Nis it. —.y2 , AIR HANDLING UNIT(OVER 10,1100 CFM) g ur of ApplicanVConmamor ff Dau EXHAUST HOOD(W/DUCT) PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,0(10 BTU) Date Receipt# Will the applicant or future building cecapem sire or handle hamrdous material as defined by the Cupeninm Municipal Code,Chapter 9.12,and the Health and Safety HEAPING UNIT(OVER 100,000 BTU) AU Crave.Semicon 25532(.)1 ❑Yea 11 N. VENTILATION FAN(SING LE RESID) BOILER-COMP(3HP OR 100,000 BTU) ISSUANCE DATE With e acontaminants on a in nts as huilding by the Bay Area Aen Q uality nagement O h amdoua air conmmiwna as JefnW by the Bey Area Air nugemrnt BOILER-EOMP(DVER 100,000 BTU) © D t rl is dc' ❑Ycs ❑Na NEW RESIDENTIAL MECH. SQ,PT. 1 hove mind the hamrdous mmedals uquiumenu under5 of the SEP 21 1994 California Health&Safety Cade,Sections 25505,25533 and 255and Nat �'Iifthe building doesnot emremlyhaeaaml that it Nmy uaponotify she Ut- occupant of the reyuiremenu which must be run prim m issuaniEcn¢ofwncy.Ownerminti m ..gemine TOTAL: ISSUED BY: OFFICE