S 2472 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL P-OINT PEN ONLY - U�
CITY OF CUPERTINO BUILDING.ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL C 2472 7 n
tlU1LU1NGPROJEC'P IDENTIF'ICA'nQN J 'T G
SA ITARY NO. APPLICATION SURMITTAL DATE
BUILDING ADDRESS:
` --- 10840 Bubb Road, LOT "C"
OWNER'S NAME: PHONE CO'TRACTOR'S NAME: LIC NO:
DeblinsI, a CA Lim Part 255-4300 Debcor Corporation 385712B NIC CONGRROL.#
KCHITECDENGINEER: LIC NO: - ADDRESS: ED �/ 3
Environmental Innovations 12280 Sarato a-S'vale Road 11101'
CONTACT: PHONE: BUILDING PERMIT INFO
Shannon D. Paboojian 255-4300 ❑ crns.Rant Fees Paid by Applicant(Initial) ZI ELEC' PLUMB NEED
Project Manager - Debcor Corporati Ft
LICENSED CONTRACTOR S DECLARATION QTY. - ELECTRIC PERMIT PEE
I hereby affirm hat[ licensed d provisions orChapter 9(commenting - - JOB DESCRIPTION
add, with Seci on 9fNh0)nrD". 3 fie Bur dP fissions Cade,ntd my license - RF
WOO in PERMIT ISSUANCE 3 �LJ
Fly Poll force and uRwl SFDWL ❑KITCHEN REMODEL
LUV License Class Lie# APPLIANCES-RESIDENTIAL. ❑ADDITION El PLUMBING RE-PIPE
F R W Dam Cmmcmr
m6G ❑MULTI-UNIT El STRUCTURAL
ARCIIII'F,CT:S DECLARATION
F,D m PANELS CHIMNEYREMODIFICATION
'L O V-i'FZ 1 undercmnd my pl...hall he usul as public recoN,
O Z-.Q UP'I'0200 AMPS [-1 INTERIOR El CHIMNEY REPAIR
W Licensed Prderctnal 201-I0IMAMPS IMPROVEMENT 0SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER 1000AMPS El BATH REMODEWREPAIR ❑DEMDLITIGN
ya%�at 1 hereby affirm that 1 am exempt front the Commdnr'x Lieman Law for the
ac O y U fallowing ream..(Section 90315,Naxinese and Professions Codc.Any city ur euro, SIGNS ELECTRICAL OTI I8R ,
W a W F wh h I ' arnad,a.construct, ILL P demolish, r repair any structure -
F��1c� pF t I 'Iadmiresth 'ppl tl hp tt fi 'g d statement SPECIAL CIRCUIT/MING
that he d inatimmretire provisions ❑1 C t t I L (Clamer9
WG O
(can wiIhSvalmr700m. 11'vsnn rattle Foxand lrotessiam Code)or TEMP METER OR POLE INST. COMMERCIAL,
m
6 o that he is exempt therefrom and the basis for the alleged exemption.Any violation 0 ❑NEW BLDG/ADDITION ❑DEMOLITION
Section 7031,5 by any npplictml for a permit subject,the upplicamma civil penalty of POWER DEVICES [I TENANT ❑FOOD SERVICE
b not..of than rive hundred dollars($500). I 0 N
�Fd ❑ Ln owner of the pmpeny,orm to eeswithwu was lheirmlecom tion, SWIMMINGPOOLELECTRIC
5G yemP Y K' pens. HER
a E. will Pr the won,Calle he Crap isnot Licensetended La.doesed i.,road,
is,an,Business
W�� and Profession,Codc The Cnmmemr'a License Law docs not apply N an owner of OU'I'LP.TS-SWITCHES-PIX'I'URNS
�' pmpeny who hail(,or improve,Woreon and who Jne,sucb work himself nr Wmuglh
his own rumnyov,,provided that such improvmnem,am mol intended or ofRred far NEW RESIDENTIAL ELEC'I'R SQ Fri.
sale,if,however matulldingolimpmvement is sold within one yearofemnplmion,the / S@NI'.FLOOR AREA $/SQ.FT
evorcol udder will have the burden of proving(hat be did not build or improve for par- OY 6-7
It)
2 3 5 y
p,e -7 O
con,asowe rofad pmpeny.vin ticami and cunwctins with Ii Iticr-sed cometeavractors m
mnwet the project(Sec.7044.Bueinass and Professions Code:)Tlh.Convector's Li- - -
xoLalawsErolapplyma, ,Inr nfpropeny wcti,edd,ef amour mentracmhd QTY. PLUMBING PERMIT FEF, t . /
who rtmnucts Ersuch pr jests with a amvvmar(s)lieensul pumunmm Ihr Convreetoe's h C7
IimnseLnw. PERMITISSUA
Lamexemptumlu Sec. ,B&PCfor this mason
ALTER-DRAT T-NER(EA) VALUATION
Own, Date
WORKER'S COMPENSATION ofFarman DECLARATION BACK IIOW PROTEC , :VIC O
1 hereby off rm antler penahy of perjury enu of the fnllowing deelamtionx.
I hnveund will mvimvina Certiriate of C�nsem meolf-insure for Wndei,Compere- DRAINS-PLOOR.BOOP,AR STORIES 'TYPE CONSTIEUCTION
moon,as pmvidal far by Sinton 3900 of the LuMor Crede,ler the performance of le
T
vismirldrhoulami,pernotish,ced. FIST URES PER TRAP
❑ I have d ll un I W k -Co p s i I as co,mand by Section
3700 afthe Labor Code,for the performance of walk for h h lik Detroit is ed. GAS EA.SYSIEM-1 INC.4 OUTLETS (yCC, yOUp APN
My Wink Compensate.1 nave w r.nd Policy comber tree (�
Cnrtim: Policy No GAS-EA.SYSTEM-OVER 4(HA)
_ CERTIFICATE OF EXEMPTION FROM WORKERS' PASUINDUSTRL WASTE INTERCECIOk
COMPENSATION INSURANCE GRi ' ll ]5 DIVISION PIAiS _
Q'hisws0on need rat becontplHulif thu pemoil isfmmaahunlreddellnrs($10d 4 V -
or low.) GREASE
'rRAY 17C.-F&
L CH[� P •�i
I certify that in the performance of the work for which this permit is lssuN,l shall SI;WER-SANITARY-STORM EA 200 Ff
not employ any persona mty manner xo as to become.,,],act to the Worker,'Cnnpea- ERGY 3 A
vv a 8_
zZ .,ran Laws of California,Onto WATER HEATER W/VENT(ELEC'fR
.Z O Applicam G AN
NO ICE TO APPLICANT:IL utax onagn,this Cettimade of Exemption,you should WATER SYSTEMCFEA'I'INC.
(Ny~ � becomeory,tl m the Worker's Compensation provisions of the Labor Code,you must SOILsEl
2' forthwith comply with such praviciomor this peoundiall be deemed revoked. WATER SERVICE
Q
CONS'T'RUCTION LENDING AGENCY NEW RESIDENfIALPI.MB. SQ.Pf. PAID
'Z Iwant,air thin Here is a conxouction landmgagency for the performance of Date Receipt#
n
the wad forwh,,h this p.nnit lx issued 3097,Civ.C.)
W F-' Lender(,Nauru 'b 1
Lenders Address
V L'
r7-e [L BUILDING FEEFe 1 certify thin 1 have read l¢.ppllcvtion and xtme lCt the above information is
.w correct.l agree m cmnply with all city and county o mature,and tate laws relating m QTY. MECHANICAL PERMIT FEE
aZ huildingeon,wetian,and hereby Culanize mprcscmwives oflhis city lo.nmrupmh the SEISMIC Fr: Z
abovo-memioned pmpeny for inspection pml - PERMIT ISSUANCE
(We)agree to save,lad annify end keep burial...the City of Cupertino"insl EI,HC ICF P. 2' 9 7A
_
liabilities,judgments.cosis andexNases which may in any way xcrruc against said City ALTER OR ADD 10 MECH. �j q
cnfnectrnce ofthe grmin,of this per it, P GFEE C� C
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINTAIR HANDLING UNI T(TO 10.100 CPM) ,H ICAL PFE
SOURCE REGULATIONS, (7 r
AIR HANDLING UNIT(OVER 10,00)CFM) CO "IRUC'L'ION TAX 'r
Signamreof Applicant/Commmmr Dom EXHAGS'f HOOD(W/DUCT) USINGMI'rIGAHON FEE OZ
HAZARIlOUS MATERIALS DISCLOSURE
WiIIlbeappli,dar,fmuro building acapant,wom handle tremulous arterial HEATING UNIT(TO I00,000 B'I'U) "
as defied by the Cupertino Municipal Code,Chapter 9,12,and the Health and Safety
Cxla,Section 25532(a)7 IIEA3'INC,UNIT(OVER 100,000 BTU)
F-1 Yes E]No PAID
VENTILATION PANS INGLB ICES ID) Date Recaipl#
Will the applicant or future building occupant use equipment nr devices which
mit hazardous air contaminants as defined by the Bay Arca Air Quality Management BOILER-COMP(3HP OR 100,000 BTIp
)istdnp
Yes ❑Nn BOILER-COMP(OVER 100,000 BTU)
❑
AIR CONDH TONER
1 have mad the homMaus enatcnaLa rcquircmenls ander Chapter fi.95 nr the Car-
ISSUANCE DATE
brain Health&Safety Code,Sections 25505,25533 and 25534,1 understand that Fine NEW RESIDENTIAL MECH. SQ,ET.
/// (1
building does mol curtcmly haveamnanl,tom it i,my re,panxihillly In nrnify Wcoceupam ( � 1 - 2-
......ex
ssuance of v Ccniticateof Occupancy.
Act oremthcrized agent Date ISSUED BY:
OFFICE