24798 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-MECHA ICA PERMIT No. 7
BUILDING DIVISION APPLICATION/PERMIT PING PRODBING CT MECHANICAL
BUILDING YNOJF.CI'IDENTIFICATION
98
BUILDING ADDRESS: n II -- ^� ,{/�� SANITARY NO. APPLICATIONSUBMIITALDATE
{', l l..! & UNITN f vI1Yl N g/�a� trcm
O S AME: ��, PHONE: CO CTOR'S AME: LIC N �V/
/f NIC CONTROL#
s17
Y rn
A CHITECT/ENGINEER: LIC ADDRESS: 7 ❑
NTACT: PHONE:
QTY. ELECTRIC PERMIT PEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE 1:1 El
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL �Fl TOB DESCRIPTION
OCZ Iherebyaffirrn thin l am licensed underprovisionsofartlocr9(commencing with
lWOO Section 7000)of Division 3 of the Business and Professions Code.and my license is in PANELS
K full farm i nd effect. QJ
FZ� License CJJ,,uag�ryN Lic.# 3)0359 UP TO 200 AMPS
y6y Data I!Mk Conn .., 201-I"AMPS
z fOyZ� ARCHITECTS DECLARATION OVER I"AMPS SQ,It.FL000.AR f/SQ.FI'.
OZ—A I understand my plans shall be used as public records.
r o,F uSIGNS ELECTRICAL
<y5 Licensed Professional
F r,W OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
yL,OiF I berchy affirm that 1 am exempt from the Contractors License Law for the
413 m y< following reason.(Section 7031.5,Business and Pmfessioms Cade:Any city or county TEMP.METER OR POLE INST.
�O J which requires a permit m consumer,all,,, demolish,
er.improve, of resw
pair any nurt
not 0.
prior m its ioemmes knotauires the applicant for such permit m filen signesdtement POWER DEVICES
LL''E:MC) that he is licensed pursuant to the provisions of the Cimin cols License Law(Chapter
9(commencing with Section 7")of Division 3 ofthe Businessend Professions Code) SWIMMING POOL ELECTRIC VALUATION
yKj-^,y orthm h7031.5 by any aefromnt for a parent
thedexempti to civil
of OUTLETS-SWITCHES-FIXTURES
�QSection 7031.5 by nundredicamrs($50rmit subjects the appllcammacivil penalty of i fro
not more than five hundred dollars($500). NEWRFSIDENTIALELECIR S .FT. 111
tto ❑ 1,asdwnaroHhepropeny,ormyemployees with wmgesastheirsolecompensation, —SQ.FT. TYPE CONSTRUCTION
a3= will do the work,and the structure is not intended stuttered for sale(Sec.7044,Business '
and Professions Cmc:The Contractor's License Law does not apply to an owner of
propany whdbaildamimprevexthe oro.andwhodou each work himseloadamugh his r ES.UNITS
wnemployces,providedthatsuchimprovemen"a notinwnd oroffeMforsale.If. Ir ^ '
however,the building or improvement is sold within one yearofcompletion,theowner-
builder will have the burden of that he did not build or improve for f TOTAL:
proving P purposed
side.).
❑ Las ownerofshe property,omexclusively contracting with licensed tomato to QTY. PLUMBING PERMIT E /I OOD ZO E APN
onatmet the project(Sec.7044,Business and Professions Code:)The Contractor's
License Lawdeesnnt apply manewnerofproperty whobuilds or improves thereon,and PERMIT ISSUANCE
whorentruv,forwch Projects with acontowtor(a)Iicetued porsuamm the Commerce,License Law. pLTF.R-DRAIN&VENT-WATER(FA) AR
Y
❑ 1 an,exempt under Sec. ,B&P C for this rens,, OUTSIDE FEE
BACK PLOW PROTECT.DEVICE SANITARY Y N
Own, Date DRAINS-FLOOR.ROOF,AREA.CONI. RECEIPTp
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ Thereby affirm that l have a certificate ofconsem to self-hours,or a re"ificam of pIXTURES-PER TRAP RECEIPT#
'orken'Compcnmtidn lmdmntt oraccnifimropy thereof(Sec.3800,Leb CJwhicry PARK FEE YN
veno all employee's under this permit. GAS-G.SYSTEM-1 INC.4 OUTLETS RECEIPTN
obey If BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4EA) PLANCHECK FEE
❑ Cmifred copy is hereby famished.
❑ Certificdcopyis filed with the city inspection division. GREASC/INDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS PEE
COMPENSATION INSURANCE
(This section need not be,complete fee permit is forces hundred dollars(5100) SEWER-SANITARY-STORM EA.201 ENERGY FEE
mless.)
I certify that in the Perfonnanm ofrhe work for which this pernit is issue,I shall WATER I1pMR WIVEN'DE-LECfR
not employ any penoon in any maaner so as as become subject an she Wmkeri PAID
Compenottion Lawsdf Califnmiu. Dam WATER SYSTEM/IREATING Data Receipt#
,7. Applicant
z0 NOTICE TO APPLICANT.If.after making but Cerificate of Exemption,you should NEW RESIDENTIAL PL IL SQ,FT. TOTAL:
p4 become subject o she Worker's Compensation provisions of the Labor Cede.you must
7 Ethic da comply with such provisions or this permit shall be deemed evoked. BUILDINE�g
CONSTRUCTION LENDING AGENCY SEISMIC zI hereby affirm Nat them is a construction lending agency for the performance of
U Othe work for which this examot is iasaul(See 309],Civ.CJ TOTAL: ELECTRILender's NameD" Leman Address QTY. MECHANICALPERMIT FEE PLUMBII certifytat 1 have readthis application and sate that the above intimation is MECHAN>" ren.Ingres axomply with all city and county ordinanecs and stem lows relatingm PER LIASSUANCE
F-' Q" building conswction,andhereby militris represeradvesofthiteity m entarupon they CONSTR
U 7 above-mentioned property for inspection purposes. ALTER OR ADD TO MECH.
(We)ogfee m save,indemnify and map harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue uguimtsaid City AIR HANDLING UNIT(TO to."CFM)
acne of the granting ofthis permit.
AM HANDLING UNIT(OVER I0,007 CFM)
rgomureof ApplicanUCommaor Date EXHAUST HOOD(W/DUCI)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date Receipt#
Will the applicant or future building occupant store of handle haaanlousmutefial HEATING UNIT(OVER 100.000 BTU) IOTA :
an defined by the Cupenino Municipal Code,Chapter 9.12,and Ne Health and Safny
Code,Section 25532(x)? VENTILATION FAN(SINGLE RESID)
❑Yes ❑No
ISSUANCE DATE
I Will the applicanmrfnum buildingoecupant useaquipmenmrdeviceswhich emit BOILER-COME(3HP OR]BLOOD BTU)
7=�mic air conwminants as defined by the Bay Arca Air Quality Management BOILER-COME(OVER 100,000 BTU) A I7 Y9❑Y. ❑No NEW RESIDENTIAL MECIL SQ.FT.
I have rud the hazudeas materials requirements mother Chapter 6.95 of the A S 2Qifdmneaph&Sa1underarathats�HMe building does nut currently have a taaan6 that it is my responsibility to notify the
aptainofertgdireupancy.ner m uuNoriud agam Dem TOTAL: ISSUEDBY:
OFFICE