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27245 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITU'OF BUILDING PLUMBINGUUILDN -ELECTRICAL PERMIT NO. 27245 BUILDINGc DIVISIONSION sloN APPLICATION/PERMIT -MECHANICAL BUILDING PROJECT IDENTIFICATION IIAING ADDRESS: SANITARY NO. APPLICATTON SS/.UBM,IKTTSAL DATE 22.4 22 (...PT r`(V OV l7T I UNIT# LOT# �.1-1 V OWNERSz1—Lfly NA,MEe LJC.V�� P ONHZ5 ACTOR'S NA / LIC NO: N/C CONTROL# �RCHITECT/EN_GINEBR: LIC NO: - ADDRESS: ❑ /i C?S T r o CGNTACT: PHONE: - BUILDING PERMIT INFO p o u(5 � f QTY. ELECTRIC PERMIT FEE 7 V BILDO PLUMB EC PERMIT ISSUANCE �{ El CONTRACTOR'S DECLARATION pppL1ANCPS-RESIDENTIAL Qc`z Ihereby affirmthat l am licensed underprovisions of Chapter9(commencing with IOB DESCRIPTION Poo Section 7000)of Division 3 ofthe Business and Professions Cade,and mylicense is in PANELS fall FU Licerrceandeffm[. `�- � E GamZ, License Class Lia# UP TO YOO AMPS H rn 7 y Dme Conuactor 201-1000 AMPS O8`.n Z4, ARCHITECTS DECLARATION OVER IOW AMPS SQ.FT.FLOOR AREA $ISQ:FT. I understand my plans shall be used a9 public records. Q��1 Licensed Professional NSIGNg ELECTRICAL FJ N - OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. 1• t F I hereby affirm that I am exempt from the Conuaetoes License Law for the W m following reason.(Section 7031.5,Business and Professions Cade:Any city or county TEM.METER OR POLE MST, E 3O which requires a Permit m construct,alter,improve,demolish,or repair any sweture pWray Prior to its issuance,also requires the applicant for such Permit to file a signed statement POWER DEVICES yI�5 O p that he is licensed pursuant to the Provisions of the Contracmis License Use(Chapter a p,ow 9(commencing with Suction]")of Division 3 of the Business and Professions Cade) SWIMMING POOL ELECTRIC VALUATION y(_,y or h70315 by exempt mtherefrom and the ba.its bjthe ct.alleged exemption.Any violation of O • /A ,,.a��� G Sedion]03 LS by any applicant fora permit eubjedathe epplicannoecivilpendry of DDTLETS,$WITGHFS-FIXTURES Lis a�jJ( C[V not mare than five hundred dollars($500). NEW RESIDENTIAL ELECIR _SQ.PT. H. ❑.Lasowrk,and'property,ormyemployeol.feegesasthei(sole c0mpem mess STORIES TYPE CONSTRUCTION L will dotbcwons and rhes o Contractor's intended sicse ofw ed does not applyrame t an Business and Professions Cade:The Contractors License Law deer r apply lf am owner of ' .. property whobuilds 0rimproves thereon,and whodoes each workhimselforNroughhis own empinye.,pmsided Nmsuchimprovemen[earemotintendedorofferedforsaleIf, - OCC.GROUP RES.UNITS however,the building or improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve for purpose of le TY. PLUMBING PERMIT I,as owner project (Sec.70 4.Business =it Professions s Clic,.)sed To,Comctotsto Q PEE FLOOD ZONE ApN I con ct the project(Sec.]044,Business and Professions or arp The Contracwr'e who commove, ewdmsnohproj manow.cmimaoperty who buddsadtnproves Hereon,and EMIT ISSUANCE whence Lamsforsuchprojems witb econrcamor(s)licenced pursoan[mthe COnuecmr's License Law. AL -DRAIN&VENT-WATER(EA) FEE SUMMARY ❑ lam exempt under Sec. B&P C for this ices BACK W PROTECT.DEVICE OUTSIDEES SANITARY Y N Owner Dat° DRAINS (30R,ROOF,AREA,COND. RECEIPT# ' WORKMAN COMPENSATION DECLARATION SCHOOL TAX YN ❑ Ih Cmaperereby nmlausithat I aveaceni to a ceateofconse therof(St to Self nsure, certificate of FIXTURES TRAP REC # Worker%Cmployer'ionler this ermit. ifW copy thereof(Se ,Lab C.)which PARK FEE Y N resit employee's under this permit .SYS -1 INC. 0UTLETS REC PT# Policy# % BUILDING DIV ION FEES Company - AS-LA.SYS OVER4 EA ❑ Certified copy is hereby famished ( ) PLANCHECK FEE ❑ Certified copy is filed with the city inspection division. GRFi1SF,/1 STRL WASTE INTERCEPTOR GRADING PEE 0 f36 oafs /�a I. CERTTFICATEOFEXEMPDON FROM WORKER 5 GR ETRAP SOILS FEE COMPENSATION INSURANCE (This section need not be completed ifthe permit is for one hundredd ars($100) EWER-SANITARY-STORM EA.20 ENERGY FEE reby a' cutlass.) I certify that inthe Performance of work for which this permit is issue Ishall WATER HEATER W/V not employ any person in any meaner se as to become subject m the Wo a PAID zCompensation Luwsof California. Date WATER YS IN 1 pate Receipt Applicant ' O NOTICE TO APPLICANT:If,after making this Certificate,of Exemption,you should E R Fr TOTAL: In become subject to the Workers Compensation provisions otthe Labor Cada yodrisus. Forthwith comply with sucM1 provisioru m this permit shall be rimmed rooked, d, BUILDING �+ pW,a Q CONSTRUCTION LENDING AGENCY SETS I hereby affirm that there is s consumed..leading agency for the perfotmaaee of r U O the work for which this permit is issued(Sm.309],Civ.CJ Q I TOTAL: ELE EE C) ULenders Name Lender's AddressQTY,,#., MECHANICAL PERMIT AEE PLUMBING FEB LTI I certify that I have read this application and state that the above information is MECHANICAL FEE correct lagan tocomply with all city andemartyordireaneesaod stimlawinchongto PERMIT ISSUANCE y building construction,and hereby amNorize representatives of Ms city to enter upon the U z above-mentioned pre for inspection purposes. ALTER OR ADD TO MECH. ' CONSTRUCTION TIX (We a to indemnify and keep harmless the City of Calandra against liabilitie. judg a andexpereseswNchmaymanywayaccm dna[ id Ciry IR HANDLING UNIT(TO IO,gq CEM) in s of r[/./ AIR HANDLING UNIT(OVER 10,000 CPM) Signature V pplicano'Contrador Dale EXHAUST HOOD(W/DUCD PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date Receipt# - Wil l he applicant or future building occupant store Or handle hazardous material t m define by the Cupertino Municipal Code,Chapter 9,12,and the Health and Safety HEATING UNIT(OVER 100,000 BTU) Code,Seedim 25532(a)] ❑Yes 0N VENTILATION FAN(SINGLE RESID) ISSUANCaM - E Will theapplicantorfulumbuildingaccupunt useeqvipmentordevices which emit BOILER-COMP(3HPOR NXLpX)BTU) - P ® Mous 11 Yes air contaminants se,defined by the Bay Area Air Quality Management BOILER-COW(OVER US),"BTU) �� o Yes No _ NEW RESIDENTIAL MECIL' SQ.ET. /1 I have read the hazordous materials requirements under Chapter 6.95 of the 4 .Ve '/`I 1999.S` California Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building does no[meats ly have a must tanq thato is my responsibility to notify the occupant of the requirements which must be met prior m issuance of a Certificate of Occupancy. Owner or authorized agent Dale ISSUED BYWV� •// OFFICE