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25696�0 `Z y? He OZN ggF�k u�3o N AwG a3 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 11 CITYOFCUPERTINO BUILDING -ELECTRICAL APPLICATION/PERMIT PLUMBING. MECHANICAL. BUILDING DIVISION BUILDING PROJECT IDF.N'TLFICATION y o. e b � ULicensed ti 4. y GSection G PERMIT NO, n C 6 9 C G J J v BUILDING ADDRESS: SANITARY NO. APPWCATIONSURMIRTALDATE UWT# LOT# 1 — WNI ' SNAME' t PHON `�O� Le JCS Cf0'SNAME: LIC NO: s NX CONTROLp RCHITECIENGI LIC NO: A D a GON'rACf: PHONE: QTY. ELECTRIC PERMIT FEP. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �� PERMIT ISSUANCE ,JC D � A E3 Ws LICENSED CONTRACTORS ims,dCalt.9 Ihereby co mmencing with APPLIANCES - RMIDENTIAL JOB DESCRIPTION Section7")ofDPisml 3 oftheBuinss no Professions Cars,a and effect. on J of the Business sad Professioan Code, and my license is in Lin (arae and efrect. PANELS Ijanm Class Llc.# UPT02W AMPS Dam Contractor 201 - IOW AMPS ARCHITECTS DECLARATION 1 undersand my plans shall be used as public records. OVER 1000 AMPS SQ. FT. FLOOR AREA I/SQ. FT. SIGNS ELECTRICAL Professional SPECIAL CIRCUIT/MISC. OWNER -BUILDER DECLARATION I hereby affirm that 1 ata exempt from Rat Communes License Lew for the following reason Sculion 703 1.5, Buairram and Professions Code: Any city or county which requires n permit re construct, ppcn improve, demolish, ore a sig any alande t p rcquims ppi permiriofleasi tied suimment poor pursuant the applicant Co that he is licensed pmsuanno the provisions theContractor's Lew (Chapter �I l'_r © IN \ � _ ✓ t II TEMP. METER OR MILE INST. / �, - POWER DEVICES 9 (commencing with Section ]OW) of Division J ofNe Busistw end Professions Code) a Businessand Pro or that he is exempt therefrom and the basis for the alleged exemption. Anyviolation.f 70315 by any applicant forapemit subjects theapplicanno acivil penal f SWIMMING POOL ELECTRIC ` yALUA OUTLUTS-BWITCNES-FIXTURES SAIL' not more l.uowthan roftheve dnddollars mSSW). ❑ I, me work. S .compensation, (part armyemcurred wimwagesast(Sm. will dathewons and 'he Business formictipply NEW RESIDENTIAL. ELECI'R Q. FT. STORIES TYPE CONSTRUCTION La doesad he Comm rce License m an, and Professions Code: The Comracmra Liana Law does not apply m an owner of ' property who builds or improves thereon, end who des such work himself m through his own provided mrovemmprovements formthen OCC. GROUP RES. UNITS ever,temployees, ld willninot eyearofoomoffered however, meave the burden of prangthat edidnoneyem or improve for thrower- nee. builder will have the burden o! proving that he did not build or improve far purpose of ale.). ❑ Lvowncr contractors's TOTAL: Qom' PLUMBING PERMIT FEE FLOOD ZONE APN project (Sropany 4. Business conswct the project (Sec. ](Ha, Business end Professions Cr Imp The Contractor's Profesiions Core-) n License Law dasnot apply maaawdecafpmpeny who builds mimpmme momma,and PERMIT ISSUANCE / rej whence Lacu(orsuch projate withecontrumrts)licrnaed pursuanuothe Contmcmis License Law. ALTER (PA) FEE SUMMARY ❑ I and exempt under Sec. , B & P C far dus reason BACK ROW PROTECT. DEVICE SANITARY YN - RECEIPT# Owner Dat° WORKMAN COMPENSATION DLCLARATION ❑ Ihereby affirm that l have a certificate ofconsent to self -insure, or a cesificute of Weken'Compenution lnsumeeor a cenified copy thercof(Sec. 380), Lab C.) which coven ell employee's under this permit. Policy # DRAINS- FLOOR, ROOF, AREA, COND. SCHOOL TAX YN RECEIPT# FIXTURES - PER TRAP PARR FEE Y N RECEIPTM GAS - EA. SYSTEM-] INC a OUTLETS BUILDING DIVISION FEES Company ❑ Canified copy is hereby famished. GAS - EA. SYSTEM -OVER 4 (EA) PLANCHECK FEE ❑ Certified copy is fled with the city inspurion division. GREASIONDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASETRAP SOILS FEE (This section need not be completed ifthe permit is for arm handled &JIM(SIW) or lay.) SEWER - SANITARY - STORM FA. 20017. ENERGY FEE WATER HEATER WIVENTIELECTR I criifynotm the performance of the work for which this permit is issued, lshall not employ any person in any manner so as to become subject to the Worker' Compcmation Laws of California. Dam ANOTpplI nt WATER gYS /TREATING Jl PAID Data Rcceiptp E Exemption you ,you mind NOTICE TO APPLICANT: the W-Tla's Coafter eruiki li this Certificate addle becomeh provisionsofthe Labor Code, you moat the Workers Comms MDENTUL PLMB. SQ. FT. TOTAL: BUILDING FEE fnMwith comply with such provisions or this permit shell be deemed revoked.- comply or this CONSTRUCTION LENDING AGENCY SEISMIC FEE 1 hereby affirm that hem is a construction lending agency for Be performance of ELECTRIC FEE me work for which this Permit is issued (Sec. 3W7, Civ. C.) Lender's Name Lander'. Address QTY. MECHANICALPERMIT FEE PLUMBING FEE 1 certify that 1 have read this application and suite that the above information is PERMIT ISSUANCE MECHANICAL FEE come[. l agree to comply with all city and county ordinances end state laws relating to I i construction, and hereby authmire representatives afthis city teener upon the above- entioned proposes. property for inspection puoses. ALTER OR ADD TO MECH. CONSTRUCTION TAX ( c) agree to save, indcmni ad keep harmless the City of Cuportip against liabi'tic,Jud ents,cmtsande nseswhichmayinmyway¢aueegv tsaid ity AIR HANDLING UNIT (TO 10,000 CFM) theffin this permit. AIR HANDLING UNIT (OVER 10,000 CFM) � olka iced omorctor Try, EXHAUST HOOD(WIDUCO PAID HEATING UNIT (TO I00,I300 BTM HAZARDOUS MATERIALS DISCLOSURE Dole Receipt It Will the applicant or foram building occupant sloe or handle hezandous roam ial as defined by the Cumi pno Municipal Cade, Chapur 9.12, and the Health and Safety HEATING UNIT (OVER I W,OP'1 BTU) TOTAL: Code, Section 25532(a)7 13 Yet 11 No VENTILATION PAN (SINGLE RPSID) Wilhhea licantafuwrebuildin acre pp g pantau BOILER- COME GHP OR 100,0(10 BTU)) ISSUANCE DATE Are. Aon QualityMarr mord Disardom air cameminums es defined by the Bay Arco Air Quality Management District? BOILER - COME(OVER 100,000 BTU) ❑ Yes ❑ No NEW RESIDENTIAL. MECH. SQ. Pr. I have mad the hevardems materials requirements under Chapter 6.95 of the 1 undersand me[ if the buildingdocsnot if the uil ing lthdo &Safety Code, genions 25505, 25531 and responsibility nmmntlyhave alarval, that it is my nuance of. to notify the cupant of the requirements which must ed met prim to issuance a(s Cenificete of 41 • V O O Occupancy. C/ IgSUED BY: Owner or aumanzed agent Data TOTAL: OFFICE