27319 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPENO hLECJ
- PERMITNO,
BUILDING DIVISIOSIO APPLICATIONIPERMIT N PLUMBING-MECHANICAL
BUILDING PROJECT IDRNTIITCA'1'ION 27319
BUILDING ADDRESS: SANITARY NO. APMCATONSSUBMMHTALDATE
Ct-I LOT 330 1
OyslkRS ME: PHONE: CO CTOR'S M� P� LIC NO:
`Y NIC CONTROLM
ARCHITE /ENGINEER:RCA& LIC NO: DRES � I P� ❑
CONTACT: P}}B��pyyB12-4
s ._,S, i G r.J
."°� k QTY. .A kat ECIRIC PERMIT FEF. BUILDING PERMIT INFO
1 1 B_ LDG C XPERMRISSUANCE I�IIT�'T/)
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL -TOB DESCRIPTION
OnoI hereby affirm that I=licensed underprovision achapter9(cmarmneingwith
00 Section 7(W)of Division 3 of the Business and Professions Cade,and my license is in PANELS �•�
eclj� fall Licen res and eRect. UPTO2WAMPS a 44005
Faye License Cfvy Contractor—
, `
y6y D' Condrazd- 201-1000 AMPS
ZOrrnn ARCHITECTS DECLARATION SQ.FT.FL000.AREA 6/SQ.FT.
OVER 1000AMP5
CZ-0
1 understand my plans shell be used as public records.
P nsy tS; SIGNS ELECTRICAL
K Licensed Professional
ddQ OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
LxLO F I hereby affirm that I nm exempt from the Convector's License Law for the
following reason.(Section 7031.5,Business and Professions Cade:My city or a party TEMP.METER OR POLE MST.
Oy which requires o permit to a nmrucd,When improve,daraolish,m mpan any suucmre
'rrY� prior to in issuance,also requires the applicant for such permit file a signed statement POWER DEVICES
W Nat he is licensed pursuers w the provision of the Cannot License Law(Chapter -
ao,o 9(commencing with Section 7000)ofDivision 3 ofthe Business and Professions Cade) SWIMMING POOL ELECTRIC ^ VALUATION��
y—y nouns is he exempt therefrom and the brie for the alleged exemption.Myvioladion of UTI,E'fS-SWITCHES-FIXTURES Lg
t F Q Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of 6.(..(/
F not more than five hundred dollen(550(1). NEW RESIDENTIAL ELECIR FT.
S .
C� ❑ 1,asownerofibepmp ay,ormyemployaswithwegesa th irsolecomp moon, —SQ.FT. STORIES TYPE CONSTRUCTION
Wa3— win do the wark.and the structure isnutimeaded oreffered farsan(Sec.7044.8uainess
and Profession Cade:The Comnctoes Licene Law does not apply an em owner of
property who builds or improves thereon,and who does such work himselfor through his OCC GROUP RFS.UNITS
own employes,provided that ouch improvements arc not inserted-offered for sale.If,
however,the buddingorimprovement is sold within one yearofcompletion,the owner. TO A
'builder will have the burden of proving thm he did not build or improve for purpose of
sale). QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
❑ Lu oe pixjeshepropeny,amexclusive ting withlicrnsM conhecsonw
constnet the pioject(Sec.7044,Business d Rafe s Cade:)71ta Comnctor'8
License Lawdoarcurapply doenownerof perry who builds onatherson,°nd PERMIT ISSUANCE
whowmminisforsuchprojecdsaoEtten cmr(s)licensed pumuant eConwctor's ALTER-DRAIN&VENT-WATER(EA)
License Law. FEE SUMMARY
❑ I um exempt under See B&P C for this RACK FLOW PROTECT.DEVICE ID: `E
SANITARY YN
Owner m° DRAINS-FLOOR,ROOF,AREA,COND. RECEIPTp
WORKMAN CO PENSATION DE TION SCHOOL TAX YN
❑ Iherebynffirmthatlhave cnificamobeonsen elf-insure,-• rtifam of RECEIPTN
XTURES PER TRAP
Workers'Compensationlnsum eoraceriri he USec.3800, . which PARK FEE Y_N
rs all employees under d permit. GAS-EA.SYSTEMAINCAOUTLETS BUILDING DIVISION FF
Policy N
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Cenifaed wpy is he by furnished.
❑ Cerifedeopyis ed with the city ins a ndivision. GREASFANDUSTRL WASTE INTERCEPTOR GRADING FEE
CERT CA OPEX ON FRO /ee KERS' GREASETRAP SOILS FEE
P INgURANC
nfiiaseetionne lmulbac on,isforon°hundrMdoll ($100) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
m les.)
I cenify that undue pert for which this pvmit is iss ed,Isbell WATER HEATER W/VfNT/F.LECTR
not employ any person in any Warmer sen s to became subject to Worker' PAID
Compensation Lawsof Califomie. Dme_ WATER SYSIFMTREATING Date Receipt#
O Z Applicant
z 0 NOTICE TO APPLICANT:If,after making this Cent ate of Evmpti n,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
,r zzi become subject to the Wadmes Compensation provision he Lab- de,you must
7
forthwith comply with such provision-this pemdl shalIb revoked. BUILDING IEE
114
(1]. o CONSTRUCTION LENDING AGENCY SEISMIC FEE
1 hereby affirm that there is a construction lending agency An performance of
U O the work for which this permit is issued(Sec.3097,Civ.C.) ELECTRIC FEE 'N
Lead
Name
LTa PLUMBING FEE
U larders Address QTY,.- MECHANICAL PERMIT FEE
W I certify Nm 1 have mad this city
and
and sense that the shove information rmming is 1 MECHANICAL FEE
4
correct.1 agree to comply with all city and county ordinances and state laws relating w PERMIT ISSUANCE ` ��
U) building construction,and hereby authorize represenntivesofthisciry wenderupoothe CONSTRUCTION TAX
U z above-mentione perry for insp "on purp-es. ALTER OR ADD TO MECH. t
(We)a d ate,mdemrdfy and keep hanNesv the City of Cupertino agwnst
liabil'ien,j r.stsnndexperres y in any way acemeugalnss swd City AIR HANDLING UNIT TO MIKE CFM)
.ane ftyeg maid. !_1.2s
HANDLING//. AIR HANDLING UNIT(OVER 10.000 CFM)
m
a fAMI tca Date EXHAUST HOOD(WIDUCT) PAID
lAZARDOUS MATERIALSin . rdiamnDISCLOSURE
HEATING UNIT(TO 10p00)BTU) Date Receiptp
Wills ache Cuamorfmuseicipal Code, pamswre-anddh Health
and Salty GRATING UNIT(OVER 100,004 BTU)
as defined the Cupertino Municipal Cade,Chapter 9.12,end the Ha1dM1 end Safety
Code,Section 25532(a)7
❑Yes 13 No VENTILATION FAN(SINGLE RESID)
BOILER-COMP(311P OR IM."BTU) ISSUANCE DATE
Will theapplicunmrfusure building occupant F a
hsnardous air emuncinants as defined by the Bay Arta Air Quality Marugemcm BOILER-COW(OVER 10,000 BTU)
Dinnict1 NOV 21
❑Yes ❑No NEW RESIDENTIAL MGCII. SQ.FT. 1994
1 have mad the harerdous materials requirements under Chapter 6.95 of the /./�
California Health&Safety Code,Sections 25505,25533 and 25534.I undennnd that V r(Jt—
if the building does net currently have a tenant,that it is my responsibility to notify the Try/t
occupant of the requirements which must be,met prior to issuance of a Certificate of V
Owner or authorixd agent Data O ISSUED BY�•a�'r-•
OFFICE