20055 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Pm'ed Identification PERMIT NO.
Building Addrev: S O
�3 o r ��,;� P� 6•- 20055,
rs .me one:
FO(4uK G-cZpUp CITY OF CUPERTINO-BUILDING DIVISION !_
centrad° .Nam: �n pp (/C}J�Na: APPLICATION / PERMIT r'7 �J
^' / `s ' • • BUIL DINGELBCTRICALML INGMECHAMCAL CATWORY CONTROL I
Arches /En mer. -F- - Llc, o:
2('/1 c_ QTY ELECTRICPERMrr FEE BUILDING PERMIT INFO
Address Hl�b 1 s�.c S� PERMITISSUANCE ❑ ❑ ❑
LICENSED CONTRACTORS DECLARATION
I hem-by afflrenthat l am Bcmud under provhionsaf Chapter9(cromenc APPLIANCESRESIDENfIAL N�
IngwllhSMbn7000)of DivWm3oftheBwine dPmfn omCode,and I p(7`,a� (l' lU �-.y_
MPS
U bin fuF LeffeR 40 Z ,a PANES L_Rf2� I'--a V t ^�
DNey'�J/f+ to Contractor l'i>Ex9to�4C � .
r/1 ICHRECPS DECLARATION pl'1000a
m0 L. I urdemlvd my plaru.hall be,u d v public records JOVER10XIAMPS SQ.IT,FLOOR AREA $/SQ.Fr.
Licerued professional STGNSELECTRICAL D IN
OWNER-BUILDER DecuxwnoN saecuLCBcculr/MISC
I„ Ihereby af/lrmthat l am
exempt from the Contractor's Literate law for the
7p
ffill.wing reason.(Sectlm 7m1.5,Business.rad Profrsbw Code.An e or
FZ" o y TEMP. OR POLE INSE.
� muntywh4h mqubeaperrNttomvtrud,alter,lmprove,drmoWh, rrtpair
any atmenum prior to its)sans sere,also requite.the applicant for such purNt to POWER DEVICES
y
f
Ne a signed statement Ih.t he Is licensed punnunt to the provbbv of the
�0
� Contractor's LiterateLaw(Chapter9(mmmencingwith SMb00)
n70ofDwi-
sbn3oftheBusinevandPrde CWe)ort ahebe mpttherefmmard SYVBdMNGI'OOLEIECIRIC V/I UATION
• �.' the basis for the alleged exemption. Any violsibn of SeGbn 70315 by any
applicant fora permit,oub"the.pplkant to a dull Penalty of not mon than OUTLETSSIVITCFIFSFiX1UR6
Ove hundred dollars(SW.
I,as owner of the my mployee. B NEWRF�ENTIALELECR SQFT. STORIES
�?< ❑ Property,d a witheranutfer sok CONSIRUCf10N
mJe0=7m,wHldoshework,and W.Code. hnotintended Or offered for
❑ vk 7011,to atr¢vandf pmperty Code.The Comracor's G¢veLaw
_$ don ml appy loan owner dthmugh who Wildeor ly.,prwtknon,and OCC.GROUP RES UNITS
who dmsuch work hbroen ed orwghhisownle.Ifh weprovidedthatsuch
Improvements.rerotintended earof o pletio.If,however,thee,)dingm 70TAli
bnprovement batt withinoneyesrofcmnpletbrnthe owner-WBd rrwW hart
114,1,1rden of prodngthat he did not build or Improve for purprseafsale3. QTy, PLUMBING PERMIT FEE FT-OOD ZONE APN
L a.owner of the property,am exclu,Ney contracting with li enssd
eontracmnm wearuct the project(See 70G,Business.ed Profeabv Code: PERMTTISSUANCE
The Comracwe.Lim.Law does not apply to an owner of property who ALTER-DRAIN k VENT-WATER(EA)
Wilds r improves thereon, and who contracls fee ouch p(," with a
mmt(act¢(e)Bomaed purwant to the Colmar'.License Law. BACKFLOWPROTECE.DEVICE FEE SUMMARY
LJ I.m exempt under Sec B! P C for this reason
DRAINS.FLOOR ROOF,ARE A,COND. SANITARY Y_ N_
Owner Date RECE UT If
WORKMAN COMP a cerb mofhf ren.ARALION FLXTURFS PER TRAP SadOOL TAX Y_ N
1 hereby.fibro that I have•nrsura.e of cmetnf b o y-bwn,m a
¢ - of Works 'Comp<vabmlwn ¢a¢rtlfkd copy bet. RECEIPT
3800,Lab C. CAS EA.SYSITM-1 RJGlOVII.ElS PARK FEE Y_ N— RECE _
Pdlcye �n¢ GAS EA.SYSTEM-0VFR4(EA)
Co lc rj� BUILDING
g
INCDI ?I
VI510FF.ES
Gr+l « -ropy hereby GREASE/INDusrtu,WASTE INTERCEPTOR PLANCHECK FEE
certified ropy b filed with the my Impmroo dNuMon.
CERTIFICATE OF EXEMPTION FROM WORKERS' GRFA,SETRAP PAID
COMPENSATION INSURANCE SEWQLSANfTARY STORM FA 700F7 Date Remi t#
Ghll N ommdl n¢Wcomple di l(th permB hfaone hundred dallan
bt001 or 1ess3 WATER FIFATMW/VENT/ELBCR ENERGYFEE Y N
(certify thatotae Persrtun¢ofthew¢k for tobthio nubjcbred,
I dull hat employ any poem b any manner at u to become eub}M to the WATERSYSI.QA/TREATING
' W¢kenv
'Canpsatblaw.of lao(GWmnla.Dote PAID
O Z Applicant NEW RESIDENTIAL P M8. BQF. Date Rem tp
Z 0 NOTICETO APPLICANT:U,after making thbceM(lrate of Exemption,you
should become subjectto the Warkeri Comperuatbn pravbiom of the=r - TOTAL
CCN Cade,ymnu.tfwthwW ply Mth.uchprovhlomorthbperM "lbs UVILDTNG FEE
W F3mdeeed revoImd.
CONSTRUCTION LENDING AGENCY SEISMIC FEE
CL IhenbyafRrmthatther<bamvtrunim kndingagerry for the perforrry ELECTRIC FEE
7 Z arce.fthe work(ase whkhthb pemdehblued bee 3097,CW.C.) TOTAL. -
() O Iander'aName PLUMBING FEE
LL 1— lemer'enddre.e QTY. MECHANICAL PERMIT FEE
O W lmdifythatl Fat me thhapp"WnaMate Lhattheaboveinfommion ^� rys MECHANICAL FEE
boort
ext.I agnetocomplywd con w.
lth all tityarunty ordinauend state laPERMIT ISSUANCE IyaW FEES PAID: ROL
Y 4 relmingto Wlklingmmtmdion,aMknbyauthatr pre.e.Ua .ofthb
(— N tltyt.tgem
tbnedp for lexpectbn purposes. ALTER OR ADD TO MECR
(Wean P es.theC fcupertma Date Recei tp
V aga Wtts ex wMeh nary ywayacvue AIR HANDLING UNIT(TO 10,W0 CFM) SUBTOTAL:
agalmt gr g of thio t.
7 _ CONSTRUCI70N TAX
1*7
Sigvor Date EXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the appliance!utun building occupant stop or handle havrdous HFATINGUNCr CrOIW,o00BM Date ReCel ill
materlalaede0n dbythe CupeAi.Mu Ndpal Code,Chapter9.lZ..dthe
He lthand SafctyCod Scalm 75$3l(a)t FiEATWGUNIT(OVER t00,lXA BTU) TOTAL: O
n Yn
Hltheapplinm ase tun Wllding oaupamuse the Baym.Air VFN-ILLATION FAN(SINGLE RESID) ISSUANCE DATE
hkh eMlhanNou.W tamW msvdeRned by the Bay Ana Ab a"H'w
�havoIlly Motu gemeed 7 BOILER-COMP Ol9'DR 100,000 Rr11)
Yn U 1 1990
,b the )AyC rlah reams,% , under Chapter 6.95 of BOILER-COMP rovlxlW,IXA BTU) L�"` .3.1
the Glifmnla Health Code,$M ,75573 and 755.'k4. I `-
undrntand that i e W Iogdces mrnn y have a tens ttut II h my NEW RESIDENTIAL MECH. SQ.FT
naporulbll allfy narvpa dthe Immenbw Trusthmm
prior to 5,fK,of rtlBate )t ��J ^. �{n�•]
nerorauthoriadagentDate QY ISSUED
TOTAL
OFFICE COPY