20051APPLICANT TO FILL IN INFORMATION WITHIN REDLINES —USE BALL POINT PEN ONLY
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20051
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CITY OF CUPERTINO-BUILDLNG DIVISION
APPLICATION I PERMIT
Contractor's Name: Lfc. Na
BIM.IX ELBCTRICALL'LUMBING-MF NTCAL
CATEGORY
CONTROL a
ArcAltca/Esgl Llc. No:
QTY ELECTRIC PERMIT FEE
BUILDING PERMIT INFO
Add— ( �% S
PERMTISSUANCE
❑ ❑ ❑
LICE SED CONTRACTOR'S DECLARATION
thombyafflrmtlutlemlkemeduMerpr Wmsof Chapter9(�
ingwthSecaon7000)of Urolelm3ofNeBualr dPmfesa CedC, d
hems le In full fora and effect.
APPUANCES-RESIDENTIAL
O DE9CRIPITpN
� (� 1^/ ^L-�1�• .
PANELS
Lleroe Clans_ Lk.4 927562
Date Contracior I(y'�man Marisa nl 031
up To 200 Ah(Ps
Pl'
ARCHT EC'S DECLARATION
I undenlaM my plans shall be eati as Public rtmrda
AMPS
OVER10DOAMPS
5Q. FT. FLOOR AREA
S/SQ.F .
SIGNS ELDCTRICAL
Licensed Professional
mri'tAL CIRCUIT/MLSC
OWNER -BUILDER DECLARATION
Iherebyaf oothatIamexempt fr«nthe Contracmri(JameLawforthe
'ItiA1P, METER OR IDLE INST.
following reason. (Section 71015, Bualnm ant Profevloro Code My city or
county which esquires a pemdt to mrobut, alter, bnprove, dennWh,or reply
'
anys mmpricetalbbt ma aLwrequbestheappBantf«suc pent to
Ole a signed statement that he is he sed pumrant to the pmvltlo s of the
POWER DEVICES
y}yQ,/hgNG li%]I. FI.ECTRIC
Contractor's License law Chapter 9(mnvrcncJng with Healon 70 N) of DIW-
tlon3 ofthe, Business and Prdubm Code) orthat he b tempt therefromand
VALUATION
the boob for the alleged exemption. My Wdation of Section 7MI5 by any
.Pplfont for a permit subjects the applicant to a civil peruHy d nor room than
pU-D,EISSWI.ICI,I6FLCfURF5 -
NEWRESIDEM7ALFr O7M SQ.FI'.
Iv undred down LSSM.
as owner of the Property, or my employees with wages as their sok
STORIES
TYPE CONSTRUCTIONI,
compentaHm, will do the work, and the stmtu re b not wooded or offered for
nit (Sec 701. BusRtne snd Prof.w. Code The Contractors Ucr. I w
does not apply to an owner of property who builds or improves t heron,and
who don such work himself or through hbown employm, provided that such
OCC -GROUP
RFS IInT15
.Improvements am out intended or of c and for sale. If, however, the wilding or
impmvermed is add whAk one yearof completion, the owner-wllduwill have
TOTAL:
-
ri
t co of pmvM
log that he dout build or Improve for purpose of sale.).
�; as owner of the property, am exclusively contracting with licensed
contraton to conswct the project (Sec 70K BuBusinessant Professions Cade:
QTY. PLUMBING PERMIT FEE
pp(Mpp ISSUANCE fLs
(..(J
Fl000ynnT
AI'Fr
License, La
The Contractor's censw does not apply to an owner d property who
wilds or Improv theorem, and who conboma f« N such ptojewith s
S�acta(a) licensed pursuant to the Cmtratoe.Licenselaw.
LJ I am exempt order Sec B kCTP C for this reason
ALTER -DRAIN k VENT -WATER (EN
FEE SUMMARY
BACK }TOW PROTECT. DEVICE
OUTSIDE FEES
—
DRAINS FLOOR, ROOF, AREA, GOND.
pp[[U]✓Fw.I'EL[TRAP
SANITARY Y_ N
RFLFIPTa
Owner Date
WORIQAAN COMPENSATION DECLARATION
ITI herby aHbm that I have a ertlf cote of consent to self -born, a a
mrRilcateofWorkers'Cwnperualmlrmunneaamrifledmpytheeff5ec.
3800, Iab CJ
a �610/y�40Z7g
Co Policy y oar H RR.
SCIi0IX. TAX Y_ N_
RFGFBT s
GAS EA.SYSFFM-1 ING4O[JIiE15
PARK FTE Y_N
RECEIPT#
CAS EA. SYSIEM-0VQtt(FA)
BUILDING DIVISION FEES
CerUBed copy b hereby
CcetNed copy, b Ilei with the mY inspection dlvWm.
dwith the cit.
GREASE/INDUSfRLWASIEIN7ERCEP'IUR
PLANCHECKFEE
GREASE TRAP
CERTIFICATE OF FYF FTION FROM WORKERS'
PAID
SEINER-SANITARY-STORh1 EA. 7()0FT
COMPENSATION INSURANCE
(This section need rad permit completed lf the pedt b for Gm hundred dollars
Date Recel [H
WATER HEATER w/vFxr/ETFCTR
ENERGY FEE Y N
%IW)orl'')
I certify that N u
the perfomna of the wcak per
rout which this pedt la Issued,
I s1uB not employ any person In any manner ao as to become objet to the
W«ken'Compensatbnlawso(C.WrmRa. Date
WATERSYSEEM/TREAnNG
'
PAIDAppli
NOTICE 70 APPLICANT:
NOTICEafter makingthioCe you
Date Recel tin
NEW RESIDFNTIAL PCMB. SQJ 7..
TOTAL:
sheuld become subject to the Workers C pmdExemption,
epmvbloro of the ]awr
Cade, you coke f«1hwM comply with such provbkro orthb permit shall be
6pnwi is
deemed revoked.BUILDING
SEISMIC FEE
. CONSTRUCTION LENDING AGENCY
I hereby afRrmthat there is a construction lending agency for the perform,
Inceof the work for which thispemJt b bared (Sec 3097, CW, CJ
TOTAL
ELECTRICFEE
QIY. MECHANICAL PERMIT FEE
PLUMBING FEE
lenderi Name
]ender. Address
I mrtlfythat I have mad thhapphW ion and wstethatthe above Infomutlm
bcormt.Iatieetocomplywhhallcityand county onEnances and crate laws
MECHANICAL FEE
PERMIT ISSUANCE
FEES PAID:
relatingtow[wl gconstmwm.MherebyauthociaempresenUtivofthio
city to enter upon the aboveircntbed Property f«Wpectlon purposes.
M'e) agra to save, Jodrmufy an d keep hamssdethe City of Cu rtiou
against
agat BabfUtw,jtdgmrna saMexpemmw "k ylnanywayamue
against said CRY lo consequence, of Vnt Ing dthlapermit.
_
ig
ALTFRORADDTOMBCH. a
Revel [k
AIR HANDLING UNIT (TO 10," CFM)
SUBTOTAL:
AIR HANDLING UNIT (OVER 10,110) CFM)
CONSTRUCTION TAX
Sig tumdAppB«est/ est t« Date
E)GLAUST HOOD »
CONSTRUCTION TAX PAID:_
HAZIRDO SMATERIALSDISCIOSURE
Will theapplbnt«future wddingoempntstoreorhaMk hazardous
material as defined by the Cupertino Municipal Code, Chapter 9.17, and the
Health and Safety Code Section 25532(p)i '
1 Y. ri No
\
HEATING UNIT HO 100,000 B1V)
Date Revel tH
HEATING UNIT (OVER 100,000 B7T1)
TOTAL:
O
VENTILATION FAN (SINGLE RESID)
lj�W DATE
111 the appilant orfuture hu llding occupant use equipment or deeim
which emit Forardous ab contsmlrunt. as deBmd by the Bay Ana Air
BOfLFR-COMP QHP OR 100,000 BTU)
Qra1Ry Alsrugemeot Dbtnet7
Yet nn No
haw 'ad the harardous materiab requirements under Chapter 6,95 of
t C.hf.UHeaRhk SofstyCoda Setloro]5505,25533and25534.I
�/
JUN M I/ 19VU
BOILER-CO.MP(OVER100,0001IM
NEW RESIDENUAL MECH. SQFT.
uMen thstlfthcb lUdingdcetnu wev tlyhaveatenant,thatltbmy
nsporolbdq to nalfy the oeupnt d the requirements which crust be rest
prior tolssuarurd.Cerdfwtc o—pancy.
,,,,aa ss,.
NF CIIDB�R10
_%+G� zs-9D
ISSIIGU BY:
Owner orawhMud agent a Date
TOTAL:
OFFICE COPY