20944APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Pmicd ldentlfkatfenpF3th0T
NO.
Building Address:
23 � , Cc, "'W-0 �;����,
20944
FE5QK , : erP �e
UCITY
OF CUPERTIN0.BUILDING DIVISION
APPLICATION / PERMIT
,ro A
e —1 r ^�(D
Coetr.dor's Name: Lk. No
#24E"NC, AMCH. d_'dN 'M222
BURAwr—ELECTRIGV.PLUMBINGMFLHANcAL
CATEGORY
CONTROL 9
rchhted/Engin .. Lk. N.
QTY ELECTRIC PERMIT. FEE
BUILDING PERMIT INFO
Add.
PERh9TIS5UANCE
❑ 1:1 1:1LICENSED
CONTRACTORS DECLARATION
IMreby,ffC H tlam UcenseduMerpro WonsofChaper9(c«nmen
Ing with Section 70U11)of DfWslon 3 ofthe Buss
lneand Profesa.Code, and
APPLIANCES -RESIDENTIAL
7oB D6CRBT1 N
Ikeosei.i.fullf.m,andeff
Ll¢nrcfa v 2 Z
PANELS
/.� •L1 _1T
_i��
Date �_'o�_Cb o C% ,
vs 1 I
Ml-IODO AMPS
ARCHITECTS DECLARATION
OVERIODBAMPS
SQ. FI. FLOOR AREA $/EQ.Fr.
I uMerstand my phvehall be rued as public recmde.
SIGNS MZCTRICAL
Licensed Prof®brut
OWNER -BUILDER DECLARATION
1herebyalarmthatIameuemptfromthe Comnctors Li¢ Lwfmthe
9aF3'JAL CIRCUIT/MIS[
TEMP. M7TFRORPOMINSf.
'
(ollvwing rtaon. �nfian 7(BIS. Buslnea arW Pmfesebru Codr. Any dry or
cuuntywhkhrequlresapemd[tomru o,dter,Wpo demdi,h,arrepair
-D '
any,tm mpMtoits me,a6 requ r theappbmntf«s 6pe to
fila • signed rte
atemnt B¢
that he b naed pursuant to the previsionsof the
Contractor', LIceme Lw (Chap er 9 (mmerrendng with Sealun 7000) of Divi-
sion 3of the Business and Professions Co4r) or that he is emmp therefrom end
POWER DEVICES
UATION
SWIMMING POOL ELE(7TRIC
the bub for the alleged exemptkn. Any violation of Stolon 7M15 by any
nt fora permit ash" the appint to a civil penalty m than not mon
,pplloin
OVTLETSSWITCIiSFlR!aEAES E
I DA
NEW RESIDE24IIALEIECER SQ.FT.
SPLIFIES
7YPECONSTRUCDON
five mtndred dollars (soot.
n1, as owner of the property, or my employees with wages as their we,
mmperu+tlo t, will dothe work, and the structure b net Welded or offered for
_
ale (Sec 7064, Bu.Irca+,M Pmf.ism Code: The Contractor, IJ¢nse law
don wt apply to an owner of property who Wilds or Improves therton,and
doessuchwork himself «thwgh NmW
sownemployees, pvad that such
•
OCC.GROIIP s
R6 UNITS
improveme artwtIntendedoroffenedf¢ule. If,however,thebuildNg¢
bnprovamant Is wlthlnomyearofcamplet kthemmerbuUderwWtuve
TOTAL
t rdenofproWngthathedW not WBdorfmpmvef¢purpoudult).
Las ^weer of the Property, am eulusivefy �traeting with 11¢n ed
mntraccoatumrutruct the projeet(Sm70K Bwlno and Profnsbro Cade:
QTY, PLUMBING PERMIT FEE
PERMIT ISSUANCE
FLOOD ]ONE'
A['N
The Contractor's License law does not apply to an owner of property who
Wilds or Improvn, es thereoand wW m.such ractn for ch pPjects vfth a.
c9allae1orW B¢nrd pursuant to the Contndais License Lw.
LJ I am exempt uruler Sec B k P C for this reason
-
ALTER -DRAIN 4 VENT - WATER WA)
'
,
FEE SUMMARY
BAGS: FLOW PROTECT DEVICE
IXUINS FLOOR, ROOF, AREA, GOND.
FDnURES. PER TRAP.
SANTTARY Y_ N_
RECEIPT Jr
Owner Date
WORIONAN COMPENSATION DECW RATION
❑I hereby .Birth that I have a ¢rtifhte of coni. to aelf-Wort, or ,
certWaaeof Worken'Comperuadoolmun ence. nertiled mpythersof&S .
3800, Lb C)
SpdOOL TAX Y_ N
RECEIPT
GAS FA. SYSTEM-11NG4OUTLETS
PARK FEE Y N
I olky I
RECEB•P
CAS EA. SYSIFM-0VER 4 (FA)
C. %
BUILDING DIVISION FEES
1 ICedNed ropy Is herebyfumeetty
rL�Ji CedNei copy Is(heedwiththe ed. WpeUbn division.
GREASE/WDUSIRL WASTE WI.QtCFPTOR
PLANCHECKFEE
GREASE TRAP
• CERTIFICATE OF E'XUvIPTION FROM WORKERS
COMPENSATION INSURANCE
(rhlsa,rUen need not be ccmpided Bthe peredt la f«om hundred dollar,
PAID '
Date RC i tp
SEW'EILSANRARY STORM EA.
(f100)«fythut
I certify . lo the pedorman¢ o(Ne w¢k for wNch thio pemW b issued,
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y N
1 WB not employ any pe. In any manner. as to become subject to the
Wmkern CompensaUan Lw, of Califor ou. Date
PAID
WATLli SYSTEM/IRFATfNG
NOTICApplo,aE
NOTICE TO APPLICANT. tot Ff, ahs making thio Cedn pro is Exemption, you
Isomme Workers'Compematbnpmhis Labor
Date ReCei ted
NEWRISIDENTIALP[JdR. SQ.FT.
TOTAL
I h,f1the
Code, peofthe
Cade, yaa moat forthwhh comply with wch provbbm m thh pemdt shall be
kILDING ME
deemed revoked.
'
TOTAL
SEISM19 FEE
CONSTRI ION LENDING AGENCY
Ihereby.111 thatthenb. mrmmdlmteM g,grmyforthepedomn
an¢ of the work for which thio pemdt b Ivaed 45«.3097, CW. CJ
ELECTRIC FEE
Fender'. some
Lenders Address
Icrett. lhg IlovereadtwthaDobnd natethrtthaabovedeateatlah
bmIngt
aBcityand muhortne in,nms,na etsofthIa
QTY. MECHANICAL PERMIT FEE
PLUMBING FEE
MECHANICAL FEE
PERMIT ISSUANCE �7.r07
FEES PAID-.
Wildigcompfywhh
nlaing to Wilding malWve- on, aM representatives at Wes ofthis
-
d property for
chywe)to n enter ,bove-mefyandpropedy far the Ckyn Cope
(We) a to uvea Ude and keep harmless the City d Cupert W
ALTER OAADD TOMBCH.
Date Recei tp
SUBTOTAL:
gu
as. 1 Cin,�udgments, fid capermes whkh myln any wayamue
dCNy in roes the gr .Ing his permit.
_/ —
AIR FiANDIJNG UNIT 8010,000 CFM)
AIR HANDLING UNIT (OVER 10,000CFhn
CONSTRUCTION TAX
EXHAUST HOOD (W/DIICD
CONSTRUCTION TAX PAID:
rump of Appaant Gontnctm Date
AlA RDOUSMATERURE
IFATING UMT(ID]00,000 BTU)
nH
Will the appurcruparttorearluMlchvrd
matedalm fdbytheCupertinoMurodpal Code,Chapter 9.17and the
Date RCCCI [N
xFAnNc UNIT (OVER toD,nrn BTU(
TOTAL:
'
1
1Tnnhand SretyCode sextan 75532(.)I
Yes Ir�—rI No
VENTILATION FAN (SINGLE RF_SM)
ISSUANCE DATE
he
WBltapplloncmQWt Wllding«cupantuseequlpmentmdevkes
whkhemithanrdouaairmnum NaasdeRrrdbythe Bay Asea Air
BORER-COMPOHPOR100,0DBTU)
-
a
0YeaWy Marugeme.Mstrictl -
[']No
PAID �l�
- l�AID
BOILER.COMP(OVER 100,0[1) BLU)
tuve read the h ..materials¢qulremenb under Chapter 6.95 of
ety Code. Sedbm 25505, 75573 and 75531.1
ingdoesnatarrtntly have.te... I, that It is my
Ct EP 1, S 1990 .
NEWRESTDFSJTIAL N.ECH. SQJ;T
«mpantd roq"�fkate fiery.
aQ29
Fi
Of qVIPOT"!
J
aatharl> d,gent D t
D
TOTAL
OFFICE COPY