22386APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY \
Building Preen Idenfifkatlon
BB °d Add.
&'J7eb E r-)coN�'c-,d or Un is I l e E
PEILWT NO.
22386
Owner'. Naom,.
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION if PERMIT
^_
.[
Contractor'.Name: Lk. No
BLn DING-ELBC ICA4PLU MG-MEQIAMCALLCATE)GORY
CONTROL I
ArchLLen/Fagineer. Llc Na
QIY ELECFRICPERMIT FEE
BUILDING PERMIT INFO
Addnrsx -
PERMITIS91JANCE
❑ ❑ '-vr
-l' ❑
TR
LICENSED CONACTOIPS DECLARATION
IMrcbyaftbm that l an, lkmud under prwhlonaof Chapler9(mrturien
ingwith Sectton7000)ol Dlvision3ofthe Busiressard PmfxamosCode, and my
11¢r. la m (u8 f effect. �4
LIm, Cont to T7E /.�
Drte Contra 1-40
APPI]ANCESRESIDEMIAL
_ r�;09 IASCRIT'nON
I �j ��`/
T
/V
PANES
UP TO 2DOAM5
AM
ARCHITECTS DECLARATIOATIO N'
IuedewMmy pliveWBWuaed upubllc recvda
R 10
OVER 000 AMPS
SQ. FT. FLOOR AREA
5/SQ. Fier
Lkenscd Pmfeaslovl
SK:NSELECT[ ICAL
i?eP IQ C e5
SPECIALCIRCUIT/M19Z
OWNER -BUILDER DECLARATION
I hereby affirm that f am exempt frwn the Contrutor'a License Law fmthe
r I
TIMP'METERORPOLEINSI.
POWER DEVICES
fallowing reason. $shun 7.15, BuJnm and ProfessionsCode: My cityor
muntywhl requbesapermktoanstruMOter,Mpm demolbh,ormpalr
anynromnmprbrtolafrauarice,.lwrequWtheappllant(machpemLLto
flle a signed statement that he Is Ibenxd pumant to the pmvislons of the
Contractor, Llceve law(Chapter 9(osmrrcntlng with Section 7000) of Dlvl-
sion3 of the Buslnmand Prtdmbv Code) orthat he b eumpt them(romand
VlJ
SWIMMING POOL ELECTRIC
VALUATION
the Web for the alleged exemptlon. Any, violation d Section 70315 by any
app0ont for a permx abjeev the app0canl to a WII pevky d nn more thin
O1177.ETS54VIiCI1ESE
NEW RESIDENTIAL
flvtundred dollars (S5=.
I, ae owner of the property, or my employ. with wag. u their Bole
TYPE CONSTRUCTIONLJ
compensation, will do the work, and the structure is rot Wended or offered for
vie (Sec. 7064, Buatneu and Pmfmlov Code: The Contractors Limve Law
does not apply to an owner d property who builds or Improv. thereon and
who do. wM
chwork meeif a through hks own employm provkled that sud
CRO
RFS I/hTIS
DATE
Mn
Improvements am rot Intended oroffered foraale. If, however, thebulkling or
Improvement laxeld within aneyearofcompinlon,the owner-bullderwBl have
TOTAL:
t rden of proving that k did not bulla or Improve fee purpose of sale.).
1 u owner of the property, am exchuively contracting with llmved
contracts to construct the project (Sec. 7014, Buslum and Pmfesbns Codr.
QTY. PLUMBING PERMIT FEE
PEJESITr ISSUANCE
FLOOD WIVE
-
APN
Tno Commences Lkxwe Law does not apply to an owner of Property who
builds or Impov.
rtheore , and who anuracts for such PP)ens with a
olNetons) llmnmd pensuant to theCmtractora Uranus Law.
U I am exempt under Sec B A P C for this renin
ALTER -DRAIN kVENT- WATER (EA)
,
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
OUTSIDE FEES
DRAINS FTnoR ROOF, ARCA, COND.
FU(7lJRES PER TRAP
SANITARY "Y_ N_
RECEIPT s
Owner Due
WOR KMAN COMPENSATION DECLARATION
ns�,(11 hereby affirm that I have • mMBraw of consent to seC-bwum, rc a
pEn�te of Workeri Compe.allanlvu moa mrtifkd copy therto(($ec
3800, Lab C.) �-y _ �q�ys LU,
rat . Ci G- l77 (VN
�ZjCCertified ^ is herded.
�"QCertlfied copy b flied with the city Inspection cifvlalm.
SSY"���
SCIdOOI, TAJ( Y_ N_
RECEPpl
GAS EA. SYSTEM -1 PJC4 OUTLETS
PARK FEE RFfF1l N
GAS EA. SYSTEM-OVFR 4 (EA)
BUILDING DIVISION FEES
CREASE/INDUSIRL WASTE INTERCEPTOR
PLA NCFIECK FEE
GREASE TRAP
CJJITIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION WSUMNCE
(MiI section recd notal completed B the permit b for one hundred dollars
PAID
Date Recel l#
SEWER.SANITARYSTORM EA 31Q;I•
WATER HEATER W/VENr/ELDZTR
ENERGY FEE Y N
PAID
(f100)mlm.)
so as tohcomeem it Is Ihfxd uued,
[cony that In the peomammoy manner
I stall not employ any pcuom f any miner se er to become ubjrn to the
Werkem'CmnpenartlonLaws of GB!«raiser D.
WATER SYSTEri/TREATING .
AppH.NOTICE
Date Reeei t#
NEW RESIDENTIAL PLMB. SOFT.
NOTICE TO APPLICANT: ll, after .king fhb Certiflnte o/ Fie.�lon, you
shaild loam. eubjct to the Wonkern' Comperurtkn pnvvbbv of the labor
TOTAL:
Code, you mut forthwith amply with such pmwmns orNb permB Jail be
deemed revoked.
BUILDING
SEISMIC FEE
CONSTRUCTION LEhIDINGAGENCY
I hereby affirm that them b a m.huctlon herding agency for the perform
nmotthe work for permNbbsued (See 3097,CIv. G)
TOTAL
ELECTRIC FEE y
PLUMBING FEE r1^1EVg) 05
I< acr, Add
I mot. IanIlivemplybappl ay,oul nate nmaat the obey Inbrmatlm
recorrect. L:grcem comply with all herb countyonl Nanmandore of this
orfurepr.enpurpo o(thb
QTY. MECHANICAL PERMIT FEH
MECHANICAL FEE
PERMIT ISSUANCE
FEE$PAID: r
/�1 Q
citytbgtobu pongmmooe-me,ardlarcby property
clt(to W)arupontWabove-mmbrcd pmpertyfm tape Cit p of
(We) agme to ave, and keep haroom the City of
ALTER ORADD ED MECH.
_
Date Recei t#
SUBTOTAL:
ay accrro
ag+Bat WbWt es, jrdgmentq mete and asoma which may any amore
no, costs
agalvtaJ k lo o a e fthe graining dthls Permit
AIR HAhDUNC IJhTf (T010,OD0 CFM)
AIR HANDLING UNIT (OVER 10,0)0CFM
CONSTRUCTION TAX
Slgvtumof Appll o a to
EXHAUST HOOD(W/DUCIT
CONSTRUCTION TAX PAID:
ZARUOIS ATEIUALSDISCLOliURE
HEATING UNIT(TO iW,= BTU)
Will the appi, too, or handle havrdov
material as defined by the Cupertino Municipal Cade, Chapter 9.1 Z and the
Date RCCCI [#
HEATING UNIT (OVER 100,0(D RTU)
TOTAL:
I lea lth and Safety Core Section 25572(.)?
II�� Y. iz
m
'�JRl the applicant, bullding.NotuaeequipmModed
which coot W vrdaus W cenuM V Me ate defined by the Bay Area Ab
Qoallty Management +trict7
Yea D�,j1�jj]� No
No
VENTILATION FAN (SINGLE RESID)
ISSUANCE DATE
BOLEF MPOHPOR 100,0(10 BTU)
BOILER -COMP
BOILER-COHP(OVIX tN,000 BTT(
Iha c read the of
IM Gllfornia }health A SafetyCode, Sections 25505, 2SS33 and 25534. I
NEW RESIDENTIAL MECH: SQFT.
uMastaM tint if the buliding do. nix amrntly have a tenant, tNot it b my
r.ponsWlllty to notify the ocapard d the requirements which oust be met
Prioncr �dlf of Occupancy.
—Date
ISSUED Ja&-�
6iv m� agent
,TOTAL:
OFFICE COPY V