24848 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
BL TDI. :-U.M.HI AL PERMIT NO.
E 24848
CITY OF CUPRTINO rl.u5wmc-mF:cxemcAl
BuaF mvlsloN APPLICATION/PERMIT BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: ///,//I/ A /1�•''/� SANITARY NO. n->44
MIT.ICATIONSUBMITTALDATE
'IO&OO9�v�'v
/V ,. U( Nffe � � O LOT. / VV-
OWNERSN.yyE: — PHONE: COh-IRAQQ NAff�: LIC N S NlC CUNTROL0
S /✓\ Gens
,jICHITECTlFNGINEER: NO: ADDRESS:
SYDCO A ONE: Q.LY. ELECTRIC PERMIT FEE BUILDING PERMIT WFO/py3Sy�— BLDG ECT PLUMB MECH
S'727 pLR.MITISSUANC'E
LICENSED CONTRACTOR'S DECLARATION :PAN�
LIANCES-RESIDENTIAL JOB DESCRIPTION
^xZ Ilerebyaffrmda,I am li'loreduMerpmvisiamof Cluptn9lcommmcinf with
-�70 Senion](1001 of DivivonJ of the Business and Pmfewions Ca de,andmylicense is in
X.0 full force and Beer
<iV cnx�T4/Lin.7.-r' �- 0200AMPS
Condncdor f 1000AMP5 SQ.FT.FLOOR AREA S/Sp.FT.
ARCHITECTS DECLARATION OVER 1000 AMPS
Z-0 1.M.4 my plana shall hostel as public records.
r F to I I SIGNS ELECTRICAL
—�] licensed Professional
zs< OWNER-BUILDER DECLARATION SPECIAL CIRCUITIMISC.
acv 1 hereby,affirm that 1 am exempt from Jae Contreaas License Law for the
_Oy follawin[reasor.(Section 7031.5.Billions.and Professions Cade:Any city or county TEMP.METER OR POLE INST.
which rnlvires.pertrut m comoucs.alta,impo w.dwaoliN.a repair any stnucrun
>� priarto its issuance,also requires Ne applicant for such peanut d.fill,ad sed radiation, POWER DEVICES
=<o that he is licensed pursuant to the pm0,nom of the Co..License Law Corn.
_z 9(eommercing with Sec,ion70001of Divuim JofJae Budraesend Pmfessimu Cede! SWIMMING POOL ELECTRIC VALUATIO.%aCW
?y or died he is eaemfn therefrom coddle basis fee the lege,eaempioa Any vWlivanaf 1
"Z< Section 70313 by any applicant for a Knorr subjects theapplicant taacivil Penalty of29
OUTLETS-SWITCHES-Fl)(7VRE5 IO
< tan rtcre than five hundred dollars(S500). NEWRESIDFNOALELECTR _SQ.FT. Sm IYPECONSLRU ON
s_ ❑ I.ssownaa/Jupoprny,ormYemploymwiNwagnsaJwirwlecompetasatim.
will do Ne work,andthesmrmure isnmimendedomffead for ule(SacAOaM1.Buamea,
and Profession.Code:The Canoane.U.law does eta apply t.as or of
Ismpe^Y who builds or imFmvm thereon.and who dm well wart hinoelfor through his OCC GRO RES. NITS
employem,provided Net suc h improvertwnu art nd intended m affend far d c.I L
however,Ne badcin8orim ofMvmis wldw(thinoneyeamcomp)vcfmNeowner-
We.). will lure Ju burden of proving Jar he did Aad build or improve(m puryow of
We.). •:..."' tAJ"FEE '.. FLOOD ZONE APN
❑ I.mo nerofthepto M.ameaclmivelyconowungwidhlicensedconmc,mato Qom' (:; . PLUMBING PERM14['^"-^ "'•
comaaun the project(Sec.70th,Business and Professions Code:)The Conouers ppRNBp ISSUANCE
Lice se lawdoe.rotapply w anownsof In pmy who biliWsceimprovesthereond
n,a
wbaconmms forwch pmietswidhamnoutm(al Teemed putsvand to doe Conteaclor. ALTER-DRAIN&VENT-WATER IEA) FEE SUMMARY ' ..
License Law.
❑ 0
BACK FL . SANITARY
Y_N_
War DataF, dC�N,D. 11 RECEIPT♦
WORKMAN COMPENSATION DECLARATION � II SCHOOLTAX Y_N
Maltby affirm that I have.certificate of coowd w.cif-insure,ora cerditcau of •PER']y�ss i RECEIPT•
Compmwuonled.ilra certified ropy thereof(Sec.3800,Lab G)which --- ) PARK FEE Y_V
"^ mall employee's under this pemuL ASS'Eh.SYSTEM•I DIC. BUILDING DIVISIOa'
Policy.
y YSIEM PLANCHECK FEE
Certified copy is hereby furnished.
Cntifod copy is fled with thcitye city inspected division. - GREASFJINDUSfRL WASTE INTERCEPTOR - GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(11o..,I..need norbe completed ifdhe Parris is for onehundad dollars(SIM) , SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
or Itis.)
I cora that in the performaom of the work for which this Form,is isued.l shall I WATER HEATER WNFNTIELECTR
nm employ any pawn in any manta,w as d.become subjad to the We&. I PAID
C.'ressimlaw.of CalifomRFA
is. Dade WATER SYSTEM/ITWece
G Dare Riyte
iZ Applicant
0 NOTICE TO APPLICANT:If.ofe,making this Cerufcate of Exemption.yau.hould NEW RESIDENTIAL PLMB. SQ.FT. TOTAL
V5 become subjmmth<Workers Compcwuan provisiom of Ne laborCMe,you mute j BUILDING FEE
5: foMwith comply with such provisions.,.this Pmnit shill be planned onoke6
Q CONSTRUCDON LENDING AGENCY I ' SEISMIC FEE V
J Z I hneby affirm that there iso mnsouction landing almitcy for the piolf ceof \ TOTAL ELECTRIC FEE �f
O the work for which this Fermi,i.i...ad(SM.3097.Civ.C.)
Lenders NameWi PLUMBING FEE
lsndn's Address
MECHANICAL PERMIT FEE
L'] co I certify that 1 have reed this apPlio,ima and ss-,.that No above infortnnim is MECHANICAL FEE
L nter.lags tocomply wish all city andcovmy ordine es andatate laws relating dr mpuuTISSUANCE
buildin8conawni you onz, .."upon the CONSTRUCTION TAX
z .boo aped property far i purpowr. ALTER OR ADD TO MECH.
(We)
.gree lesson'.r fy anR Ins dsc Cityyyy in.again.
ilidim.judgmmts.c .which ma inan agilnst rid Ciry AIR HANDLING(INR(TO IO.Oro CFmI
in consequence of Ne gnn,in8 1 in,!.fir/ I AIR HANDLING UNIT(OVER IO.OW CFM)
rgnatum of Ap fanV Antos
no I EXHAUST HOODIWNUCTI PAID
HAZARDOUS MATERIALS DISCLOSURE I HEATING UNIT ATO 100,001)BTUI Date Receipt.
Will appilcan,orfuture building occupant Water or handle M1amdou.tiaterid I HEATING UNITdOVER Iof.tgoBNl .t
w defned by the Cupeni.Municipal Code,Chapin 9.12,red the Health and Safety
Code.Section 255324)? VENTILATION FAN(SINGLE RESID)
❑Yes ❑No ISSUAjJCE QQTE
Will doe,plicwt arfmrn buildin cir mw tardevices whichemit I BOILER-COMPIJHP OR IW.WOBNI FY's' HH 1 LJ
Bac pan equipnir
""orad,air conuminants u defned by the Bay Am Air Qvili,y Management I BDBFR�COMP 100.000 BLV) �sR �I
-J ❑Ycs ❑No ( NEW RESIDENTIAL MECH. SQ.FT. LIAR 18 19,93
. 1 hove wad the hard.,nou,nals require .muter Chapter 6.95 of the
California Health d:Safety Cede,Sections 25505,'_5533 and 25534. 1 undtah"that VIII VT Vv.if he building does nm curmmly have a tenant,tha,it u my responsibility to ndify the
occupant of the requir mems which must he tin poor to iauatWe of a Cenifana of
Occ%i,ney.
Owner nr amhatized'vgcm Dim
TOTAL: ISSUED BY:
OFFICE