24795 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-RLEC'I RICAL PERM I NO.
APPLICATION/PERMIT PLUMBING-MECHAN[CAI, n ^ (] C
BUILDING DIVISION BUILDING PROJECT'IDEN'IIFiCA9'ION GLI J J
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
1651S E. EAZL,, ,/\I UNIT# LOTH
WNERSNAMEL_HONE: CONTRACTOR' NAME: LIC NO;
NIC �CON�--T--RyccO��L
#
•ARCH,ECTNG NEER: LIC NO. ADDORESS: , .
CONTACT: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BL ECT PLUMB MECH
PERMIT ISSUANCE t E ❑ ❑
LICENSE,DCONTRACTOR'SDECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
Metz I hereby affimtrhd l am licensed un&rpmvisionsofCapter9(commencing with
00Section 7000)of Division 3 ofthe Business and Proe ions Code,and my license is in PANE S
yvutF. full force and effect
FUU UPT02MAMPS
ZUI Date cC Lic.# C •�
Tony Date v Cuntmctor 201-1000 AMPS
Zb-z ARCHITECT'S DECLARA'f OVER TWO AMPS SQ.Ff.FL R AREA $/SQ.FI'.
O Z—O I undersand my plans shall be used as public recu .
t:,to I_; SIGNS ELECTRICAL
Licensed Professional
yea OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. JF
XOaF 1 hereby affirs that I am exempt from the Committers License Law for the
W3ay following reason.(Section 7131.5.Businessund Professions Cale:Any it,or county TEMP.MET BR OR POLE INS'F.
co which requires Permit n construct.alter,improve,demolish,or repair any structure
KQ7 Prior to its issuance,also requires the applicant for such Permit to file a signed statement MOWER DEVICES
0
that he is licensed pursuam m the provisions of the Contactors License Law(Chapter
�ox � 9(contmencing w ith Section]W0)of Division 3 of me Business and Limestones Code) SWI M MING POOL ELFT RIC VALUATION
m—w or that he is exempt therefrom and the basis for alleged exemption.Any violation of u100
T—Z> Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of OUTLETS-SWITCHES-FIXTURES
a not nmre than five hundred dollars($500).
KFp ❑ I,asownerofthepropcfty,ormyemploymswimwagesmtheiraolecompertsetion, EPERMIT
TTALELECTR _SQ.FT. STORIES TYPE CONSTRUCTION
6'3 e—° will do the work,unit the strecom isnot intended oroffcred fbrsele(Sec.7044,Business
and Profusions Code:lac Comracmr's License Law does not apply m an owncr of
properly who builds or improves mercon,and who dace such work himself or through his
employs,provided tbet such improvemcntsere notimcndeJoroffered formic.
If, OCC.GROUP RES.UNITS
however,the building or itnprovcmem is sold within one year of completion,the owncr- TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I,usuwneroDhe pmpcny,am exclusively contracting with licensed cnmranoato QJY. UMBING PERMIT FEE FLOOD ZONE APN
construct the project(Sec.]044,Business and Professions Ciotti)The Contractor's
License Lawdoesnot apply man osocrefpropety whobuildsorimprovcs doctors,and NCE
who contracsforsuch projects with a contractor(s)licensed pursuant mthe Contractor's ALT'F.R-DRAIN&VIiNT- (' ) FEE SUMMARY
License Law. WATER LA
❑ 1 ass exempt under Sec. ,B&P C for this rtaxn BACK FLOW PROTECT.DEVICE OUTSIDE,FEES
SANITARY Y N
• Owner Dmc DRAINS-FLOORROOFAREACOND. RECEIPT'#
WORKMAN COMPENSAT , . ,[ON
1 Thereby affirm mat I have a certificate of consent toself-insure,or a unifica¢ SCHOOLTAX Y N of RF,CF,IPT p
FlXTVRES-PER TRAP
Workcts'Compmsnuov lnvuance oro cenificJ rnpythcrcof(Sec.3g100,Loh CJ which PARK PBB YN
ere aIle pinyee5,'s� m roti GAS-EA.SYSTEM.I INC.4 OUTLETS RECEIPT#
Iblicyp Isk ry Esq,; BUILDING DIVISION FEES
Company S�IItI/il a GAS-F.A.SYSTEM-OVER PLANCHECK FEE
❑ ¢d copy is hereby famished.
Cenifiedcopy is filed win the city inspection division. GREASEANDUSTRL WASTE INTERCEPTOR GRADING ITE
CERrGFICA'1'E OF EXEMPT ION FROM WORKERSGREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This section need not be completed if Ne permit is for one hundred dollars($IW) SEWER-SANITARY-STORM FA.20f11T. ENIiRCY FE
o'
I rectify that in The performance ofm orkforwhobtMapemtitis iss ,Ish.11 WATER HEATER WNFM/ELECTR
not employ any p ;o any towns s o be tel object to t orkers' PAID
z ComApplicant n s f£n� on. WATER SYS'1tiM,TRFATING Date Receipt#
z O NOTICE
Z TO APPIA -a rmakin his esti at f I Homy should NEW RESIDENfIAI.PCMB. SQ.FT. TOTAI.
> becomithco dy the such
provisions
or this r sen fmcla revoCork muvt
� > I'enhwith comply with such provisions or this Permitshallbe Deemed revoked. BUILDING FEE
t
g Q CONSTRUCTION LENDING AGENCY SEISMIC ITS ISD
Z I hereby affimt that there is a construction lending agency for the performance of
U O the work for which this permit is issued(See3097,Civ.C.) ELECTRIC FEE
lender's Name
U.
U Lclu sAddress QTY.Ej4jP
EE PLUMBINGFEEI certify mat 1 nave read this application and sate that the above information is�" cort«t.Iagree menmply with all city and counry oMinancea and amts laws relating to MECHANICAL FEE� building construction,and hereby oamhoriu rcpreicntaiivesofthi,v city tomuer upon meV Z above mentioned property for inspection purposes. CONSTRUCHONTAX(We)agree to save,indemnify and keep harmless the City of Cupertino againstliabllitiesjudgmentx,co..sts and expenses which mayiany way:mcrueegai 'said City AIR HANDLING UNITQO 10,1#110 CM)
in nseyucnce of me tenting of tela permit.
ILAIR ITANGLING UNIT(OVER 110,000 CFM)
re fA first Const' or Dam EXHAUST HOOD(WOUCT)
PAID
kIAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date Receipt#
11 the stp,licunt or mtwm holding necupard,hmecr handle hazvdous material o .y�
e6ncJ by the Cupertino Municipal Col Chapter 9.12,and the Health and Safety HEATING UNIT(OVER I#,000 BTU) TOTAL: 3�aS0
code,Section 25532(apl
❑Yea 0N VENTILATION FAN(SINGLE RUSH)
Will thsapplicantorfatre buildiagnecupam exequipmemordevices whichemit BOILER-COMP(3HPOR 100,0008TU) ISSUANCE ATE
• b andous air comaminana as defined by the Bay Arca Air Quality Mami,emau BOILER-COMP(OVER 100,000 BTU) A
Uistat'?
❑Yes ❑No NEW RESIDF,NTIAL MECH. SQ.FT.
I have read the humorous materials requirements under Chapter E95 of the MAY 2 81993
Culifomia Health&Safety Cede,Sections 25505,25533 and 25534. I undersand mat
if the building does not currently have a tenant,that it is my responsibility to notify the {,I IY Ur VUrCF1IdIVU
occupoa of the requirements whichdaust be m t prior to issuance of a Cem
He.
I
Owner teon uumorizcJ agent Dote 'TOTAL: • l 1 v`U�l,
SSUED BY:
OFFICE