24339 APPLICANT TO FILL IN IN FOR MATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Pro est Identlfkatlm PERMIT NO.
Building Addnas:
7908 Fes�.'��� co21 . �c £e:,;a o �.� • SIS-o�1i, Z
4339
vers
Al�le z22/24' O9124s, 2s -Bar CITY OP CUPERTINO-BUILDING DIVISION
Contractor's Name: Lie.Na APPLICATION /PERMIT
/O 7 BUIIAINGELECTRICALPLUMBING-MTCHANKAL CATEGORY CONTROL a
_ Architect/Engl Lie.No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Addmse:26679ulAeea4-zlo 4'�f/Ay''y- ve0 7L .
PFRF9"f]%UANCE y
LICENSED CONTRACTORS DECLARATION
Ihh dn7Othat lamll=3ofheBunder ovwdProf apter9dc anm APFllANC6RFS1OFM1Al
...a DESC
Ingwlthal full7000)sed
the Budrimmd RofedaruCode,and �' 1
Ikewa t In lull f and d(ect. PANELS
UP TO 200 AM
Lloe"� ppnLk.e�
Date 4/. ' Contractor R£�/
ARCdea]] e •SDECIA TION // OVER 100AM
pkv QQ Iurderatard my phmahaBh used upubhe temda OVER 1000 AMPS SQ.FI. S/SQ.FT,
Fi p Lke sad Prdmbnal SIGNSELEC'IRICAL
6 OWNER-BUILDER DECLARATION SPECIALCIRCUIT M15C
f., G I hereby affirm that l am enempt from the Contractor's License lAw for the /
Z9 pp folbwing mission.(Section 7m15,Business and Profmbrs Cade:Any city or
�YL�'�a TEMP METER OR POLE INS(.
county which mqulrn mct
a pet to mmtru ,alter,Improve,demolbh,or repair
county
q�4 anyumctumprlortolttssuaricq.ism mqubumeapptlantfor wch permBto POWER DEVICES
PJ K V fit a dgned statement that he Is Ilmnaed pennant to the provW m of the
3w Contracture LkenselAw(Chapler9(mmmendngwtth Seaion7000)of Dlvl VALUATION
OS .bn3ofthe BuelnmmdPdesatom Code)orthrt hstexemptthertfromandB'D'UNG POOL ELECTRIC ,,,
_ ch hub forme alleged esempten. Any vldari n oiSectlon 71D15 by any1
apptlantforapermitsubjecutheappllcanttoadA]l mhydndmomtMn OVll,h'ISSIVITCI ES-HXNRFS t O
$2 five hundred doltm WM. NEW RESIDENTIAL ELECTR
p ❑I,as..of the Property,or W employees with wage..their sok `SQ'Fr. STORIES TYPENNSIRLCDON
compensation,will doth work and me structure b wt W ended or offered for
0 0 v1.(See.7UN.Bualms sed Prdesebro Code.The Corumct.e.U..l.aw
don oat.pply to m ownerd property who buBdaor improve themoR and OCC.GROUP RIS,UNITS
0.0.Y whodoceachwork hlmael/orthrwgh hlsownemployen,provided thatmch
Improvement arc not Intended oroffertd for vale.K however,mebuikRng ee
improvement'snlawhhlnoneyearolccmpledomthemner- Meru Uhw -
t rdeoofpmNngthat he aid nalmildorimpron,forpurposeofaakJ. QTY. PLUMBING PERMIT FEE
I,as owner of the property,am exchnh2ly contacting with licensed FLOOD ZDNE APN
mntnctan to construct the pmject(Se 700 f1winm and Prdemlon Code: PERMIT ISSUANCE �
The Cum do,'.Lbmse I. does not apply to an owner d property who ALTER-DRAM k VFM-WATER TA)hullds or Impmms memos, and who mrtraes for sueln phujecta with
c%tileter(a)Ilaovd prneant to the Contractor's Lice.Law. BMOC FLOW PROTECT,DEVICE FEE SUMMARY
L jI am exempt under Sec ve
B k P C for this man
e DRAINS FLOOR ROOF,AREA,CUND. SANITARY Y_ N_
Owner Date E+pt®Ta
WORKMAN COMPENSATION DECLARATION SCI{OOL TAX Y N
❑1 hereby orke that 1 have a mHBat of consent to o y then;,or PFR TRAP �^ RECEIPT
If
UM,L.eofWorken Compers.tlmtlmuraneemanrtBkd copythem f6ec. GAS EA.SYSTEM.I INC40UTIEM PARK FEE Y N
PolPollic hid C)
s If
GAS EA.SYSTEM-OVER 4 LEA) DING DIVISION
I
y BUILDING DI V ISION FEES
shudi
❑wCertNed copy b heed with the
GREASE/INDUSIRL WASTE INTFRCEYTOR PLANCHECKFEE
F-1 Certified mpybfued witsth sty inspection division. _
CERTIFICATE OF EXEMPTION FROM WORKERS GREASE TRAP PT INSURANCE
(Thl.acabnneednat beeompleted Lith pemdt lslmonehuidred dollar g}ypl.ytM.I. Y Dae Rttei tq
m kale the F�E�t'FE Y N
IaertBy that tithe performance of the workfor whidi this permktbsued, WATER HEATER W/ / C II.��
I shall net empty any penin in any manner n as to become subject to the
WATER SYSlI]N/)RFA NG
Workery Compensatbn IJM d California. Dace ID
PP
A Ilam
Z2 NOTICE become,
APPLICANT:,abpatoine fllers'Comprn Cettulateis Exemptbn,yw NEW Ratmin —ar PEM D OTA tft
N e e,yo mate subFct tome Waken'Compewllonprovhis permit s Laborbe TOTAL:
Code,you must fmlhwBh comply with such provisions or this permit atW I h
� > darted rooked. BUILDING FEE
CONSTRUCTION LENDING AGENCY SEISMIC FEE
CL O Ihereby.f/irm that them Is a mnalructem bending age nry for the pertnrnw ELECTRIC FEE
:) aa
Z arm of the work for whkh this permit h Issued(Sm 3097,CIv.CJ
U O I<rders Name PLUMBING FEE
ly Lender's AddruAl
QTY. MECHANICAL PERMIT FEB MECHANICAL FEE
IL
O W Icect.Iaatlhw react with all
ll cit andcatuemattheaess and ate laon
S bmrtM.Iaibling mplywW andhereb muherlam bunco anavtatlaws PERMIT ISSUANCE ►�� FEES PAID'.
} (1) city to gtobupon t mrolruMan,and hereopertyorlr<peclinnttivea of this
F Z city to enter-Wee,1 sae abwrm ify a ed lump
for ids hect it purpose ALTER OR ADD TO MFLH.
— against
agree to mw,indemnify an d keep harmlm the City ty CupertW Date Re c'
agalrutliabWthy jrdgment...fthevarting which may banywayacvue AIA HANDLING UNIT(TO 10,00D CFM) SUBTOTAL:
aguirut ul CNyUmnsequerre of tie granting dtMs pemW.
AIRxANDUNC UNIT(OVER]ooaa CFM) CONSTRUCTION TAX
Sig mof Ap rot/ ntactor DatYe EKHAUSTHOOD(W/DUCD CONSTRUCTION TAX PAID:
HA]ARDOUS MATER LS DISCLOSURE
WWthea Ilam or fsum�ildingo pantoomarha Icha rdous I-IFATINGUNTT(ID100,0D0BIU) Date RttCI ted
material as defined by the Cupertino Municipal Code,Chapter 9.1 7,and the
Ile❑alth and Safety Code Section 25532W? HEATING UNIT(OVER 100,000 81111
WYnMN
Itthe applicant or futum building occupant use equipment m devices VFNJILATION rAN(5INGLERE5ID1 e ISSUANCE DATE
which enet harardoua.4 mntmloa...defined by the Bay Area Air � '
Quality A/a�ugement District? BOA.FR-COMP OHPOR IM, BTU)
Yn ❑❑No
Ihave read the huaracros materialsrequirtmentunderClupter6.95of BOMER-0DMP(OVER 1m,ODDBTU)
the Ca Womlalicahh&Safety Cade.Sectbro75505,25St3and25534. 1 OCT 14 1
undmtid that if the buildingdoes not currently have.tenant that it k my NEWRESIDENDALMECE1. SQFT
responsibility to ncllfy the occupant d the mqulmerents whkh.9 he met
prior to Lreuance d a Certifiate of Oauparcy.
CITY Ur (aVI't TL MVV
Owner or authaleed agent Date ISSUED BY:
OFFICE COPY