22048 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Pro ed Idevifkalon PERMIT NO.
22048
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C4, C-k CITYOFCUPERTINO.BUILDING DIVISION
Contra �eName: Lic.Na APPLICATION /PERMITAILZ1
7
1 CIIK _3,17x-1 SrB(ALDfNGELECTRICALPLUM 1lNGM1KHAMCAL CATEGORY CONTROL It
AnhBed/ glneer. Lk.Na
QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO
Add. � PEthITISSUANCE -2,CDC)
LICENSED CONTRACTORS DECLARATION
Ihereby
eetto.70that,amlLeevMurdn provWonsoffes*1 rod,,anrn AP['f1ANCEbRESIDFNIIALirgOB DESCRIPTION_
lio, h5eafullfp..f DlvWon3 o(the BuelvmandPmfenl¢uCade,and ('�
L i�¢tise C n Tuft fp...d
S 4 all PANES
Da4Contnctor�eNff• UP TO 2WAMPS
ARCHITECTS DECLARATION 10-1
reCl uedenta d y P4rabal be eupbcreOVER IMO AMPS f/SQ.FT.__
0O
u [.l¢nadProfesiovl SIGNS ELECTRICAL P U T E R
< OWNERexmTtf R DECLARATION SPECIALCIICUIT/ML9C
� 11-�owirg r afRr (Seed a 7MI.5, t fromthe Cb rot min Lt¢ve law forthe /� �,
Uum
r,Q.. f my hr req.(Setllon9mlS,Bue MOt r,cpm , Cade Anytltyor e.L/
OG TFAIP.METFRORIOIE INST.
K5 muntywhtch requlmapemdtto meutauct,alters lmpewe,derroWh,arrepalr
any rtmcturetatement heave,lkemed hesthea to
fm,i,Z. mN a POWER DEVICFS
0k a signed statement that M b ll¢naN pursuant to the proWbv d the
(yI OrContactor', ve
onLkeLaw(Chapter 9(mrmnenctng with Section 700D)of Dld- SWI(MING FOOL ELECTRIC VALUATION
rn al3 oflhe Bualnetaand Rvftmbvor
Cude) that hebexem m
therefroand
~ O the basis for the alleged eum ion. An violation of Section 7015 artI a�.� O ` _v J
<.t OUTLEISSWr7CHFSFU(TUR65 W [_Y
� aPPlmtlora permit wbjecv Mie applinnt too dull penalty more than l Q (�
$� flue undred ddbrn(SM. NEW RESIDENTIAL ELFLTR
.. FT,u owner of the property,or my employees with wages sa their sok �'�' STORIES TIDE CONSDtUCf10N
I-.
71 ounpewtlm,willdothe week and the smucture b not Weeded.,of/eml Tar
C`�O sok l$ec.704d,Bu,Ncu and PMewbv Code:The Contatlora IJ¢ve Lw
don not apply to an owrerd propertywho butWsor imprwes thereon,and OCC.GROUP RFS.UNFIS
CC who doessuchwmiclu uelf mthmugh hla..employ.,Provided that such
Improve arenot Intendedoroffemdfma .ILhoweverthebuildinger TOTAL:
Lnpmveme wld Wthinomyearofcompldbn,lheowner-b Werwihave
t",denwpmvingthrthedld na Buudar Wprowfropurpmea/„le.). QTY, PLUMBING PERMIT FEEp�OD�
LJ L as owner of the property,am eaciwtwly mntracHng with li¢vM
AFN
mn1
ntctma to mvtrud the project(Sec.7011,Butlers and Prof.uou ppRMR13T1ANCE Code:
Flu,Contndora License Law don eat apply to an owner of property who ALTER-DRAIN DRAM&VIM-WATER(EA)
Wilda or Improv thereon, and who mntam for wch ptokcts wW a
oonq.da(w)lloenmd pursuant to the Contractor's Lt..Law. gAIX FLOW PROTECT DEVICE FEE SUMMARY
VI am exempt under Sec B 4 P.0 for thb¢aeon
OUTSIDE Ft7q
Owner Dao DRAINS FLOOR,ROOF,AREA,COND. SANITARY Y_ N_
. R_ Na
WORIQIAN COMPENSATION DECLARATION pOCNRES pER TRAP 1'�� SCITOOL 7AX Y_ N_
❑I hereby affirm C I leve a¢rtl d aunt l to opythe res,or.
¢W tflute o(Worken'Canpemrtlm Imuran¢ora¢Willed mPY therm((Sec. RECEIPTa
' 380,U6C) GAS E.A.SYSTEM-1 ING40UT1.E15 PARR FEE Y N
p 1 GAS E.A.SYSCFM-0VER 4 CEA) DILFLT a
Co� % BUILDING DIVISION FEES
Cert mpy b herehyfumlahed. GRFA.SEANDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
tilled mpy b filed with the my Inspection dlvlMon.
CERTIFICATE OF EXEMPTION FROM WORKERS GREASE TRAP PAID
COMPENSATION INSURANCE
( aI ion need raSEWEt.g�TARY-STORM EA 3)�f. Date RttCI t#
or d bac¢repleted Rthe permN b(¢om huMred dollars
(sIID)D)mina.) WATER HEATERW/VENT/ELECTR ENERGY FEE Y N
]llnot emhatploy
to the Penton^¢dthewark(ors to hthbpembted to red. —
1 atoll nM employ any person N any rrwner at u to bemme aubJect to the WAM SYSTEM/TREATING PAID
O Awlt�Compenutbn law,of GlQamb. Date
Z NOTICE TO APPLICANT:11,after making this Certif"te of aemptb^,you NEWRESIDEJTIALPLMB. SQFT. Date Recef t#
should bemrne wbkct to the Workers'Compereatbn provblov of the Labor TOTAL
CC N Code,you rrustfurthwkh romply with arch provisions or this permit dull be
W B
W > deemed revoked.
C CONSTRUCTION LENDING AGENCY SEISMIC FEE
CL Ihereby affi hat there b a nerat,edion Lending agency for the perform ELECTRIC FEE ?L,�
0 anceof the workfor which Nb permit b bard(See 30YJ,CW.C) TOTAL
VIL12INC FEE
U Lenten Name PLUMBING FEE
LL 0 Ier1 ert Add.UP that
QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W 1¢rtllythaH have reed this application entethrtthe above Information 1 r7' , Lz
bent., l.greelo cmnplywlth aO MyanO counry ardWnaro and nate laws PERMFFISS [, CE l� ` FEES PAID
} N rel atingto bulbbgmmtmdtm,and mbyauthar mpr nutivno!this
F Z city toe r pan the abovrmcntbmd Property for lvpedton purpose. ALTEt ORADDTOMECI-I. Date Recei t#
U _ b mve,mdemmry an a keep h.mdes a,e city err cupeWw
ago Wb t"ljadgmems,mGaardexpemnwhk yinwywayaaave AIR HANDLING UNIT CFO 10,000 CFht) SUBTOTAL:
erg City in coruequenne o ming of thta pemot.
AIR HANDLING UNIT(OVER IQ00o CFM) CONSTRUCTION TAX
Sig io err oat ants at E)(HAUSTIIOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAlARDOU MAT RI SCIASURE
WBlthe ppBorLL¢future bull, Pant atoreor hiedk harardov HEATING UNIT CFO 10,000 BTU) Date Recei t#
material..dAmd by the CupeWln Ndpa,Code,Chapter 9.17,and the
Health and Safety Cade Section 7553 )I HEATING UNIT(OVER IO,0co BTL>) TOTAL:
❑
Ye, No
Wllemit11 the appBoMor tonbrolding.&II nd by the Ba Area
ordevics 71 VFNTT LATION PAN(SINGLE RESID) ISSUANCE DATE
which eMthag anent airrict? m,ude0md by the Bay Amo Air
QualityYea vgaercnt Dbt No BOILER-NMP OFIPOR I0,Q10 BTln
YY Ird No
4haread the Health
moue mode,Se¢qulreme5, u Sand 2SS3r G95 of BO ERCO.MP LIVE 10,00B P
the CalifornialfHealth building Safety Code,SMbv 75505,w a t and 75574.I
AIM
underatandyto that if thet), does note renn0yhavea 4vnL that It la my NEW RF9DENRIAL MEai 9QFT ��
mor in ftyto of rallyt),, dthenqulrcmenb which erdMMmet
Prior b bmaerc d a Certificate d(hcvpancy.
Owner en autheviued agentDate T.. �-•L,.
TOTAL 155UEDB t
OFFICE COPY