22587APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Fra ect Identification
Bmding Address:
PERMIT NO.
n n
5 8 7
G G f
3
CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
Cantractor'Wame: Lk. NoF
BAIL W—FLDCTRICAL,MUMBINGM HAMCAL
CAIS ORY
CONTROL
ArchdeR/Fnglneem Ile No:
QTY ELECTRIC PERMIT IEE
BUILDING PERMIT INFO
Add.
PFRMITISSUANCE
® O 1:1 ❑
LICENSED CONTRACTOR'S DECLARATION
I hereby dorm thatlam lknuduMerpmvfalona of aapt<r9 (mrtunnc
BUMrBesand Iko(emlou Code, and
Ingwithiln
AI'P[lANCISRFSIDEM7AL
JOB DFSCRIPIION
to.afDlvWan3-!Elie
11¢ue a In filo lone and dfM.
PANELS
,
Lice
Date Cas Cond
Date Comrastor
UP TO 200AMPS
a ^y
201-1000AM15
ARCHITECTS DECLARATION
1 underatard my plam shat be used u public Rmma
JOVERlMAMPS
SQ. FC. FLOOR AREA
6/9Q. Ff.
SIGNS ELDCTRICAL
Llrensed professional
SI'E('fAL CEtCI1R/MISC
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt fmmthe Comracmra Lketue Taw for the
TEMP METER OR POLE INST.
follow -tog Rasar.6Mlon 7015, Buslnesand Aof.lc.Code:Anycltyor
cauntywhkhrequimapemdttowr Malter,Improve,de=lleh,ormpalr
anystm=mpdmtoluL ame,aborequlrntheapph=tfmauchpem to
file a signed statement Butt he Is limmed pursuant to the pro idose of the
Contrast -c" License Law Chapter 9 (commencing with Section 7000).! Dlvl-
d r%3ofthe Businms anded PrJona Code) orthat he b exempt therefromard
POWER DEVICES
SWIAA9NG POOL ELECTRIC
VALUATION
the bash (or the dleged aemptbn. Any vldaUon of Section 7015 by any
appuont fora permit mbjecu, the applicant to a chit penalty cinct mom than-
Me�ypdRdddWahepr.
.a owner of the property, or my employem wvgn there sole
OUTLETSSWITCHFSFDMJRFS
00
O
NEW RESIDENTIAL ELBCTR SQ.F.
STORIES
=CONSTRUCTION
pe woPrudthe atmde: bPmt Weeded Or-Basedfor
o, r
.Le 5-uman,wuld011ie
ale !Se-. apply aircw and Code: The Comnctort thmrue Lawd
to
donwlapply toanowrcr ofprosughisonempoyme, pr nthdR.R +std
f property who
Idaownemplgm, provided that wch
whodoemerts
OCCCROUP
RFS. UNITS
orwgh
are one intelf nded
ImprovemerMs arecwt Intended earofco fortale. It however, t3dee Bli have
impmvemem hadd whhlnorcyearofc.mpletbM theowner-bullderwBl love
TOTAL:
mien of pm.dng that he did rent bund or Improve for purpoee.fsale.).
Lj 1, as owner of the property, am e=lustvely contracling with Ikmaed
.reactors to comtmct the project (So. 7DK Bushes and Prdesbns Code:
QTY. PLUMBING PERMIT IEE
PERMIT ISSUANCE
FLOOD ZONE
APN
The Comrsctori License Taw does not apply to an owner of property who
builds or Improv thereon, and who mmeasts fee such plojects wish a
ctaZ+ctor(s) Barund pursuant to the Contrsct«b License Taw.
B & P C for this rc-n
LJ I tin evemp under Sec u
ALTER -DRAIN &VENT -WATER (FA)
FEE SUMMARY
BACK PI�W PR077CI. DEVICE
DRAINS FlD(3R ROOF, AREA, COND.
SANITARY Y- N
BBC=.
Avner Due
WORKMAN haw a 15AT10N DECLARATION
❑ I hcrtaffirm that affirtthatI love • certificate of consent to uB-bort, « a
«fW-rken'C.mpereatlonlnurana «•artillM copy thereof
,IAb Lb C)
380000,
Fp((U PER TRAP
SCIIOOLTA Y_ N_
RECEIPT a
AS F.A.
GSYSTEM-1 INC -4 4 OUTLETS
PARK FY N
4
RIZ'FR'f a
Coy
GAS PA. SYSIFM-0VER 4 (EM
BUILDING DIVISION FEES
Certified copy Ie hereby Tum Wed.
❑ Certified copy b filed with the dry lrupettbn dfvwm.
GRFAASE/INDUSML WASTE INTERCEPTOR
PLANCgwHECKFEE
GRFA.SETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID / 13'—gl O
COMPFNSATIONINSURANCE
ObL+sestbnneed na PENS letN Ht he permit SUIZAa/morehundred dollars
Date Reeei til
&"%i
gEWFR-SANITARY STORM EA 201
D1OOJOf1e�')
IRmly thrt In Elie pedomana.rmeW«k br whichtw permRla mn,ea,
I shall nm employ any perm y manner n u t b to the
Workers'C N/n Date ii r�
U.J.ll
WATER HEATER W/VENT/ELECIR
ENERGYFEE Y N -
WATER SYSTEMITREATING
Applicant //�� �l
N07ICE TO APPLICANT: IT aper mit Cemflate, of Esemplbn, you
should become subject to the Workers' C-rnpematloo pmvhbru of the Labor
Code, you must fort hwhh ownply With such prmislon or this permit shall be
deemed R ooked.
Date Recef tN
�
NEW RIRDEMIAL PIMB. SFT.
TOTAL
-Vo
SE MIC FEE
—2
CONSTRUCTION LENDING AGENCY
Ihembyaffimr that them Is a contmstlun lending agency for the perform,
ant of the work for which thts permit N Issued bee 309'/, CN. C.I
TOTAL:
ELECTRIC IEE
Ierdee. Name
Lender. Add—
IRrtifythat IlunereadthbappuatbnaMr wthaltheabove Infomatimr
bcormci. IagreetocomplywithWdtyand countyordbunmandstatelaws
QTY. MECHANICAL PERMIT FEE
PLUMBING FEE
MECHANICAL FEE
PERMIT ISSUANCE
FEES PAID:
tobuildingmn,andherebyr n RpmentatNn of this
cry toenterupon tlb� aboexnentbned property for Inspe
(WOagmo,touvt,WemNfyand kepharMestheCuyofCupe,bo
ALTRORADD TO MIfF
Date Reei tN
-
SUBTOTAL:
ager W[IIablBtln, ydgmew, mHaaM operon which nay Many wayamue
.ga[rat .ata chybmn.eq.eocewthe gram tog dw.pemw.
AIR HANDLING MIT (TO 10,000 CFM)
AIR ITwNDurac UNIT (OvER 10,00- CFM)
CONSTRUCTION TAX
Signatum.f Applicant/Contract« Date
EXHAOBT HOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
HEATING MIT (70100,000 BTU)
Wlilthe applicant or future, bullding occupant start or handle hazardous
material as dented by the Cuper f. Municipal Code,Ch.pter 9.I2, and the
HcaltYnrd Saretyem 2W2a)7
Date Recti t#
HEATING UNIT (OVER 100,000 BTM
TOTAL:
119.ZS
VENTILATION FAN(SINGLE RFSID)
ISSUANCE DATE
wthe.ppucant« tore building occupant use equipment mdevkes
which eMt lu-ldout.ic contamlrunts u defined by the Bay Arca Air
BOILER -COMP DHP OR 100,0(0 WM
QualNy hUrugcmem Distrkt7
4Yn o/
h..are.dthehaadouem`crfabmquirementsunde,CFapier6.95of
PAM
BOILER -COMP (OVER 100,DOOBTU)
the Califomh I latish & Safety Code, Sections 25505, 75533 and 2:531. I
NEW RESIDFNTIALMECIL SQFi
underatardthatlfthebuildbgdm=mmntlyh.veatenarn,thatltfemy
reopowbuu to tify theo� m of the RqulRmrntawhirh berrut
"WIG7 e� �QQ�
1 IG i 99
%��� of - oa„wmr. .
1 d g Date
19077
yyff 'IF��}aF�FyHc
ISSUEDBY:�S/Q ��y1,T A. (ICG.
TOTAL:
OFFICE COPY