20507 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Bulidins Pre'eat Identification - PERMIT NO.
Building Address: — e 2050
1
non
5— � 2 CITY OF CUPERTINO-BUILDING DIVISION
cmntracto °N.m: eb'Nce ,,ll APPLICATION / PERMIT ((
L.\ -S N6►.. C_TjDC, l BufLD ELDCTRICALI'LUMBING-MECHANICwI. CATEGORY COMROLY
ArchR /Fnglreer, Lle.Na
QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO
Add. A PFRMITISSUANCE f ,0 D ❑
LEl ElICENSED CONTRACTOR'S DECLARATION
Ihereby a/firm that l am llcensedi under prwlalom of Chapter 9(mmxne APl'1]ANCESRESIDEMfAL - - DESCRIPTION
Ingwffi ctbn7OOfnof Divblon3ofthe Budm,and Profetao Code,and my
Ibeme b in/u11''fur¢and effect. PANELS
LI¢me Cbsr LILY s6`7 s7'�� Q
Date Cormactor Lt.AaaT6 1,aLASTS( lee,
ARCHITECTS DECLARATION
pkv OR] l understand my pbmahall be wed as publicrtmrd> OVER IODOAMPS SQ.FT.FLOOR AREA S/SQ.FT,
Lkcnsd Professional SIGNS ELECTRICAL .
rn<aFyl�l OWNER-BUILDER DECLARATION r SPRMALCIRCUIT
7'-'GIS IhenbyafOrm that lam exempt from the ContMor's Lfceve Law for the ^
qqqq fo myw which
eq Llmaprmit to Raab and Pmlesbro Code:M tl
�g cvunywhlmpe toi peattoalrom,qu,altheapnm tfmo p par
gqqq anyanuavrt tat,mi,lb Wu arcs abortqu lnattart to
to
O� (Ile a signed Ratement that k b 11¢naed purwant b the proal bm of the
POWER
3 a G Contractor',Lk.Law(Chapter 9(m..eing with SeNon 700D)of Divi- L C
H OS 'on3 oltha Bu,ina,and PrefesloroCode)mrthat hebeaemptthertlremeM \ VALUATION
the Waia for the alkged exemptlon. Any vlWafbn a Section 70715 by any
E` permitm
applcant fora permit aubjecta the applicant to a civil peky of not more than ]l%TIJR
Q Rv undredddbrs($5ML
1,u vwnu of the property,or rtry emptoyen with wages an thrtr sole NEWD FL7R FI. STORIES =CONSTRUCTION
mmpenntlan,wllldotk wok udtheaWwrtbwt Welded or offend for
pvie Qac 701q Bu,iroaand Prd®bro Cade:TheComnctors Ll¢me law
S>� don nn aPPty to an noon o(pcoperty who bulldaoimprwetkreon,and OCC.GR )UP RES.UNITS
C who doe,eurhworkhlmeelf othwgh Neownemplgen,Prwlded wch
Improvemenb are mtintended orof(ered(o ask.IL howecor,the WldlnB or - TOTAL.
improvement bsold within oneyearo(completion,theoWever,uildb. dIhave
tryRyardan of proving that bedd not Wlid orlmpovefapurposeofsale.). QTY, PLUMBIN MI FEE FLODD ZDNE APN
LJ L as owner of the property,am exclueivety contracting with licensed
mntralo,to mmimct the prayet(Set,70K Bwlnesand Pmfesbm Code: PF 117 ISSUANCE
The Conductors LI¢me LAW don not apply to an owner of property who ALTER-DRAIN 4 VEM'-WATER(EA)
Wads mr Improve thereon, and who comrarta f¢and jr jem with
ctor(y lbenaed pursuaotto thaCmtractor's License Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY
am exempt un
LJ I der Sec B k P C for thio rt
uonBUMDE FEES
Avner Dee S R DRAINFLOOR.ROOF,AREA,GOND. SANITARY Y N
RECEIPT#
WORKMAN COMPENSATION DECLARATION FD(TURE&PER TRAP SQ3DDL TAX Y_ N_
RFC If
f\ ❑1 heherebyaffirm that have a certificate of rnuent to aeV-Inerrt,¢a �I
,U ¢n10¢t-ofWorker'Comperuauonlrieunn¢oamrtlfled copy thereof l$ec.Gb G GASFA.SYSI}M1 ING40UTLETS PARK FEE Y N
P _
olic dkyl GAS F.A.SYSTEM-OVER 4(EA) REX:EIl'IY
Cu ray, BUILDING DIVISION ITES
I IcenNed copy b heed with tie city CREASE/INDUSIRLWASIEINTFECEP'TOR PLANCHECK FEE
`R�f_-enNed copy 1,(Ikd with the city Impectbn dlvlelm.
CERTIRCATE OF EXEMPTION FROM WORKERS' CREASETRAP PAID -
COMPENSATIONINSURANCE SEy.,EFSANITARYMRM FA.37 1' Date RL'CCI tic
(D)or1 ion need not kcompleted Bthe permk bI¢oro hundred do0an
(5100 ,UfesJ WATER HEATERVINENT/EaECTEt ENERGY FEE Y _ N
alt noy mpicyhad anyhe peraon in n sea mannweeker
brwNch thbpamdt b issued, —
1 err not employ any penin b any owner at act ro become anbjca[to the WATER SYSTFA7/TREAUNU
O Applicant¢ Compenutbnl�vn of Gllfamb.Date PAID
Z 0 NUIICE TO APPLICANT:IL after making tMa Certlfl¢te v/FAempllon, NEW R13DFNTfAL P11.1B. SQFi. Date Retei ted
ahold become eubFct b the Worker'Comperoatbn provbbm of the I�bor TOTAL
~ N Code,younu ft hwNhmmplywthwchpmvlabmorthbpermflahallk
LU `� deemed revoked. I FEE
CL p CONSTRUCTION LENDING AGENCY SEISMIC FEE
= Z Iherebyaf/lrm thattherah acomtrudicnkMingagengfmtheparform TorwL: ELECTRIC FEE D
an¢of the work(or which thio permit b Laeued(Sec 30#7,Civ.CJ
02 IenderaName PLUMBING FEE
LL F fender,Aadmaa QTY. MECFIANICAL PERMIT FEE MECHANICAL FEE
O W Irertifytbat l have read thb applhd m
tlnnantethm aW
thevelnfomWlon
b comer.Iagne to c¢nply with all city and county ordlnuca and ante laws PERMIT ISSUANCE - FEES PAID:
} N relming to Wllding contmctfan,and harebyauthorlu reprmentamvesoflhb .
F Z city to enter upon the above-oa,mioned Property for WpecUon purposes. ALITRORADDTOM CH. —Date ReCCI IN
V — (We)agree to rave,Indemnify an d keep harm]m the City of Cu pertlno
.,.taut liabilities,judgments,man and experun which may In any way accrue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL:
agadClyin. eroeoltit rating of thio pemnR. AIRHANDLINGUhTr(OVERIQ"CFM) CONSTRUCTION TAX
vturf-ofApPlIcor Arte IXHAIhT HODD(W/DUC7) CONSTRUCTION TAX PAID:
HAZARDOUSZARDOIJSMATERULS DISCLOSURE '
Wtheapp0
HEATING UMf(TO 10,0DO BT1)
materols, ,lbyt niwMuNdpa[Cde,Chrxer9.1Zancitha Date RCCI Iq
IkahheSafetyCade Sectk,n2sSJZWr TiTATINe uNrr(OVER 1O,DBra) TOTALYa 11 No WapPBant«( building ndevices VENTILATION FAN SINGLE RESID) IT{p7DAI
theE
which rout havmlwaaircarenmwnba.defined bytI,e Bay Area AU :
Quality hbvgemerd DMdct7 BOILER-cUMP OHP OR IW,IXA BTU)
171 Yn No reg° JUN 0 1990
have read fleet ty Code,
b25rnb 5533 an Chapter 1 of BOII.17iCOMP(OVER 1 W,IXA BTT!)
theerlardlt Healthk ildtn Code,net currently
a tenant,that ltbmy NEW RESIDENTIAL MECH. SQ.Fi '
napommrllity to notify the ocaN m d the requirement,which must be met /
'Ci*y of0 ca
prim to isua.a.Certificate of Onupncy. °
OWoer or authorind agent Date TOTALISSUED BY: V CC
OFFICE COPY