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24803 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY .1-lo-FIR IAI. PERMIT NO. N CITY OF CUPERTINO PLUMBING.MECHANICAL 24803 BUILDING DIVISION APPLICATION/PERMIT BUILDING PHOJEL'I'IUF.N'TINICAT'ION BUII.DING DR'SS: SANI'T'ARY NO. APYLICA']ION SUBMITTAL DATE o UNITN LOT# OWNERS A i' PHONE' CONTRACTOR'S NAME: LIC NO: N/C CONTROL It ARCHITE /ENG NEER: LIC NO: ADDRESS: CONTACT: L+ OWOC�© QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO pompQ� (v�.G'l— •�(�� BLDG ELECT PLUMB MECH mS( PERMIT ISSUANCE LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL py.Z Iherebyaffitn madam licemed underpmvisions of Chapter9(commencing with JOB DESCRIPTION µp100 Section TOW)of Division 3 of the Busincssand Professions Code,andro,hoomuiain PANELS \ full farce and effect. , D W% t+L Liense ClUP TO 2110 AMPS cass Liap y=y Date Confirm 201-IW AMPS - S .JiQORAREA S/SQ.FT. F-y Z_ ARCHITECTS DECLARATION OVER 1000 AMPS l ,, � OZ y 0 1 understand my plans shall be used as public records. ��n y F-W SIGNS ELECTRICAL. O Vet Licensed Professional A` red G OWNER-BUILDERDECLARATION SPECIAL CIRCUIT/MISC. / taaJO LU 1 hereby n.(Se that I am exempt from the Cations Co e:Any law for the i 3 it following reason.a Permit to 7031.5.um r,aims and improve, de Professions h.or re repair city or county TEMP.METER OR POLE INST. OyN which requiresn permitce imsthe,almgimprove,demolish,ore a sig anysmucmm >� pat heorm licensed pursuant to i the prvisiosocant f flu,ch Copemor's filLicence Uw( hapterned statement POWER DEVICES C 60 Natbe Ta licensedpursuannothe).fDiionaof the Comtecmra License Lawos Cuumr i y�Otg SWIMMING POOL ELECTRIC V UATION e 9 that he is(commencing he Division Sof the Business and Professions Code) 3� /AO or that he is exempt send the basis for me alleged exemption.Any violation of OUTI.M S-SWITCHES-FIXTURES q�+�/. lso Y Section 703 Li by any applicant for a permit subjects the applican'a a civil penalty of 6 plollere than five hundred dollars(5500). IY m -JK I,esownernUhepropmy,ormyemployceswithwagcs astheirsolecompe,codon. NEW RESIDENTIAL ELECTR _SQ.PI'. STORIES TYPE CONSTRUCTION i3— ill the work.and the structure iana intended oroffered for sale(Sec.Tl44,Business '✓ and Professions Cade:The Contucmr'a License Law does not.11Y an an owner of l property who buildsorimprovesthemon,and whodoessuch work himadforhroughhia OCCGROUP RFS.UNITS own emplOyca.provided,hat ouch improv emsvreno,imenJeJ proffered foranle.IL howeverJhe builAing orimprovemem'u sold within ane ycm of completion,the owner- TO A builder will have the burden of pmving that he did not build or improve for purpose of sate.). QTY. PLUMBING PERMIT FEE ❑ .1,mownmof the propenY.ant exdusivelyconvacLing withlirenud contracmrto ITOODZONE APN construct the Project(Set.7044,Business and Professions Code:)The Contractors Licenu LawdoesnmapplymmowncrofpropenywhabuilJsorimpmvesthereon,end PERMIT ISSUANCE ,�► who contracts for such Projects with a concommos)licensed Furman,mthe Contractors ALTER-DRAIN&VENT'-WATER(EA) FEE SUMMARY License Law. ❑ T em exempt underSa. .B&P C for,his reason HACK FLOW PROTECT,DEVICE OUTSIDE FRES SANITARY YN Owner Date DRAINS-FLOOR,ROOF,AREA.COND. RECEIPTN WORKMANCOMPENSATTDNDECLARATION SCHOOLTAX Y N El Thereby affirm tbatlbave acenificam of conunuosd0imum,oracenificme of RECEIP #FIXTURCS-PF.R TRAP Workers'Compenutionlnsumnceoracenifiedcopythereof(Sec.3g W,Lab CJ which PARK FEII Y_N covessall emplo,ims under thiapemnit. GAS-CA.SYSTEM-I INC.4 OUTLETS �� RECEIPI'N Policy N BUILDING DIVISION FEES Company GAS-EA.SYSTEM-OVER 4(FA) PLANCHECK FEE ❑ Cwfed capy is hereby fumished. ❑ Certified copy is filed with the city inspection division. GREASFIINDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS FEE COMPENSATION INSURANCE (This section need not be completed ifine permit is for one hundred dollars IS IPU) SEWER-SANITARY-STORM EA.2WIM ENERGY FEE or less.) I certify that in the performance of the work for which this Permit is issued.I shall WATER HEATER W/VFM/ELECTR no,employ my person in any manner so as to become subject,o me Workers risk PAID Compemmior Lawsaf Califerou Dam WATER SYSTEIA/TRHATTNG Date Receipt is Z Applicant � 0 NOTICE TO APPLICANT:If,afrar making this Comficme of Exemption,you should NEW RESIDENTIAL PLMIL SQ.FT. TOTAL: become subject n the Workers Compensation previsions of the Labor Code,you must Ki forthwith comply with such provisions or this permit shall he deemed revoked. BUILDING ME �] QSEISMIC FE II 6. CONSTRUCTION LENDING AGENCY z Ihereby affirm that them is a commction lending agency for the perfomunce of ELECTRIC FEE V O Ne work for which this permit is issued(Sm.3091.Civ.C.) T -- D. E Lender's Name PLUMBING FEE O Lcadcr'a Address QTY. MECI[AN[CA L PERM IT FF-F, SI Lk1m an I cool If that 1 have real this application candidate than the above information is nrtMECHANICAL FEE et.la gree comply with all city and county oninces and sum laws relating to PERMIT ISSUANCE ' baildingcons,me,ioq and hoods, ummn.reprtaerniivesofmis city menmrupon the CONSTRUCTION TAX V Z above-ment&thfthi, spection purposes. ALTERORADDTOMECH. (We)emission nify and k less the City of Cupertino against livbiliriea,juxpensn is ay' anywayeccmeagmnsteau City AIR HANDLING UNIT(TO IR"CFM) in ctas,onuque AIR HANDLING UNIT(OVER 10,000 CFM) SZ.Tum Appiward/ An,mct Dom EXHAUST HOOD(W/DUCI) PAID HAZARDOUS MATERLJOISCLOSURE HEATING UNIT(TO 0)(1,00)BTU) Dote Rmsa n I Will the applicant or future building occupant store or handle haeardoms material HEATING UNIT(OVER 100,000 BTU) as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health aM Safety Coda,Secdon 25532D)? VENTILATION FAN(SINGLE RESID) 11 Yes ❑No ISSUANCE DATE Wilhheapplicantorfmurc building accupanmmequipmemardevices whichemit BOILER-COMP QHP OR 100,000 BTU) erallom air contaminants m definod by the Bay Area Air Quality Mania mant BOILER-COMP(OVER 100,000 BTU) isvict? IN A ❑ye. ❑No NEW RESIDENTIAL MECH.—SQ.FT. I� I have mad the becmmus materials requirements under Chapter 6.95 of the 121993 California Health&Safety Code,Sections 25505,25533 and 25534.I understand that �n n if Ne building does no,currently have a tenant.ma,it is my maporssibility to notify die n1, Ocupant of the requirements which must Minn prior to issuance of a Cenificmo of ccupancy. Owner or nuthoriuJ agent Date TOTAL: ISSUEDD BY:BY: OFFICE