20908 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project idetification PER.WT NO.
BuBz�reas: ,o 20908
71 G
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CITY OF CUPERTINO-BUILDING DIVISION
Co
Nama:'tj OZ4Lm No: APPLICATION / PERMIT
"`� _ (] BUILDINGELEC:MCAI.PLUMBINGM RAMC, CATEGORY CONTROL# / L/
q
A IlttY/Frgin¢r. Lic.Nee 'T'
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Addrcu: PERMITISSUANCE E-1 [ILICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9(cemmanc- APPLIANCES-RESIDENTIAL JOB DESCRIPTION
Ingwlth Secthm7000)o(DiWMon3ofthe Buslnessand PmfessionsCode,and my N
license is in full ores and affect PANELS / �C
LI¢n O Lk p >
Date Co.-da
ARCHI77: DECLA T 201-1000 AMPS
r�
'47 O I undentand my plansshallbe xd as public¢rords. - OVER 1000 AMPS R AREA $/SQ.FT.
G CC<ZW ` R
0.' (0 Licensed Profemioml SIGNS ELECTRICAL
(%,
- OWNEReBUILDER DECLARATION SPECIAL CIRCUIT/MISC
whigrherebyason. Secdo 731.5,B from the Cordficado License Law tw the
pp following reason.(Section 7071.5,Business and Pro(esslom Code:Any city it
TLMP,METER�R POLE
F� any structure
requlma permute,onstmuires the
wprovedemollah,orto
Q any atmcwd exte to its Ounthat
he q also licensed
pursuant to the provisor ions
ofpermit e POWER DEVICES
u.U file a signed statement that he la Iicensm pursuant it the proWions of the
Om Con ofthe Liceres Law(Gupter9Commencing with Section herefofDivl-
30 eion3o(the Busincasand Professions Code SWIMMING POOL ELECTRIC
p Ey )orthat n of
Secmpt therefrom and VALUATION
the basis for the alleged exemption. Any vlolatlon of Section 7031.5 by any M
apphantf.r.pem tsub*e theappllcantt..dl ilpewlty&nu=m Hun OUTLET&SW17CHFSF]XTURE,c
fy 2 five hundred dollars(S500).
p jun ❑I,as owner of the property,or my employees with wages as their NEW RESIDENTIAL ELECIR sole SQFT. SRlWFS TYPECONSTRUCTION
t: ¢ compematlon,will do Ne work,and thestruchure la not intended or offered for
9 O sale(Sec.70K Business and Professions Code:The Contractor's Licerue I,w
does not apply to an owner of property who builds or improves thereon,and OCC.GROUP RE Uws
0.0. who doessuch work himself orthrwgh his own employees,provided that such �.s.�
Improvements are not intended oroffered for sale.It,however,the building or TOTAL: eW
Improvement lasold within omycarofcompletion,the owner-builder will have
try£purden of proving that he did not wild or improve for purpose ofsale.). QTY, PLUMBING PERMIT FEEFIppDTONE APN
LJ I,as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
ontradon to onsteed the Project(Sec.7044,Business and Pro(esslom Code:
The Contractor's Liceme Law does not apply to an owner of property who ALTER-DRAIN&VENT-WATER(EA)
Wilds or Improves thereon, and who contract; for such pipocts with
onacten(a)e¢nsd pursuant to the contractor's License Law. FEE SUMMARY
LJ I am exempt under Sec. B&P C for this recon BACKFLOW PROTECT.DEVICE Q1 ITS'DE ELL5
Owner to DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N_
WORKMAN COMPENSATION DECLARATION RECEIPT N
❑I hereby al4m that I have a certificate of consent to sel6lnsureor a FIXTURES PER TRAP SCHOOL TAX Y_ N_
¢rttficate of Wor rani Compensation Insurance or a¢rtifted copy thereof(Sec RECEIPT X
380),Lab C.) GAS EA.5YS1'EM-11NG4 OUTLETS PARK FEE Y N
Policy# R[C1ID'f p
Com any GAS EA.SYSTGS-OVER 4(EA) BUILDINGPTVISION FEES
❑p Certified copy is he¢byth the city
d. GRFASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE
E]Certified copy is filed with the city inspection division. Qs 1 �j
CERTIFICATE OF O(.Z fPTION FROM WORKERS' GREASETRAP pare,,
V/1r IO s'�
COMPENSATION INSURANCE SEWERSANITARYSTORM EA 200FI Date Recei t# ,7b1��
(Ihlssection need net be completed Hthe parl b f¢cam hundred dollars
($100)rtifytJ WATER HEATER W/VENT/ELECTR ENERGY FEE Y N
I¢rtlty that oche performance o(Ne work forwNch this pemdtblssud, _
I shall not employ if parson In any ray s, so m bev-`Y 0 the
Workcri Comp aH b✓E( 1/ is O ! <!/—% WATER SYSIFN'/iRFATING PAID
C• Z Applicant [
Z O NOD LICA NT: (,aft king this ertllate of Exemption,you NEW RESIDENTIAL PLMB. SQFT. Date Recei t#
should beadr➢f ns
bject to the Wor Compensation provisions of the Labor
c N Cde,youmustforther comply withsuch provlslonsorthes permit shall ba
W > deemed revoked. _ TOTAL:
nrEE
G -E eCrddE3 CONSTRUCTION LENDING AGENCY FEE '}a= ZIherebyaffirm that there is a onstrudlon lending agency for the perform- C FEE —U�ante of the workfor which this permit la taared(Sec.3097,Civ.CJ TOTAL:O O Lender'sName G FEELL H TendersAddress QTY. MECHANICAL PERMIT FEEOW Icenlfythatlhave¢adthbappuatlonandstatethattheaboveln(or tion - ICAL FEEis carred.I agree to comply with all city and county ordinances and nate laws PERMIT ISSUANCE ID:Nrelating to building ronstructimsind hereby authorize reprasenWtives afthisZcitytoente Pon the ahovcmentlond property for Inspection purposes. ALTERORADDTOMECH.— (We) c tsave,Inde an d keep harmless the City of Cupertino Reccipt#agaWtl'lu ca-'a nes, eandeapenseawhichmayinanywsyaccrue AIR HANDLING UNIT(TO l0,"CFM)
d Cd nnt�yrammgoftM. it SUBTOTAL:^ ��� AIR HANDLING UNTT(OVER 10,000 CFM) UCTION TAX'gra tureofApplian/ ntnicl pate E%HAUSI'HOOD(W/DUCT) UCTION TAX PAID:HA DOUSMATERIALS DISCLOSURE
illtheapplianto future building occupant store or handle haaadous HEATING UMT(T0100,000 BTU)cerci as de0ned by the Cupertino Municipal Code Chapter9.12,and the _ RC .' t#Health and Safety Cdctlon 25532(a)1 HEATING UNIT(OVER 100,000 BTU) L a
❑Yes No TOTAL: J
Wivouthaxanhm future wilding occupant use equipment ordevices VENTILATION PAN(SINGLE RF_5[U) ISSUANCE DATE
whkhemltha:ado alrontamlmntsaa defined by the Bay Arca Air
Quality Mamgemcnt Dlat' 7 BOILER-COMP(3FN OR 100,0W BTU)
Yes
n f'Al�i
I have read thehJ cam materials requirements under Chapler6.95 of BOILER-COMP(OVER 103,000 BTU)
the Californ Health&Safety Cde, Ions 25505,25533 and 25534.I (.
understand tlfthewildingdoe mc�e tlyhaveatenant,thatitismy NEWRESIDEMIALMECH. �.FT. r��lT 21 1990
nsponsib ytonati(yt of tbP,¢buirements which must be out
canes of p qY" f a,.
rauthotluda en Ulf Cf PII-Irfir,n
Date
TOTAL: ISSUED BY:
OFFICE COPY