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26186
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO' HUU.)IN;-ELMIT A PERMIT NO. APPLICATION/PERMIT PLUMIIING-MECHANICAL 26186 C vl O C BUILDINC DIVISION BUILDINOPROJE(J'1'IDEN-riFICATION U 1 o v BUILDI GA DRESS: y�ys� `,,`1 SANI'T'ARY NO. APPLICATIONSUBMDTALDATE UNIT. LOTH 2 IOW /I•I IONII ,ria CONTRA' R'S LIC NO: N/C CONTROL 0.C111T IiCl'4NGINF:ER: 5!ULICC-N/OV'si_X`• 11 ADDRESS: ❑ 'ONTACP: PHONE: BUILDING PERMIT INFO QTY. ELECTRIC PERMIT FEF. .UG T PL ME❑CII PERMIT ISSUANCE LICENSED CONTRACTOR'S DI3CLARA'1'ION gppLIANCCS-RESIDENTIAL 1QH DF N /1� GKZ IM1ereby nllimuhatlenJicenseJ underprovixinnsnl Chepmr9(cnmmencingwilh {s10W0O fall I. and on7of the Business and Professions Cale,and my license is im PANELS ec U(J full force and effect. I<„Zu1 I-iceme Class Lia. UP T0200AMPS w<� Dam Convector 201-UNTO AMPS ZOyZ ARCHITECTS DECLARATION OVER IOIIUAMPS SQ.FT.FLOOR AREA $)SQ.Ff. CZ-0 I undcramn l my plans shall be used as public records. - f.,ee t W SIGNS ELEC IUCAL <y f j License)Professional �=W< OWNER-BUILDER DECLARATION SPECIALCIRCUIT' SC. �x-Oau 1 hereby affirm thus 1 am exempt from the Cmatiner.License Law for the ssl3kr following cancer.(Section 7031.5.Business and Professions Code:Any city a county TEMP,M OR POLLS INST. F 3`4 which requires a pernot to construct,alter,improve,demolish,or repair any structure KW}� prigmitaissua.ton,m necatireams. plireatfor such permit to fileosignedstmemem POWE -VICES �C�Qp 9 promiareirv,with Se issi700)of Diiisinf the Ce Imair,umamnctersa xCode) 40.0 9 that he is exemithherel rn]and the Division Sof the ed exam to PAny'nns Cole) SW MING PO I VALUgy'i� XW�m nnhw he is exempt and the basis for the allege)exempion.Any.vinlution of O LITS / ©/N' 4 Section OIIJ LS M1ymsy npplicxm furnpermi,subjens rho upplicunnnncivil penalty of �+ (do 01ipi BvehmlJmdlln0ars(5500). NEW ESIULc 11.' 'R 9Q.FT. ytV�m I,as nwncrnf,bcproperty,ormyemployees with wagesnsmcirsoleeempcnation, STORIES TYPE CONS'PRUCI'ION a3 wit work,vnd the shaman roenem kende Law not apply 1 an Rosiness � unJ Pmles.xione Cale:The Cnnvaanfs License Lnw Joes not apply m on owner of propcny whobuildsorimproves thereon,sod whodoessuchwerk himselfor ihroughhis buildingemsern sold maarcne earefcmplelircd foeown IL I OCC.GROUP RES.UNI'T'S hnweer ,will avec a ardero pcovinix sat he within or unloose foron,theowncof T �_ builder will have the M1urJrn ofproving the,he did not build or impnwe for purpose of see. )I,m ownerofthe property,um exelusivelycommeting with licenaedconwemmte QTY' Ph BNO PERMIT FEE ft 001)ZONE APN ❑ comma,the project(Sec.7M4,Business and Professions Cala:)The Cmermune PERMIT ISSUANCE License Law does not apply to an owner of property who bui lds or i m proves thereoroadn, M who contracts nonsuch pmjeets with acantrector(s)licenxd punuannathe Conmeto's ALTER-DRAIN&V[NT-WATIiR(EA)License Law. ) FEE SUMMARY ❑ 1 nm exempt under Sec. B&P C!or this mason BACK FLOW PROTECT.DEVICE SANITARY Y N Owner Date DRAINS-FLOOR,ROOF.AREA,COND. REM, fp WORKMAN COMPENSATION DECLARATION SCIIOOI.TAX Y N ;❑ I hereby affirm that l have acertificate ufconsennoself-insure,oracenifica,eo! FIXTURES-PERI RAT' RECEIPT'. Worlers'Cmnlwmmion Insurance oro certified copy Ocreof(See.3800,LbC.)which R PARK FEE Y N covers all anpinyce's under this pertnic GAS-F.A.SYSTEM-I INC.4 OUT LITS RECEIPT. Policy. BUILDING DIVTS1qqkq S Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE ❑ Ccnifed copy is hereby famished. ❑ Cenifetl copy is fled with the city impaction Jivisinn. GREASEANDUSTRL WASTE INTIiRCEPTOR GRADING FEE CIIRTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE COMPENSATION INSURANCE (This sectimmed oat be completed if Ne permit is furore hundred dollars PI Iff) SEWER-SANITARY-ST'ORM EA.100FT. ENERGY FEE artless) I ccnifythm mile,performance of the.,it far which this permit is issued,I shall WATER I(EAT ER W/VfNT/ELEMR not employ my .on in any manner so u to become subject as the Workers' PAID z Cnmperalion Lawsof Califnmiu. Data WATERSYSTEM/fREA'ONO Date Receipt. p O Applicant z NOTICE'1'O APPLICANT:If,after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ,FT. TO L: e-: (q become subject to the Worker's Compensation Provisions of the Labor Cala,you must L� > forthwith comply wiih such provisions or this permit shall he deemed revoked BUILDING FEE Q. CONSTRUCTION LENDING AGENCY SEISMIC FEE Vz I bcerby affirm Ilia,there iso construction lendiagagency for the performanceof 0 the work l'nr which,hu permit is issued(Sec.3097,Civ,C.) ELECTRIC LER LL. f.y Lenders Name _ PLUMBING FEE L� Lender's Address QTY, MECHANICAL PERMIT FEE L) I certify that 1 have bead this application and auto that,he above information is correct. I agree to comply with all city and county ordinances and some laws miming to PERMIT ISSUANCE• MECHANICALFEE �-' building construction,and hereby audience representatives ofthis city to enter upon the CONSTRUCTIONTAX U Z abovemebnioned property for inspection purposes. ALTER OR ADD TO MSCI I. We)agree to save,indemnify end keep harmless,he City of Cupertino against liabilities,judgmems,emu and expenses which may in my way accrue against said City AIR HANDLING UNIT(TO 10,000 CIM) in consequence of the granting of this permit. ] j 1 J AIR HANDLING UNIT(OVER R IIW CFM) Sign ure of Appliesn omracmr I Data EXHAUST HOOD(W/DUCI) PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO IOga10 BTU) Data Receipt. Will these isantorfumrebuilding Code, hnntorenr handle h haxahnand Salty HEATING UNIT(OVER 100,000(ITU) m defined by the Cupeninn Municipal Code,Chapter 9.12,onJ the I lahh and 9a4ry Cale,Seel an 255320)'! YBNT'ILATION FAN(SINGLE RIS]Of ❑Yea ❑No Will the upplicam nr Ibwre building occupant use equipment a devices whicM1 emit BOILER-COMP(71IP OR 1010,000 BTU) ISSUANCE DATE haarlous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU) DistncR p'k ❑Yes 0N NEW RESIDENTIALMIiCH. SQ.FT. � A PAID ' 1 have read the hvarJoue materials requimments under Chapter 6.95 of the "R 23 Califnmiu Ing do&Safety Code,Sections 25505,25537 and 25534. I understand that ifthebuilofthe returemenn,es not whihmustly have a o,met it i is myrtmus,oil. tonficas the C// Ocopam of the rcquirtmems which must be me Poona issuance of n Certifiam of - Occupancy. � Vr ,l Owner or ammbfevi stem Date TOTAL: ISSUED BY: l I �U OFFICE ' f