26299 I
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTIINO RHI INSPI-EITCTRTCall' PERMIT NO.
APPLICATION/PERMIT PLUMBING-MRCHANICAL 2629/�(�
BUILDING DIVISION BUII.DINGPROJEC'1'IDF:N'rIFICM'ION O G J
9.
BUILDINGIT
ADDRESS: SAND NO, APPLICATIONSUBMITTALDATE
10551 UNIT# LOTat
O9R$ .ey p110N_35 � CONTRACf AME: I,IC O: NIC CONTROL
ARCHITEC'I'/ENGINEER: ',7/LIC NO: J ADDRESS:
CEDON'�AA� "£G rlfo . .
BUILDING PERMIT INFO
F.yy QTY. • ELECTRIC.PERMIT. PER
BLDG wu, PLUM NIECE
.7sT� PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
r)=Z Iherehyaffirm that l a mlicensalunderpmvisiomofCbapter9(com ening with JOB DESCR ION
¢100 Sation]000)of Division Sof the Basin.,and Preheat ..Code and my lions¢is in PANELS -
W V t full forte and effect.
p¢-,Zu1 Licenu Class Lic.g UPT0200AMPS .
why Date Continuum-
201-I"AMPS
ZOyz ARCI{ITECI'S DECLARATION SQ.FT.FLOOR AREA SfSQ.FT.
OZ—O l understand my plum shall be used m public records. OVER ISO AMPS
E.y�WSIGNS ELE
Licensed Prafeasmal
OWNER-BUILDER DECLAMATION SPECIAL
LxL�dOyF 1 hereby affirm that 1 torr exempt from the Contmctaes License law for the
W 3 0.ma following reason.(Saban 703 1.5,Business and Professions Code:Any city or county TEMP.M R MST,
E' �'] which inquirer a permit to comunish,¢Iter,improve,demolish,or repair any eauc[ure -
IY2 prior to its issuance,also require.the applicant for such permit m file a signed smmmrnt POWER DE ICE
ty <0 that he is licensed pursuant to the prmisiansof,ha Commerce.License Law(Chapter
eyo�' 9(commencing with Section 70th of Divisism 3 of the Business and Professions Code) SWIMMIN PO LELECIRIC VALUATION
WMW or that he is clumistmo,from and the basis for the alleged exemption.Any violmios of U.pLE.pS- ITCHES-FIXTURES
g a Section 7031.5 by any applicant for n permit subjects the applicant to a civil penalty of
?5J I Seto
yZ nal marc than ofthe five properly,
or my employees
NEW RESIDENTIAL ELECT SQ.FT.mEo ❑ 1,esuwnernfthepruperty,mmycmpluyec,with wages as their sole compensation, — Q SI'ORIIiS 01 TYI'L'CONSTRUCTION
will do the work,and the structure is notiidcnded or of fared for sale(Sec.7144,Business
and Professions Code:The Cnmrunor's License law does no,apply to an owner of
Emptily who huddsorhaproves thereto,slid who does such work hintselforthroughhis
own employees,pmvided that such improvements arc not intended orofferexi latitude.If, 04 OCC.CROUP RES.UNITS
however,the building or improvement is sold within one yearofcompledmi the owner-
builder will have the harden of proving that he did not build or improve for purpose of tirm
Bala).
Qr I,as owneref the property,am exclusively contracting with licensedmntracmmm QTY. PLUMBING PERMIT FTE 19.001)Z.ONE APN
consul the project(Sec.7(144,Business and Profession,Codc:)The C. tome is PERMIT ISSUANCE
License Lawdoes notapply loan ownerofFropcny who builds or improves thermn,and
whocildhocts forsuch projects with acommcmr(s)licensed pursuant tothe Contrucmr's ALTER FA
License Law. BEA) FEE SUMMARY
❑ 1 ora exempt under Sec. - ,B&PC for this lemon BACK FLOW PROTECT.DEVICE DI
SANITARY TY—N—
Owner
Owner Dem DRAINS-FLOOR,ROOF,AREA,COND. RECEIPT
WORKMAN COMPENSATIONDECLARATION SCHOOLTAX s Y N
❑ Therebyaffirm thmlhave.ceni0cam of conxnuo ulGinsum,m ilvenificlmafRECEIPTa
FIXTURES-PER TRAP
Workers Cmtpenmtionlnsumnccorecenif dopy Chemof(Sm.Jg00,Lab CJ which PARK WiP. YN
covers ell employee's undenhi.permit. GAS-NA.SYSTEM I INC.4 OUTLETS RECEIFf x
Policy It BUILDING DIVISION FERS
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE b
❑ Curified copy is hereby famished.
❑ Ccnificd copy is filed with the city inspxdan divixion. GREASFJINDUSTRL WASTE INTERCEPTOR GRADING FEB
r�
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS IlE
COMPENSATION INSURANCE
(This section need lathe completed H da,permit is forone hundreddollan(5100) SEWN- EA.200FT. ENERGY FEE
or less.)
I certifythat nine pal-fi nceofthe work for which this permit i,issued,) WATER EATERWIVENT/ELECTR
me employ any .an in any manner sun s g5jret to the ,kers' ASIA
Z
C. .,a sof Cali! 1) WATERS STEM/TRFATING Dme Ree to
Applic
ODNOT ICETOAPPLICA :If,atter .king this Ceniftcaleof option,you should NEWRESI NTIALPLMB. SQ.FT. TOTAL:
(~ V1 become subject 1.he Workers Coope re, mparoulans eLeboI Code,you must
a ; forthwith comply with such provision,or this parmit be deentpd revoked. BUILDING[;BE �4
L)Lel Q CONSTRUCTION I, ING AGENCY SEISMICFEC Lltb
Z I hereby affirm t'a,them is a comma on lend.,itgency for the K ELECTRIC !1
(� O
the work for which this Permit is issued IS .3097,C .C.)
C) {r Lendees Name PLUM rh
t-' Lenders Address Y. MEC NICALP1iRMIT FEB
C) I certify that I have read this applicati and stat t the ve coal o i �.
�" a correct. In reeocnm with.11 sir den t bin nc sand tmel MIiCIIANICAI.Efai
B pY Ym yo wii gt PER ISSUANCE
F-' Inildlo,emobuctiumandhereby uohoriacrep mentals . f@is you liter upn the CONSTRUCI'1 VN
V Z above-oeoioned properly for imlwctin.puna, r LTER OR ADD TO MECH. 8 a
(We)mgrs.lo mumu,indemnify uhd keep In, less the Cir,.1 Cupertin,against
liabilirics,judgmeno,costs and expenses which mu 'nanywayascomaadIma sand Ct AIR HANDLING UNIT(TO 10,00(1 CFM)
in asequence of the good ng of this permit/
r
AIR HANDLING UNIT(OVER 10,00)CFM)
Signalure of ,Allam tm c r aler EXHAUST HOOD(W/DUC)
PAID
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT(TO 100,000 BTU) Oete Rec r p
Will the the Cuantorfut re Municipal
Code,Cng amsmreor handle I Icahn
und Safeul -
arJefined by the Cupcnino MunicipalCode,Chapin,9.12,and the lleahh and Safety HEATING UNIT LOVER IW,000 BTU) TOTAL:
Code,Section 25532(a)] ,y,� VENTILATION FAN(SINGLE RFS ID) f 15
1)Ye, +4No
Will theapplicmt or future builJinguccupem useeyuipmentordevicu whichemit
BOILER-COMP(3HPORIOQ000 BTU) - IS^ AN ,DATE
limitations air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,0X0 BTU) �n�/ '1 Q �a,�q
mm. MAY •1•/J 9 'F
is ❑yes A No NEW RESIDENTIAL MECH. SQ.ET.
1 have mad the humardous matxriais requirements under Chapter 6.95 of the CI1 Y (,fl- UUrtn I IIY '
California Health&Safety Code,Sections 25505,M533 and 25534. I understand that V
if the building dines not currently have a mumm,that it is my responsibility to noify the
oc parr of the requimnent hi<h must be met prionm immuce af.Cadificme of
°- /tin
Owner or¢mho zed atgrnt - Dux TO A.. ISSUED BY,
OFFICE
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