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24792 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OFCUPERTINO BUILDING-ELECTRICAL MRMI'1'NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL BUILDING PROJECTIDENTIFICATION 24792 BUILDING ADDRESS: / ' !� SANITARY NO, APPLICATIONSUBMHTALDATE CQ o2D.5(P ,L-ruoq Utsrf►- P� V— LOT« 3-ate-q OWNERS�k) J( NE% CO CfOR'S NAME: fOaN LIC yO^ NIC CONTROI.p ARCHITEEC IENGINMR: LIC NO: DRBSS: J F 3aY�a J D 'W60/J a r_1 CONTACT: PHONE: QTY ELECTRIC PERMIT EEE BUILDING PERMIT INFO ELECT PLUMB MECH 3 / 7J �i PERM T ISSUANCE ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL. nialzI hereby flims that l am licensed under mvisionsofChet 9(commencin with /�/�D{{sa IOBDESCRIFI'[G 1402 Ye 0 Per gwi W/�I•s /V�.� �'•�� tst00_ Section]O(p)of"yD�ivIisionJ9f the Business and Rofasions Code.end my license is in PANELS FZ License `s`f Liap 39o3s 9 UPT02IXIAMPS r m=y Dae Convacoor .-v 201-1000 AMPS ZOyz ARCHITECTS DECLARATION // OVER 1000 AMPS SQ.FT.FLOOR AREA sISQ.PT. O z G I utuferstand my Plans shell be used ss public records. F¢�m F SIGNS ELECTRICAL Y� Licensed professional a�y.K OWNER-BUILDER DECLARATION SPECLV.CIRCUITIMI, . k0 V I hereby alrinn tha I armcompo from rhe Convectors License Law for rhe 00'3 u.,xF¢'s following mason.(Section]o31.5.B7mcss and Professions Code:Any city mrcounty IEMP.METERORPo rINST. WO J whtcb requires a permit m co csfive alms Improve,demolish,or repair any memou m =!•0 domhe is licensedc,alsardtoth fivesphericalofthe Co permit's rile a LiceseLad matement POWER DEVICES yWjCGp thatmis licensedpursuanowtheprovisionsof the Contractor's and Pro Law(Chapter SWIMMING POOL ELL 'RIC 9(commcncing with Section 7000)of Oivieion3ofthcBmineas tins Profession Cede) VALUATION W_y or that he is exempt therefrom and the basis for the alleged exemption.Any violation of ^ t4Q Section 7031.5 by any applicant for a pt OUTLETS-SWITCHES permit subjects the applicana civil Penalty of FIXTURES eXS not mom than five hundred dollars($500). 1,75NIiW RESIDENTIALE =11 —SQ PT. ❑ 1,nsownerol'theproperty,ormycmployeeswithwagasaslheirsotecompensation, STORIES 'IYPECONSTRUC'HON will codes work,and the structure is not immuml oroffered missile(Sec.71344,Business end Professions CMC The Convectors License Law docs not apply to an owns of propeny who buil ds or improv es t ancon,and wha does such work hi mself or through h i s own employees,provided that such improvemenuarenot imendedorofferedforsale.If, OCC.GROUPEA however,the building mimprovement is sold within ane ycarof.unpletian,the owner- TOTAL: builder will have the burden of Proving that he did two build err improve far purpose of ❑ I,as ownerof rhe property,omexclusively cnntracoing with licensed commctors to QTY. PLUMBIN PERMIT PEE FLOOD ZONE construct the pmject(Sec.7044,Business and Profusions Code:)The Contractor's License Lawdoeanotapp[ywmownerofpmpertywhobuil&orimpmvesthemon,and PERMIT ISSUANCE who contracts forsuch projects with acontmctor(s)licensed pursumvothe Contractor's ALTER WATER(EA)License Law. FEE SUMMARY ❑ 1 em exempt uMer Sea ,B&P C for Nis reason BACK FLOW PROTECT. EVIITARY _N O EF Y L Owner Dam DRAINS-FLOOR, 1• CIM . RECEIPI'R WORKMAN COMPENSATION DECLARATION COL.TAX Y—N- RECEIPT 0 Kos Compensation Insurance or a certified copy thereof(Sm.380,Lab C.)which KI• Y_N overs all empinyec'a under chis permit.i•a/�© RECEIPT p eC f GAS-G.SYSTEM- 4OUTLETS Policy p BUILDING DIVISION FEES Company - T�s; GAS-EA.SYSTEM-OV PLANCHECK FEE Certified copy is hereby famished. Certified copy is filed with the city inspection division. ,. OREASFANDU l, TE IM'ERCEPI'OR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE COMPENSATION INSURANCE (This section need nothe completed ifthepemit is for one hundred dollars($HXh SEWER-SANITARY-S RM BA.200FT. ENERGY FEE or less.) I certify that in for perf..i,cifthe work for which obis permit is issued,I shall WATER HEATER W/V%fLrELECTR not employ, any person in any manner so n to become subject to the Workers PAID Compensation Laws of Calimmiu. Date WATERSYSTEM/IHEANG Dam Receipt C O Applicant z NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should NEW RESIDENTIAL P B. SQ.Ff. TOTAL: F+ � become subject to the Workers Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this pemtt that[be deemed revoked. BUILDING FEE W [� CONSTRUCTION LENDING AGENCY SEISMIC FEE Uz Ihereby affirm that them is a contraction lending agency for the performance of TOTAL: ELECTRIC FEE O the work for which this pemnit is issued(Sec.309].Civ.CJ lender's Nome LI, F Lemma Address QTY. MECHA ICAL PERMIT FEE PLUMBING FEB.V I certify aha I have mad this application emit stare that the above information is 6Wicomet.I agree to comply with all city mid county ordinances and state taws reading to PERMIT ISSUANC MECHANICAL FEE Co) building construction,and hereby autormin ispxwentatives ofthissity w enter upon Ne U 7 above-mentioned property her inspection purposeER . ALTORADDT MECH. CONSTRUCTION TAX (We)agree to save,indemnify and keep bmmless the City of Cupertino amint liabilities,judgments,ensu and expenses which may inanyway accrue against said City AIR HANDLING IT(TO 10.00()CFM) in consequence of the granting of this permit. AIR HANDLING qNfT(OVER 10,000 CFM) Signature of Applicann'Contractm Dem EXI IAUST HOOD WJDUCT) PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT( 10(h00UBTU) Dam Raeiplg Will the applicant or future building occupant store or handle hazardous materiel HEATING UNIT VCR 100,000 BTU as defined by the Cupenlmo Municipal Cote,Chapter 9.12,end the Health add Safety ) TOTAL: Cade,Section 25532(a)] 0Yes ❑No VENTILATION VN(SINGLE RESID) Will the applicant arfuture building occupanuse eyuipinentordevittswhich cash BOILER-COMP 3HP OR 100p00 BTU) ISSUANCE DA TE harsNous air commitments,as defined by the Bay Area Air Quality Management BOILER-COMP OVER 100,000 BTU) District] q A ❑Yes ❑No NEW RESIDENT L MECH. SQ.Ff. 1� 1 have read the hvmdon mamtI iet thio tense under Chapter 6.95 of the YY//�R� California Health&Safety Code,Sections 25505,25533 and 25534.1 understand that I'V e building does notpsents h ve a tenant,that it is my responsibility m notify the a pmt the require encs w ust be met names of a CcniOeam of CI I Owneror umho' dagent Dae TOTAL: ISSUED BY. OFFICE