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25914 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY ' CITY OF CUPERTINO B HICAL PERMIT NO. ' APPLICATION/PERMIT PLUMBING-MECHANICAL 25914 BUILDING DIVISION BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: SANITARY NO, APPLICATION SUBMITTAL DATE *7 phol Ang UNIT# LOTH 12"oATt PHONE: CONT CTOR' NAME: LIC NO: I _ r` C 1C J N/C CONTROL# ARCf11TECT/ENGINEER: LIC NO: A DRE I ❑ S CONTACT: PHONE: IL 1913 PERMIT INFO - QTY. ELECTRIC PERMIT FEE BLDG ELECT PLUMB MECH PERMIT ISSUANCE E] rw LICENSED CONTRACTOR'S DECLARATION LITF- 1:1 pppL1ANCPS-RESIDENTIAL TOB DESCRIPTION 0 yz, I hereby affirm thml am licensed underpmOdonsof Chapler9(e mmencingwith 0r Section 0000)of Division 3 ol'ihe Business and Professions Code,and my license is to PANELS 1r p(zp full force and effect. 6 License Class _ '� Lic.k� UP T0200 AMPS ypvDa Date Contractor Oji✓ 201-1000AMPS I-'ro z ARCHITECTS DECLARATTON f SQ.FT.FLO AREA $/SQ.FT. Z O rn OVER 1000 AMPS O2.^ 1 understood my plans shall be used as public records. - �''J SIGNS ELECTRICAL < G^� Licensed Prohseicnal OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. ryry,,O a F I hereby affirm that I am exempt from the Contractor's License Law for the do3 C following reason.(Section 7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST. 15 rn.] which requires a permit to construct,alter,improve,demolish,or repair any structure ori point.its issuance,alsomquires theappimant forsuch permit to fileasigned induced, POWER DEVICES that he is licensed pursuant to the provisions of the Contractors License Law(Chapter - xo 9(commetring with Section 7000)of Division 3 of the Business and Professions Code) SWIMMING POOL ELECTRIC VALUATION Iy�y or that he is exempt therefrom and the basis for the alleged exemption.Any violadoof OUTLETS-SWITCHES-FIXTUR�S 4 Section]031.5 by any applicant for a permit subjects the applicant to a civil Penaltyf M=more than five hundred dollars($500). Q El1,asowneroftheproperty,ormyemployeeswithwagwastheirsolecompensadon, NEW RESID AL ELECIR' t r ISQ.FT. - STORIES TYPE CONSTRUCTION G.3n will do the work,andthestrucome isaotimended ocofferedforsale(Sec.0044,Bulinus and Professions Code:The Contractor's License Law does not apply 0 an owner of property who buBdsorimprovesthereon,andwhodcessuchwork himselforthmugh his ` employees,provided Nat such improvememsarenolinlendedorofferedforsale.If, (OCC.GROUP -RES.UNITS however,the buildingor improvement is sold within Meru ofcompletion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ I,as ownerofthe property,atnexclusivelycontracting with licensed contractors to QTY, PLUMBING PERMIT FEE FOOD_ZONE APN construct the project(Sec.7DH,Business and Professions Cade:)The Contrectors .oD License Law does not apply to a a owner ofproperty who builds or improves thereon,and PERMIT ISSUANCE whocontracts forsuchavoccts wilhacontmcmr(s)licensed pursuant To The Customers ALTER PEE SUMMARY License Law. (EA) ❑ 1 am exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT,DEVICE OUT D FEES SANITARY Y N Owner Dale DRAINS-FLOOR,ROOF,AREA,COND.- RECEIPT# WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N ❑ ers'Co affirmthat lhave rance orla compact copsent to y thereof(Sec. Lab C.)ate ofwhich RECEIPT'# FIXTURES-PER TRAP r. Workers'Cmployee'sndarthisermioenlBeO copy thereof(Sec.3g00,Lab C.)which - PARK FEE Y N covers Policy#Ilemployee'sunder this permit, GAS-EA.SYSTEM] J TS RECEIPiq s✓�'%" BUILDING DIVISION FEES Company -faGAS-Ea .LEA) PLANCHECK FEE ❑ Certified copy Is hereby mished. i ❑ Certified copy is filed with the city inspection division. ORrIo ,KC WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' 61.✓TRAP SOILS FEE COMPENSATION INSURANCE (This section need not becompleted ifthepermit is foronehundred dellars($I00) SEWER-SANITARY-STORM EA.2110FT. ENERGY FEE or less.) I<ettify tha[in the performance of the work forwhich thio permit is issued,(shall WATER HEATER W/VENT/ELECTR not employ any person in any manner so To become bject to the Workers' PAID Compensation ICalifo Dnp Y/'-9 WATER SYSTEMiTRGTING ryW�y t 3- [� De[e Receipt# Q z Applicanty �.L%SLL z7�+ � NOTICE TO APPLI oAork If,is toter making this C visions m of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: t� become subject m the Worker's Compensation provisions of the Labor Code,you mum �i fonhwith comply wish such provisions or this permit shell be deemed revokM. BUILDING FEE aCONSTRUCTION LENDING AGENCY SEISMIC FEE U z I hereby affirm That there is a commortion lending agency for thm The Emf dMi,of - TOTAL: _O' ELECTRIC FEE O the work for which this permit is issued(Sec.3097,Civ.CJ Lender's Name C U Lender's Address QTY, MECHANICAL PERMIT FEE PLUMBING FEE I certify Net I have read this application and state that the above information is acontext.l agree to comply with all city east county ordinances and state laws relating to PERMIT ISSUANCE MECHANICAL FEE rA 7 building construction,aadhereby authmies representatives ofthis city to enter upon the CONSTRUCTION TAX V a above-mentioned property for Inspection purposes. ALTER OR ADD TO MECH.' (We)agree to save,indemnify and keep harmless the City of Cupertino against /I liabilities,judgments,costs and expenses which may in any way income against said City AIR HANDLING UNIT(TO 10,000 CFM) 7, • a0 in c f then "tedo,of Bit pe it onseypenceo y5�: AIR HANDLING UNIT(OVER 10,000 CFM) Sn Aa[ure of` n'— 66 1 r{e- EXHAUST HOOD •1 g pp t/Conuactor b� PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,0100 BTU) Dam Receipt# Will the applicant or future building occupant store or handle hazardous material HEATING UNIT(OVER 100,000 BTU) TOTAL: •J as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Cade,Section 25532(e)? VENTILATION FAN(SINGLE RESID) 11 Yes 11 No ISSUANCE DATE Willtheapplicanmrfumrebuildingoccupanluseequipmenlordevices whichemil BOILER-COME(3HP OR 100,000 BTU) harardous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(OVER I W,000 BTU) PAID hod"? t ❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FT. FEB �� ���� I have renhazardous d the materials Momentums under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533 and 25534. I understand that if the building does not currently have a tenant,that it is my responsibility (�to notify the. ^I I Y Ur L urth 1114U occupant of the requirements which must be met Prior To issuance of a Certificate of Occupancy. Owner or authorirod agent Data TOTAL: ISSUED BY: OFFICE