26046 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-KLEC FRICAL PERMIT NO.
PLUMBING-MECHANICAL
RUILDING DIVISION APPLICATION/PERMIT F— BUILDING PROJECr IDENTIFICATION 26046
But 1,DING AD BESS SANITARY No. APPLICATIONSUBMITTALDATE
�ar) UNITSCHAUMANN PLUMWM 8, HEATING
NE.,s vAsso
PHONE: CONTRACTORS NA1465 LaurelwoOT-RU. Lic—No N/C CONJUROL#
-497f-z SAN2&WRA, CA 95054
All rflCT/ENGINMR: le—LA LIC NO: ADDRESS: Vdb-W44 El
CONTACT: PHONE: Qw ELECTRIC PERMIT FEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE F-1 F-1 0
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
CJWZ I hereby affirran that I wa licensed underprovisimeofCbeaptucii hamincommaing,with JOB DFZCRIPTION
POO Section 7M)offAvisions 3 ofthe Business and Profiensiours Cocie and no can . . PA"B"S
2-D "Far UPT0200AMPS
fall Came and affect.
U
,Zw E3 C
tx,<� Data VAh 16—�
V� 201-Hall AMPS
ZM�D qLr� A I C I I ITE'=CID0 ECLA RAT I ON SQ.ff.FLOOR AREA $/SQ-FT,
OVER I"AMPS
OZ-n I anderstrad.,,I...hall be.,ad a publicnarcrods.
Licensed Promccizarad SIGNS ELECTRICAL
OWNER BUILDER DECLAILATION SPECIAL CIRCUIT/MISC.
MU I hereby afficars final I vare exempt from the Committees License Law her the
z-�; following mown,(Secties,7031.5,Business it professions Coda:A.,city or an,, TEMP.MEDIR OR MILE INST
oo I which.,at..Permit 1.consurrosel..11,improve,demolish,or repair curaymeatter,
�2 prior to its issuance,alson sequires the appliesed forsuch peranitto rile a signed statement POWER DEVICES
c-MO that he is fiecreved Nimmons to the Provisions oftheConerector's License Law(Chapter
90commerming with Section 7")ofDivision 3 ofthe Business and ProfesitoraCcole) SWIMMING POOL ELECTRIC
VALUATION
or that he is exempt therefrom and the bricaus for the alleged exemption.Any violation of
Section 703 IS by any applicant for a pennant subjects the applicant to a civil Penalty of OUTLETS-SWITCHES-FIXTURES
no, me than five hundred dollar,($50%
ce 0 l.asownerofthepm�rty,ormyemployceswiffiwagesastheirsoleca panam. NJEWRESIDEWIALELLCTR —SQ,F7.
her, STORIES TYPECONSTRUMION
will clothe work,and the structure is not intendecorofficred for
HL sale(See.7 M
and Prommions Code:The Contravenes License Law does not apply be an owner of I
prormy who buildsorimproves themon,and whadoos such work him,affouthrough his
own catiployets,provideddard suchimpenevencrents susecomincended oroffened ficassim.If. OCC.GROUP RES.UNI I S
however,the building or improvement is sold within one yearolfcomplation,theowner.
builder will have the burden onproving that he did not build or improve for purp crof
sale.).
0 l.asownerofthepmpwy,mexclusivelycm�ing�ffili�n�con�tomto QTY. PLU ERNF 117E FLOODZONE APN
construct the prijeel(See 7041 Business and Professions Cache)The Commences —— .", ——1 40-0
License Law does not apply toarrouncerofloolparty wholowiciancrimporoves thercon,cond PERMIT ISSU
who contmao;forsumfonjects with accurtracturfs)licensed puromant to the Contractor's -L—
Lice se Low. A)N WATER(EA) FEE SUMMARY
0 at we exempt crude,Sec.—,B A,P C for this reman !2y� OUTSIDE FEES
W PROI ECT.DEVICE SANITTARY Y—N—
Owner Data RECEIPTI$—
WORKMAN COMPENSATION DECLARATION DRAINSYMOOR,ROOF,AREA,COND, SCHOOLTAX Y—N—
[3 1 handbyriffirear that I have a cenificaw renascent 0 self-imaine,Ora certificate of FIXTURES.papm RECEIPT#—
WorkersCizennedusatimi firwasocam.,miffied cap,thatmoof(See.38M.Lab C.)which __ PARK FEE Y—N
covers all employee's under Jois permit. OAS-EA INC.4 OUTLETS RECEIPT#
Pelicyals BUILDING DIVISION FEEiS
Company G M-OVER 4(EA) PLANCHECK FEE
CI Ceitifiedeopyishonabyformshod.
C] Carfiried copy is filed unh the city inspection division. �\dn,eWNbUSTRL WASTE INTERCEPTOR GRADING ME
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE , WTRAP SOILS ME
(This section readout be complaied ifthe pormit is formse hundred dollars S 100) EWER-SANITARY-STORM EA.200FT. ENERGY ME
car I
1WATERHEATHRW/VEN`J/ELECTR
not employ my parom in my manner so as to become subject to the Workers , PAID
Z Compentatiocal-awsofCalifterria. Date WATER SYSTEMrrR PTING Dam Receipt#
Applicare
Z 0 NOTICE TO APPLICANIT,If,after causing this Cerfifficato of Exiamption,you should NEW RESIDENTIAL PLMB.—SQ.FT.. TOTAL
[A become subjw to the Wacker's Compensation Provisions of the Labor Code.you must
F- — forthwith comply tib...It provisions an this parannit shelf be,cleared mv.kM. BUILDING ME
M >
F1, 0 CONSTRUCTION LENDING AGENCY SEISMIC ME
I thereby reform coal them is a construction lending agency for Ile performance of
c ,he work far.hich his .it is issued(Sar.3097,Ci,.C.) TOTAL: ELECTRIC ME
Z
Leader's Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE
Landet's Narma
I cenify that I have read this apporaction and them that the above information is MECHANICAL ME
correct. PERMIT ISSUANCE
Le) building construction,and hereby authorize reprevandativesofthis city to smar upon the CONSTRUCTION TAX
U Z above-meniumsed propeny for inspection purposes, ALTER OR ADD TO MEOU
(We)spone,to save,indemnify and keep hareless the City of Copernicus against
liabilities'ml pEM(padmat said City AIR HANDLING UNIT(TO IBM CFM)
in &=AN44in
1455 Laurel AIR HANDLING UNIT(OVER U),"CM)
Si,pmuma fAp%jAS*kIBmcw1aIsrs�, 9 A54 Dole EXHAUST HOOD(WMUCT) PAID
1,408� 986-9044
HA ABDO SMATERIALSDISCLOSU HEYPING UNIT(TO Hol"BTU) Dole Receipt#
Wit I the applicurn or future building occupant store or handle hazardous material
defired by the Cupertino Municipal Code,Chapter 9,12,and the Health and Samly HEATING UNIT(OVER 100.000 BTU) TOTAL:
Code,Section 25532(c)?
as 0 yes 0 No VENTILATION FAN(SINGLE RMID)
Will themptioner,curfunumbuildingoacurpart ustooluipmentordeviceswhicheran BOILER-COMP SHE OR 100.00B BTIJ)
me,cur mansurnincents as refined by In.Bay A.Air Quality Management BOILER-COMP(OVER IW,000 BULL,
am,,? r
0 Yea 0 No NEWRESIDENTIALMECH—SQ.FP. U-
I have=it the losearchous materials requiremants under Chapter 6.95 of the FEB 1 1994
California 11,411&Salary Code,ScIfime;11101,21111 and 25534. 1 mulanicand thit,
I
I if the building does not currently have a tenant,that it is my responsibility to notify the
(axii,xvin pof
- a lractumements which must be met prior to issuance of.pidruste of
Occapstor . BLUR. INSPECTION DEPAR
'12aga - ;rLMY )c
Owner onturcomized agent ,PW,,O
pitta TOTAL LCUPERTIN(W k�-n
OFFICE V