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27283 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY CITY OF CUPERTINO BDD.luVG-EI:ECTIIDAL PERM['1'NO, APPLICATION/PER T I'I.UMIIING-MECHANICAL 27283 7�p q NUIhDING DIVISION BUILDING PROJECT IDENTIFICATION / O J BUILDING ADDRESS: SANITARY NO. APPIKINTIONSUBMDTALDATE G 1 l7li—)1 NIT# LOT# 4 —k%-k.,Q Lt OWNERS NAME: CONTRACTOR'S NAME: LIC NO: l•♦ QT C' N/C ��+C�O,NTROI.p 0RCNI'TIiCI'AiNGINEER: LIC NO: ADDRESS: �O _� (_+ 'MInI ❑ V'A ug CONTACT: PHONE: BUILDING PERMIT INFO QTY. ELECTRIC PERMIT FEE BLDq ELECT PLUMB MECH PERMIT ISSUANCE LICENSEDCONTRACTOR'SDECLARATION APPLIANCES-RESIDENTIAL Oy.Z I hereby affirm that l man licensed under provisions ofQupter 9(commencing with JOB DESCRIPTION ¢FlOO Scanlon 7000)of Division 3 of the Business and Professions Code,unit my license is in PANELS C W full fru unJ e[fem, FZ, License Classp UP T02D0 AMPS vr�/wV H Q n. Dam y I Convector 201-1000 AMPS FyZ ARCHITECTS DECLARATION SQ.FT.FLOOR AREA $/SQ.FT. ZOvr— Iunderstandm 1 shall be used as public moths. OVER 1000 AMPS OZ—O YPaas c-vs F_w SIGNS ELECTRICAL Q Y f J LI[cnxJ Professional (-7-- ^ (O syce6 OWNER-BUILDER from m the Co ATION SPECIAL CIRCUIT/MISC. KO y V I hereby affirm that 1 am exempt from the commnuro e:Any Lew for the n n / / Z- W 3 vF-i following reason.(Semon 1031.5,Business end Professions Code:My city or county TEMP.METER OR POLE INS V QK• fI F L-Oa which requires ap mmi to construct,alter,improve,demolish,or repair my svunure CW}:F prior to its itaamec,also requires the opplicam for such Permit o file a signed statement POWER DEVICES ,90 that he is licensed am-am ,, provrsions m tic Convenor's License Law(Chapter SWIMMING POOL ELE Id 11 o�' n nomncing with Secaon 7000)of Dlvisima 3mf,hc Business and PmPoseions Code) VALUATION or that he is exempt lLcreGnm and Nebasis for the alleged exemption.Any violation of /O� ,ZQ Section 7031.5 by anyxppllcam for a pmmilmbjcns tncapplicumm anvil peaalryuf OUTLETS-SWITCHES-FI O a ♦Q!a'1- out more than five hundred dollars($500). � 0 NEW RESIDENTIAL ELECTR❑ LasowncnrflM1epropeny,ormycmployees with wvgcsastheirsolecomperlxation, STORIES TYI'Ii CONSTRUCTION d3— will Ja the work.and the swcmre ismairmnded oroffcal formlc(Sec.TJ44,Business mJ Pndessions Code: Me Contractor's License Law does not apply to an owner of property whabuildorimpsveadmrson,mdwhodoessuchwork himselfor through his OCC.GROUPEAPI owmandoyees.pmmmar vided that such impveemsenot imendedoroffared fortune.If, however,the buildingor improvement is sold within one year of completion,the owner- ` builder will hove rhe burden orpmving that he did not build or improve for purpose of sale.). QTY. PLUMBING PERMIT FEF. ❑ I,ue ownertJNe pmanr..mendusivdy mnvacting with licrosdconwmorsm ROOD ZONE construct the project Sec.7044,Business and Professions Cited The Contractor's Licensel.awdmsnolapplytomownerofpmpenywhobuildsorimprovesthercon,end PERMIT ISSUANCE whocormacts for such preecl.s with acmmrctods)licensed personal Jolla Centranor's License Law. ALTER-DRAIN&VENT-WAPER(EA) FEE SUMMARY ❑ I nm exempt under See. .B&PC for this masonBACK FLOW1'ROTECI'.DEVICE OUTSIDE ITIS SANITARY YN OwnerUmRfiCEIPfp a DRAINS-FLOOR,ROOF,AREA,COND. WORKMAN COMPENSATION DF.CLARKf10N SCHOOLTAX Y N I hereby affirm that l have a cenificam of consent to sit f-insum,or a certificate of FIXTURES-PER TRAP RECEIPT# Wmkcri Compensation Insurance or acenified copy thercof(Sce.38011,Lab C.)which PARK FEE Y N coven ell emn y der this permit GAS-EA.SYSTEM-1 INC.4 OUTLETS RECBIP p Palicyp <:o�,'��wlrin��� BUILDI DTVI ON FEIS Company 'dTN T"--(r b GAS-EA.SYSTEM-OVER 4(En) PLx,NCHF.CK FEE C ❑ Cenifid copy is hereby famished. Certified copy is filed with the city inspection division. GREASEIINDUSTRL WASTE INTERCEPTOR GRADING FEE w CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE COMPENSATION INSURANCE (Ihissemixamed notbccompletdifNepermhis faronehendrddollers($Ig) SEWER-SANITARY-STORM F.A.20017. P.NERGYME or less.) I certify that in the Performance ofthe work for which this permit is issued.)shall WATER HEATER WNHIBIDE,LECTR not employ any person in my manner an as to become subject to the Workers' PAID Compensatiml.awaof Caliromia. Dam WATER SYSTEMO-REATING Dan, Rcccipl Oz Applicant zO NO'I ICE'1'O APPLICANT:if,after making this Cenificale of Exemption,you should NEWRESIDF.M'IAI.PLMB. SQ.FT. TOTAL: Fr�i become mhjccl to the Worker's Compenmtion pmmsans of the Labor Cole.you mast a forthwith comply with such provisions or this permit shall be comic evoked. BUILDING r� a [� CONSTRUCTION LENDING AGENCY SCIS F Q a Z I hereby affirm that is a construction lending agency for the performance or L L R Ft U he vends rot water thin pemlh it irsed(sec.3D9T,civ.c.) L mler'a Name L ' TNG 'E u' F Lender.nNle•. QTY. MECHANICAL PERMIT FEE U n cenify that I have and this application and slate Nat Ne above information is H I AL FEE Lir cored I agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE I— 0. building convection,and hereby aatnonse representatives ofthisciy w enter upon the CON$TR ION TAX U uba,n " ro ' spa'[ion proposes. ALTER ORADDTDMECI I. - c,indent ify and kcep harmless the City of Cupertino against cousandc penes which mayirm,way reemaagainat said City AIR HANDLING UNIT(TO 10,000CFM) thegmmin fthit permit. AIR HANDLING UNIT(OVER 10,(X10 CFM) 51 le.co Convenor Date EX)IAUS'1'l1DOU(W/DUCT) PAID 9ARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO I W,000 BTU) D:c Rmcin# W 11th aero m future building accupant store or hurdle hazardous material HEATING UNIT(OVER 100.00)BTU) TOTAL Ined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(x)? VENTILATION FAN(SINGLE RESID) its ❑Ycs KIN. SUANCE DATE Will thitiMlicantorfumabuildiagaccupien useequipmem ordeviceswhichemit BOILER-COMP(3HP OR 10D.000 BTU) us com air neoninis as defined by the Bay Area Air Quality Management BOILER-COMP(OVF.R 100,000pBTU) A Distrix! ,wx,�rr W ID ❑Yes sNo NEW RFSIDENTIALMECH. SQ.FT. I have ad us m ❑rials Tcqulrcmems under Cm,lm 6.95 of the JUL ,$7 199 Cnlifnmiu Ileal) & urACode,Sec ions 25505,25533 and 25534. 1 understand Nal r it the building mol ncndyhav aannnt.Ihal it is my rcsryntsihility lm notify the C!/Y y19 Ooccupant rr a qv' ,cora wni mea 6c son prim to Lmllnea sur a cetifipae nr Uh GUPt mup:Inc. 4 kllNO Owner r Dna t ISSUED BY: _ OFFIC APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY CITY OF CUPERTINO BDD.luVG-EI:ECTIIDAL PERM['1'NO, APPLICATION/PER T I'I.UMIIING-MECHANICAL 27283 7�p q NUIhDING DIVISION BUILDING PROJECT IDENTIFICATION / O J BUILDING ADDRESS: SANITARY NO. APPIKINTIONSUBMDTALDATE G 1 l7li—)1 NIT# LOT# 4 —k%-k.,Q Lt OWNERS NAME: CONTRACTOR'S NAME: LIC NO: l•♦ QT C' N/C ��+C�O,NTROI.p 0RCNI'TIiCI'AiNGINEER: LIC NO: ADDRESS: �O _� (_+ 'MInI ❑ V'A ug CONTACT: PHONE: BUILDING PERMIT INFO QTY. ELECTRIC PERMIT FEE BLDq ELECT PLUMB MECH PERMIT ISSUANCE LICENSEDCONTRACTOR'SDECLARATION APPLIANCES-RESIDENTIAL Oy.Z I hereby affirm that l man licensed under provisions ofQupter 9(commencing with JOB DESCRIPTION ¢FlOO Scanlon 7000)of Division 3 of the Business and Professions Code,unit my license is in PANELS C W full fru unJ e[fem, FZ, License Classp UP T02D0 AMPS vr�/wV H Q n. Dam y I Convector 201-1000 AMPS FyZ ARCHITECTS DECLARATION SQ.FT.FLOOR AREA $/SQ.FT. ZOvr— Iunderstandm 1 shall be used as public moths. OVER 1000 AMPS OZ—O YPaas c-vs F_w SIGNS ELECTRICAL Q Y f J LI[cnxJ Professional (-7-- ^ (O syce6 OWNER-BUILDER from m the Co ATION SPECIAL CIRCUIT/MISC. KO y V I hereby affirm that 1 am exempt from the commnuro e:Any Lew for the n n / / Z- W 3 vF-i following reason.(Semon 1031.5,Business end Professions Code:My city or county TEMP.METER OR POLE INS V QK• fI F L-Oa which requires ap mmi to construct,alter,improve,demolish,or repair my svunure CW}:F prior to its itaamec,also requires the opplicam for such Permit o file a signed statement POWER DEVICES ,90 that he is licensed am-am ,, provrsions m tic Convenor's License Law(Chapter SWIMMING POOL ELE Id 11 o�' n nomncing with Secaon 7000)of Dlvisima 3mf,hc Business and PmPoseions Code) VALUATION or that he is exempt lLcreGnm and Nebasis for the alleged exemption.Any violation of /O� ,ZQ Section 7031.5 by anyxppllcam for a pmmilmbjcns tncapplicumm anvil peaalryuf OUTLETS-SWITCHES-FI O a ♦Q!a'1- out more than five hundred dollars($500). � 0 NEW RESIDENTIAL ELECTR❑ LasowncnrflM1epropeny,ormycmployees with wvgcsastheirsolecomperlxation, STORIES TYI'Ii CONSTRUCTION d3— will Ja the work.and the swcmre ismairmnded oroffcal formlc(Sec.TJ44,Business mJ Pndessions Code: Me Contractor's License Law does not apply to an owner of property whabuildorimpsveadmrson,mdwhodoessuchwork himselfor through his OCC.GROUPEAPI owmandoyees.pmmmar vided that such impveemsenot imendedoroffared fortune.If, however,the buildingor improvement is sold within one year of completion,the owner- ` builder will hove rhe burden orpmving that he did not build or improve for purpose of sale.). QTY. PLUMBING PERMIT FEF. ❑ I,ue ownertJNe pmanr..mendusivdy mnvacting with licrosdconwmorsm ROOD ZONE construct the project Sec.7044,Business and Professions Cited The Contractor's Licensel.awdmsnolapplytomownerofpmpenywhobuildsorimprovesthercon,end PERMIT ISSUANCE whocormacts for such preecl.s with acmmrctods)licensed personal Jolla Centranor's License Law. ALTER-DRAIN&VENT-WAPER(EA) FEE SUMMARY ❑ I nm exempt under See. .B&PC for this masonBACK FLOW1'ROTECI'.DEVICE OUTSIDE ITIS SANITARY YN OwnerUmRfiCEIPfp a DRAINS-FLOOR,ROOF,AREA,COND. WORKMAN COMPENSATION DF.CLARKf10N SCHOOLTAX Y N I hereby affirm that l have a cenificam of consent to sit f-insum,or a certificate of FIXTURES-PER TRAP RECEIPT# Wmkcri Compensation Insurance or acenified copy thercof(Sce.38011,Lab C.)which PARK FEE Y N coven ell emn y der this permit GAS-EA.SYSTEM-1 INC.4 OUTLETS RECBIP p Palicyp <:o�,'��wlrin��� BUILDI DTVI ON FEIS Company 'dTN T"--(r b GAS-EA.SYSTEM-OVER 4(En) PLx,NCHF.CK FEE C ❑ Cenifid copy is hereby famished. Certified copy is filed with the city inspection division. GREASEIINDUSTRL WASTE INTERCEPTOR GRADING FEE w CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE COMPENSATION INSURANCE (Ihissemixamed notbccompletdifNepermhis faronehendrddollers($Ig) SEWER-SANITARY-STORM F.A.20017. P.NERGYME or less.) I certify that in the Performance ofthe work for which this permit is issued.)shall WATER HEATER WNHIBIDE,LECTR not employ any person in my manner an as to become subject to the Workers' PAID Compensatiml.awaof Caliromia. Dam WATER SYSTEMO-REATING Dan, Rcccipl Oz Applicant zO NO'I ICE'1'O APPLICANT:if,after making this Cenificale of Exemption,you should NEWRESIDF.M'IAI.PLMB. SQ.FT. TOTAL: Fr�i become mhjccl to the Worker's Compenmtion pmmsans of the Labor Cole.you mast a forthwith comply with such provisions or this permit shall be comic evoked. BUILDING r� a [� CONSTRUCTION LENDING AGENCY SCIS F Q a Z I hereby affirm that is a construction lending agency for the performance or L L R Ft U he vends rot water thin pemlh it irsed(sec.3D9T,civ.c.) L mler'a Name L ' TNG 'E u' F Lender.nNle•. QTY. MECHANICAL PERMIT FEE U n cenify that I have and this application and slate Nat Ne above information is H I AL FEE Lir cored I agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE I— 0. building convection,and hereby aatnonse representatives ofthisciy w enter upon the CON$TR ION TAX U uba,n " ro ' spa'[ion proposes. ALTER ORADDTDMECI I. - c,indent ify and kcep harmless the City of Cupertino against cousandc penes which mayirm,way reemaagainat said City AIR HANDLING UNIT(TO 10,000CFM) thegmmin fthit permit. AIR HANDLING UNIT(OVER 10,(X10 CFM) 51 le.co Convenor Date EX)IAUS'1'l1DOU(W/DUCT) PAID 9ARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO I W,000 BTU) D:c Rmcin# W 11th aero m future building accupant store or hurdle hazardous material HEATING UNIT(OVER 100.00)BTU) TOTAL Ined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(x)? VENTILATION FAN(SINGLE RESID) its ❑Ycs KIN. SUANCE DATE Will thitiMlicantorfumabuildiagaccupien useequipmem ordeviceswhichemit BOILER-COMP(3HP OR 10D.000 BTU) us com air neoninis as defined by the Bay Area Air Quality Management BOILER-COMP(OVF.R 100,000pBTU) A Distrix! ,wx,�rr W ID ❑Yes sNo NEW RFSIDENTIALMECH. SQ.FT. I have ad us m ❑rials Tcqulrcmems under Cm,lm 6.95 of the JUL ,$7 199 Cnlifnmiu Ileal) & urACode,Sec ions 25505,25533 and 25534. 1 understand Nal r it the building mol ncndyhav aannnt.Ihal it is my rcsryntsihility lm notify the C!/Y y19 Ooccupant rr a qv' ,cora wni mea 6c son prim to Lmllnea sur a cetifipae nr Uh GUPt mup:Inc. 4 kllNO Owner r Dna t ISSUED BY: _ OFFIC