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26082 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO HB,.,��hinou frt UAL' PERMITNO, APPLICATION/PERMIT PLUMBING,-MECHANICAI, 26082 BUILDING DIVISION BUILDING PROJECT'IDENTIFICATION BUILDING ADDRESS: oo q q ft Z'Cr l SANITARY NO. APPLICATION SUBMITTAL DATE Ol �• I I l- I UK"" LOTp Q -� OWNERS NAME:�('1�' � / PHONE:�+ CONTRACTOR'S NAME: ; LICNO: NIC CONTROL JI l� aa0 ,—I . 5,19S <qjxn •ARCHITECT/ENGINEER: LIC NO. ADDRESS: Elloo a""` SAN 2 CONTACT: So5 PRONE: - 3� QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO J I/t11 Q 40oQ ITS /,5GY Arm BLDG ELECT' PLUMB MUCH �I PERMIT ISSUANCE fCb El C1 El LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL K� pyz I hereby affirm that l amlicemeJ underprnvlsinnsof Chap¢r9(cnmmcnem,with -4 14e, JO/H IDFSCRIPI'ION aQ00 Section 700B.f Division Sof the Business and Professions Cade,and my liecree is in PANELS ChlhPl�r �SIr yamF—. full force and effec. pI <jW Liccnu ClusJJ�Tic.# UPTO2(IOAMP$ rlr�� (,k> ti?y Dare ]—Cnntructor-Si eS/MS 201-His)AMPS Y ,0yz ARCHITECTS DECLARATION OVER]"AMPS SQ.FT.I7LOOR AREA S/SQ.PI'. 0 z— I undeamm�d my plans shall be axd u public necoNs. k 04 SIGNS ELECTRICAL NQy Licer'd Professional y d'< OWNER-BUILDER DECLARATION SPECIAL CUTDMIS dxOa V I hereby affirm that 1 am exempt from the Comrmmr's Lianx Lew for the W3LLy following reason,(Seetion 7031.5,Business and Professions Code:Any city or county TIME.METELE INST. ermit m sw F tojO< which merries a pconct,at req improve,demolish,or repair any sumenne �tyyjYM primmit issuance.also requires Nc applicant far such permiuo fileasigned statement POWER DEV E' .25<0 that he is licensed pursuant to the provisions of the Calibration's License law(Chapter o.pno 9(commencing with Section 9000)of Division 3 of SWIMMINPOOELECTRIC he Business and Professions Cade) VALUATION X LL ar that he is exempt thertf rom and the basis for the al le dexemption,An 1 t f p geylPnityO OUTLETS-SWITCI IGS-FIXTURES /' H Z Q Sermon than by any applicant fora permit subject the applicant a civil penalty of a q Q -OZ1 5 0 not mom thanfive fffie re ay,ormycmdollater ). NEW RESIDFNTIALELECIR _SQ,FT. ❑ I,asowncrof thegmpcny,nrmycmployeeawith wages ustheirsolccompensation. STORIES TYPE CONSTRUCTION yg_ will do the work,and thesounure is not immradedoralfered forsale(Sec.9144,Business - and Professions Cade:The Contractor's License Use does not apply to on owner of property whobuildsorimprovesthere<m,and whodoes such work himaefor#rough his OCC.GROUP RES,UNITS own improvements employees,provided that such impvemes one notimanor dedoffered foliate.IL builder r.will have the prim idprovmLsat he inone ywr or infants on,for the f 'TOTAL: builder toil l have the burden of proving that he did not build or improve for purpose of "1e')' QTY. PLUMBING PERMIT FEE FLOOD ZONE APN ❑ 1,asowner ofthe progeny,=exclusively contracting with licensed commnotxm Linstruct 0 e project(See 90FL Business and Professions Code.)The Contractor's icense Lowdoes not apply to an ownerofproperty whobuildsarimproves flamm nd FERMI TISSUANCH whocontmns for such projects with acantrsnm(s)licensed pursaanumhe Coneracrrs gL'IFR-DRAIN&VENT-WATER(EA) FEESUMMARY laccase Law. ❑ 1 an exempt under Sec. ,B&P C for this re mon BACK FLOW PROTECT.DEVICEO OUT FIES SANITARY Y N Owner Dam DRAINS-ILOOR. FARPAGOND. RECEIP # WORKMAN COMPENSATION DECLARA'T'ION . , SCI 1001.TAX YN ❑ Thereby ul9rm Nmlheveucertificur nrcaneonua self-insure.nrncuri9catc of FIXTURES-PER TRA RECEIPT# WorkersCompensation humads,m.certified copy theavd(See.3900,Lob C.)which PARK FEE Y N covers all employee's undcnhis permit. y IT411K3 _QS GAS-FA.SYSTEM_I W- .40 EfS RECEIPT# Policy p BUILDING DIVISION FEES —cT- ' Cmnga^Y—orf" ,a .GAS-EASYSTEM-OV (E "t PLANCHECK FEE L4 Camped copy is hereby fumished. ❑ Cenified copy is Bled with the city inspection division. ..t%� GREASFA US EINTERCEPI'OR GRADING FEE CIiR'1'IPICATE 017 COMPEN.ATIONIIIN MOM NSURANCE WORKERS 0 �p � ' GR AIH' �l " SOILS FF.F. (Thisxctionncednmbecomplacd ifthepermit lsforone handl 11.(S 000) SEWER ANITA S EA.if 0014.1 ENERGY M-C nr less.) 7 r v Icerd that in the peffernanecof he week for which this permit ms'ssued,lehall WATER i- TE /HLF.CTR .t not employ way person In any manner se as ar become sobj el m Walken' a PAID Compensation Licasof Califomia. Date S IlsTING .' Dam Receipt# C) z Applicant k — z NOTICC'TOAPPLICAN'DIf,eBermaking this Cmm9cmcofExet tion.youxhauld NEWRESIDEN IAL PCMB; SQ.F. TOTAL: E•-' i,, Mrame subject to the Worker's Compensation provisions of the Le Cade,you must a > fanhwith comply with such provisions or this pemrit shell be deem liked. BUILDING IBE a (� CONSTRUCTION LENDING AGENCY ...a.N"x'1'"' SEISMIC FEE f z Ihereby affirm that is a nmsuuction lending agency for the Performance of TOTAL: ELECTRIC FEE U O the work for which this permit is issued(Sec.3097,Civ.CJ CT, P Lender's Name PLUMBING FEE Lend,,,Address QTY. MECHANICAL PERMIT FEE U I cedify that 1 have read this application and .at that tht above information is MECHANICALFEE 1 correct.l agree m comply with all city and county onirences and state laws reining to PERMIT ISSUANCE buildingeonaruction,and hereby aothoriu reprtsenwtives of this city mercer upon the CONSTRUCTION TAX U z above-mentioned property for inspection puWars. ALTERORADDTOMECE. (We)agree to save,indemnify and keep harmless the City of Cupertino against Iiabilities,judgmen¢.emas adexpenses which may in any wareacerue against said City AIR HANDLING UNIT(TO 10,000 CFM) in consequence of the granting of this permit. AIR HANDLING U (OVER 10,000C ) Signature of Anlricant/Conuacmr Date EXHAUST HOOD(W UCI) HAZARDOUS MATERIALS DISCLOSURE HEATINGUNIT(TOI , BTU) wane Receipt# Will the the Cupertino or future building de,C ant erre or handle haealth a material as defined by the Cupertino Municipal Cede.Chapter 9.12,and the Health and Safety HEATING ON]'1'(OV- W.IpII BTU) '1'O1'AL: Code,Section 25532(.)? VENTILATION In IS GLERESID) ❑Yes TN. ISSUANCE DATE Will thcappllwrorfntum building«cup tum quipmcntordeviceswhichemit BOILER-COMP(31POR 100,0000TUl ha[adous air comamimams as defined by the Bay A.Air Quality Management BOILER-COMP(OVER 100,000 BTU) DisWet? 1:1A B A Yes IWNo NEW RF,SIDENTIAL MECB. SQ.Fr. I have mad the hsoulful materials requirements under Chapter 6.95 of the 1 uJUN 30 1995 Culifomiu I Icalth&S.I'dy Cudc,Stations 255115,23573 and 255]4. nderswndat Gh if the building does not currently have a¢num,that it is my msponshifiq to notify the occupant of the mquim rat which must be met prior to issuance of a Certificate of Occupancy. I I Y Vr in IIVU Owner nr uuthoriecd gent Dam TOTAL: ISSUE OFFICE