26144 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY _
CITY OF CUPERTINO xSCi—iMr�LE(' RI AL PIiRMI"I'NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL. q /I
BUILDING DIVISION BUILDING PROJECT I I)N.M1'IFICATION 1 `t
BUILDING ADDRESS: w SANITARY NO. APPLICATION SUBMGT/A�L DA III
y Q UNIT# LOT 3
OWNERSN M1:: P1 � (O� CONTRALTGAM
77 Z NE: CC_
AM NIC CON'1'ROLp
HI'IECT/ENGINEER: LIC NO: ADDRESS: ❑
7
CON'TACI^. PHONE: BUILDING PERMIT INFO
QTY, ELECTRIC PERMIT FEE
BLDQ LLECI' PLUMB ME❑CII
PERMIT ISSUANCE3Z.rlI BS�1{ IL-aL
LICENSED CONTRACT'OR'S DECLARATION APPLIANCES-RESIDENTIAL
I hereby Ilirm that l an licensed under fCha t l th JOB DESCRIPTION
0y7 ya prnvisimm� perr(commcncingwi a
�s10�Y0❑ Scution]IX0)of Division 3 of the Business and Rofcsions Code,end my license is in PANELS
QUU bad tor and effttt. _ r C2J ll C�
F-LW License class Lie# UP TO2 AMPS
y=y Date Comrenmr ia.f� G 201-1000 AMPS SQ.Fr.FLOO AREA S/SQ.FT.
ARCHITECTSDI tAT'10 OVER]"AMPS
7Oy— T understand in,plans shall Is,used is public nomads.
oz
W SIGNS ELECTRICAL
Licensed Professional
f ar d'6 OWNER-BUILDER DECLARATION SPECIAL CIRCUITIMISC.
OpW,U I hereby,alum that 1 am exempt from the Comor
rad 's License Law for the
W 3 a y following reason.(Section]031.5,Business and Professions Cade:Any city mr coumy TEMP.METER OR POLE INST.
t llov; whudouuims a rerun.conwmc,ulcer,
timprove,demolish.or Otero, roymmoom POWER DEVICES
'nQ7 prior to its icsuadce,olro requires the uppliesom forsuch prmtI.file asigoed statement
C tha he ix licensed punmm to the provisi.m of the Cmnoacmts License Law fC'hrpSer VA ATION
aXo 9(commencing with Section 7(M)or Division 3 ofthe Business and Professions Cade) SWIMMING POOL ELECTRIC r O
m_rn orthat he is exempt Premiums and the basis for She rllegeri exemption.Any violation of �t
Fla Section ttpl Shy my upplicamfora permit subjects the epplicanno acivil penalty of OIfTLETS-SWRCHFS IXTUR / ' •� D V
rd morcthen five hundred dollars(SSW} NEW RESIDp1JTIALELECTR _SQ.FT. STORIES 'TYPE CONST RUCTION
�F�� ❑ 1.asownerofthe Mr ay.ormyemployttswithwagesas Neirsolecompcnsadon.
W will dodo,wo,kand the Structure is not immiderimullcrrA Gasale(SO..9044,Business
and Professions Code:The Contracme,License Law docs not apply m no owner of
property who builds or improves chemor.and whodoes such work himselfor through his r GBp��P r5 RES.UNITS
employms.provided Nat such improvememsarc not imendmWnr offered hermit.IL � f li fi—'h1 V�
however.the building or improvement is sold within te yearofeempletion,the owner- TOTAL: r' .I v� (- IL'm. GOP
bookie,will have the Forder oI'proving that he did not build or improve far purpose of
1
sale.). QTY. PLUMBING PERMIT eE t�
i ❑ Lus ndthe pr.peny.umuclusively c.mmning with li<enswcononaorsm P L Ii ANN
s.
omimct thenpmject(Sec.7044,Business Said Professions Code)The Contractor's
License law docs not applydoanownerefpropeny,whobuildsmimpraares te
hreon.and PERMIT ISSUANCE OC.
wb.contractsforaocb projects with nconootogs)licensedpursuommNa Comructoes ALIVR-DRAIN&VENT-WATER(EA) M
License law. -
❑ I run exempt under Sec. B&P C for Nis reason - SIDE FEES
BACK MOW PRO'1'F.CT.DEVICE SANITARY YN
Owner Date DRAINS-MOOR,ROOF,AREA.GOND. RECEIFTis
WORKMAN COMPENSATION DECLARATION SCIIWLTAX Y N
❑ I hembyaffimrtbo I have a certificate ofmnsem toself-insum.ora me ificamof FIXTURES-PER TRAP RECEIPT#
Workers'Compcnsauon Insurance or acenified copy themo((See.3800,Lab C.)which PARK FEE Y N
covers all employee's under this permit. GAS-EA.SYSTEM-1 INC.4 OU'TLET'S RECEIM#
Policy# BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PIANCHECK FEE
❑ Ccmid c p t I by is Y 1 '�
Certified on,is filed with the city inspebdiomdivlsion. ORE- SRANDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERSGREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This sectionneed Hot le,completed illM1e permit is format hundred dollars(510(d) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
hallI certify thelia tuns in any manfthewos 10lahiamse Subject
0 the Wlkent' WRIER HEATER W/VfiNT/LLIiCfR
not employ any permn m any manner so as do become subject do the Workers PAID
C.mpenamion laws mf Califmntia. Date WATER SYSTEM/TREATING Date Receipdp
Z Applicant // r
Q h Id NEW RESIDENTIAL PLMIL SQ,FT. TOTAL: C -C
z NOTIChTOAPPLICANTor'sif,Compensation
this Cenio^am the
Exemption,yeas ou
Ftn bechwithc subject WorkersCicars Orcin,p.ii s.Ithelabor Coked. muse BUILDING FLIT
� > .6 7ill
fonhwichcomply with such pmvisions mShis RrmiS SM1a11 t<damed revoked.
Q. Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
1 hereby affirm that there is a construction lending agency for the performance of
U 'z, ereconstructionTOTAL: ELECTRIC FEE
U O the work for which this permit is issued(Sec.3097,Co.C.)
Lenders Name PLUMBING FEL:
Un
U" F der,Address QTY. MECHANICAL PF.RM11' FEE
0 U I minify thin I have Head this applicaci.n and sum Shed the above information is MECHANICAL.FEF.
>- W corerr l agree to comply with all city and county announces and state laws relating to PERMIT ISSUANCE
F aM building mo,truchmorind herebyrmhorieOtpresenatlyexofchis city m,mer upomhe CONSTRUCTION TAX
U z above-mentioned property for inspection purposes. ALTER OR ADD TO MSCIL
(Wc)ogre r save,indemnify wd keep t Cidy of Cupenlno against
C. It liabilicies,ju acs,cosy an :s_ moyin. synmonerasnotsaid City AIR HANDLING UNIT(1'0 I(kUW CPM) �2
Sequ mf thegm term this aw it. �7/s\�
AIR HANDLING UNIT(OVER 10,0(11)CFM)
Signa cof Appliormo, CJ Date EXHAUS'I'HOOO(W/DUCry
e nPAID
❑AZARDOUS MAT ALS DISCLOSURE HEATING UNIT TO 100,010 BTU) Dace Receipt#
WiIINpplicantmfuture holdingoecuonedtoo,orhandle horardousntmerivl HEATING UNIT(OVER I00J)00BTU) TOTAL: 7a•�C
,fined b the Cupertino Municipal Code,Chapter 9.12,and the Hwlth and Safety
Crile,Section 25592(u)? VENTILATION FAN(SINGLE RESIDE
❑Yes P_44� ISSUANCE DATI7
Willdhe applicant.,future boildlagoccueam ace cmEndiemmdmiceswhlch emit BOILER.COMP(3HP OR 100,000 BTU) p� A I D
• hazardous air conuanireas as defined by the Bay Arca Air Quality Management BOILER-COMP(OVE:R 1W.000 BTU) 1•• P'i
District.' 1:11 @ yes - o NEW RESIDEM'IAL MECH. SQ,FT. MAR +u 1994
1 have read the Enormous materials requirements under Chapter 6.95 of the
California He, Srely Code,Sections 25505. 1 mrd 25534. 1 understand that
if fund run cmrenttyh msi
to spobilitywnwify1h. CII Y Ur WFumpliU
c vn of c r' mrcme nth enificace of
occur _ _ 1
raudhorixded um TOTAL: ISSUED BY:
OFFICE
r
- 75
v o co E 3 m c� o
76 fi .. 1• .
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o - p�XQ b� \S
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Load-bearing wall or beam Z •
Mora`the
r6 C d r
C',
oa
Stairway opening rl _
!Y W G
Cn
Double headers r � , ?c�C..,
Tail joist
i trimmer pias
'I .foist
Wall or foundation
Header s//pan exceeds 4 feet
�/7E'IJ �Ko� /ijs�/rier s%o �SfaT"
Douobl
ApDouble header
Tail joist
eader joists exceeding 6 feet
Approved ha48noedhwSourceNFPA
Tail Joists exceeding 12 feet
FRAMING AROUND OPENINGS
Sec. 2517004