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28280 APPLICANT,TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OFCUPERTINO BUIL DING•ELECTRICAL PERMIT NO. /N /N a1 /10 APPLICATION/PERMIT PLUMBING-MECHANICAL - L VX L VX BUILDING DIVISION BUILDING PROjEcT IDENTIFICATION BUILDING ADDRESS. /,/////,. / �� (�f�f Q/ SANITARY NO. APPLICATIOONNSUUBBmirTALDAW �O�- /!/�Y//Tk%(� UNITN LOTH 4(,/`+J � 1 OWNERS NAME: Ir PHONE: s CONI CI'OR'S NAM LIC NO:'AD N/C CONTROL ARCHGUCT/ENGINNNEER:J LICNO: S ❑ O 3 CONI'ACf: PHONE: /gip e 77 QTY, ELECPRIC PERMIT FEC BUILDING PERMIT INFO Ge✓� / BLDG ELT PLUMB MUCH PERMIT ISSUANCE ❑ ❑ ❑ LICENSED CONdunderOR'g DECLARATION APPLIANCES-RESIDENTIAL I hereby IOrtn diellam licrnsed unJtt siomofCTa t r9 c mmencin LOB DESCRIPTION OCZ yet pmvi pe (o eis in A N tt100 Senian]IXIO)nf Division Sof the Business and Professions Cole unJ my license is in ppryPLS s /—`I gu fullf;ants` � LIn.N [ /y� G UP TO 200 /-J/ �Fr�r 6 y Doe Lot ,f...i 201-IOII�I AMPS ZsM ARCHITECTS ECLA ATION OVER 1000 AMPS SQ.PI'.FLOOR AREA S/SQ.<T. 1 understand my plans shall be used as public records. 9 k��LLLL SIGNS ELECTRICAL Licensed Profesximol tY NVQ OWNER.BUILDER DECLARATION SPECIALCIRCUIT/MISC. n•OyU I hereby affirm that I em exempt from the Cantranm's License Low for the R 314 following aas..(Section]031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST. BOJ which requires a permit to construct.alter,improve,demolish,or repair any structure m}� prior t.its hermea.M.requires theapplicant for such permit o filersinumd statement POWER DEVICES p that he is licensed pursumnothe pr,,isimis fthe Contractor's License Low(Chapter nXo�' 9(commencing with Section]000)of Division 3 ofthe Business and Professions Code) SWIMMING 1+001.ELECTRIC �� VALUATION nn ,_-y bm he is exempuhcrefromapd the basis fortheeleged exemption.Any violwom.f d� 1-.ZQ Section 7031.5 by anpermit y applicant for a peit subjects the applicant to a civil penalty of OUT LET5-SWITCHES-FlXTlIRCS ^s. not more thmftvehundred dollars myem). NEWRISSIDENTIALCLECIR _SQ.FT, STORIES TYPE CONSTRUCTION m ❑ .cisI.mwrk,adep,unica,,I...I ployeeswiNwagcsusea(Sec.compensation, I a _ will dmhe work,C d e:tibrmcmre is mors License a se La does not apply to an owner of / ss and Professions Code:Thc Contractors License Lew duce not apply m an owner of own crulUms,property who pdvids or edtrovnth improvements ancrsuchwmkhirrlulfa through his OCC.GROUP RIS.UNITS awnemployea,providedthussuchimprovementswenot intendedmo!fend for sole. r. builder will avec a burden ofpmvingth he build or Improve ms,for the ars,of TOTAL: We). will have the burden ofproving Nm he Jid not M1uiIJ or improve for purpose of t We.). ❑ I,mownerof theprtiperty,umexclmivelyamuuning with licensed contractors to QTY. PLUMBING PERMIT PEC FLOOD ZONE APN on.wct the Pa t(Sm.1044,Business and Professions Code:)The Contractor's PERMIT ISSUANCE License Law dote not apply wan owner of property who builds or improves thereon,and aha carouses fmmchprojectswiNacommdm(s)Iicens pursumttoihe Convector's License Inas. ALTER-DRAIN&VENT-WATER(FA) FEE SUMMARY ❑ I ern exempt underSec. B&P C for this reasonOUTSE IU.FE - BACK FLOW PROTECT.DEVICE SANITARY Y N Owner Datc RECEIPTN 7, WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF,AREA,GOND. SCHOOLTAX Y_N ❑ l hereby affirm that l hove a ecui0cate of consent to self-insure,nr it."Inome of RECEIPT FIXTURES-PER TRAP Workere'Corymrypeynaetion lnsuymynycpeTmacenified copy N<oof(Sm.3800,Lab C.)which PARK FEF. YN "icy NII c(UpL 7�I�7 GAS-EA.SYSTEM:1 INC.4 OUTLETS BUILDING DIVISION FEES tiroGAS-EA.SYSTEMOVER 4(EA) PLANCHECK IEE Ceni led copy is hereby famished. ©/(edified copy is filed with the city inspection division. GREASQTNDUSTRL WASTE.INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION PROM WORKERSGREASETRAP SOILS FEE COMPCNSATIQQQN INSURANCE (Thissectinnnadnmbemmpletedi�pennitisformuehundrddollms(SI00) SEWER-SANITARY-STORM EA.200FT. ENCRGY ME or less.) I cmify thatin the pe do c f e kfor which this permit is issued,l shall WATER HEATER WNENVELECTR t not employ a person in any us m become ubjyef to the Workers PAID Compensation oma C m" . ere m WATT3R SYSTEM/IRLATING Date Recciptp Q Z Applicant z Q NOTICE. A :IC eOcr mvkingt mifjgte of mptionyouahould NEWRESIDE- ALPLMB. SQ.1'f. tibecome auM1j he Worker's Cnmpen p tum of the Labor Cale,you must l'OTAL: llyr forthwith comply ith such provisions is shall be deemed invoked. BUILDING FEE �. Z '`C STR CTI ON LENDING AGENCY SEISMIC FEE I herehyefirm t `ret ::mduction leadingagency for the Nrfo ..f TOTAL: ELECTRIC FBF. (, O the work for which this s issued(gee.3097,Civ.CJ Lender's Name PLUMBING FEC 0 U Lender's Address - QTY. MECHANICAL PERMIT FEE I certify that I have rte this application and state that the above information is MECHANICAL PEE correct.I ugmemcomply with Ocity andcouatyominamesmd slate laws orating 1. PERMIT ISSUANCE �•' fA buildingeonstrumioo,and hereby authorize refamenmtives ofthis city te enter upon Ne CONSTRUCTION TAX L) Z shove-mentioned property form,pemian purposes. ALTER OR ADD TO MECH. (We)agree m save,indemnify and kap harmless the City of Cupertino against o�aas'hies,judgments.costs and expenses which may in my yarentn'sinstaaid City AIR HANDLING UNIT(TO 10.000CFM) in n quence of0 gran' N-0 is per'. �]. r 4 AIR HANDLING UNIT(OVER I0.000 CFM) Si woe ppleanUC.tract., ma EXHAUST HOOD(W/DUCI') PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 RTU) Date Remain a WiliftitpPlicantnr furore building occupant it..or handle Instructions material HEATING UNIT(OVER IOO,tXlO BTU) T u defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Cace,Section 255J2(a)'! VENTILATION FAN(SINGLE RMID) a .. ❑Ya, E3 F BOILER-COMP(3HP OR 100,o00BTU) 'ISSUA CEfjATE Will Oteapplicanmrfutume building mention use equipmemordevices which emit - sonorous err commumansu defined by the Aree Air Quality Management BOILER-COMP(OVER 100,0111 BTU) OCT' /y ❑Yca o NEW RESIDENTIAL MECH. SQ.FT. 19 95 I have read Na innuendoes mmimid,requimmenu under Chapter 6.95 of the 0111 Ur LIjYQ]�I California Health&Safer Comic,Sections 25505,25533 and 25534. I understand that Hit.build' nomoncraly have.se...t,that it is my responsibility,I.purify the cupanl a require. s which must he et Prior uni6swarIm of a Certificate of Occup ]. Ow roramho cdagcar Date TOTAL: ISSUED BY: OFFICE s