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26903 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO -ELECTRICAL PERMIT NO. CAL BUILDING DIVISION APPLICATION/PERMIT PLUMBING Ilii -MF:CHATIFICA 26903 BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: SANITARY NO. APPLICATIONSUBMITALDATE f ^_UNIT# LOT# OWNERS AMR; F PIIONB: CO RA R'S NAM A LIC 0: N/C CONTROLp J �� ! ARCIIITF.C'f/ENG Elili: CNG: ADDRESS: A ❑ CONTACT: PHONE: �' I I QTY. ELECTRIC PERMIT PEE BUILDING PERMIT INFO BLDG ELECT PLUMB MECH PERMIT 13130 LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPI'ON pmly I hereby affirmthal l em licensed underprovisionsofChmun9(mineencingwife 1400 Section 700fmf Division 3 of the Business and Professions Code,and my license is in PANELS �W full flad effeN� F;ZW License...Class_s„]C� I.ic.p UP T0200AMP5 mDy Dam Cont r 201-IOWAMPS Z O.zm,'3q HITS SDEk6ATIO1 OVER IOW AMPS SQ.FT.FLOOR AREA $/SQ.FT. OZ—qWty tante ub' G��3 Lie dPr SIGNS ELECTRICAL WG WNER-BUIhDER DECLARATION SPECIAL CIRCUIT/MISC. EMU aW.V mrcby that I am exempt from Ne Contractor's License Law for the following rcason.(Section 7031.5,Business and Professions Code:Any city or mumy TEMP.METER OR POLE INST. which requires a permit to contuse,alter,improve,demolish,or repair my muctum tYj2Q� pron ioitsiss...ce,also ulre reqrtheepplicmt frmanth permit to fileasmt igneci ement POWER DEVICES W(1 0 that he is licensed Panama India provisions of the Contractor's License Law(Chapter a p�' 9(commencing with Section 7")of Division 3 offal Business and Professions Code) SWIMMING POOL ELECTRIC VALUATION ' mow or that he sexempt therefrom and the basis for be alleged exemption.Any violation of t y< Section 7031.5 by my applicant for a permit subjects the applicant to a civil penalty of OUTLETS-SWITCHES-FIXTURES W mnot more than Eve handled dollars($5(0). NEW RESIDENTIAL ELECIR $ .FT. ❑ I,as owner offer property,ormyemployms with wages m theirsole comsamom. n, Q STORIES TYPECONSTRUCTION a will do de work,md feommeure isnot imendedof0ffered fmiale(Sce.7044,Busin .ad Profess ns Code:The Contractors License Law does not apply he an owner of properly who builds orimproves Barron,and whodoes such work himselfomhmugh his OCC.GROUP RES.0 ITS own empfoyees,pmvided that such improvements menmintendedoroffiami formle.If, however,the built ingor improvement is sold within oneycarefcompletion,the owner. TOTAL: builder will have the burden of proving that he did not build or improve for purpose of le.). ❑ 1,mownerofthe propeny,umexciliuvely contracting with licensed contractors to QTY, PLUMBING PERMIT FEE FLOODZ NL APN construct fee project(Sec.7094,Business and Profession,Code:)The Contractor', License lawdcesnot epplyto mnwrherofproperry whmbuildam improvufeertrn,md PERMIT ISSUANCE whocontmeta formula prejamwife.cadmousr(s)licensed punuanuofee Contractors AI:IFR-DRAIN@VENT-WATER(RA)License I., ALTER SUMMARY ❑ I am excmin under Sec. ,B @ P C for this ream. BACK F10W PROTECT.DEVICE D' SANITARY Y N_ s Owner Da¢ AINS-FLOOR,ROOF,AREA,C11 RECEIPT# WORKMAN COMPENSATION DF,CLARATION SCHOOL TAX Y N ❑ Ihercby effim thmlhuveecertificem of cmneenno sal Gimurc,nrncenifi 00f RECEIPT# Worken'Compe aillum[asumnce or ac.nified copy thereof(Sec.7MW,Lnb . which FIR URPS-PER TRAP PARK FEE Y N coven all employed gyp r s it GAS EA.SYSTEM-I INC.40U'fLETS RECEIPT# Pali �•i BUILDING DIVISION FEES Company GAS I EA.SYSTEM-OVER 4(EA ) PLANCHECK FEE ❑ CeNfial copyn rc y 'aanlr f�CertifiW copy is fled ilh laeciryimparmn division. OR SPJINDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFItnmy OP EXEMPTION FROM WORKERS' GR SCTRAP SOILS FEF. PENSATION INSURANCE (Thissectlonneedompleted Him permit is formate hundred dollars T$10(1) SE ER-SANITARY-STORM EA.2WFT. ENERGY FEE or less.) I amifythat in Ne announce of the work for which this permit is issued.I shift ATER HF":'/VENT/ELECIR not employ my person summer so as to become subject the Workers PAID Z Compensationlawsofie. Dale WATER SYS'IEM/1'REATING Dem Rccciptp zOAOTICEl NOTICE act altIC :IL after making Ois Catfica of ..You should fiW RESIDP.NTIAL PLMB. SQ.FT. TOTAL: Vu biome subjatmfecW heM1 Coope rim provi' nso bur Code,you mu ai ; forfewife comply wife ¢h provisions th' ad. reCv,oY#�J! BUILDING FEE NS7RU I DINGA \�/ SEISMIC FEE Uz (hereby atfirm at them ince sat on lrntlinli my so a rfomanc� TOTAL: ELECTRIC PEG 0 the work for which lM1' permit is issued( 3W7.Civ.C:) Isx Lender's Nnme Lender's Address / QTY. MECHANICAL PERMIT F13E PLUMBING FEE �^ I vanity that I ave mad his application and sante that the above igfoimatm is 4 correct. Iegree to ply with all city mdcoua ordinmeu andvure laws miming to PERMIT ISSUANCE MECHANICAL FfiP. building consmct al and hereby authorize repmentabsesoffeis city meteoritical fee CONSTRUCTION TAX .brae-mentimnedpm rryforinspemionpu ALTER OR ADD TO MECH. rte• (We)agree tesec emnify cap les, 'City of Cupntno.gainn liabiluies,jadgment swh' as y way memeagairet said City AIRHANDLINGUNIT(TO10,OWCFM) inconsequence s is 11 T AIR HANDLING UNIT(OVER 10,000 CFM) Sig u n pp' ntmenr Date EXHAUSTHOOD(W/DUCT) PAID AZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO IW,000 BTU) Data Receipt# Will the licmt orfuture building occupant amus or handle hamrdoms materiel as defined by the Cupertino Municipal Code,Chapter 9.12,and fee Health and Safety HEATING UNIT(OVER 100.000 BTU) TOTAL: Cale.Section 25532(.)7 13 Yes ❑No VENTILATION FAN(SINGLE RESIDE BOILER-COMP(3IIP OR 100,000 BTU) (SSU LDgTF m � Will lheupplicmr(murebuildingoem cup. use equail #�V1 ipmcmordevicwhichemtl hemott'f lY mrdous air cmnmrninams as defined by the Bay Arca Air Quality Management BOf1.ER-COMP(OVER 100,000,WO BTU) D� J1 ❑Yes 11 No NEW RESIDENTIAL MEC11. SQ.Ff. �2 r 1 have read fee hamNous materials requirements under Chapter 6.95 of the Cpy L! 1995 California I lealfe @ safely Code,Sections 25505,25533 and 25534.I undersmnd that f (-Lt.- ` Ifthebuildingdmsnmcm tlyhovealenanl,(hatiiismymWnsibilitywnotifyfee tlylJA— ,..Pa.[of the"ithamenm which must be at prior to issuance of a Certificate of Occupancy. Owner or authorized agent Data TOTAL: � ISSUED BY: OFFIC