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26064 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OFCUPERTINO BUILDING-M'EC`I RICAL PERMIT NO. APPLICATION/PERMIT PLUMBING-MC'HANICAL 26064 BUILDING DIVISION BUILDING PROJKCI'IDENTIFICATION BUIL. 0ADDRESS: ,{{ ✓ SANITARY NO. APPIJG TIONSUBMTITALDATE jm ��g g V cI • UNIT« LOT OW d DCF— 2&-167 / ;HONE: CONTRA OR'SNAM�:01V LIC NO: N/C ARCH1 'Cf/FNGINEP. TIC Nj: ADD 'SS. n/ L ❑ O ACT: IRJ �PHHOONE: QTY. ELECTRIC PERMIT PER BUILDING PERMIT INFO M JAKO 399_�i PERMIT ISSUANCE B ELECT PLUMB MECH µ / LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL. IOD UCSCRIPf10N GKZ IM17000)of Division wo 3 of a Busired ness and Professions oste, (co mmencing with ` a00 Seamon 701ap of Division 3 of to Business and Profession Cale,and an license is in PANELS J` dd full force and effect. Up TO 200 AMPS 6.e-Zm Licenu Cleu Lic.p &i 6 y Data Connote 201-I000 AMPS ZOyZ ARCHITECPS DECLARATION SQ.FT�OOR AREA /SQ.FT. z0o,i- I understand my piansshall beuudss public records. OVER I000AMPS 0 rn C SIGNS ELECTRICAL � f0 Licensed ProfessionalOWNER-BUILDER DECLARATION SPECIAL CIRCUITIMISC. x3 YYI6eel'l' 1 hereby riff that I am exempt from the Convectors License Lew far the W following rearm.(Section 0031.5,Business and Professions Code.Any city or county TEMP.METER OR POLF.INST. O which requires a permit to commun.aher,improve,demolish,or repair my swcmbe }.� prior to its issuance,also requires the applicant for such permit to lila a signed statement POWER DEVICES G OY shot he is licensed pursuant to the provisions of the Contractor's License Lew(Chapter a oLL 9(commencing with Section 7000)of Division 3 ofthe Busincssend Profasims Code) SWIMMING POOL ELECTRIC VALUATION or --y or that he is exempt themfom and the basis for the Whetted exemption.Any violation of Section 7031.5 by any applicator for a permit subjects the spplicennoacivilprnWyof OUTLETS-SWITCHES-FIXTURES � C, nt more than five hundred dollen(5500).❑ I,mownereftheprogeny.ormyemployaswiNwagmutheirsolecomprnsanon, NEW RESIDENTIAL ELRCIR SQ.Pf. STORIES TYPECONSTRUCTION d will Bothe wod.and the structure isnot intendMoro(tared for sale(Sce.7044,Business and Professions Code:The Commcmrs License law does not apply to en owner of property wha builds or improves menom,rind who does such work himeelf or through his own empleycesildingri improvement hintis mid willonneyearmeumpletercd formic.Tf, OCC.GROUP RES.UNITS however,wilt have the b r improveroem is hold a didnoneywr of c gboave foron,the purpose f L builder will have the harden of proving than he did not build or improve for purpose of u1eJ. ❑ TY. ERMIT FEE FLOOD ZONE ApN consumer the project(Sri.704ul,Business and Professions Code:)The Contrndra PERMIT ISSUAN Licenu Lawdocanot applytoaowrrerofproperty whobuildsm Improves thercaa,and who contracts for such projects with a c ontmctods)licensed promotion uthe o Commerce. License law. A N&V TER(PA) IEE SUMMARY ❑ 1 can exempt under Sec. ,B&P C for this reason BACN.OWQOTECT.DE SANITARY OUTSIDE FEES Y N Owner DateDRAINS- GORRE;CEIPf N , AREA, .OND. WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N • c❑e l hcComprorm taInsura c eertlbede of consem to od(Steuse,or Lob C.)which RECEIPT A FIXTURES-PE Wnrkcn'Compenation Insurance urnecnified copy termf(SecJSfp,Lob CJ which PARK FEE Y N rs all employee's undeeahis permit. GAS-RA.SYSTEM- C. .ITfS RECEIPTg Policy BUILDING DIVISION ES C any GAS-EA.SYSTEM-OV ( PLANCHECK. Certified copy is hereby promised. Lldt ❑ had copy is bled with the city inspection division. GREASEIINDUSTRL ERI RA CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP ` � � l COMPENSATION INSURANCE (This section need not In completed lithe pemtit is forom hundred dollars($100) SEWER-SANIT -STORNMT.2fN LL E. or less.) I certify that in the performance of Ne work for which this permit is Issued,l shall WATER H WN T/ELC not employ any peourn in any meaner so as to become subject to the Worker% Z Compematian Lawsof Califomiu. Data WA' SYSTEWTR - — - - — Receipt# Applicant Z 0 NOTICE TO APPLICANT:ILafier making this Canificamaf Exemption,you should NEW RESIDENTIAL PLMB. SQ,ff. TOTAL: y scome Subject o the Worker'a Compensation provisions of the labor Code,you must forthwith comply wit such provisions or this permit shall be deemed revoked. BUILDING FEE �+ W O 'CONSTRUCTION LENDING AGENCY SEISMIC FEE rrR�� I hereby Wfinn that them it u constructdin ion leng agency for the performance of TOTAL: ELECTRIC HE work for which this permh is issued(Sec.3197,Civ.C.) Lender's Name OF Leader's Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE V 1 cenify that I Rave read this application and amre that to above information is correct, le to comply with cit and court Ordinances and stale laws tabbing to MECHANICAL FEE gree gyve' y ry g PERMIT ISSUANCE U Z adinvang rationed propert hertbypectio p purposes. ivesohhiecirywrnRr upon to CONSTRUCTION TAX V z ebove-mentagmepsave, for inspection purposes. ,.,...�-- ALTER OR ADD TO MECH. (We)agree to save,indemnify and keep harsnwrny at cupcnits against Riddilities,ju mnts,em and pence w 1 aymany weyecrneageinm said City AIR HANDLING UNIT(TO 10,gN)CFM) in coreey ming this AIR HANDLING UNIT(OVER IQ ) ewreo pplicue ntractar CXI IAUSTHOOD(W/DU PAID AZARDOUS MATERIALS DISCLOSURE HEATING UNIT ITO I ,000 BTU) Dale Receipt a Will the applicant m future building occupant stare or handle haurdous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Haps and Safety HEATING UNIT(017M I(p,(100 BTU) TOTAL: Code,Section 23532(e)T CI Yes ❑No VENTILATION FAN(SINGLE RESID) Will theepplicunmw rfure huup iltlingoccant useequipmenmrdevi¢s OOILER-COMP(3HPOR IUgObo BTU) SOCE DATE which emit 66// humidors air contaminants as defined by the Bay Arca Air Quality Management BOILER-COMP(OVER 103,000 BTU) ©(1 _ Diatderr n!'I �9A^ ❑Yes 13 No NEW RESIDENTIAL MECH. SQ.FT. C! 1 have mad the Safety Cos,materials 5505,2mrnu under Chapter 6.95 rd to V California Halts&Safety Code,Section 23505,25533 and 25334. I understand Net C�rCh/II yV if the building does not currently have a IenrnE that it is my rcsponsibiliry to notify to occupant o(the requircmenu which muss be ma prior to iuuence of o Cenifiam op Occupancy. Owner in adhrri,ced agent Data TOTAL: ISSUED BY: OFFICE APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OFCUPERTINO BUILDING-M'EC`I RICAL PERMIT NO. APPLICATION/PERMIT PLUMBING-MC'HANICAL 26064 BUILDING DIVISION BUILDING PROJKCI'IDENTIFICATION BUIL. 0ADDRESS: ,{{ ✓ SANITARY NO. APPIJG TIONSUBMTITALDATE jm ��g g V cI • UNIT« LOT OW d DCF— 2&-167 / ;HONE: CONTRA OR'SNAM�:01V LIC NO: N/C ARCH1 'Cf/FNGINEP. TIC Nj: ADD 'SS. n/ L ❑ O ACT: IRJ �PHHOONE: QTY. ELECTRIC PERMIT PER BUILDING PERMIT INFO M JAKO 399_�i PERMIT ISSUANCE B ELECT PLUMB MECH µ / LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL. IOD UCSCRIPf10N GKZ IM17000)of Division wo 3 of a Busired ness and Professions oste, (co mmencing with ` a00 Seamon 701ap of Division 3 of to Business and Profession Cale,and an license is in PANELS J` dd full force and effect. Up TO 200 AMPS 6.e-Zm Licenu Cleu Lic.p &i 6 y Data Connote 201-I000 AMPS ZOyZ ARCHITECPS DECLARATION SQ.FT�OOR AREA /SQ.FT. z0o,i- I understand my piansshall beuudss public records. OVER I000AMPS 0 rn C SIGNS ELECTRICAL � f0 Licensed ProfessionalOWNER-BUILDER DECLARATION SPECIAL CIRCUITIMISC. x3 YYI6eel'l' 1 hereby riff that I am exempt from the Convectors License Lew far the W following rearm.(Section 0031.5,Business and Professions Code.Any city or county TEMP.METER OR POLF.INST. O which requires a permit to commun.aher,improve,demolish,or repair my swcmbe }.� prior to its issuance,also requires the applicant for such permit to lila a signed statement POWER DEVICES G OY shot he is licensed pursuant to the provisions of the Contractor's License Lew(Chapter a oLL 9(commencing with Section 7000)of Division 3 ofthe Busincssend Profasims Code) SWIMMING POOL ELECTRIC VALUATION or --y or that he is exempt themfom and the basis for the Whetted exemption.Any violation of Section 7031.5 by any applicator for a permit subjects the spplicennoacivilprnWyof OUTLETS-SWITCHES-FIXTURES � C, nt more than five hundred dollen(5500).❑ I,mownereftheprogeny.ormyemployaswiNwagmutheirsolecomprnsanon, NEW RESIDENTIAL ELRCIR SQ.Pf. STORIES TYPECONSTRUCTION d will Bothe wod.and the structure isnot intendMoro(tared for sale(Sce.7044,Business and Professions Code:The Commcmrs License law does not apply to en owner of property wha builds or improves menom,rind who does such work himeelf or through his own empleycesildingri improvement hintis mid willonneyearmeumpletercd formic.Tf, OCC.GROUP RES.UNITS however,wilt have the b r improveroem is hold a didnoneywr of c gboave foron,the purpose f L builder will have the harden of proving than he did not build or improve for purpose of u1eJ. ❑ TY. ERMIT FEE FLOOD ZONE ApN consumer the project(Sri.704ul,Business and Professions Code:)The Contrndra PERMIT ISSUAN Licenu Lawdocanot applytoaowrrerofproperty whobuildsm Improves thercaa,and who contracts for such projects with a c ontmctods)licensed promotion uthe o Commerce. License law. A N&V TER(PA) IEE SUMMARY ❑ 1 can exempt under Sec. ,B&P C for this reason BACN.OWQOTECT.DE SANITARY OUTSIDE FEES Y N Owner DateDRAINS- GORRE;CEIPf N , AREA, .OND. WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N • c❑e l hcComprorm taInsura c eertlbede of consem to od(Steuse,or Lob C.)which RECEIPT A FIXTURES-PE Wnrkcn'Compenation Insurance urnecnified copy termf(SecJSfp,Lob CJ which PARK FEE Y N rs all employee's undeeahis permit. GAS-RA.SYSTEM- C. .ITfS RECEIPTg Policy BUILDING DIVISION ES C any GAS-EA.SYSTEM-OV ( PLANCHECK. Certified copy is hereby promised. Lldt ❑ had copy is bled with the city inspection division. GREASEIINDUSTRL ERI RA CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP ` � � l COMPENSATION INSURANCE (This section need not In completed lithe pemtit is forom hundred dollars($100) SEWER-SANIT -STORNMT.2fN LL E. or less.) I certify that in the performance of Ne work for which this permit is Issued,l shall WATER H WN T/ELC not employ any peourn in any meaner so as to become subject to the Worker% Z Compematian Lawsof Califomiu. Data WA' SYSTEWTR - — - - — Receipt# Applicant Z 0 NOTICE TO APPLICANT:ILafier making this Canificamaf Exemption,you should NEW RESIDENTIAL PLMB. SQ,ff. TOTAL: y scome Subject o the Worker'a Compensation provisions of the labor Code,you must forthwith comply wit such provisions or this permit shall be deemed revoked. BUILDING FEE �+ W O 'CONSTRUCTION LENDING AGENCY SEISMIC FEE rrR�� I hereby Wfinn that them it u constructdin ion leng agency for the performance of TOTAL: ELECTRIC HE work for which this permh is issued(Sec.3197,Civ.C.) Lender's Name OF Leader's Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE V 1 cenify that I Rave read this application and amre that to above information is correct, le to comply with cit and court Ordinances and stale laws tabbing to MECHANICAL FEE gree gyve' y ry g PERMIT ISSUANCE U Z adinvang rationed propert hertbypectio p purposes. ivesohhiecirywrnRr upon to CONSTRUCTION TAX V z ebove-mentagmepsave, for inspection purposes. ,.,...�-- ALTER OR ADD TO MECH. (We)agree to save,indemnify and keep harsnwrny at cupcnits against Riddilities,ju mnts,em and pence w 1 aymany weyecrneageinm said City AIR HANDLING UNIT(TO 10,gN)CFM) in coreey ming this AIR HANDLING UNIT(OVER IQ ) ewreo pplicue ntractar CXI IAUSTHOOD(W/DU PAID AZARDOUS MATERIALS DISCLOSURE HEATING UNIT ITO I ,000 BTU) Dale Receipt a Will the applicant m future building occupant stare or handle haurdous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Haps and Safety HEATING UNIT(017M I(p,(100 BTU) TOTAL: Code,Section 23532(e)T CI Yes ❑No VENTILATION FAN(SINGLE RESID) Will theepplicunmw rfure huup iltlingoccant useequipmenmrdevi¢s OOILER-COMP(3HPOR IUgObo BTU) SOCE DATE which emit 66// humidors air contaminants as defined by the Bay Arca Air Quality Management BOILER-COMP(OVER 103,000 BTU) ©(1 _ Diatderr n!'I �9A^ ❑Yes 13 No NEW RESIDENTIAL MECH. SQ.FT. C! 1 have mad the Safety Cos,materials 5505,2mrnu under Chapter 6.95 rd to V California Halts&Safety Code,Section 23505,25533 and 25334. I understand Net C�rCh/II yV if the building does not currently have a IenrnE that it is my rcsponsibiliry to notify to occupant o(the requircmenu which muss be ma prior to iuuence of o Cenifiam op Occupancy. Owner in adhrri,ced agent Data TOTAL: ISSUED BY: OFFICE