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28109 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPIsR'PINO .>I, - LL 1 AI. PERMIT NO, APPLICA'T'ION/PERMIT PhIIMIIING-MECHANICAL. 2 O a� O 9 BUILDING DIV]SION% BUILDING YROJEC'I'IDEN'I'IF'ICA'['[ON L o 1 J y . BUILDING ADDRESS: AyF q/�J `xp SANT I'ARY NO. AR'LIGTIO/N9SUBMfITA1(�DA`TE ZOO 1 / -02/rJ i"Voi> A994 UNIT# LOT# JJJJo 7 L ((r+ OWNERS AME: PHONE: CONTRAC R'SNAME: LIC NO: t /1 xr /.vrn � 7 leo N2 CONTROL# ARCHI :CHI'./^1N : �( IAC NO: AUDHI�SiS'/(o /�LD/Lr lO/l�4`a CONTACT: �1 PHONE: QTY.. ELECTRIC PERMIT FEE BUILDING PERMIT INFO BLDG ELI!C7 PLUMB MEECCIII� PERMIT ISSUANCE 3z. el(�Jj 1 jc LICENSEDthCON censedRAM OR erpreSDECLARATION APPLIANCES-RESIDENTIAL )OB DESCRIPTION p0Z 1hereby affirm7")ofDi that rum ofthnxdinss and previsionsofapter Code. 9nd(commencing cense wish �SOO fall iocettedofDivi.inn3afthe Business and Rvfessions Code.and my license is in PANELS mF. rullraree.anderceet. ? �U[) S3o7 UP T020h AMPg YLX, p L2an�xcwx.��--yy/��'/-1.m.k bo< Dae , e 'F A Car", or G[.1/r/v 201-I(Xp AMPS F^v Z RCHI MCPS DECIARATIONSO.IT.FLUOR AREA S/SQ.IT. ZOv, OZ—❑— lundenand my plans shall be used as public lecordv. OVEN ILOO AMPS P w Ful SIGNS ELECTRICAL ayEjLicensed Professional ryrca OWNER-BUILDER DECLARATION SPECIAL CIRCUITIMISC. KOiu 1 hereby affirm that 1 am exempt from the Contractor's License Law for the m3Wm following rcusun.(Scent 70313.Ravines i I Profe,irse,Code Any city,coumy TEMP.METER OR POLE INSP. OJ which requires a permit to couslmcl,since.improve,demolish,or repair any structureFEY2 priorm its issuance.also remains he applicant forsuch Permit o file a signed statement POWER DEVICES ui,JapO that he is licensed pursuant to the provisions of the Contractor's Licenx Law(Chapter SWIMMING POOL ELECTRIC 9(commencing with Section]"N))ofDivision 3 or the Bulinus and Professions Code) A _ _VALU,VI[ON onhat he is exempt therefrom and the basisfnrthe alleged exemption.Any violmionof OUTLO S-SWITCHES-FIXTURES �{�y�/j� T �ZG Section 7031.5 by anYapplicant for a permit subjects the applicanuoacivil pcnahy of �� !l'�—„ not more than five hundred dollam(5510).�Fo NEWRESIDENI'IALELECR S .PT.❑ I,asnwncnrf the property,onnycmployccswilh wages aslhcinnlemmpcnsndon, Q STORKS TYPE CONSTHUCfION a3De will Jmhe work.sud thesmcmreisnut i,nenJMoroffered fn aleXce.7044.Business and Professions Cade:The Committers License law does not apply to an owner of property wlnr milds or Improves thereon,and who does such work himself rOhrough his cmployccs,PmviJedhmsuch intprovemm�ls¢renin imenJaf or nlfcrcdforsulc.If, OCC.GROUP RBS.UNITS however,the buildingur improvement is sold within one year ofcompletion.the owner- TOTAL: builder will have the burden of proving that he did not build or improve far purpose of sole.). PLUMBING PERMIT FEE F, C] I,arawna of the propenY.um exdmively contrnning wish liven%eJ cunuaaatsm FI.GGD ZONE APN answer the project(Sec.7044.Business and Professions Code.)-Me Contrailms ] License Lawdeas notapply in an ownermpropcny,whobuddsurimproves thearn.and PERMIT IS E Z �4 whoconuacts for such projects with u conmicba(e)licensed pursuantto the Conmictors iccnu Law. AI TER DRAIN&VENT-W R(EA) PEE SUMMARY L ❑ I am exempt under Sec. ,B&P C for this reason BAC ROW PROTECT.DEVICE SANITARY PEES SANITARY YN Owner —D.— D AINS-FLOOR,ROOF,AREA, RECEIP 0 c WORKMAN COMP ENSAI[ON DECLARATION , . . SCHOOLTA% Y N /a�L•I hereby affiw that l have a certificate ofcomen,loself-inmrc,or a uni0cate of XTURES PER TRAP RECEIPT# Workers Compensation Insurance or a cenifiedeWy thereof(See.381X1.Lab C.)which PARK FEE Y—N — covers allcmpo cc's under this pemtit. GAS-IiA.SYSTEM-IINC.4OUTL S Policy r ham— ono an.2 RIiCEIPT#BUILDING DIVISION FEES YGAS-FAVE .SYSIM R 4(EA) PLANCHECK FEE ificd copy i.hereby famished. ❑ Certified copy is fled with the city inspection division. 0 EASE/INDUSTR(WASiPE 1 1 F O GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETR P W SOILS FEE COMPENSATION INSURANCE if ('this section need not be completed ifthc Permit is forome hundred dollars 51000 SEWER-SA -g R f LA.20(l ENERGY ITE or less) I certify that in perfownnce ofthe work for which this permit is issued Is 11 WATERT 'Al AWN )E R not employ any person in any manner so as to become subject to the Worke PAID Coon,emmina Law%of Califomi¢. Dale WAT' TF.M/IAEA N, Dam Receiptp O z Applicant NE FSIDI? IAL .MB. SQ.FT. TOTAh: Z NOTICE TO APPLICANT:IL after slaking this Cenificate of Exemption,youshould I-' fA become subject to the Worker's Compensation provisions of the L¢hor Code.you must � ; forthwith comply will such provisions or this Permit shall be deemNrevoked. BUILDING FEE (] CONSTRUCTION LENDING A6I7NCY SEISMICFEE V Z thereby affiw that them ixa careameJon lendinga8ency for the performmceof a the work for which this permit is issued(Sec.3097,Civ.CJ TOTAL: ELECTRICITE 1 D L umer'%Namc 1<ndee,Address QTY. MECHANICALP PLUMBING FEE Mll' FEE _rV U I certify Lha I have reed,his application and state rh¢t dm Axwe information is MECHANICAL fliE ,J r�- Lkl correct. l agrcemcnmply with all city and county oninnnces and%rate lawsrclaingm PERMIT NCE 32.v 3 I— buildingeonaruclinn,and hereby umhodm representatives ofthis city to enterupon the CONST RUCTIONI'AX U Z aMve-memioned prepeny far inspection purposes. ALTER OR ADD TO MSCI I. (We)agree to save,indemnify and keep harmless the City of Caper iso ag¢ims l iabilitics,jadgo.,r sit andcxperecvwhich may in:m ueagainstsaid City AIR HANDLING UNIT(TO 10.000 CFM) in canscgmace,of/�+,Eyr/+��go isis pesnm. AIR HANDLING UNIT(OVER 10,00 CFM) Signature of AppliwnVCon¢acmr Dem EXHAUST NOOD(W4)UCq PAID X=(9 cite--vrrlll -1 HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100.( BTU) Date 0X1 W III the applicant ser(mare huilding rccupam stem or handle ha>.Mmcs material u..Jelbnvl by the Cupertino Municipal Cale,Chapmr9,12,and the health suit Safety HEATING UNIT(OVER 100,000 BTU) TOTAh: 0 Code.Section 25532(x)1 VENTILATION PAN(SINGLE RMID) ❑Yes ❑No ISSUANCE DATE Will l6cuppllc¢mer fmurcbulldinSrxcltpamuueyuipmemnr Jeviceswhichemil BOILER-COMP(JHPOR 100,lKK1 tlTU) haaudous air commonests as defined by the Bay Arc.Air Quality Msua,wical BOILER-COMP(OVER 100,000 BTU) A 1 /� District? A 9 V ❑Yes ❑No NPW RESIDENTIAL MECH. SQ.IT. I have read the haradnus materials rcquiremems under Chapter 6.95 of the MAY 191995 Califomia IIca1,h&SafetyCalc,Sedans 25505.25533 and 25534. 1 undersand that, if the huilding does an,torrent,have a tenant,that it is my responsibillty m notify the I� aapart of the reyldrem enis which must be met prior to issuance of a Cerem fe, of Cl I Y Occupancy. lrurtH1llly , Owni,mitucauedit,rd Date TOTAL -� ISSUED BY�r OFFICE