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