22516 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
Building project Idemifteaion . I ,PERMIT NO.
Building Address: F s ,5, , '�. 22516
la O /LL i A 6
•'I° ners ams: - one: rA
CITY OF CUPERTINO-BUILDING DIVISION" -775
�•,
s APPLICATION / PERMIT '--L
�Contractor'e Namc: L34P?-1
Ic��sNppo��a _
B ✓1^ O£f I /'T o: BUILDINGELECTRICALI'LIIMBINC-MECHANICAL : CATEGORY CONTROL N
Architect/Engineer. Lic.No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address: r"� *-s,
T P[RMIT ISSUANCE L•L� Ilk l (— 0
LICENSED CONTRACTORSunderDECLA RATION LJ /LAJN
Ihereby hSacfi n7000afDimilicensed3.fthnderprovlslonsa/Chapter9 do,and c APPLIANCES-RESIDENTIAL JO DESCftII'ffON
inenseiSection to.and dieon3 ofthe Buslneaeand ProfenslonsCode,and my' A
License
Is In full lora and e.N' _ PANELS (.^`A �1 ,
License Claw Contra ,N:•-1F t lJW
Data Comnctor ,
ARCHITECTS DECLARATION 201-1000 AMPS
re0 ZO "
Licensed Professional I understand my plain shall be used as public records. OVER 1000 AMPS - SQ.Fr.FLOOR AREA $/SQ..y17-
Ce �j SIGNSELECTRICAL /r,,'�' 7q, -` 2-
GG< OWNER-BUILDER DECLARATION ikt d
G a SPECIALCIRCUIT/M I
E,Y� 'I herebyafOrmthatlamexcmptfmmthe Comnttofs Limnee hw(oaths
oo following reason.(Section 7031.5,Business and Professions Cade:Any city,or
F7q, cmntywhichrequimsapermittommtmct,alteglmpmve,demolbh,ormpalr 7FMP.METERORI'OL B IVIFVTER .
�2aecqa anystmv mpdorto RsL ancgal requlmstheapph.niforsuch perrNt to POWER DEVICES C
K c U file a signed statement that heat licensed pursuant to the provisions of the L
Contractors License Law(Cha er9(come
encin ith Section
7000)of Diel. SWMMNG 1AELECTRIC
�3gtslon3oftheBusinessandProfesdomCode)orthagheIsexempttherefeemand VALUATION
the base,(or the alleged exemption. Any violation of Section 7MLS by any "OUTLETSSWITCIIFSFIXTURFS
<� applicantfora permit sub)ects the applicant to a civil penalty a not more than ..JJJ
p, flue hundred dollars(5500). NEW RFS[DENTULELECIR SQFT. STORES TYPECONSTRUCTION"
�j.. ❑I,as owner of the property,or my employees with wages as their sole'
�7< corhPreagion,will clothe work,and thestmcture is not intended or offered for
❑
sale(Sec.706d,Business and Professions Code:The Contractors License Law
$$ does not apply to an owner of property who builds or improves therron,and t OCC.GROUT' RES.UNITS
whodoeesuchwork hi�Borthrargh Msownempleyees,provided that such
immn
proveenam not Intended oroffered forssle.I(however,the buildingor .TOTAL: '
Improvement lswM within oneyearofcomplctiogtheowner-bu0derwill love
tlr�isrden of proving that he did not build or improve for purpose of sale.). QTY. PLUMBING PERMIT FEE FLOOD TONE APN -
u L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
contractors to construct the project(Sec.70K BwNess sed Profevioru Code:
The Contractor's License law does not apply to an owner ed property who ALTER-DRAIN&VENT-WATER ffN
m
bu0ds or imp.thern,and who contracts for such projeets,with+ FEE SUMMARY
tTcactors)licensed pursuant to the Contractor's License Law. - BACK FLOW PROTECT.DEVICE
aexempt under Sec. B& P C for this masonOUTSIDE FEES
DRAINS FLOOR ROOF,AREA,COND. SANITARY Y_ N_
Owner Date - - _ RECEIT N
t
Of
hereWORKMAN COMPENSATION DECLARATION ,,' FIXTURES PER TRAP r1`..eh SCI TAX Y_ N_
by affirm that I have a certlRnte of consent to self-Insure,ora l s-CJ RECEIPT N
cenBicmeofWorkeri Comperoatlonlwuranmora certified copy thamof(Sec. CAS EA.SYS7Qd-1 INCA OUTLETS PARK FEE Y N +
3800,Lab Cd —
RECEIT N
Policy M CAS PA. BUILDING DIVISION FEES
cram any � -
�Certifiedcopyatherebyfurnished. CRF I`INDUSIRL WASTE INTERCEPTOR PLANCHGCK FEE
❑Certified copy is filed with the city inspection division.
CERTIFICATE OF EX'EMPTiON FROM WORKERS' GREASE TRAP PAID � s��-
COMPENSATION INSURANCE SEWER-SANITARY-STORM EA 2WFf - Date Recei tk ` L�
f
(E100)o(( ele )ss. need not dc�mpleted if the permit atforonc hundmd dollars
ifyth WATER HEATER W/VFNT/ELECTR ENERGY PGE Y_ N_
I certilythat In the performance of the work for which this permit is Burned, '
I shall not employ any person to any manner w as to become subject to the WATER SYSTEM/TREATING
Workcri Compensation Laws of Calfonn. Date PAID-
0
AIDO Z Applicant NEWRESDENTIALPLMB. SQYr. Date. Recei t#
Z 0 NOTICE TO APPLICANT:If,after nuking this Certificate of Exemption,you
should become subject to the Workers*Compensation provblovof the Labor _ TOTAL:
Code,you must forthwith comply witheuch provisions orthls permit shall be BUILDING •E
p' `> deemed revoked.
W E CONSTRUCTION LENDING AGENCY SEISMIC FEE f _
ll O Iherebyaffirenthst there 6a construction lendingagency forthe perform TOTAL: ELECTRIC FEE
Z sore of the work for which that permit Is Issued(Sec 3097,Civ.C.) `
U O Iaedere Name PLUMBING FHB (L&00
F Leaderi Address QTY.I MECHANICAL PERMIT FEE
O W. Icertlfy that l have madthat applicationand statethat theabove Information MECHANICAL FEE
Is correct.I agree to comply with all city and county ordinances and nate laws PERMIT ISSUANCE FEES PAID:
} W relating to building construction,and hereby authorize representatives of this ,
F U) ,city to enter upon the abovc�rmntloned property for inspection purposes. ALTER OR ADDTO MECH.
Date RecciptA
(We)agree to save,indemnify an d keep,harmless the Cly o(Cupe tho
V erem ago Wtllabilitle nsd count, expenses which may In anywayamue AIR HANDLING UNIT(TO 10,000 CFM) � SUBTOTAL: '
agar O�i o e nc of the grant g of this permit.
., AIR--11/ 2 � p1. I I-IANDUNG UMT(OVFR IB,aro cFM) � CONSTRUCTION TAX
Si nstem erA punnvcannrta f7. o;n EXHAUST 110013 CW/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS ER IALS DISCWSU RE
Will the applicant or future b11 ng occupant store or handle hazardous- HEATING UNIT(70,100,000 BTT) Date Recei t#
material as defined by the Cupe no Municipal Code,Chapter 9.12,and the -
I With and Safety CdeerrrSectiosi 25533(a)? HEATING UNIT(OVER 100,000 BTU) TOTAL:'
❑Yea M No
Will the applicant or futum building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit hast pious air cents minams as deo ned by the Bay Area Air
urIlty Management District? BOILER-COMP OEI'OR 100,000 BTU)
n Yes ❑No' nn..
Tb] read the hazardous materials raquircmenb under Chapter 6.95 of BOILER-COMP(OVER 100,000 BTU)
the California Health&Safety Code,Sect least 25505,25533 and 75536. 1
understand that if the building does not curmntly have a tenant,that it at my NEWRESDENTIALMEf71. SQ.FT. •�
responsibility to notify the ecru pa rat of the requirements which at be met of 1!4
_ 'prior to issuance W a Certificate of Occupa pry. � 1
Owner or authniud agent Date Y ISSUED B i I
TOTAL:
I' OFFICE COPY