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25835 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY BUILDING-ELECfRTCh. I'IiNMIT NO. CITY OF CUPERTINO PLUMBING-MECHANICAL BUILDING DIVISION - APPLICATION/PERMIT NUILDING YNO.IECIII)EN'1'l F'ICA'1'ION BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DAII a 8(/q ©//�. `ELLE UNIT LOT4 ltila-�t3 O #ERS/ Maw1/00� _ PHONE: C M'RACT 'S(]$ NAME:_ /I LIC NO: SIC CONTROLp ARCHGECUENGINEER: -- LIC NO: ADDRLSSGxaovK''Ga/'`�G- V/✓ CONTACT': PHONE: QTY .,i it "�,,'quBL'ECTR�IC PERMIT:' FEE BUILDING PERMIT INFO 2'S C-fjZ3 Y BLDG LE B MECH G/.IOL ,/✓✓ /!� PERMIT ISSUANCE LICENSEDCO�NTRJACfTOOR'SDECLARATION APPLIANCES-RESIDENTIAL TOB DESiCRIPTION mwl hereby aflimt that l am licensed under provisionsof0apter9(commencing with _ p100 Section 7000)ur Division Jof the Buslnexs and Prof essnot Code,and my license i5 in PANELS 6�'WtF- lullforte mW ellect. <_ L.icenWCm a Lic.p Z /�f� UP T0200AMP5 Fm e. Date A CHITECTSDECItM 1 I. �^'- 201-1000 AMPS FT.FLOOR AREA E/SQ.FT. 70y— OVER 1000AMP5 I em Is ilewia OZ—O IunJcmmnJ plunsx usod as ublic mcoN Cy SIGNS ELECTRICAL T ,7 ®�Il WV` (J co ��dd hI¢nmA Pnquxim OWNER-BUILOH E RATION SPECIAL CIRCUIT/MISC. a0a0 I h'mh'affirm that 1 am exempt m the Cnnuumur's License Law for the N 3 a ti following reesan.(Section 7031.5.Business and Professions Code:Any city or county TCMP.METER OR POLE WS . f—u' which rcyuircs a permit to construct,alter,improve,demolish,or repvr any structure - CWQS prior to its issuance,also requires the applicantfnsuch permitto file asigncd smarmnt POWER DEVICES W,'QQ thus he is iccn.wA pursuant the provisions of Ne Contranor's License Law(Chapty SWIMMING POOL ELECTRIC l N 1a0d e� 9Unmmcncing With Section 70018 of Division J ofthe Business end Profexsimns Code) 1 or that he is exempt therefrom and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES-FIXTURES 1 �- F g QSection 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of F 0 not more than five Hundred dollars(5500). NEWRESIDENTIALELECfR _SQ.IFt. STORIES TYPE CONSTRUCIIOI, Wim ❑ I.asownaofthepropcny.mmyemployecswithwagcsmt irsolecomprnumion. a3— willdothc wurk,and the structure is not imendedoroffered foretaste(Sm.7044,Basimss and Professions Crate:The Contactors License Law demes not apply to an owner of property who builds or improves therc+m.und whodmsstmh work nimmlforthrough his I dad Nat such ire e 1 wenot in¢ndedoroffercJ forsale.IL OCC.GROUP IGS.UNITS amp eex,pm.i provem n s however.the building or impzmvemem is ante within one yearoremmpletfon.Neownn- builder will have the burden of proving that he did not build or improve for purpose of sale.). QTY. PLUMBING PERMIT FEE Fl.00D ZONE AYN ❑ Las wnerofthepropmy,amesclusivelycommetingwithlicensodconwetomw construct the pnjm,(Sec.70,14,Business and Profasbms Code:)The Commemr's License Law Jocx not apply to an ownend'propeny whobuildsurimprmvestnaman,and PERMIT ISSUANCE who concoct%Gro such pmject,s with demorecmr(s)licensed pursuant o the Contractor's ALTER-DRAIN&VENT-WATER(EA) 1717E SUMMARY License Law. C] 1 am exempt under Sm. ,B&P C for Nis mason BACK FLOW PROTECT.DEVICE TSIDE FEES SANITARY V N Owner Data DRAINS-FLOOROORAREA.COND. RECEIPTp R, SCf100LTA% YN WORKMAN COMPENSATION DECLARATION ❑ Thereby affirm Natlhaveaceri0cau of conxm mself-insure.orneenificam of FIXTURES-PER TRAP RECEIPT# Workerd Cnmpencminn lnsurnncm oracenl0ed copy therud(Sec.3800,Lab CJwM1ieh �'^ PARK PliI3 YN covers all employees under this permitGAS-FA.SYSTEM-1 INC.4 OUTLETS RECEIPT# BUIL ING DIVISION f;",5 Policy# Company GAS-EA.SYSTIiM-OVER4(FA) PLANCIIECK FEE ❑ fied copy is hereby bummed. Pzified copy is filed with the city inspection division. GREASEANDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS 1'1 COMPENSATION INSURANCE flbisaemimn needriorh emmplenal if Ne permit is formic hundred dollm(SI00) SEWER-SANITARY-STORM EA.200FT. ENHNC or less.) I cenifythm in the performance of Ne work for which his permit is iuvod.I shall WATER HEATER W/VENT/ELECTR not employ any person in any moaner so as to became subject to the Workers' PAID Compensation Lawsmf Califomia. Dam WATER SYSTEM/TREATING Dre Receipt# O Z AppitroNOTICE NEW RESIDENT'IALPLMB. SQ.PT. TOTAL: Z Z NOTICE TO APPLICANT:IL ager making Nis Ccnificam of Exemption,you should (- fA lam,pe ubjecuo the Workers Compensation provisionsofthelabor Code,youmard .J ? final comply with much provisions m this permit shall ba deemed revokW. BUILDING 'E W0. F CONSTRUCTION LENDING AGENCY SEISMIC q E i 2n Z I Hereby affirm that is a construction lending agency for the performance of U O The work for which this permit is issued(Sec.3097,Civ.CJ TOTAL: ELECTRIC E Lender's Name PLUMBING D" F Lenders Address QTY. MECHANICAL PERMIT FEE Ll 0 U I camiry that I have read this applicefion and sum that th<above information is MECHANICAL W correct. legree In comply with Wl city vtd county mNirTnn«send sou laws mletingm PERMIT ISSUANCE f^ 0 building cooswmlon.andhereby authorize momaenativesofthiscity to crime upon the CONSTRUCTIONT % Uabove-mentioned propcny for inspection purposes. ALTER OR ADD TO MECH. (We)agree Ht save,imlemnify w0 kap females,the City of Capetian ugumst Iiabililas,judgracep.costs and cxpemes which may in any way accrue against said City AIR HANDLING ON]'1'(TO 10,W()CPM) me f thcgadndrg ofthis pc tit. (c' ^A AIR HANDLING UNIT(OVER IO.IXq CFM) Signature of Applicnm o 1K• EXHAUST HOOD(W/DUCT) PAID HA RIIOUS MATERIALS DISCLOSURE HEATING UNIT(TO[00,WO BTU) Date ecciptX Will the applicant or future building mcupam store or handle hazardous material IIEATING UNIT(OVER 100,"BTU) TOl'AL: ns defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(x)? VENTILATION FAN(SINGLE RFSID) ❑Yes EI No ISSUANCE DATE Will the applicantorfuturebuil(lingmcupmt usecquipmencmrdevices which emit BOILER-COMPl3HP OR 100,000 BTU) hocardous air conuminants as defined by the Bay Arca Air Quality Management BOILER-COMP(OVER 100,000 B'TO) .'District? TIPAID ❑Yes ❑Nn NEW RESIDENAL.MECH. SQ.FT. 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533 and 25534.1 understand that di iDEC 10 19 if the h ng does not currently have a tenant,that is my responsibility to notify the t occupant of the requirements which must he met prior et issuance of a Certificate of p J OccupanuY. 'CBY Owner or auNnrivN agent Dam TOTAL: ISSUI?D BV' INV OFFICE