24448 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project IdemiHueon PERMITN24448 .
Q, 4 4 4 8
Building Address_/[''- Z
wnero a one: p q A -
WTX T CITY OF CUPERTINO-BUILDING DIVISION 11 T1,1
Contrac�:, LIc.N. APPLICATION / PERMIT
�_V BUILDIN60,ECTRICAL-PLUMBINC-MECHAMCAL CATEGORY CONTROL N
Architect/Engineer. Lie.Na:
QTY ELECTRICPERMIT, FEE BUILDING PERMIT INFO
Address: PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that lam licensed under provisions of Chapter9(commmc ANCESRFSIDENTIAL JOB DESCRIPTION
Ingwlthgect1on7000)of Divislon3otthegusinewand ProlssslonaCode,and my
license Is In full force and affect. PANELS
Limme Chas Lic.s s•1-fT
Oats GHITaeter - KI
�P/')
ARCNITECTSDECLARATION OVER
000 13SAM �r3 $/S
In
O 7 ]understand my plans shag be used as public records OVER 1000 AMPS SQ.FT.FLOOR AR E/�.
CO
Licensed Professional SIGNS ELECTRICAL
. ¢ - OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC "^s
Iherchyat@mthatlamexempt fromthe Cenvacure License Lawforthe
07.: � following reason.(Section 7MIS,Business and Professions Code:Any city or
O M H TEMP.MLTLR OR POLE INST.
r� anusmw cop orto[Np ancoao regt,altegimpbv tforsul orrepto -
ga file.anyssucwreprtarto itshathe If alw requimsuant t the forsuionsof�pet e POWER DEVICES
u file a signed statement that helicensed pursuant it the ti provisions Of the
Contractor's Llcenselaw(Chapterg mnurencin IthSedlon7000Io(Divi.
H 0r^ ston3ofthe Business and Profeions Code)or(hatt he b exemptiherefecmand
SWIMMING POOL ELECTRIC y p VAp,IION
6 5 the basis for the alleged exemption. Any violation of SV
ection 7031.5 by any OUTLEISSWITCHESFIXTURES A Y T E y.{
�O applicant Fare permit subjectsthe applicant to a dvil penalty of no morethen E l
red dollars($500). NEWRESIDENTIAL ELECTR �.FT. RI TYPE CONSIRI/CI'ION
�n ?'Elsu
owner of the property,or my employees with wages as their sole .A�r.E
� ¢ for -_-
7054 Business and Professions Code:The Contractors License LawuIR pply to an ownerafpropertywho Build..,improvnthereon,and OCC.GROUP RES.UNRB
who docs such work himeafforthrough his own employees,provided that such
Improvements are not intended or offered for ask.If,however,the building or T
ImprovementlssoldwoM...o,e...k.,letion,theowner-WBderwElluvs
tm .nden of proving that he did not build or Improve for pu rpose of sakJ. QTY, PLUMBING PERMIT rrE FLOOD ZONE APN
u L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE 1
contractors to comtsuct the project(Sec.7054,Business and Professlors Code:
The Contractor's License Law docs not apply to an owner of property who ALTER-DRAIN VENT-WATER(EA)
Wilds or Improves thereon, and who mMracb for such p,*U with a ct[actor(s)licensed pursuant to the Contractor's License Law. FEE SUMMARY
uI am exempt under Sec. B&P C,for thio reason BACKFLOW PROTECT.DEVICEDRAINS FLOOR ROOF,AREA,CON). SANITARY Y N�Owner Date RECEIPT N
WORKMAN COMPFI96ATION DECLARATION FIXTl1RFS PER IRAIs SCgOOLTAX Y N_
F-11here affirm that I have a cerHOmte of consent to saB-insure,ora RECEIPT a
certificate mWorken'Compensation Insurance ora certified copythereof(Sec. GAS EA.SYSTEM-1 INCA OUTLETS PARK FFR Y N
3800,Lab C.)
RECEIPT'X
CF3policy y GAS EA.SYSTEM-OVER 4(EA) BUILDING DIV]SI ON FIT ES
�m an
[�CcrtNed copy is hereby furnished. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
❑Certified copy is tiled with the city inspection division.
CERTIFICATE OF IXEM PFION FROM WOR K ER S' GREASE THAT PAID
COMPENSATION INSURANCES[WER-SANPfARY-STORM EA.200FT. Date Revel t#
(fhissectbn need not be completed If the permit h forom hundred dollars
(S1 W)orless.) WATER BEATER W/VFM/ELECTR ENERGY FEE Y= N_
I certify that In the performance of the work forwhich this permit is Weed,
I shall not employ any person In any manner an as to become subject to the WATER SYSTEM/TREATING
Workers Compensation laws or California. Date PAID
O Z Applicant NEW RES DENT AI PLMB. SQF.
F- Date Recei t#
Z O NOTICETO APPLICANT:If,after making this Certificate of Exemption,you
should become sub)ect m ns
the Workers'Compensation provisions or the Labor TOTAL:
(7 Code,you must forthwith comply with such provisions or this permit shall be BUILDING FEE
LLI j deemed revoked.CONSTRUCTION LENDING AGENCY SEISMIC FEE
d Ihereby afRrn that there is a construction lending agency for the perform- L ELECTRIC FEE
Zanceoftheworkforwhlchthispermitls Weed(Sec.3097,Civ.C.) PLUMBING FEE
(� O Lerdcre Name
H Lender's Address QTY. MECHANICAL PERMIT FEE MECHANICALFEE
LL U I certilythat l have read thisapplicalionand state thatthe above information
O W . iscorrect.I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE PEES PAID:
>- 1. relToing to building construction,and hereby authortm representatives ofthis
I.- city to enter upon the above-mentioned property for inspection purposes. ALTER ORADDTO MITCH.
(We)agree to save,Indemnify an d keep harmless the City of Cu pen in Date Receipt#
V against llabilllies,judgments,cost sand expenses which may In any way accrue AIR HANDLING UNIT 8010,000 CFM) SUBTOTAL:
against said City In consequence of the granting of this permit.
' AIR HANDLING UNIT(OVER 10,000CIiM) CONSTRUCTION TAX
n ore of Date EXHAUSTHOOD(W/DUCT) TAX PAID:
s
HAZARDOUS MATERIALS DISCLOSURE -
Willtheapplicantorfuture building occupant store or ha odic haeadom' HEATING UNIT(TO 100,000 BTU) Date Recel CCV7��
nstertal as defined by the Cupertino Moulded Code,Chapter 9.1 7,and the
flealthand Safety Code Sccoon75532(a)7 • HEATING UNIT(OVER 100,000 BTU) - TOT f—
❑ Yestl+�-,I No
Will the applicant More building occupant use equipment or devices V FNTIIATION FAN(SINGLE RFSID) ISSUANCE DATE
which emit hamudns air contamins ats as defined by the Bay Area Air
Quality Mawgcmcnt Di tdct7 BOILER-COMPOHPOR 100,000 BTU)
No4yeaodl�
havereusmaterials irement...derChaper6.95of BOILER-COME(OVER100,000 BTU)the Californfety Code, I m 7550.5,75533 and 255M. I1understandI ' cid n rrcntly havr.uua.t,th,tItismy NEW RESIDENTIAL MECH. SQ.IT.prior t issutc mquircrrents which must W met5 19 prior to WuIf a •,0VQOveneroraum Date ISSUED BY-. C,I�ItIVU
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project IdemiHueon PERMITN24448 .
Q, 4 4 4 8
Building Address_/[''- Z
wnero a one: p q A -
WTX T CITY OF CUPERTINO-BUILDING DIVISION 11 T1,1
Contrac�:, LIc.N. APPLICATION / PERMIT
�_V BUILDIN60,ECTRICAL-PLUMBINC-MECHAMCAL CATEGORY CONTROL N
Architect/Engineer. Lie.Na:
QTY ELECTRICPERMIT, FEE BUILDING PERMIT INFO
Address: PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that lam licensed under provisions of Chapter9(commmc ANCESRFSIDENTIAL JOB DESCRIPTION
Ingwlthgect1on7000)of Divislon3otthegusinewand ProlssslonaCode,and my
license Is In full force and affect. PANELS
Limme Chas Lic.s s•1-fT
Oats GHITaeter - KI
�P/')
ARCNITECTSDECLARATION OVER
000 13SAM �r3 $/S
In
O 7 ]understand my plans shag be used as public records OVER 1000 AMPS SQ.FT.FLOOR AR E/�.
CO
Licensed Professional SIGNS ELECTRICAL
. ¢ - OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC "^s
Iherchyat@mthatlamexempt fromthe Cenvacure License Lawforthe
07.: � following reason.(Section 7MIS,Business and Professions Code:Any city or
O M H TEMP.MLTLR OR POLE INST.
r� anusmw cop orto[Np ancoao regt,altegimpbv tforsul orrepto -
ga file.anyssucwreprtarto itshathe If alw requimsuant t the forsuionsof�pet e POWER DEVICES
u file a signed statement that helicensed pursuant it the ti provisions Of the
Contractor's Llcenselaw(Chapterg mnurencin IthSedlon7000Io(Divi.
H 0r^ ston3ofthe Business and Profeions Code)or(hatt he b exemptiherefecmand
SWIMMING POOL ELECTRIC y p VAp,IION
6 5 the basis for the alleged exemption. Any violation of SV
ection 7031.5 by any OUTLEISSWITCHESFIXTURES A Y T E y.{
�O applicant Fare permit subjectsthe applicant to a dvil penalty of no morethen E l
red dollars($500). NEWRESIDENTIAL ELECTR �.FT. RI TYPE CONSIRI/CI'ION
�n ?'Elsu
owner of the property,or my employees with wages as their sole .A�r.E
� ¢ for -_-
7054 Business and Professions Code:The Contractors License LawuIR pply to an ownerafpropertywho Build..,improvnthereon,and OCC.GROUP RES.UNRB
who docs such work himeafforthrough his own employees,provided that such
Improvements are not intended or offered for ask.If,however,the building or T
ImprovementlssoldwoM...o,e...k.,letion,theowner-WBderwElluvs
tm .nden of proving that he did not build or Improve for pu rpose of sakJ. QTY, PLUMBING PERMIT rrE FLOOD ZONE APN
u L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE 1
contractors to comtsuct the project(Sec.7054,Business and Professlors Code:
The Contractor's License Law docs not apply to an owner of property who ALTER-DRAIN VENT-WATER(EA)
Wilds or Improves thereon, and who mMracb for such p,*U with a ct[actor(s)licensed pursuant to the Contractor's License Law. FEE SUMMARY
uI am exempt under Sec. B&P C,for thio reason BACKFLOW PROTECT.DEVICEDRAINS FLOOR ROOF,AREA,CON). SANITARY Y N�Owner Date RECEIPT N
WORKMAN COMPFI96ATION DECLARATION FIXTl1RFS PER IRAIs SCgOOLTAX Y N_
F-11here affirm that I have a cerHOmte of consent to saB-insure,ora RECEIPT a
certificate mWorken'Compensation Insurance ora certified copythereof(Sec. GAS EA.SYSTEM-1 INCA OUTLETS PARK FFR Y N
3800,Lab C.)
RECEIPT'X
CF3policy y GAS EA.SYSTEM-OVER 4(EA) BUILDING DIV]SI ON FIT ES
�m an
[�CcrtNed copy is hereby furnished. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
❑Certified copy is tiled with the city inspection division.
CERTIFICATE OF IXEM PFION FROM WOR K ER S' GREASE THAT PAID
COMPENSATION INSURANCES[WER-SANPfARY-STORM EA.200FT. Date Revel t#
(fhissectbn need not be completed If the permit h forom hundred dollars
(S1 W)orless.) WATER BEATER W/VFM/ELECTR ENERGY FEE Y= N_
I certify that In the performance of the work forwhich this permit is Weed,
I shall not employ any person In any manner an as to become subject to the WATER SYSTEM/TREATING
Workers Compensation laws or California. Date PAID
O Z Applicant NEW RES DENT AI PLMB. SQF.
F- Date Recei t#
Z O NOTICETO APPLICANT:If,after making this Certificate of Exemption,you
should become sub)ect m ns
the Workers'Compensation provisions or the Labor TOTAL:
(7 Code,you must forthwith comply with such provisions or this permit shall be BUILDING FEE
LLI j deemed revoked.CONSTRUCTION LENDING AGENCY SEISMIC FEE
d Ihereby afRrn that there is a construction lending agency for the perform- L ELECTRIC FEE
Zanceoftheworkforwhlchthispermitls Weed(Sec.3097,Civ.C.) PLUMBING FEE
(� O Lerdcre Name
H Lender's Address QTY. MECHANICAL PERMIT FEE MECHANICALFEE
LL U I certilythat l have read thisapplicalionand state thatthe above information
O W . iscorrect.I agree to comply with all city and county ordinances and state laws PERMIT ISSUANCE PEES PAID:
>- 1. relToing to building construction,and hereby authortm representatives ofthis
I.- city to enter upon the above-mentioned property for inspection purposes. ALTER ORADDTO MITCH.
(We)agree to save,Indemnify an d keep harmless the City of Cu pen in Date Receipt#
V against llabilllies,judgments,cost sand expenses which may In any way accrue AIR HANDLING UNIT 8010,000 CFM) SUBTOTAL:
against said City In consequence of the granting of this permit.
' AIR HANDLING UNIT(OVER 10,000CIiM) CONSTRUCTION TAX
n ore of Date EXHAUSTHOOD(W/DUCT) TAX PAID:
s
HAZARDOUS MATERIALS DISCLOSURE -
Willtheapplicantorfuture building occupant store or ha odic haeadom' HEATING UNIT(TO 100,000 BTU) Date Recel CCV7��
nstertal as defined by the Cupertino Moulded Code,Chapter 9.1 7,and the
flealthand Safety Code Sccoon75532(a)7 • HEATING UNIT(OVER 100,000 BTU) - TOT f—
❑ Yestl+�-,I No
Will the applicant More building occupant use equipment or devices V FNTIIATION FAN(SINGLE RFSID) ISSUANCE DATE
which emit hamudns air contamins ats as defined by the Bay Area Air
Quality Mawgcmcnt Di tdct7 BOILER-COMPOHPOR 100,000 BTU)
No4yeaodl�
havereusmaterials irement...derChaper6.95of BOILER-COME(OVER100,000 BTU)the Californfety Code, I m 7550.5,75533 and 255M. I1understandI ' cid n rrcntly havr.uua.t,th,tItismy NEW RESIDENTIAL MECH. SQ.IT.prior t issutc mquircrrents which must W met5 19 prior to WuIf a •,0VQOveneroraum Date ISSUED BY-. C,I�ItIVU
OFFICE COPY