2517 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILD '- "- rcc. PliRndITN'O.
APPLICATION/PERMIT PLUMIIING-MECHANICAL, n C '1 7
BUILDING UIVTSION ".,BUILDING PROJECI'IDENTIFICATION a L 51 / `
BUILDING ADDRESS: .am^�y//��gg'\\��• ''g SANIIARYNO. AI'MICAT0N SUBMITTAL DA
V?�Tv_O five
N UNIT# LOT# G
'N R. NA .: a PHONE: CONTRACT'OR'S NAME: LIC NO: N/C CONTROL#
m �r 7333758
�ARCHITECT/ENGIN[ER: LIC N'O: A ESS: ❑
CONTACT: PHONE: `•2' i•tsK1 =m t a _ t. L"r' - S ".�'3'"BUILDING PERMIT INFO
//JJ }•� ;.,q r EmEC�I'RIC PERMFf{.:�, a y,FEES ..
ERMUM yECI�
< PIT ISSUANCE 'Mf
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
p4,Z Ihereby affirm'bar l am licensed underprovisionsofChapter9(emmencing with JOB DESCRIPTION
WOO Section 70(t0)of Division 3 of the Business and Professions Code,and my license is in PANELS �L
y`U
full foreand effea UPT02M AMPS .-..
FZ w License Clusa Lic.p
moi Uam Comrucmr .1100AMPS
n
i—�Z ARCHITECTS DECLARATION OVER 1000 AMPS SQ.Ff.FLOOR ARE 5/SQ.FT.
=� I understand my plans ll h s shaused as public records. OVER /'�
I..,2_1 SIGNS ELECTRI L ��6N
<,2_1Licensed Profasonal VVV Y
z OWU OWI a.BUILDER DECLARATION he ORATION SPEC MISC. ��
40x0 1 hereby affhm thm 1 am exempt from the RATI l.rs License Law for the
CJ following reason.(Section'7071.5,Business anal Professions Code:Any city.,coup6ii I P ETERORPOLET
which rtyuimsapermit to construct ager.improve,demolish.or rcpau my c t
IWr� prior to its issuance,also requires the applicant for sues Permit to file a signedsm WER DEVICES
,W<O that he is licensed pursuant the Provisions ofthe Commemes License law(CTapte
4XCLL 9(commencing with Section 9000)of Diviaion3of the Business and Pmfessiona Code SWIMMING POOL ELECTRIC VALUATION A/'s.
BI_ySntion7hot he031.5byanyapps exempt omanfrtebutato,tbeasegedcxmprisoacivlPenaonof OUTLETS-SWITCHES-FIXNRES 2Q9 V���
FZQ Out an703L5ve hundred
loch for apermit subjects the aPPlicmtmocivil penalty of
not mom tM1m five hunJrcd Jnllars($500). NEW RESIDENTIAL ELECIR _SQ.FT.
6's F_C' ❑ oche wrk,adtepropecium is yemployedoroferedmrsthe(Sine«mpaasadon, STORIES TYPE CONSTRL'CTIOI
3- will Jo the work,and theswnurc is not immndedorofftrtd foraaie(S«.9064.Business
and Professions Cone:The Contractor'sLicense Law does not apply to an owner of 24893LOI ill
property whobuilds or improves thereon,and whodocssuch work hinmelforthrough his OCC.GROUP RES.UNITS
employ«s.providedthatsuch improvements Creat intendedoroffend forsale.B,
however,the building or improvement is sold within one yearofe.mpletion,the owner-
builder will have the burden of poising that he did not build or improve for purpose of _
isle.). i,at 'i4(• F4W .1.•.--•..., y`. ane-�)'�.. -i's
❑ l,m.wnaofthepmo ny.ameselusivel =dn thlicensedconwmors to Q K' -PLUMBING PERMI'P. *:{9.'�'`• T 'FEE +: FLOOD LONE APS
ycon gwi . 53Ti$:n.v'::-•ceJ.w•_ ..na'.,.5svra Sr.2 ..f" .
construct the pmject(Sec.7044,Business and Professions Ccue:) inc Contractor's
License Lawd«anot apply to anownerofpropeny whobuilds mimpmves Nercon.vtd PERMIT ISSUANCE
whoc.mram forsuch projects with aconsamorts)licensed pursuant to the Contractor's Law. (EA)se
License ALTER-DRAIN&VENT-WATER
;i�'.f+i:, a},•';•'' FEE SUMMARYji=lji y, u..-
ElI ren exempt undo Sec. ,B&P C far this reason BACK FLOW PROTECT.DEVICE OUTSIDE S
SANITARY YN
Owner DataRAT DRAINS- R.ROOF,AREA.COND. RECEIPTN
WORKMAN COMPENSATION DECLARATION SCHOOLTA% Y N
❑ ehemb Compensation
Insuve rance
or 2 cam of copytuoadf(Sesure,ar oast C.)which
FlXTIIRES PER P!^ t REC PT'p
cover, 1Compcneatiorder is non. fled copy thereof(Stt.1800.Lab C.)which \ t— �_ K E N
covers all employee's under this pe,mit GAS-EA.SYSTE E.j INC.4 OUTLETS IPPN
or—
Policy N t !� B TNG NISI FEES
Company GAS-EA.SYSTEM-OVER d ECK
❑ Cerifedcopyisherebyfamished, iii�a�__
❑ Cenified copy is flea with Ne city iresptttion division. GREASM USTRL 01141 TERCEPt DI G �
CERTIFICATE OF E%EMPTION FROM WORKERS' GREASETRAP ---- O �#
COMPENSATION INSURANCE
(This miction neednm b,completed if Ne permit is for one hundred dollars SIM) SEWER-SANITARY-STORM EA.200FT. ENEMY FEE
.,less)
I certify that in the performance ofthe wart for which this permit is issued.)shall WATER HEATER WNENT/ELECTR
not employ any Pers. any manner so as to bttome subject to the Workers PAID
CompeuaJonlaw.sof California. Data WATER SYSTEM{TREATING Date Rece
C) z Applicant
Z0 NOTICETO APPLICANT:If,afmrmakingthis Ccrtifiemeof Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
.N.. become subject Ne Workers Compensation provisions of the labor Code,you mon
a >
forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE
LIJ .r SEISMIC FEE
6. � CONSTRUCTION LENDING AGENCY ONs—�
z I hereby affirm that them i construction lending agency for the performance of
U O the woande,rk for wIdich 'tisjasyed} —9S1,047.Ci1(CJ TOT 1 ELECTRIC FEE
IcMer'a Address T ih mss:.QTY inat nMEC71APtI A'PERMITe;•}�� {; i p4,' PLUMBING ME
V I certify that I have read this application a,W sate that the above information is MECHANICAL FEE L�
c ren. I agree to comply with all city and county ordinances and state laws rtlming to PERMIT ISSUANCE
(• buildingcmucruNon,and hereby amhmi¢rcprtxnmdves of thisciry,.error upon the CONSTRUCTION TAX
L) Z ourve-mentioned property for inspection purposes. ALTER OR ADD TO MECB.
(We)agree to save,indemnify and keep h:umleas she City of Cupertino against
inn;IBia.j Tec fl cos.and en w yinmy way acrN dry51 ity AIR HANDLING UNIT(TO
OVER 100 CPM)
i � fthcg n fthis t. / //
AIR HANDLING UNIT(OVER 10.000 CFM)
Si ApplicaoMmomemr DafF E%IIAUSTHOOD(WMUC1)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100.000 BTU) Use Retain.N
Will the applicant or future building«cupmn store or handlebaewdous material HEATING UNIT(OVER 1W.000 BTU) TOT
as defined by the Cupertino Municipal Cade Chapter 9.12.and the Health and Safe,,
Cale,Scction 25532(y1 VENTILATION FAN(SINGLE RESID)
❑Yes ❑ No
BOILER-COMP13UPORIIX).000 BTU) ISSLI NCE DATE
Will meapplicmt.r future builJingcoccupmmxcyuipmenmrJaiceswhich emit Ir' A f1
hazaNums air ct i..ms as defned by the Bay Area Air Quality Maragemem BOILER-COMP(OVER 1ft"BTU) 1J
Tistnnn
❑Yea ❑No NEW RESIDENTIAL MECIL SQ.FT. AUG 18 199
1 have real the hazardous materials requirements under Chapter 6.95 of the !+ t� V
C.hi mi.Health%Safety Cede, m
Sections25505,25533d2553a. Iunderstandmm Cil
rUr
Ifthe building does norcurrently have a mtm.thata is my.,,mWbilitym notify the Gur-
,cupmu.f the requirement which must he met prior to issuance of a Cenficme of
Oecupuncy.
Owner or authorized agent Data T Tn. I, ISSUED BY