22326 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO.
Building Address:
Po 22326
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wnera ams:
one;
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E-•1�-q• d b b ( 31(0) CITY OF CUPERTINO-BUILDING DIVISION
c°ntmaor',Name. Lis.No: APPLICATION I PERMIT �—'Z"" S�f
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�
P'bj �ZNm 7 BUILDING-ELECTRICAI I' UMBINGMECHANICAL CA CORY CONTROL N
Architca/Englncer. Lk.
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address:
n
LICENSED CONTRACTOR'S DECLARATION PERMIT ISSUANCE ❑ El �'• F-1
I MrebyafllrmthlBcmunderprovislonlef Chapter9(commene APPLIANCESRE4DENTTAL JOB DESDESCRIPTIONIngwBo Section7000)oatam aed
I Division 3 ofthe Business and ProfessionsOods,and my 4,D1
BE
is In tuI Iosco an act. PANELS
Limn Cep L>m�'34 c"yre,M Z S
Dat ql 7 contneo /b dLM IQ 2MAMRS
ARCHITELTSDECLARATION OVER08 AMPS
OVER 1000 AMPS FT.FLOOR AREA b/SQ�FT.
q�v O ZO I understand my plan sisal be used es public records SQ.
k� Licensed Professional SIGNSELECTRICAL
�� OWNER-BUILDER DECLARATIONlhcmbySPECIAL CIRCUIT/MISC A L E D I N
p, owingraf@mlhallam31.5,Business
fromthe Contractor's License Law forlhe
Q f ntywhichmnquimape.(Section 7 tt.. to d,.Id Professions hnyatyor
county which roqulrcsa permitto coniretiaizesth, a p Boastf rsuch,ormittompair POWER EfVICES LE INST. P T E R
anystmcturc priorto Ile issuance,also requlrcstheappBent(orsuch permit to ppkyFR DEVICES
file a signed atateoent that he is Ilemoxf pursuant to the provisions of the
Ow Contmetor's License Law(Chapter 9(commenangwith Section 7000)ofDivi.H�O� sion3ofthe Buslnessand Professions Code)orthathelaemmpt(hemfromand SWIMMING POOL ELECTRIC A' ON
O the bash for the alleged exemption. Any violation of Section 70775 by any I
am — #
applicant fare permit subjectsthe applicant to a civil penalty ofnot more t ban OUTLE7SSWITCHESFIXTURRS
$ tlt�1,as
neroftdollars(SM. NEW RESIDENTIAL ELECTR SQbT. STORIES TYPECONSIRIICTTON'
�n I,as owner will
the property,or he employees with wage.as Their door
C compensation,wWdo the work,ess and Pr and theswde:Thcture 6 Contet actor o icense offered Lfor
5 sale(Sec. pply to a nos and Professions Code:The Contractors License Law
does$ whodolapply roan imserofthroug property who Wilds nemporimprwnthermryand OCC.GROUP RES.UNITS
whodoenoreaworkMmsededoroughhloowne.If,ho eprovidedildingh
Improvementsarenet Intended earofc for tile.thea nvep deer ilI have TOTAL:
Improvement hsold wlihlnoneycarofcomplalon,theowner-bullderwlll have
thLItrden of proving that he did not build or improve for purpose ofsele.). QTY, PLUMBING PERMIT FEE F1) NE APN
(_J L as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
contmctma to mmtrua the project(Sec.70/4,Business and Professions Code: a
The Contractor's License Law does not apply to an owner of property who ALTER-DRAIN&VENT-WATER(RA)
Wilds or Improves thereon, and who contracts for such pWjeas with a
oq➢t(actor(8)Bcensed im omen to the Contractor's License Law. BACK PLOW PROTECT.DEVICE FEE SUMMARY
IJ 1 am exempt under Sec. B k P C for this maven -
DRAINSFLOOKROOF,AREA,COND. SANITARY Y N
Owner Date RECEIT
�/"' WOBIO.fA veaMPCce OND et ION FDTURES PER TRAP SCI 1001,TAX Y N
�yLLiereby affl at 1 have e m Rcate of cwnt t self-Insure,or a
rtiflren afWor n'CompsruaHmn uranceoracertlfled spy lhemo((Sec. RECFTTPTPTN
38M,Lab C.) r GAS EA.SYSTEM-1 INC.6OUTLETS PARK FEE Y N
PolicyN 22'/ RECEIPT M
Com an GAS-EA.SYSTEM-OVER 4IRA) BUILDING D I VISION FF.ES
Com
Inspectlon slut IRedeopylsherebytumieh
1liHoupyla0ledwlththe atGREASE/INDUSTRL WASTE INTERCMUR PLANCIIECK FEE
) on.
CERTIFICATE OF EXCM ON FRO ORKERS' GREASE TRAP PAID
COMPENSATIO INSU NCE SEWER-SANITARY-STORM EA,200n. Date Reeei Ul
(Thi ..c1hmneed^olbecomplete ifthe rmitisforonehundreddollan
(f100uHI 11m)11m) WATER HEATER W/VENT/ELECTR �� ENERGY FEE Y N
IThat In the performance ework for wbkhthbpermitue
permit is lsvd, —
1 shall not toy any pe y manner an as to become subject to the WATER SYSTEM/TREATING PAID
Workers'C°m woof aBlooms.Date
O Z Applicant NEWRESIDENITALPLMB. SQ.Rr. Date Recel tN
Z 0 NOTICETO APPLICANT:If,e r making this Certificate of Exemptlon,you
I•' dhouldbeenesubjecttolheW rkeri Compensellue provisions ofthe Labor TOTAL:
N Code,you most forthwith omm y with such provisions or this permit shall be
� ) deemed revoked. BUILD
I
aCONSTRU ION LENDING AGENCY SEISMIC FEE
I hereby afflmlhat there is construction lending agency for the perform- ELECTRIC FEE
D Z anceoltbewmkforwhiehth permit b issued(Sce.3097,CIv.C.) TOTAL:
02 Icndee.Name PLUMBING FEE
LL H Tender's Address QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
I mrtlfyt?,Al have read this pplimtbnand slatethAtheabove Information
O W
1 iscomM.Iugree to comply w h all city a rad county,ordinances and elate law. PERMIT ISSUANCE FEES PAID:
>. N relating to building construal n,and hereby authorize ropmarmatives of this
Z city to enter upon the above- rationed property for lrapealon purposes. ALTERORADDTOMECH. Date Recei tN
(Wo)agree to save,Inde 1!y an d keep harmless the City of Cupertino
at rats, As and expensed which may In anyway accrue AIR HANDLING UNIT OO 10,000CFM) SUBTOTAL:
against said City In co equ of the granting of this penult.
AIR HANDLING UNIT(OVER 10,W0 CrM) CONSTRUCTION TAX
Signature of Applicant/ actor Date EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or furors building occupant atom or he nd Is hazardous HEATING UNIT(TO 100,000 BTU)
material ad defired by the Cupertino Municipal Code,Chapter 9.12,and the Date Retei tit _
Health and Safely Cade Section 25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL:
F1 Yo []No
Will the applicant or futum building occupant use equipment or devices VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emlt hazardous a4 conlaminume as deRmxi by the Bay Area At,
• allty Management District? BOILER-COMP(3FIP OR 100,000 BTU)
4 Yo I—I No
have mad Healthe h
esus materials l 25505, 5533 aChapter. 1 of BOILER-COMP(OVER100,0110 BTU)
theerstan that lithe
buildafetying
Code,Sectionsntly have
a rms,that 1
undersmndlhat notify the occupant
of ret
erenllyhants which that b iset NEW RFSIDFIJITAL MEIN. SQ.FT.
pspoto isautyto softlyerrsiate Of oftheroqulremenb which must be met
prior to issuance of Certificate olOttvpanry. ,,LLrr••��_,,
Owner orauthorlmd agent Data ISSUEDBY:
TOTAL:
OFFICE COPY