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27527 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO HIM LVING-ELEUrRTCA' PBRMD'NO' BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL n C BUD DING PROJECT IDENTIFICATION G J BUILDING ADDRESS: / SANITARY NO. APPLICATION SUBMITTAL DATE. (sL{ eAl//-e_ UNIT OW / � / V C AMEQACTOR'S2yY A LCNN/C CNTROLN A CHI Ip3NGINEER: LICNO: ADDRESS: ❑ ""A"41-SPS-0 COMPACT: PHONE: BUILDING PERMIT INFO QTY. ELECTRIC PERMIT FEE �"z� 1/ BLDG EL PLUMB MECH . ,u/(/� �/ �'�i T��]Cj PERMIT ISSUANCE LICENSED CON CfOR'S DECLARATION LOB DESCRIPTION APPLIANCES-RESIDENTIAL, y�y Ihcrchy affirm that lam licensed undcrprovisionaofCTepter9(comrmnuncing with 00 Sectiams0 7")of of Ne Business and Profession Code,and my license ism PANELS � � 'UF full force and effect. I¢„Z, License Class Lic.p UPT02NAMP5 yjy Dale Contractor 201-1000 AMPS IZO'z ARCHITECTS DECLARATION SQ.FT.FLOOR AREA $/SQ.FT. O Z C tp I undertmnJ mY Plans shell be used av public records. OVER 1000 AMPS Tk SIGNS ELECTRICAL 2�� hCQ Licensed Professional OWNER-BUILOFR DECLARATION SPECIAL CIRCUFDMISC. r a F 1 hereby effimr rhes I an exempt from the mr Camrn 's License Lew for the sr] 0.•m following reason,(Section 7031.5,Business and Professions Code:Anycity or county TEMP.METEROR POLE INST. uJ which rnpmims a permit to construct,alter,improve,demolish,or repair any swctura � prior to its is so.nonesonequirestheapplicam fir such .I,to filo.signed stounum, POWER DEVICES m ty O that he is licensed pursuant to the provisions of the Con ctors License Lew(Chapter rMypeL 9(commencing with Section 7000)of Division 3 of snessand Professions Cade) SWIMMING POOL ELECTRIC VALU/A�TION J)Z, Sectio M1ei.ve.5 hyayapfic and the permit th leg txemanato civilonaltyof OUTLETS-SWITCHES-FIXTURES FZa not Section bya undredicollars .permit jeenhea licanuoecivil penalty of J "'I fF0 not mom ,of,hi eope"lers(ES NEW RESIDENTIAL ELECTR _SQ.FT. K 22 ❑ odo,w,k..deproperty, employodmoeredfor tMirsole044,13 mon. STORIES TYPE CONSTRUCTION y3— will J- work,wda nommi inticense Law e(Sec.JB 14,Business 6S 1 r4`53 and ' c:The vesftm's License Law does no apply lf an owner of 77 pm ywhnbuimvi impmvesthimpwvmcnls notihw himuoubtfooec.1f. OCC.GROUP RES.UNITS employebuildividedmprovehimpt, Id msem mycarnf.rmffcreddx We.IL no r,the willaveTieng urien ofpmrntis Idwhinalailro(corpledom,rmor- buiderwillhaveNebudrnofprovingt t no build or int vat for purpose of L' sal .). QTY. PLUMBING PERMIT PIT FLOOD ZONE APN ❑ I,as crofthepr perry - lu yconame tin lice dcontmctorsto cons um rhe prnjcel(S 'I ess and Prmfe. ns Code:)The Contractor's PERMIT ISSUANCE LicenoLuwdoesnmupl crafpmpeny ohuildsorimog provesthoeand _ whoc tmerhasuc withacontmcmr iccnudpunu.ntmthe Commoome ALTER-DRAIN&VENT-WATE0. EA s' License .sew, ( ) FEC SUMMARY ❑ 1. asempt under c B&P C for Nis reason BACK FLOW PROTECT.DEVICEOUTSIDE FITS SANITARY Y N Owner Dau RECEIPT it DRAINS-FLOOR,ROOF,AREA,CONO. WORKMAN MPENSATION DF.CIARATION SCHOOLTA% YN ,❑ IM1emby affirm mhep eacenificam of conunnm telt-insure,orecertificme of RF.CEIPI'M FlXTURES-PE TRAA1s Workcr%Con enation sums ore cenified copy thersel(Sec.3800,Lab C.)which 1 PARK FEE Y_N eoversdlem nyoo' oder this pemtit r.c FA -IINC.4OUTLETS RECF.IITg Policy is 4- BUILDING DIVISION FEES Company OAST- ^. -OVER4 UA) PLANCHECK FEE �� EI f.asrificd copy is hereby furnished. ;:� FB Cenificd copy ie filed with the city inspection division.` " .t ' 7GREgSF USTRL WAS INTERCEPTOR GRADING FEE a..w. CERTIFICATE OF EXEMPTION FROM WORKERS'/'� g ./ SOILS FEE COMPENSATION INSURANCE r� ) U09 L (ns section need oar be completed ifthe permit is formas hand lore($I ,e$B . -SANITARY-STORM EA.200FT. ENERGY FEE e m less.) A.Stee�,a I comfy that in the performance ofthe work for which this psrmi pgh� � WATER HEATER W/VENT/ELECTR not employ any Person in any manner so as to become eubjxt the Worker' PAID Oz Compensation lrwsmf California. Date •s y'.. WATER SYSTEM/IRFATING Date Rec tp zC) NOTICE TO APPLICANT.If,after making this CmiOcau of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: became,subject to the Warksn's Compensation provisions of tho Learr Code,you must 1'� � � ecefonhwith comply with such provisions or this permit shell be deemed resulted. s7.. BUILDING FL ss—It CONSTRUCTION LENDING AGENCY SEISMIC VZ 1 hereby affirm that them is a construction lending agency for the performance of O the work for which this permit is issued(SIL.3097,Civ.C.) L ELEE Rs r.t Lcndcrs Name t' Lender's Address QTY. MECIIANICALPERMIT FEE PLUMB C .E U I certify that I have read this application and state the the.bone information is Ha career. Iegre,m comply with all city and county ominancee and state laws relating m PERMIT ISSUANCE MECHANICALFEP, ` � building construction.and hereby authorize representatives of this city to enter upon the (••) 7 cRI love-memimed pm,ny fm inspection purposes. ALTER OR ADD TO MECH. CONSTRUCTION fX a (We)a me Iave,indemNfy end keep hmmleas the City of Cupertino against liabilities' gmm en ,enuandexp nseswhichmay' acemea ainosalCity AIR HANDLING UNIT(TO 10,"CFM) incons�enceof Nsgnading ispisp AIR HANDLING UNIT(OVER 10,0WCFM) Stgnamu of APPlicanUC cwt / Doe EXNAUST HOOD(W/DUCT) PAID HA RDOUS MATERIA DISCLOSURE HEATING UNIT(TO 100,000 BTU) Dem _\"P.k Will the applicant mfmure building aecupant mom or handle haoWouscraroria HEATING UNIT(OVER 100,000 BTU) TALI as dcfired by the C.,mro Municipal Cod,Chapter 9.12,and Ne Health and Safety Code,Semi 8532(x)? 11Yes ❑No VENTILATION FAN(SINGLE RBSID) ❑ Will air contaminants; building by the Bay Amu equAir Quality Management BOILER-COMP(3HPOR IW,OWBTU) ISSUANCE DAXE Joneous air aomaminanu m deemed by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU) Jiorin7 Gl E-]Yet ❑No NEW RfSIUENTIAL MECH. SQ.FT. 1� se� I have nerd the hazadous materials requirements under Chapter 6.95 of the Spy '-7 1995 Culifomia I Icuhh&Safety Code,Sections 8505,25533 end 25534. I understand Net if the building does not currently have a mount,that it is my responsibility to notify the oecupam of the requirements which mast be ars poor to itss...of.Certificate of �I` L I O Occupancy. I Y Owner or outhodud agent Dam ISSUED BY: Q