27659APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE SALL POINT PEN ONLY
CITY OF CUPERTINODI EIyTNC-EI.I!fTian.
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING -MECHANICAL
BUILDING PROJECT IDENTIFICATION
PERMITNO.
27659
BUILDING ADDRESS, P�% [�{/� %
7767 1 \ �� 40/ s UNIT# LOTH 9667
SANITARY NO,
APPLICATIONSUBMITfALDATE
h
OWNER. NAME: PEON&
Sfe✓w
l-rf 2 --8 53
CONTRACTOR'S NAME: LIC NO:
M Vett— Cotisf+kc r
N/C
El
CONTROLN
(ARCIIITI?CT/ENGINEER: LIC NO;
ADDRESS: -aSCT� O�ii, / L4/ ljeC
CONTACT: PHONE:
QTY. ELECTRIC PERMIT r •
BUILDING PCRMIT (NEO
ILI.DTi ELE Pw a MEcfI
PERMIT ISSUANCE
IBCA/.
LICE.NSEDCONIRnderpmSDECLARATION
I hereby of 9 (co mmencing with
that emlicensedinss
APPLIANCES - RESIDENTIAL
JOB DISC PITON
PANELSfull
Section7")DivisionCoder
i and Professions
on3 of the Business end Pvfessiona Code. and mylicemeis in
fornse Cl..ffttl �a
and effect.
Licence Clas —� LIC.N <l796 r%/
License
UPT0200AMPS
If
Date Cacti
201 - 1000 AMPS
ARCIf1'EECTS DECLARATION
I understund my plans shell o used us public records.
OVER ItNI0AMP5
SQ. IT. FLOOR AREA
$/SQ. FT.
SIGNS ELECTRICAL
Licensed Profeasional
OWNER -BUILDER DECLARATION
SPECIAL CIRCUIT/MISC.
1 hereby affirm Net 1 am exempt from the Contractors Licerne Law for the
TEMP. METER OR POLE INST.
following reason (Section 7031.5, Business and Professions Code: My city or county
which reyuims u permit to construct, alter, improve, demolish, or repair any structure
PH., m its issuancc.also miturastheapplicam for..ch pemdlto file. signedammment
POWER DEVICES
that he is licensed pumuant to the Provisions of the Contmaors license Law (Chapter
9 (commencing with Section 7W0) Of Division 3 of the Business and Prode) facdca s Co
SWIMMING POOL ELECTRIC
VALUATION
or that he is exempt therefrom and the basis for the alleged exemption. My violation of
Section 7031.5 by any applicant far a Permit mbjecta the applicant toe civil Nosily of
�a
OI1l1ET5 - SWITCHES -FIXTURES �a
not more than five hundred dollars ($500).
❑ I,esownerofthepmMny,ormyemployecawithwegesmtheirsolecomp muon,
NEW RESIDENTIAL ELEC R _SQ. FT.
STORIES
]YPECONSTRUCIION
will do the work,and the smremre is not immndedoreffered forsale(Sec. 7044, Business
end Professions Code: The Caavatora License Law does not apply in an owner of
propenywhobuildamimproves therwv,and outdoes such workhhmelforthmughhis
ownemployees, Provided that such improvements rare not intended oroffered forsale. If,
OCC.GROUP
RES. UNI IS
��
however, the building or improvement is sold withinone yearofcompledon, the owner-
builder will have the burden of proving that he did not build or improve for purpose of
QTY. PLUMBING PERMIT FEE
sulo).
❑ I,mownerofibepnpmy.amexclusivelycommctingwithlicemedconuactoreto
FLOCOZONE
APN
consumer the project (gee. 7044, Business and Professions Cale:) The Conuucmr'aPCRMIT
License Law dos not apply bun owner of propmy who builds or improves thereon, and
IL ISSUANCE?
whocontmets forsuch projects with acomructor(s) Iicemedpumuanuo Ne Contractors
License law.
ALTER EA
( )
FEESUMMARY
❑ 1 um exempt under Sec. , B & P C for this rearm
BACK FLOW PROTECT. DEVICE
OUTSIDE FEES
SANITARY Y N
RECEIPTa
Owner Dam
DRAINS- FLOOR, ROOF, AREA, COND.
WORKMAN COMPENSATION DECLARATION
I, ❑ l hereby affirm that l have acandficave ofcoment to salf-insure, ora ccnifcam of
Workax Compensation lasurenceora cmificd copy thereof( See. 3800, Lab C.) whits
SC140OLTAX Y N
RI?(EPmTN
.XTURES-PER TRAP tr.
PARKFEC Y N_
en all employee's under this permit.
Policy N
GA FA. SYSTEM -1 INC. 4OTfLETS -
RECEIPT
BUILDING DIVISION FEES
Company
GAS- . SYSTEM -OVER 4(EA)
PLANCHF.CK FEE
❑ Cenified copy is hereby famished.
GREASE(( USTRI. WASTE INTERCEPTOR
GRADINGFEM
❑ Cenified copy is filed with liecity impaction division.
CERTIFICATE OF EXEMP ION FROM WORKS
GREASE TRA
SOILS FEE
COMPENSATION INSURANCE.
SCWE0.-SANITAR -STORM FA.2tIUPl'.
ENERGY IZf!
(This section need notocnmplaed EOheperrunisfor hvndredd.11am ($100)
or leas.) \
I Ctrtify shot in Ne pnforrrlanceof Newo which N'a perm it isiuued;l shall
LATER WNF /ELECfR
not employ any person In any man o as to become subject to the ke
PAID P.
EATING
Compensation lows of California. to
Uate pt N
Applic t
enificatn FExemp[i outs
NOTICETO APPLICANT: If, afteN'�it
NEW R II . IAI. PLMB. SQ. FT.
TOTAL:
become mhjecr to the Workers Camvisions of the Labor a must
BUILDIN R 'aCONSTRUCGAGENC
forth with comply with such provisiit shall. ked.
SEISMIC E1
hereby affirm Nat there is a cing agency for the .mance ofT
work for which this permit is iss, 'v. CJ
Lender. Name
/'�
LLE IC1'fil!he
Lenders Address
QT MECHANICAL PERMIT FEE
PLV G .F.
�•
1 comity that I have mud this application and state IN thhum
e move ination is
cannot. I agree to comply with sidesyatdc.mnyordinanaa dsumlavaradmngto
PERMIT ISSUANCE;
MECHANICAL FEE
buildingconsuuctioo,andhembyauthor 7,cmpeaenmuvesofthi hytoemauponthe
above-memioned progeny for inspection purposes,
ALTER OR ADD T'O MECH.
CON53RUCI'ION TA
(We) agree to save, indemnify and keep hamlus the Cityof Cu in. again
Iiabilitics,judgments, costs andexpeases which may in any wuyec eagams ty
in cnnse tithe gruntin I'Ihie Acranii. '
AIR HANDLING UNIT(TO 10,000CFM)
AIR HANDLING UNIT (OVER 10,(10(1 CFM)
Signal of ApplimaKontmcm pate
EXHAUST HOOD(W/DUCT(
PAID
HEATING UNIT (TO RX1,M) BTU)
HAZ.ARDOUS MATERIALS DISCLOSURE
Date
Receip N
Will the applicant or furore building nccaptain it.. or handle hazardom material
m defined by the Cupenino Municipal Code, Chapter 9.12, and the Health and Safely
HEATING UNIT (OVER U10.000 BTU)
Cale, Section 25532(e)T
1:1 Yes 13 No
VENTILATION PAN (SINGLE RFSIII)
Will @empplicuntorCnurebuilding«cupam useequipmem ordevices which noir
harmonious aur conommuna ss defined by the Bay Area Air Quality Management
District?
BOILER- COME CUP OR 10(,003 BTU)
- ISSUANCE DATE
PAID
BOILER - COMP(OVER 100,000 BTU)
❑ Yex ❑ No
1 have read the hamrdous material. re0uiremems under Cheper 6.95 of the
NOV 8 p
q
NEW RESIDENTIAL MUCH. SQ. FT.
CLlifinalth
nia l haft Smfny Code, Sections25505,25533 and 25534. 1 understand that
It
if the building does not currently have a tenant, that it is my responsibility to notify the
GO
occupant of the m loirements which must be met prior to issuance of a Confirms of
Occupancy.
Ur .'r - PNU
ISSUED BY:
Owner or amhorizW egcm Use
TOTAL:
OFFICE