26627 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUHAlIcRi-KL UMMAI. PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING DIVISION " BUILDING PROJECT IDENTIFICATION 26627
BUILDINGADDRESBf:�/ M � SANITARY NO. APPLICATION SUBMITTAL DATE
2 � — • IUNITp LOTM
OWNERS NAME: PHONE: CON 'S NAM LIC NO: V
N/C CONTROLa
ARCH IIVINEER: LI NO: ADDRCSS: ❑
4 1 i,Reisq1A. L&T wn J
CO @CT: PHONE: 'h'a x _
��tttt�rrrr"����@@@@J + _r BUILDING PERMIT INFO
l AJ QTY ,i R A CTRIC PERMIT
FEE
�T '"`°x T`I`$" SRI BhI3G ELECT PLUMB MHCfI
PERMIT ISSUANCE T
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
p.z Ihrmhy.ffirm thin l um licensor undupmvieione of Chnptm9(consmerism,wall
00 Section 7000)of Divis an 3 ofthe Business and IkoPossions Code,and my license 1,in ppNEl S
yt6 full force and ettem. t
6 W License Class Lice UP TO 200 AMPS
y y D'.IIC Contractor 201-1000 AMP$ • •" - ��I •M1
Z FONZ ARCHITECTS DECLARATION OVER IBM AMPS SQ.IT.FLOOR AREA $/SQ.FT.
Oz_Q I understand my plans shAl be meal m public mcci
SIGNS ELECTRICAL
Licensed Professional
5C 6 OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
K06U 1 M1crtbY uffi.m that 1 em exempt from the Contracmr'e License law for the - —'
ly 3 ss.y following reason.(Section 7031.5,Business and Professions Cade:Any city or county TEMP.METER OR POLE INST. st ® t
��; which requires a permit m construct,alter. a,demal ish,or repair any svucwre POWER DEVICES IAL oV
;!INS prior to its issuance,also mquires the applicant forsuch Permit to Elea signed alahnrent
C0 that he is licensed pursnam to the provisions of the Com isam's License Law(Chapter SWIMMING POOL ELECTRIC
\ _
tiXo� 9(commencing with SectionT000)of Division 3 m due Business and Professions Cade)
yq"y or that be is exempt and the basis for the alleged exemption.Any violation of OUTLETS /
�zG Sectio]031.5 by anyapplicam for.permit subjects theappiietra las civil penally of f0
not more than five hundred dollars(S500). NEW RESIDENTIALELECIR 5 .W ❑ 1,asownerofbepropny,ormyemployeawiwagesasheirmlecomtion,y
S NS'BUCTION
will do the work,and the stracwreis not intendedoroffered for sale(See.7044,Business
and Professions Code: ]]to Contractor's License Law does not apply to an owner of
Miami,who builds orimprmes thereon,and who docs smch work himself or through hie
own employees,prevideelthatsuch improveencrosarenm imendedmofRredforsale.If. OCC.GROUP RES.UNITS
however,the building or improvement is sold within one year of completion,the owner- .LIt
builder will have the burden of proving that he did not build or improve for purpose of
sale.). ,8
❑ I.as owner ofthe property,am esclusivelycentrneting with licensed can.,..m QTY:y":f .PLUMBING PERM IT FEE FLOOD ZONE APN
construct the project(Sec,7M4,Business and Professions Code:)The Conlrecmr's
License Law Jocanot apply loanownerof,capeny whubuildsor improves thereon,and PERMIT ISSUANCE
who contracts for such pmjcets with a commends)licensed pursuant m the Contramm's ALTER (EA)
License Lew. FEE SUMMARY
❑ I and exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT.DEVICE T DE FF.H.
Owner Dam SANI'T'ARY YN
III?CEIPfe
• WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF,AREA,COND. SCHOOL TAX YN
❑ I hereby affirm that l have arenificate ofemosenttm self-insure,macenificam of FIXTGRPS-PER TRAP RECEIPTp
Workers'Compensation lnsurwconrucertifieA copy therenff$ec.38011,Wb CJwhich PARK Wil: YN_
covers all employee'a under this permit, GAS-EA.SYSTEM.I INC.4 OUTLETS RI?CEIPI'N
Policy a BUILDING DIVISION PEES
Company GAS.EA.SYSTEM-OVER 4 BIA) PLANCIIECK FEE
❑ Certified copy is hereby famished.
❑ Certified copy is filed with the city inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP
SOILS FEECOMPENSATION INSURANCE
This station need not be completed if Ne permit is for one hundred dollars($l00) SEWER-SANITARY-STORM EA.200FI. ENERGY FEE
m less.)
I certify that in the perfnni of the work to,which this pernit I.leaned,I shell WATER HEATER WATNT/ELECI'R
nml employ any person in any manner so as to become subject to the Workers' PAID
Compensmionlawsof Califomia. Date WATER SYSTEMaRFATING Date Receiptq
Z Applicant
F� O NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should NEW RISIDENTIAL PI.MB. SQ.FT TOTAL:
.Cn-sBecome subject to the Workers Compensation presidents of the Labor Code,you must
a 7 forthwith comply with such provisions or this Permit shall be deemed revoked. BUILD I NO FEE
CONSTRUCTION LENDING AGENCY SEISMIC FEE
z
J I hereby affirm that there is a construction lending agency for performance of TOTAL: ELF.CfRIC ME
O the work for which this permit is issued(Sec.3M7,civ.C.)
I<nder's Name
OUU
Lenders Address QTY„r MECHANICALPERMIT FEE PLUMBING ME
I certify that I have read this application and saw That the above information is
�^ W correct.I agree to comply with all city and county ordinances and state laws relating m PERMIT ISSUANCE MECHANICAL ITE.
F-' h building consuucdon, it herebyumhodzerep.tauvee.Nds cayman...upon the CONSTRUCTION FAX
U 7 ahrve-mernioned property for inspection purposes. ALTER OR ADD TO MECH.
G (We)agree to save,indemnify and keep harmless the City of Cupenime against
liabilities.
judgmennyw ts t nese wl'hm inaa uegamstsuidCi AIR HANDLING UNIT OO 10,000CFM)
can quer of to un- g it.
HANDLING UNIT(OVER Ift"CFMI
ex
rgnamreo Apd0./C ,acmr Date EXHAUSTHOOD(W/DUCT)
PAID
I LAZARDOUS MATERIALS DISCLOSURE, HEATING UNIT(TO IID.”BTU) Date Receipt#
Will the applicant or future building occupant store or handle burnouts material
as defined by the Cupen inn Municipal Cute,Chapter 9.12,and the Ihealth unit Safety I1EATING UNIT(OV HR IM,NX)BTU)
Cade,Sevin.25532(a)'I
❑Yes 11 No VENTILA'DON FAN(SINGLE RESID)
BOILER-COMP(3HP OR ffal BTU) ISSUANCE DATE
Will.air co icnnlnrfumre defined
by the Bay AreaequipAir
uaiii Managemewhich nt PAID
�hezbt.? air cnntaminunta es defrncd by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000BTU)
( Duldct?
❑Yes ❑No NEW RESIDENTIAL.MECH. SQ.IT. JUN 2 9 1994
1 have mad the materiels requirements under Chapter 5.95 of the 1V st;I
Califomia Health&Safety Code.Sections 25505,25533 and 25534.I understand that
if the building does not currently have a tenant,that it is my responsibility to notify the llY Vr
scerfaol or the requirements which most be mmgrior to Issuance of o Certificate ofr Lam\ //1111vu
fR �/
ccupamcy. / `+ v"
Owner or amhorized
at Date TOTAL: ISSUED BY:
OF I