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29023\PPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING - ELECTRICAL BUILDING DIVISION APPLICATIONIPERMIT - PLUMBING - MECHANICAL BUILDING PROJECT IDENTIFICATI( BUILDING ADDRESS: / ZI#1)QA�dSvel -� Oriti NAME: HONE' RACfOR'S o0L.10 Ar -600 0 ,K. ones Z,' 11Rfj11TIi /IiNGINEBR: /&O &/ r] �RIiSS: �Q CO ACT: PHONR: Z I/`wYirA-_I 4 , A / z i 37/ 000 0 ❑ Consultant Fees Paid. by Applicant (initial) "T"""" QTY ELECTRIC PERMIT I hereby affirm that 1 um licensed under provisions orChzpmr9 (armmeneing Da'Z with Section 7000) of Divisio 3 fthe Business d Profession, Cale, andmy license is �uufill force aryl effee�' p 80S y PERMIT ISSUANCE License glass [.it. Dam Comracmr APPLIANCES — RESIDENTIAL ftC111TECTS D17CL OZy,2� I ndersr Jmy plans shell be usW es public recoNs PANELS ::4J UP TO 2M AMPS P44 a Licensed Professional' 201-1000AMPS 9WOWNER -BUILDER DECLARATION yy 1 hereby affirm that 1 nm exempt from the Contractor's License Las; for the OVER H BBAMPS 5<3 G. U foilowing rearms. (Section 7031.5, Business umd Podnoione Code: Any city or county SIGNS ELECTRICAL WF O which requires u permit to cmtswcr, alter, improve, demolish, or repair any stmemre prior to its issuance, also requires the ap,henin fonuch permit to file n signedsmmntem SPECIAL CIIICUIT/MISC. �o) that he is licensed pursaanuo ReTrevisionsofth, Contmnms License Law (Chapter 9 �p0 (commencing with Section 7000) of Division 3 ofthe Business and Professions Cale) or TEMP. METER OR POLE INST d y ^ C tbar he is exempt therefrom and the basis for the illegal exemption. Any violation of WX VN. Section ]031.5 by any vppliem fora permit subjects the applicant n a civil penalty of {OWER DEVICES EZGnot mom than Ran hundred dolhas (SSW). O Las ownermf the property, or my employees with wages as their sole compensation,SWIMMING POOL ELECTRIC will do the work, and the structure is not intended mothered for sale(Sec. 7044, Business a3 and Professions Code: To, Contractors License Law docs not apply to un owner of OUTLETS — SWITCH PS — FUCfU RES ptopeny who builds or improves thereon, and who does such work himself or through his own employees, provided that such impmvemens arc not intended or offered for NEW RESIDENTIAL. ELECT SQ FT. w lc. If, however, the building or improvement is sold within one year of completion. the nor -builder will have the burden of previ ng that he did not build or improve for pur- pose of saleJ: 0 L as owner of the property, am exclusively contracting with licensed contractors to TAI mstmet the project (Sec. 7044, Business and Professions Code:)' rhe Convectors LI- senuLaws does red apply 1. m oviner of property Is ho mild, or improves therena end QTY. PLUMBING PERMIT whocontraetw forsuch pmjeas with aeontecmr(s) ficessedpiummant todic Contractors License Law. PERMIT ISSUANCE I am exempt under Sec. , B & P C far this maven Owner ALT17R—DRAIN & VENT— WATER (BA) Da¢ WORKERS COMPEPISATION DECLARATION BACK FLOW PROTECT. DEVICE I herehy sit'. under Penalty of Perjury ono of the following declamtinns:., I have and will maintain a Certificate of Consent to self -insure for Worker'sCompen- DRAINS— FLOOR, ROOF, AREA, GOND. sadon, us provided for by Section 3701 of the Labor Code, for the perfarnumee of the work for which this pemdt is issued. FIXTURES — PER TRAP 1 have and will maintain Workers Compensation Insufanic, as required by Section 37M of the Labor Code, fol the p 'ommnce of the work for which this permit is ins d. GAS —P.A. SYSTEM -I INC 4 OUTLETS Ca Wo; M'�Cy�pPnt�grJn ntt carrier and PNicypyt�gpryrl: 731 GAS — EA. SYSTEM -OVER 4(EA) CurrieI.GG// ////MM ,, IIVV IIIIII"''''111111 Policy Nn.: WGw • CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASEdNDUSTRL WASTE IMrERCEPNR (This sect ion mend tot becompleter)if the Permit is facts, hundeaddnllma($ 1 On GREASETRAP or less.) I codify that in the yerfonmanco of the work for which this permit is issued, l shall SEWER—SANITARY— S' I' ORM EA. 201 FT. not employ any Person in any manner Is, es m become subject o the Workers Cmai OZ Smion Le., of Colifomia. Data - WATER fIGATER WIVEM'/ELF.CfR Z 0 Applicant vl NOTICE TO APPLICANT: IL after making this Cedificate of Exemption, you should WAILS SYSTE- O`RF.ATING abecome subject to the Worker's Compensation provisions of the Lthor Cale, you must {Ta forthwith comply with such provisions or this permit shall he deemed residual. WATER SERVICE Q L1s CONS '1'ftU TION LENDING AGENCY NEW SESIUENTIAI. PLM B. SQ. PT V 0 IherebyvRrm that here' acnmwmion lending agency for the perfommnce of CTs f~ the work far which t is N.v,l(Seo. 309], Ci, C.) 0 U Lenders Name {1a Leaders k= TOTAL. Iy I craily that I lulfed1cmi, application and sate that the Moose In formation is V) correct.) agreem comply with au pity uad county ordinances and state laws entingto QTY. MECHANICAL PERMIT V 7 building construction, and hereby subnriu representatives ofthis city tonneruptmthe shove -mentioned property for inspection purposes. PERM IT ISSUANCI? (We) agree to .save, indemnify and keep handless the City of Cupertino against liabilities, jodgments,eoas and expenses which may in any way reemeagairet said City ALTER OR A OD'I'0 MECH. in consequence of the ra 'ng ofthis Permit. .. APP CANT UNDI 1'A DS AND WILL COMPLY WITH ALL NON -P INT AIR HANDLING UNIT ('1'010,001CFM) S . Lr REGULA'1� NS u �f AIR HANDLING UNIT(OVER 10,"CFM) nature of APPlica to n a oram J EXHAUST]'] OOD(W/DUCD HA' )US MATERIALS DISCLOSUR Will the applicant ori e, building oecupum ware or handle marmots material HEATING UNIT (10100.000 BTU)" ms defined by the Cupertino Municipal Cade, Chapter 9.12, and the Health and Safety Cede, Section 25532(a)t IHIM INO UNIT (OVER 100,000 BTU) ❑Yes 0 N VENTILATION FAN (SINGLE RES (D) Will the applicant or future building occupant use equipment or devices which - nt hacontainment.,n mon containment., as defined by the ]lay Ams Air Quality Management BOILER— COMP GRIP OR 100,010 BTU) ,Is¢icfl - ❑Yes ON. BOILER—CUSP (OVER 100,000 BTU) I have man the haeardaus materials eqm uirenmnunder Chapter 6.95 of the Cali- AIR CONUI1'10NI7R tourist Health & Safety Cade, Sections 25505. 25533 and 25534. 1 understand that if 0e NF. W RESIDENTIAL MECH. SQ. IT. building dors not currently haven Nunn(, that it is my responsibility m notify the occupt an close rryuiremetus which must be met prior to issuance cis Certificate of Occupancy. OFFICE 29023 SANITARY NO. APPLICA ION SO MITTAL DATE 9S La. SIC f CONTROL# L ❑ BUILDING PERMIT INFO B :LE P A) MEC FEE FE ❑SFDWL O KITCHEN REMODEL [-]ADDITION O PLUMBING RE -PIPE O MULTIUNIT OSTRUCNRAL MODIFICATION L1 INTERIOR OCHIMNEY REPAIR IMPROVEMENT ❑ BATH REMODEUBEPAIR 0 DEMOLITION I OTI4EB 4XONG ONHWBIDG/ADDITION ODEMOLH'ION ❑TENANT OFOODSERVICE IMPROVEMENT []OTHER SQ. FT. FLOOR AREA - JUN 71996 FEE GI/Y UI_ L;1J1_C411Nb $/SQ. IT. BUILDING DIVISION FEES PLANCHECK FEE Q/ / ENERGY FEE , GRADING FEE SOILS FEE PAID Date Reccipt# TOTAL: BUILDING FEE FEE SEISMICFEE ELECTRIC FEE PLUMBING FEE MECHANICAL FEE CONSTRUCTIONTAX HOUSING MITIGATION FEE PAID Doe Rec<iPt # ISSUANCE