19743PELICANTTO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Project Identification
Bung Address: 6 �
EI
PERMIT NO,
19743
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Photo:
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C11.61 -e—
'CITY OF .CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
BUfLDING-ELECTRICALPLUMBINGMECEiAMCAL
2__ •�6
c° "�"ar; '"`' •, Lic't:
e _ lu
hitM/Engineer. Lie. No:
CATEGORY
CONTROL It
"QiT ELEC'TRiCtPERIviPC FEE
": ". `BUILDING PERMIT INFO,"
'
Addrea.:(�y' U� ., _
LICENSED CONTRACR' DECLARATION
Ihereby hs.di.lrmthat lam.i.3.fhunder B..irovlslonsoff., p..r9(commen
Ing anis Section farpe and dieon3 otthe Buelnemand['rofeselonaCode, and my
licenselelnfuB and ic.a -
License lam Lk.p_
Date Contracto
.,
PERMITISSUANCE 2V(rQ
.
�%j ❑ ❑"
L�I
APPL(ANCESRESIDEN77AL
PANEfS
IM ]EQ 200 AMPS
OB DESCKR'TION
-
201-1000 PS '
ARCHITECTS DECLARATION
OVERI000AMPS
SQ. FT. FLOOR AREA
$/SQ.FT.
I understand my plans shag be used as public retards.
STGNSELECTRICAL FINAUED
Licensed Professional
IN
OWNER -BUILDER DECLARATION
I herebyafflrmthat I am exempt from the Contradorb License Law forthe
following reason. (Section 7031.5, Business and Professions Code: Any city or
countywhkhrequiresapermittoconstruct,allay Improve,dem lbh,ormpalr
any structure prior to its Issuance, also requires the applicant for such permit to
file a signed statement that he Is licensed pursuant to the provisions of the
Contractors License Law (Chapter 9 (commencing with Section 7000)of Divi-
sion 3 of the Business and Professions Code) or that he b exempt therefromand
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not room than
five hundred dollars ($500).
F-1 1, as owner of the property, or my employees with wages as their sole
compensation, will do thework, and the structure is not intended or offered for
SPECIAL CIRCUIT/MISC
�'
J E R
O
'
TIII.EP. METER ORPOLE INST. WR
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUAa0tj
fi D��CryO
zJ Q
OUTLETSSWITCHE&FIXTURES
NEW RESIDENTIAL ELPGIR SQ'FL
STORIES
TYPE CONSTRUCTION
sale (Sec. 7044, Business and Prolamines Code: The Cmdractols License Law
does not apply to an owner of property who builds or Improves thereon, and
who does such work himself or through his awn employee., provided that such
lmprovemcnts am not intended oroffered forsale. If, however thebulldingor
improvement is sold within one yearof completion, the ownerbuilderwlll have
thal-hurden of proving that he did not build or improve for purpose of sale.).Ty,
Lf L as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec 7014. Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
bu
Wilds or Improves thereon, and who entrant for such projects with e
cgRjPec am(s)licensed pursuant to the Contractor's License Law,
IJ I am exempt under SB & P C for this reason
OCC. GROUP
RFS. UNITS
1
TOTAL: l
; J � PLU( MING'PERMIT "VEER""''
PERMIT ISSUANCE
ALTER-DRAIN & VENT - WATER (EA)
PL00 ZONE
APN ,
BACK HOW PROTECT. DEVICE
"' PEl<SUMMARY'`-
OUTSIDE FEES
Owner Date
DRAINS FLOOR ROOF, AREA, COND. _
FD(TURES PER TRAP
SANITARY Y N
- RECEIVE
' WORK MAN COMPENSATION DECLARATION
01 by that 1 have to of consent to ora
SCHOOL TAX Y N
ate mWoHtrm
o Icama
certificate rken'Compeneallonlnsurance oraangled copythereo((Sec.
opythemo
lab C.)
Policy
Policy N
RECEIPT M
CA&EA. SYSTEM -1 INCA OUTLETS
PARK FEE Y N
RFCE�
Com any
[PConiied copy, is herebyfurnished.the city
' �Certlfied ropy tallied with the city Inspection division.
4 (FA)
GAS EA. SYSTEM -OVERBUILDING
GREASE/INDUSTRL WASTE INTERCEPTOR
DING DI
DIVISION PEES
PLANCHECKFEE
GREASETRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thlsaection need not be completed lithe permit isfor one hundred dollars
($1I camless)
pesubjecrmit Is Issued,
the fe, as to become
Ill not employ an person in any
I shall not employ any pereon In any manner m o to 'seroma subject to the
Workers'Compensatlon Laws of California. Dale
Applica
NOTICE
NOTICE TO APPLICANT: It, akar making this Certificate of Exemption, you
should become subject to the Worker.' Compensation provisions of the Labor
Code, you most forthwith comply with such provide. or this permit shall be
revoked:CONSTRUCTION
.
PAID'
Date Recel t#
SEWER SANffARYSTORM EA. 20017T.
WATER HEATER W/VENT/ELECTR
—
i [#
WATER SYSTEM/TREATING
NEW RFSIDEN7IAL PLMB. SQ.7.
L:
"FEEZ.60
BUILDING3
60deemed
., TOTAL:
LENDING AGENCY
affirm that there is a construction leadiagagency forthe perform-
ante of the work for which this permit Is issued (Sec. 3097, Civ. C.)
LIhereby
tenders Name
Landes Address
I ceditythatl have read thisappBcatlonand statethatlheatiove Information
QTY.'' '.'MEC_ANICAL P$RIvM '.:`FEE"',
PLUMBING FEE
MECHANICAL FEE
iscorrect.I agree to complywith all cityand county ordinances and nate laws
relating to building construction, and hereby authomm representatives of this
city to enter upon the above-mentioned property for Inspection purposes.
(Na) agree to save, Indemnify an d keep harMess the City of Cu prom.
against liabilities, judgments, "sand expenses which may in anywayaceme
against said City in consequence of the granting of this peril.
"
PERMIT ISSUANCE
ALTERORADDTOMECH.
AIRHANDUNC UNIT CIO 10,000CFM)
FEES PAID:
Date ReCei P[#
SUBTOTAL:
AIRHANDLING UNIT (OVER ID,000CFM)
CONSTRUCTION TAX,
Signature of Applicant/Contractor Date
EXHAUBTHOOD(W/DUCT).
CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
HEATING UNIT (TO 100,000 BTU)
Will the applicant or lulure building occupant store or handle haxardous
material as defined'by the Cupertino Municipal Code, Chapter 9,12, and the
Health and Safety Code Section 25532(.)7
F.1 No
Date Recei t#
HEATING UNIT (OVER 100,000 DT"W
-TOTAL:
VENTILATION FAN (SINGLE RESID)
IS✓�
DATE
Gli n 11990 1890
!- 1JJU
Will the. er(utvre bWlding occupant use equipment or devices
which emit haeardoue air contaminants as defined by the Bay Area Air
Quality Management District?
Yes R❑ No
have read Healthe h ardfet materials tmqu ions 25505,25533 Chapter .1 of
the Health&Safety Code, and,
BORER -COMP (3HP OR 100,000 BTU)
MER-COMP(OVER100,000 BTU)
NEW RESIDENTIAL MECH. �, FI.
area ad that otcurrently have: i that it
undemtandthat If notify the ongdoes notof e currentlyhavetenantmustltbmy
re.pon issua roof aloe camof ccupa requlrenente whkh must be met
prior to issuance o(a Certl(kate of Occupancy.
i
catty, of Pths�syy
j
1. � �r ll"o .
-
" TOTAL:
`
ISSUED BY:✓� 4X2 ��%.S'Q'E'1
Owner or authorized agent Date
OFFICE COPY