19652 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES,— USE BALL POINT PEN ONLY
Building Pro'ect Identification . PERMIT NO.
�BWId;Ag�AcIdreas: - " - . 19652
l.o' 7 7t-� , Ft 2z C: C
Phone:
wnerV. ,e - - e U -:CITY OF CUPERTINO-BUILDING DIVISION
c6ndma Na - Lm.Nn • .APPLICATION'%PERMIT.—
BUd
fLUING- ECTRICALPLUTO
MBING MHAMCAL CATEGORY CONTROL
� .
Arch et/En neer. LI$Na:
tQTY t'c's( t t,ELEL'TRIC PEI{1411TIt i sl.. FEE' :'I t BUILDING:PERMIT(INFO a':'
Address: _ PERMITISSUANCE -
LICENSED CONTRACTOR'S DECLARATION �'• L1 `
Ihereby affirm that Lane licensed under provisions of Chapter 9(comment. APPUANCESRESIDENTIAL _ )OB DFSCRI'fION s
ingwith SeRion7000)6f Division3ofthe BuslnessandProfessionsCode,and my -
lianm Is In full force and effect. PANELS -
r License Clam '^ Llc.# s �P
Data Contractor ' UP IQ 200 AMPS
ARCHITECTS DECLARATION 201-IMOAMPS fI
9Z I understand my plans shall be used as public records. OVERI00)AMP9 SQ.FT.IlAORAREA $/SQ,FT.
µqqµ! CO
E (� Lhanse,d Professional SIGNS ELECTRICAL - -
66 w
6 OWNER-BUILDER DECLARATION f
I"n Fi3 SPECIAL CIItCUIT/MISC -
02 a owingrason.(hatlamexempt 31.5,Business
he sad Professions Code:
Law tort he -
pp following reason.(Section 7eetto Business and Professions Code:demolish, d or
O Z f.� y ty TEMP.METER ORPOLE INST.
anystmcountyhkh mguirviartolts manceao muimsth.mprove, sucorrepair tto
q .`ri- 3ny atmcture tatemelte that
he is sins reed pursuant to the provisions
rMt a POWER DEVICES.
file a signed statement that he Is licensed pursuant to the provbiom of,the
O u, Contractors License Law(Chapter 9(commencing with Section 7000)of Divi- "
�0 shun 3ofthe Business and Professions Code)or that he Is exempttherefromand SWIMMING POOL ELECT VALUATION
p, the basis for the alleged exemption. Any violation of Section 7031.5 by any OUTLETSSWITCHFSFI ES'
Q applicant fora permit subjects the applicant to a civil penalty ofn.t more than
`��5 Q five hundred dollars($500). ;
4 r`7ti+u• - '
W �n ❑I,as owner o(the property,or my employees with wages as their sole �
NEW RESIDENTIAL ELECTR STORIES TYPE CONSTRUCTION
i. compensation,willdothe work and thestructdre is not intended or offered for ,
g q ask(Sec.7044,Business and ProfessionsCode:The Contractor's License Law
F,,�� $ does not apply to an owner of property who Wilds or Improves theme,and
'�^ who does such work himself or through his own employees,provided that such OCC.GROUP RES.UNITS
improvements soared intended orofferedforsals.If,however,thebulldingor u :.. TOTAL
improvemntissoldwhhinoneyearofcompleton,theowner-bu0derwilI hav -
te mien of proving that he did not build or improve for purpose ofsal.) 'Qq'Y,:1 •t ,PLUh'IBINC'PERMtTa+ ,:x,r ?`•FEE :
•FLOOD ZONE APN
j L as owner of the property,am exclusively contracting with....need PERMIT ISSUANCE -
contractorstoconstructtheproject(Sec.7044,Business and Professions Code: L.
.The Contractor'.Licenm Law does net apply to an owner of property who
Wild. or Improve.thereon;and who contract. for such ptojets with a ALTER-DRAIN&VENT-WATER(EA)
co,Lttct 9)licensed pursuant to the Contractor'.License Law. - 'OLt:4`k •'i`.'EEL
.LII am exempt under Sec. B &P C for thta risen. BACK FLAW PROTECT.DEVICE
Owner' .' • DRAINS FLOOR,ROOF,AREA,CONTI. SANITARY Y -' N -
• Date ^ RECEIPT p
WORKMAN COMPENSATION DECLARATION. - FIXTURES PER TRAP SCHOOLTAX Y N
❑I hereby affbm that I have o l rtum h of consenti d eel theure,or - RECEIPT a
cemfiab o(Workers'Compensatlon lr,.urana ora artlfkd mpythereof(Sec. GAS EA.SYSTEM-I INCA PARK FEE Y ' N
3800,Lab C.) '
Policy q - RECEIPT#-
Com an GAS EA.SYSTEM-OVER 4(EA) „
Y BUILDING DIVISION FEES
Certified copy Is herebyth the city
GREASE/INDUSMLWASTEINTFRCEPTOR PLANCHECK FEE,
• ❑
Certified copy Is(lied with the city Wpection dlvlslon�� ,. +
CERTIFICATE OF LXEMPFIONFROMWORKERS' GRE\SETRAP PAID
'- COMPENSATION INSURANCE -
(TMssetion need not becomplted lftheperret isforonehundred dollars SEWER-SANITARY-STORMEA.200F]'. ,. - Date RCCCI f#
($i W)or leas.)., •, WATER HEATER W/VENT/dFLTR ENERGYFEE Y� N
I metifythat he the performance of thework forwhhch rile permit is Issued,
I shall not employy any person in 4n manner eo an to become sub so to the _WATER SYSTEM/TRLATING �(� PAID
Womk.rs'Corp�.AsLawe a( orris:DateZ'';LJ�_-!}� - .
0 Applicant_ 1(( //���f,' ,d/�7y NEW RESIDENTIAL PLMB. �j,.FI. Date Reuel t#
Z p NOTICE•T' ' AM:If,a er rnad Is Certificate of Exemption,you .
Fshouldberorie subject tothe Worker.Compe...tionprovl.lonsofthe L.b., TOTAL: .
N Code,you mo at fe i1h comply with such provisions orlh5 perretahall be
W > ,: deemke
ed revod. - - BUILDI G FEE
d. G CONSTRUCTION LENDING AGENCY: , rv SEISMIC FEE
I herebyaffiren that theie Is a construction lending agency for th pert rm- Ly ELECTRIC FEE
'M Z cans of the work for which this permit is Issued(Sec 3097 Civ C) TOTAL _l
0 Mders Name . t PLUMBING FEE
LL H• • Lenders Addreas - QTY _?;, MECI-(ANICAL"�LERIIIIT t"':''+t'.�FEE'�, MECHANICAL FEE `
O W Icertify that]have read thisapplicatienand statethattheabove information -
a correct.I agree to comply with all ttyand county mclin.eresand gets law. PERMIT ISSUANCE,.' FEES FAID: - -
N• relatingtobulidmg construction,and hereby authorae representativesofthb '
F-Z city to enter upon the above-mentioned property for lnspecdon purposes, ., ALTER OR ADD TO MECH. Dale' R2Ce1P[#
— (We),agree m save,Imn
ndeify an d,keep ham ess the Cltypf Cupertino -
againstliabilities,judgments,mansard expenses which may In anyway.... AIR HANDLING UNIT(TO 10,000 CIM) SUBTOTAL:
against i In romcq. the granting of this
-,f AIR HANDLING UNIT(OVER 10,00)CFMi - CONSTRUCTION TAX
r% roof Applicant/Contractor ,Date EXHAUSTHOOD(W/DUCT) - CONSTRUCTION TAX PAID:
HAZARDOUS N
fRIALSDISCLOSURi -
Wfllthceppllcantorfutureb�li hng omrpantstore or handle hatrardous HEATING UMT(TO 1(A,000 BTU)• Date Recel1 t#
materials.defined by the Cupertino Municipal Code,Chapter 9.1 2,and the .
Health and Safety Cole Section 25532(a)7 - HGTING UNIT(OVER 100,00)BTI . , -+t e
❑Yes No . 1 +
TOTAL: IS
Will the.pplica.dor future Wilding occupant me.qulpmet Aebices VENfILATIONFAN(SINGLE RESID). ' .ISSUANCE DATE.
which emit hazardous air contaminants as defined by the Bay Area Air i
Quality Management District? +` BOILER-COMPOFII'OR100,0WRTU) -
4Yee. ❑No,
have read the hazardous materials requlrementsunder Cha pter6.95otER-COMP(OVER 100,000 RTU)
the Cali(ornla Health&Safety Code,Sections 25505,25533 and 2S5M.�I r-B
understand that if the building does net currently have a tenant,that it le my NEW RESIDENTIAL MECH. SQ.FI'.
rmponsibButyto notify the occupant ofthe requirementawhich must be met' "
prior to issuance oft Certificate of Occupancy,
Owner or authorised agent Date ISSUED BY:
TOTAL:
OFFICE COPY