28356 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPL'RTINO HUILDING-ELECTRICAL HIRSHr NO. 28356^ w ^ a,x
APPLICATION/PERMIT 1'LUMIIING.MFCIIANICAL '2 l8 -3 95 {{•.;7
BUILDING DIVISION IIUII.UIN'G 1'ROJECTII)EN'I'IfICA'190N
BUILDI ' AJJD¢IiSg: SANITARYNO. APPLICATION SUBMITTAI.DATE
O E: PHONE: CONTRACTORS NAME: LIC NO:
NIC ^ /�CONI'ROLp
RCHITEC A NG NEER: f� LIC NOI ADDRESS: - ❑ r7/ ';
CONTACT. !i All
) QTY. IiLECI'RIC PERMIT FEE BUILDING PERRRMIT IIN170
�
1 "o BLDG -IFQI' PLUMB MHCH
�/ PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RF.SIDENI'LAL JOB S ION
mwz l hereby effort that l am licensed underpmvisions of Chapter 9(commencing with
POO Seeder Y000)of Division 3 of the Business and Professions Code,and my license is in PANELS
full force and effect.
vfdi y W License Class Lic.is UP TO 200 AMPS
d y Dote Contractor 201-1000 AMPS
ZOyzARCHITECTS DECLARATION OVER["AMPS SQ.Fr.FLOOR AREA $/SQ.FF.
02^G I understand my plans shall be used as audit is recoN,.
SIGNS ELECTRICAL
Licensed Profcssionnl
�bw, OWNER-BUILDER DIiCLANATIUN SL'IiC1Al.CIRCUIT/MISC.
LSC.
x�4'OaF 1 mushy affirm that 1 ma exempt from he Conlracmfs License Law for the
W3te-m lidlowingrensnn.(Section?0315.Btsmess and Prnfawinns Cale:Any city or enemy ltiMP.METER OR POLL INST.
u'�J which¢quires a pcntdt m consumer,alcor,improve,demolish,or repair any smartn
e
tamta�}� Eaton nits isstnnce,also reclaims the applicant for such permit to file a signed statement POWER DEVICES
tyC,O that hcls licensed Pursuant mike provisions ofthe Comommes license Eaw(Chapter
4 0F' 9(commencing with Section 7")of Division 3 of the Business and Professions Code) SWIMMING POOL IiLECiRIC ^ `VALUATION
or that Sectiohcisexempt thercfmrtanf the basPermfnnhetsthedexcmpti to civil
of OUTLETS-SWITCHES-FUTURES / /el OM
F.-1s r out Zr mdamS v any andredicant ollars ¢permit subjects the applicant to civil pennhy of �«�ttV// 1...V
W 5q0 out ml,asawn roftheproe y,orii empl SIBWRPSIDFNTIALELECTR _SQ.FT.
tYAFm ❑ 1,esowneroftheprnpeny,ornryemployees with wagesastheirsolecompensation, STORIES 'IVPE CONSTRIJCDON
a will do the work.anJ thestructam is not intended m.fimmd battle(Sec.7044,Business
and Professions Coil The Common's License law does not apply to un owner of
property who builds or improves thereon,and who does such work himself or through his
n employees.Provided that such impus ements arc not intended or offered for vile.IL OCC.GROUP ItIiS.UNITS
h.ever,the huilding or improvement is sole within me y ur ofconlpletinn,the owner-
hnilJerwillh�vethebuNenofpnovingthathedidnot it rimprnvefor sen! TOTAL:
pm s
sale.).
❑ I,msownerofneprolany,utnexclnsivelyc ractingwi Iicetlsedcommcansm QTY. PLUMBING PERMIT FEE FLOOD ZONE ql'N
onstrum the project(Sec.7044.Business
q ThPromeainns C cc Contractor's
Lkxmc hew Anesmm�pplymnn ownernfgmnywhn huihkor provoathereon,and PERMIT ISSUANCE
wimemamers mrsuch projects with upeor(a)licensed purse. ,.,he Cortvacme.,
License Law. ALTER-DRAIN&VENT-WATER(HA) FETE SUMMARY
❑ IamcZm.,dtmd,,X—,B& Clio this remnn BACK FLOW PROTECT. OUTSIDE ELLS
Owner Datc SANITARY YN
DRAINS-FLOOR,ROOF, OND. RECFIFI'tt
W KM AN COMPENSATIONDECLARATIO SCHOOLTAX Y N_
❑ Ibeehy off rt that lM1avou certificate of cortsnn to sed(-insure, ucedifwte of TIJRHS-PI?R'1'RAP RECELPTA
Workers'Ciampens lion lnsumnce oracmifcempythereof(Sm.3g Iah C.)whvh' PARK FEE Y N
`covers up employed under this Detroit' S-IiA.SYSTEM-I INC.4011J' R'IS RECEIPT#
Policy N BUILDING DIVISION FEES
Company A EM- VIR 4 EA)
❑ CenifieJ copy is ercby fumishnl. � - PLANCHECK ELF.
❑ Cenifiedcopyis alwiththecaa,me ae6c, do. C S RI. .'dill CF. R GRADING FEE
is
CLRTIFIC LOFF.XE OM WOR R 4EASETRAP SOILS FEE
C PHNSA'f1 RANCE' '
(Thi"mcaxnnced not be mpletnit 1 iti is bun d I SHWER-SANITARY-STORM EA.Nb ,� EIsHRGY FLE
or less.)
I eerily that in the perform enftLework whirl his II WATERHEA9ERW/VFN'OLUICTB *Ire I
not employ any person in any act so as 1. c as suhjs the ken. PAID
Compensation Laws of @lifamia, me WATER SYSIFM/1'REA'1'ING ccelpt
O z Applicant
z NO'1'ICC TO APPLICANT 11.intern king Ibis Cc
*r, should NEW RIiSIDIiNT1A1,PCMB. SQ,FT. IOTA
C6 hecome subjecno the Workds Compet ¢tion Prov ito must
7forthwith comply with such provisinnsn dr,pe tt sed.a BUILDICONSTRUCTION T4 NG SEISMI BILE
z I herebyffrmtenherc isecnnmrua lendinperformance of �'IDTAL: tELEC(R-1c
FEE
VO the work far which this Permit is i.ssed(Sec.309'7,Civ.CJLender's Name UMBINGOULenders AddressQl'Y. MIiCHANICAL PIiRMI'1' FEEQJ. I certify that 1 have read this application and state than themaws information is
0. corect.l agree to comply with all city and county ordinances and state laws selming if PERMITISSUANCE! CHANICAL FEE
,,0 builJing emolo,tion,and hereby tnthoriee representatives of this city to enter upon the CONSTRl1C1'ION'TAX
U Z above-mentioned property for'nspectinn purposes. ALTER OR ADD 3'0 MECE.
(We)agree m sive,in nify:md p harmless the City of Cupertino'mmt
liabillims,ju rots,cas uspens w mh may in any way seer ' tsaicl AIR HANDLE NO UNIT(T010.0110 CFM)
::Mhe the t gofthis
ALR HANDLING UNIT(OVER q(MICPM)
Signature of Applicnnt/CnnwemrN ay EXHAUSTHOOO W/DUCD
/ y PAID
RL
HAZARDOUS MATERIALS DISCLOSUI[RATING UNIT(TO Iffl."BTU) Date Receipt p
Will the applicant or future building occupant store or handle hazardous aramnal HEATING UNIT(OVER IW,(KKI BTU? TOTAL:
as deli tied by the CuKatino Municipal Code,Chapter 9.12,and the Ilcalth and Safety _
Code,ScetlJ2(a)7
❑Ys0N VEM'ILATION FAN(SINGLE!BESIDE
Y
Will theapplicanmrfumre buildingrccupant uscequipmem nrdevices whichemit BOILER-COMP(JI{p OR 100,000 RISSUANCE DATE'I'U) � Y '
hazalloue min contaminants as defined by the BUY Area Air Quality Management BOILER-COMP(OVER 100,000 BTU)
Cl Yes ❑No NEW RI?SEDI?M'IAL,MBCA. SQ.PT.
Nov 16 1995
1 have read the hazurdonx namerinis reyuiremems under Chapter 6.95 of the Jxl' V
California Health&Safety Code,Seaar,Z25505,25533 and 25534.Iunderstandthm V Ur (z CJI"rH I IN'Y
ifthebuildinge requirements
whaveast hic thatitismyrsuance bility enotifythe
ecupant id he reyuiremems which must be met prior m issuance of n Certilican til'
Occupancy.
Owner or authorized agent Date TOTAL: ISSUED BY:
OFFICE