27888 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CLPERTINO RUIL.)ING-ELECT RACAL PERMUTING.
APPLICATION/PERMIT PLUMIIING-MECHANICAL, 27888 O Q O
BUILDING DIVISION BUILDING PROIF.C'P OIRNI'IFICATION G 888
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBBMIITI'ALDATP,
V R rU T,L 2—S UNIT# LOT#
OWNI:N5 NAMI!: ONE: fRACTOR'S NAMI': 1 LIC O21 N/C CUNIROI,#IIe'VV
sillC
ARCHITI!CT/ENGINEER: LICNO: ADDREES,:� rsC•U.L.. — � �dl' ElCLW lU1L ��
'oNTACT: PHONE QI'Y ELECTRIC PERMIT FEE BUILDING PERMIT INFO
'Z32 BLDG ELECT PLUMB MI5
F P[RMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES.RESUIENTIAL 1pHD DESCRIPTION
pwz Ihereb,iflion that l am licensed under provisionsofChaptere)(commencingwith
¢100 Section 7000)of Division 3 ofthe Business and Professions Code.and my license iv in PANELS
fulllorce and feel. —r
< Licen Cln \ 0 Lic.# z ! UP102MAMPS
yyW
y<eS Dale _ L. Gemtmcler' kk 201-]Bob AMPS
cae—ir Z..1 ARCHITECT'Seda,FClienwo ON OVER["AMPS
SQ.Fr.FLUOR AREA "E/SQ.PI'.
0'L^Q unJeremnd my plans shall he used as public rocnNs. P
Frn� SIGNS ELECTRICAL ((
Licensed Professional D
(rj �u
OWNER-BUILDER fr DECLARATION SP[CIAL CIRCUIT/MISC. p.
aq$OaF 1 hereby affirm that 1 am exempt from the Contractor's license Law for the mAR -#
W 1�0 oe following masons.(Section 7031.5,lameness and Professions Crile:Any cis,orcoumty TI!MP.METER OR POLE INST. -• 1 l
rn which requires a permit to construct,alter,improve,demolish,or repair any structure 1
O
'�>� pnonnits issuencc.alsis requires the upplicum fnrsuch permino Bleasigned mmirenl POWER DEVICES W�/}' 996
ly�j K O¢Oz that he is licensed pursuant to the Provisions of the Contractors license Law(Chapter LlH L rr
D. ELL 9(commencing with Section 70!10)of Division 3 of the Business and Professions Cute) SWIMMING POOL ELECTRICS
' mow or thin h,is exempt therefrom and lh,basis for rile al legcd exemption.Any violation
�zQ Section 7031.5 by any applicator for a pennirsubjects the applicant to a civil Penalty of OUTLETS-SIND CH IS-FIXTURES
not more than Eve hundred dollars(S500).
W ❑ l,asownerofthc m NEWRESIDENTIALELF.CIR _SQ.Fr.
p p,nY.ormyemployecs wi[hwvgesmtheirsolecompenamon, S'T'ORIES TYPE CONSTRUCTION
y3— will do rhe work.md the shucmre isnot inrendeduroffered horstile(Sec.7044.Business
and Pmfnsions Cade:no Contmcers License Law does not apply to on owner of
property who builds or improves thereon,and who does such work himse,lfor through his
own employees,provided that such improvemer,soero intended conflicted hostile.If, OCC.GROUP NI?S.UNI"rS
however,the building orimprovement is sold within one yearofcomplenon,lheowner- TOTAL
builder will have she burden of proving that he did not build or improve for purpose of
sole.), - -Y
❑ I,as menerafthe Pror
operty,am exclusively contracting with licensed cnnuams to QTY. PLUMBING PERMIT'- FECPLooD ZONE pPN
consumer the project(Sec.7041,Business sad Professions Coled The Contractors
Licen.sel,uwdnesnntnPPlymannwnerofpmpertywhobnlldsorinrprovmlherean,and PERMITISSUANCE
wh,ennvecla fnrauchprojeclawith ucontragorts)licensed pursuannoshe Contraemr's pLTI!R-DRAIN&V
License Law. - TENTER(FA) FIiIi SUMMARY
❑ 1 um exempt under Sec. ,B&P C Por this reasonBACK IrLOW I'ROTE '.D ICIi SIDI.F EES
Owner DateSANITARY Y N
DRAINS-FLOOR,R F,AREA,CON RECI11PT#
WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN
❑ I hereby eflom that l have a certificate licenser,toself-insure,oracertificatcofpl%TURES- RECHIPT If
Werken0on'Connimulourpoweoracenifiedcopythereof(See.3800,LabCJ PER RTRAI PARKIEE Y_N
avenallemployee's yr�erth,s n GAS-EA.SYSTEM-I INC.40 S RECHIPT#
Policy# sNC. \`'\�C]mOlo00
BUILDING DIVISION PGHS
Company T moa � GAS.E1.SYSTEM-ON, ai( ) PLANCHECK FEE
CortiOed copy is h<mby Pomished. T—
❑ CertiOCJ copy is fled with the city inspection civilian. GRI!ASE/INDUSTRL WASTE INTERCEPTOR GRADING FTA!
CERTIFICATE OF H%EMLTON FROM WORKERS' GREASETRAP
SOILS FEECOMPENSATION INSURANCE
(This see,ion need no,be completed iffee permit is for one hundred dollars($100) SEWER-SANITARY-STORM BA.2IXIPF. ENERGY FEE
or less.)
I cmifytho inthe rerfom,ancc of the work for which this pernit is issued,Isha11 WATER HEATER W/VCNT/EL.L'[TR
no, employ any pets n in any manner to ns,. become 10jea to the Workers' PAID
z Compensation Lawsof Califomia. Dam WATER SYSTLMfrREATTNG Dom RecciPr#
Applicant
71� C NOTICHTO APPLICANT:If,obennaking this Clomficme of l!xemp,iml,you ahoNd NEW RESIDENTIAL PI.MB. SQ.FT. 'TOTAL.:
(Z) 'become object o the W...ker's Ciampereaatim provisions of the Lmbor Code,you most
�i 7 forthwith comply with such p addinna or this pemdmill)be decmM revoked. BUILDING FEE
6wi CONSTRUCTION LENDING AGENCY SEISMIC FEE
z I hereby affirm that there is n mentuction lending agency for the performance of
U O ,he work far which this Permit is issued(Sec.3097,Civ,C.) TOTAL: ELECTRIC FEE
Lender's Name
CU Lender's Address QTY, MECHANICAL PERMIT � FEE PLUMBING PLL'
L1a 1 certify That 1 have read this application and.,are shat she move information is MF.CIIANICAI.FEEmeet.l agree u.comply with all city and county ordinances rend state lows relating to PERM IT ISSUANCE
building cansmuctim.ned hereby mahonre representatives of this city,.emar upon the
U vbeve-memimed Property for inspection purpnsu. ALTIRORADDTOMECIL CONSTRUCTIONTAX
(We)age,in save,in lro ni ly and keep harmleas the City of Cupertino aguindr
liabilities,judgments.costs
�s said expenses which may in any way accrueag(mins,said City AIR I IANDLING ONE r(To to,"CFM)
',
Signature of Aplcan4C(Intmcwrl��o llai ) �!,— -Da , AIR HANDLING
THOO hien r(OVER 10.000 CFM)
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNI'T(TO IM,000 BT U) Uma Receipt#
Will the applicant or tome building necepana score or hwlle hazmdous material
in defncd by the Cupertino Municipal Cale,Chapter 9.12,and the Health vad Safety HEATING UNIT(OVER I00,000 BTU) TOT
Code,Section 25532(a)'f
11 Yes 11 No VEbO ILATION FAN SINGLE RESID)
Will that cmicamart future building by the Bay equipment ualityceswhichemit
BOILER-COMP(3HP OR 100,000BTU) ISSUANCE DA
TE
rurdnm air cnnmminants as dclinW by the Bay Arta Air Quality Management
IUiso-icR' BOILER-COMP(OVER 100,00(i
❑Yea ❑No NEWRESIDENTIAL MECH.—SQ.FT. v
I have rad the h Safely
Cosi
.materials requirements ander C.1 m 6.95 of the all_ko
iffive mil in,Health&Sa[euy Calc,ambers 25505,2559)and 25374.I uneersmnd that
ifshebuildingdocsnotments currently have.tenNemet it is my rsuanceofa I.modify the
occupant of the requirements which most be ten prior to issuance of a Cenifcam of
Occupancy, .
Owner or amhodred agent Dae TOTAL: ISSUED BY:
OFFICE