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26823 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY jI j0N UPERTINO nso mNc..,,C 'R . PERMIT NO. DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL ,n-68.23 IIUILDING PROJECT IDENI'IP'ICATION GL O L BUILDINGESS: //•k SANITARY NO. APPLICATION SUITMI'1'I'A1.DAl3i V UNIT# LOT# N PHONE: CONE A 'S NAME: .tf LIC NO: �L INE iR: 3gLIC NO: ADDRI:55: w ,S( ❑ LON'fACT: PHONE " 14 h1: Q�A .'i? BUhLDINGsPERMIT INPO � C Erg V vCtPERMI -FEF. t G R �PY' fi L LE PLUMBC PERMIT ISSUANCE LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL OKZ Ihercb,.rirm thin loin lice ns tal underlimsisionsnfChupter 9(commencing with JOB U IPfION w00 Section 7")of Division 3 of the Business and Professions Cale.and my license is in PANELS �FjZ :all force and effect License Class Lac.p IIP TO 200 AMPS �/'/,'►[_Ya,'_J` F W Data Content 201-1000 AMPS IIIII''�''''''���� ZOr"ir� ARCHITECTS used public OVER 1000 AMPS SQ AREA S/>iQ.FT. I une<manJ my plans shell ho used u public DECLARATION W SIGNS ELECTRICAL l Q,Y J License)Professional WOWNER-BUILDER DECLARATION SPECIAL CIRCUTOMISC. I hereby affirm that I am exempt from the Contractors License Lew for the O ti following reason.(Section 7031.5,Business ovd Rofessions Code:Any city or county TEMP.METER OR POLE INST. N� which requires a Permit to construct,other,improve.demolish,or repair any structure Wim print m its issuance,also requires the applicant for such permiuo file a signed statement POWER DEVICES W eJ GC) that he is licensed pursuant to the Provisions of the Cnnmtmor's License Law(Chapter v.Lx eLL 9(coiniverngwith Sermon 7000)of Division 3 of the Buxinessand Professions Cale) SWIMMING POOL ELECTRIC ^ VALUATION '! W_m Srtat ion 7031.5 by any mnt f the basperisfoMeasegedexemption.Any violation of U LETS.SWITCHES-FIXTURES �e / I x♦; } aaa - pQ Section 7031.5 by a andledicuntfo($50d.it subjects the upplicannu eeivil penahy of !/ L not mare than nee neadred ennara(5500). C m ❑ I,asnwnerof thcpropmy,°rmyemployaawith wagautheireolecompcnution, NEW RESIDENTIAL PLC _SQ.FT. STORI TYPE CONSTI;VCTION y,3� will clubs work,and the surname JanotimendedoroffereJ for sale(Sec.70il,Business and Professions Code:The Contractor's License Law does not apply to an owner of properly whobu Idsor improves thereon,and whodoessuch work himselfserthrough his own employees,provided thatsuchimprovements menot inteadedoro(fere)foreale.If, OCCGROUP RES.UNITS however,the buildingnr improvement is sold within one yearn(completion,theowner- T ' builder will have the burden of proving that be did not build or improve for purpose of ❑walc.)I its ownerofthe n Iusivel contracting QTY° 1 a PLUMBING PERMIT FEE, FLOODZONE AIN Pec. Y amexe y g s with Me Couoto r' q xy 7 y f,b construct Ilia project(Sec.can Boniness and ywhosfons mare The Contractor's ` License).awdorsuch ppjects own Cnfpmpeny whobuRes°dmprovesthmareeand PERMIT ISSUANCC whence Lets lin mchpro]ectswithnwntruetor(s) icensed(perswtm totho Cnntraet°r's ALTER License lows FEE.SUMMARY ❑ 1 um exempt under Sec. B&P C for this reason BACK FLOW PROTECT.DEVICE SANITARY Y N Owaer Dam DRAINS-FLOOR.ROOP,AREA,COND. RECEIPI'N WORKMAN COMPENSATION DECLARATION. SCHOOL TAX Y N ❑ Thereby affirm that l have a cenificate ofemisead to sel6msum,ora certificate of FIXTUR[.S-PER TRAP RE :In# Workers'Compensation Insurance or acenified copy mereof(See.JIM,Lam C.)which PARK FEE Y N covers all employee's under this permit. ' GAS-G.SYSTEM-0INC.40l1TLCT5 RE then Company BU CD G VISION FF.F_S Company ❑ Certified copy in hereby famished. GAS-HA.SYSTEM.OVER 4(HA) PLANCHECKF.i ❑ Certified copy is files with Ne city inspection division. GREASRgbOUSTRL WASTE INTERCEPTOR GRADING FM CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEECOMPENSATION INSURANCE Unissection need not be completed ifthe permit is foronehundrN dollars($100) SEWER-SANITARY-STORMI .200FT. ENERGY or less.) 1171, Visit I certify that in the permerance°fate work for which this permit is issued,l shall WA :R HEATER W/ : T/ELE not employ any person in any manner so as to became subject to the Workers' PAI z C°mpensutam Umosof Colifineia. Dale W R Y Dam Recciptp Applfcem 0 NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should NEW S F TALPLMB. TOTAL: rrte-. becane subject to the Worker's Competroad a provisions of the Labor Code,you moat forthwith comply with such Provisions or this Permit sled l be deemed revoked. BUILDING FEE Z CONSTRUCTION LENDING AGENCY SEISMIC FEE L O 1 hereby af9rm that there is a construction lending agency for the performance of U O the work for which this permit is issued(See 3097,Civ.C.) TOTAL: ELECTRIC FEF. �.. Lender Name 1 a Lenders Audi— fjTY - '-a MECHANICALS PERMIT„ I t.ti . . ' FEE PLUMBING FEE U I cerufy that I have read this application and sum that the shove informatirm is correct I agree to comply with all city real county ordinances and state laws relating to PERMIT ISSUANCE MECHANICAL F'E f" I,t Imildingcommuctien.and hereby anthrriu representative ofthis city to enter upon the CONSTRUCTION A% U z above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. (We)s teem save,Indemnify and k harmless the City of Cupenimo against liubi'"e' Jgmen osuand expenua nth may any w esgainst sa City AIR HANDLING UNIT(TO lO,IXq CFM) nuance egtanting of this 't. IR HANDLING UNIT(OVER 10,UW CPM) Sig a plicate Life EXHAUST HOOD(W/DUCI) PAID AZ ROODS MATERIALS DISCLOSURE HEATING UNIT(TO 100,001)BTU) Date «eijn N Will the applicant or future building occupant stare or handle hazardous material re defined by the Captain.Municipal Code,Chapter 9.12,and the Health and Safety HEA'T'ING UNIT(OVER 10.109(1 BTU) Code,$cqi 25532))7 m6A —q- 0 Yes EI No ENI ILATION PAN(SINGLE RESID) Will the applicant°dumas defining by the ay Ana Air Quality Mwhichcreat BOILER-COW(311P OR 100,0!0)BTU) ISSUANCE TE hazallous air contaminanu an defined by the Pey Area Air Quality Management BOILER-COW(OVER 100,p019TU) tricf! 11P 001 A Yes ❑Na NEW RESIDENTIAL MECH.—SQ.FT. LCalifomia have read the hazardous materials requirements under Chapter 6.95 of the _so Health&Safety Cale,Sections 25505,25533 and 25534. 1 understand Nm (111 �2 ��(Iquilding docs nut Currently have a temme,thatit is my responsibility to silly the AU9Ant of the enImementa which must be met priorm issuance ofa Certificate of ncy. CI�IYor summ red agent Date TOTAL: ISSUED BY: OFFICE CUPERTINO SANITARY DISTRICT 20065 Stevens Creek Blvd., Bldg. C PRS: Cupertino, California 95014 CHB: _ (408) 235-7071 AEF: _ "OVER THE COUNTER REVIEVV �1 � Date: ff*�yds12, File: CuSDD- MOP Building Dept-Cupertino Community Development Department- Building City of Cupertino 10300 Torre Ave. Cupertino, CA 95014-3202 / Re: Subject: tce Qd!c� Yro-t Name: Address: APN: _z;o ( Control/Plan Ck No: Permit No: 2*S2_3 Gentlemen: The Cupertino Sanitary District has reviewed the plans for the subject project: Parcel is connected to sanitary sewer. I ❑ Parcel is not connected to sanitary sewer. Refer plans to County Health Department. The following Conditions/Requirements are made: ' 1? No additions;fees or permits required by the District. i-5 i ❑ Cupertino Sanitary District Fees or Permits are required for the subject improvements please do not issue any building/grading permits ❑ Plans must be submitted to the Industrial Waste Division of the San Jose/Santa Clara Water Pollution Control Plant (Phone 945-5307) for their review and recommendations for pre treatment device requirements. Please Do Not Issue building permit until these requirementsihave been transmitted to you by the District. fm , The following Conditions! ommendatio pply: �— Locate and raise to grade a property line cleanout. ❑ Install a backflow protective device-verify serviceability if existing. ❑ Break areas authorized minor electrical appliances only. Z),iN le- 0 e❑ No dispo al'or dishwasher Installations. elp.. . - ❑ No adde lab/office equipment which results'in additionalywaste water discharge. © Other: ... . M i The condensate from any HV equipment, surface water or irrigation water shall not be discharged to the sanitary sewer. ri.NrOA'i�rrd/a— J1 PLOT I X ST i � � I Ty�bf 4tvry am. ro/KRrc� -— I Rrn• ARAB& - I i I I AMI T/Or1/� i S$!L b �ouTN 1 1 -- t•" ;:<:i` — — yy% '" <k h �c{T�uro,xlSr.Nc�.�X9FRc:QN�aLt CD � 5r M� d '1�-�Gd , ,. SroSu yocer yXl,�8EA'.n oNyx�l�b3T `` U �— —j �11'vs�P �wB�EA.2�X+lB 1p �aNuvrioE�SFFL'u�h4J9/rytA O I 1 7lAt� Rltt a Yakit f„ rY� I i Cir pLi f ' yf R ':I� `�' I �'mrsoN / (l`• �r wX HA - II ,iRsc ... I I�I � 1 O 8" 5 Y ----------- I aqq- ; * . , , • ' .- fit_ �i " fpQ.l q ,1 woRl�se/Kf1N I j l 9` I N D I5' SP4r�/s g 7" I q,zt ➢ m�h� I ° r N f ' 'L6• .cam; - - S � y' It zi -o -s �I 6aR� I . I /6"O.. I yxrl Yx ` �,. I ! 6'�.rq�,,,rNDOWV��k �1�� : - ( i — — — — — •'CRAu�I. — ei=! ur Remo En zrRE4uIRaD 13f8 / Q --- /OCl46 .GDAT/•�,U _ Ly " _. ..•., 134?w4� /f6 li Ll�GLAz/ aD �o� �Ae /iUV - - 19`0"' � Saab=� , ,� h B���Sp�n�21�9a - � a4�f I XNom, / // APPROVED BY: SCALE: `< DRAWN BY '4'• L 4 ` - DATE: � REVISED J V 7 _ OFFICEqa . 2 �,eR� /�� S/�8 , , ,copy I�"nI '�il� if�'u.--ttl � _ � DRAWINONUMBER Y � n //!) 1 IE 2 24 PRINTED ON NO.IWM CLEARPRIM