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25272 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILINNO-Iq,ICI RI PERMIT NO. APPLICATION/PERMIT PLUMBING-MECHANICAL n C n e� BUILDING DI VIRION - BUILDING PROJECT IDENTIFICATION L J G G BUILDING ADDRESS: SANTfARY NO. APPLICAT10NSUBMITTALDAtE 16© I _5AnitT06A su/qNyvnLAr_'D SATE s,/ U 1?NS :.T . /E - ,�/x PHONE: COMB. ACfOIC AiAtel„� PLVpP8/N�4`.V` . T�1/frkk l/f�d1Ar'f W aC�JC?I'V 1/11 ll Nl I�--i �p / CON ROLA RCIII'1'ECI'/1i`1GINEER: LIC NO: ADDRESS: �� ❑ CONTACT: PHONE: r BUILDING PERMIT INTO • QTY. ELECTRIC PERMIT PER BLDG ELECT PLUMB MECII PERMIT ISSUANCE El 0 7P ❑ LICENSED CONTRACTOR'SDECI.ARATION APPLIANCES-NESIDI3NTIAL "DNS[RI taglaz Ihercby affirm that lam liCONIF uACIOR'S DECLARATION (commencing with F�ffO�.. fulhforce a00nd eft rvt✓n.of gra Business Professions Code, dmylicenselsin PANELS 12 Fycw fidl I1.Cla Lic.N UP'1'02fMAMPS }»a mQy Conmvctar 201-II%M AMPS '7 FO t`ooz ARCHITECTS DE SQ.FT.FLOOR AREA E/SQ.Ff. OZ—CS l understand my plans shall be used az public records. OVER IOOUAMI'S PK ; SIGNS ELECTRICAL hLicensed P ofcssianal < OWNER-BUILDER DECLARATION Commutators SP[CIAL CIRCUIT/MISC. pp,,04 F I hereby emfiSe that 1 am exempt from the Coniranora e:Any ciLawty o far the P I R E D Ixil VI ALL t17 whichingmvmrv(S¢tion 700 L5.Business and .a,deions Cade:Any city or county TEMP.MI?TER OR POLE INST. NO¢ which rayuires a permit m vonsmucq alter,improve,demolish,or repair any structure QanQ7 prianaits ismvnce,also requires the applicant for suehparratto file a signed smmment POWER DEVICES that he is licensed pursuant to the provisions of the Cmmenr'a License Law(Chapter 4g�4o4. 9(commencing with Section 7")oUivision 3 of the Business and Professions Code) SWIMMING POOL ELECTRIC VALUATION 41—m or that he is exempt therefrom and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES-FIX'NR13S �ZQ Swtian 0031.5 by my.ppllcam for epcoal...bjectatbe eppli,am 1.a civil penalty of r� not mare than five hundred collate(ES(gp, NEW RESIDENIUALELECIR _SQ.IT. STORIES TYPE CONSTRUCTION m 6 1:11,aaownerofthepropcdy,nrmyemployeeswith wages ustheiranlecomperana, a willdo the work,and lhes0ucture isnot intended reoffered forsale(See.]044,Business and Professions Cade:The Contractors License Law does not apply to an owner of proper who builds or improves thereon,and winches such work himself err through his employees,provided mmsuch improvements are nntinnndednrufferedformle.If, p C.GROUP RES.UNITS however,the building or improvement is sold within one yearof completion,the owner. TOTAL: builder will have the burden of proving that he did not build or improve for purpose of rale.). QTY, PLUMBING PERMIT FETE FLOODZO APN ❑ Las awnerjcai IS ,70y ,nculosivelycantmmingwinde:)The Contractor's conetmd the project(Sec.16'00,Bulinus anal Professions Code:)The Conlrvctor'e Liceela « wn wdsnot apply toownerofpropeny whobuilJsorimpmvestherwnand PERMIT ISSUANCE v whocantnets forsuch projects with acontractor(s)licensed pursuant to me Contractor's Al.TF;R-❑RAINffi VENT (EA) Liceaye Law. FEE SUMMARY ❑ I am exempt under Sec. B as P C for this reason BACK FLOW PROTECT.DEVICE SANITARY �Y DE Owner Data BACK DNAINS-FLOOR,ROOF,AREA,COND. RECEIPT M WORKMAN COMPENSATION DECLARATION SCHOOL TAX YN I M1ereby ef6rm That l Lace a ccnificem of chnunuoself-insure,or a cerofi...e of RECEIPT N kera'Gam tion lrenranee or.certified copy nherenf(Sec.JAOB,Inb CJ which FIXTURI'S-PER TRAP PARK FEE Y N p Asa Pn1n all emplaya's under this permit. IP D1 REVISION 1cYN /' Q GAS-EA.SYSTEM,INC.O OUTLETS BUILDING DIVISION FI3ES Company— F .Q 1:1)4GAS-P.A.SYS'IGM-0VFR4(EA) PLANCIILCK IEE Censured!copy is hereby famished. Cenifed copy is fled with the city inspection division. GRRASFANDUSTRl.WASTE INTERCEPTOR GRADING FHL? CERTIFICATE OF EXEMPTION PROM WORKERS' GREASE TRAP �� SOILS FEE COMPENSATION INSURANCE (fhia.,no.need not be completed ifibe permit is far nae hundred dollars PS 100) lg`SEWER ANTfARY-STORM EA.200FT. ENERGY PEE orless) I certify that in me performvnce ofine work for which this permit is issued,l shallTPR EATER W/VENTIBLECTR not employ any person in any manner so as to become subject no the Workers' PAID Compensation Lawsof Califomia. Data WATER SYSTEM/1'REATING Date R«eipnN Z0 NOTICE TO APPLICANT.IL.Rer trucking this Certificate of Exemption,you should NEW RESIDENTIAL PLMIL SQ.PI'. TOTAL: s;-t In hecnme subject o the Workers Compevaram provisiore ofthe Labra Cotte,you must C� > forthwith annuity with sucM1 provaion.or this permit shall be decimal revoked. BUILDING FEE aQ CONSTRUCTION LENDING AGENCY S171SMIC FEE U z 1 hereby affirm that then is a construction lending agency for the performance of T ELECTRIC FEE the work for which this permil is issued(See.3097,Civ.C.) Landers Nome U PLUMBING FEE.Lenders Addrees QTY. . MECHANICAL PERMIT FEE 1 certify that 1 have read this application wd smm that me above murmured.is r�" OWr correct. Iagrce to comply with ell city and counry ordinance and antra law.mleting to PERMIT ISSUANCE MECHANICAL FET. building construction,and hereby authorize rcprcsematives of thiseity wanner upon the CONSTRUCTIONTAX V above-memomed proper for imposition purposes. ALTER OR ADD TO MECII. (We)agree m save.Indemnify and kap harmless the City of Cupertino against Iiabilitiea,judgments,costs and expenses which may in any wvyacerueagainstsaid City AIR HANDLING UNIT(TO IQIKKI CFM) inc nae enceo the ranlingn 's UAIR HANDLING UNIT(OVER 10,0110 CI'M) Signor eof Applicvnt/CmdmcmrDam EXHAUST HOOD(W/DUCT Prem I IAZARDOUS MATERIALS DISCLO RC HIMTING UNIT(TO IM."BTU) Dae Receipt M Will the applicant or town building«cu,ma store or handle hazardous material IIGTINC UNIT(OVER 100.000 B'I'll) TOTAL: as dhpned by the Catania Municipal Cade,Chapter 9.12,and the Health and Safety Code,Station 25532(s)1 El Yet 11 No VENTILATION FAN(SINGLE RPSID) Will he epplicanmrfuwre building«cupanruuequipmenmrdevica whichemit BOILER-COMP(3HP OR 100,000 BTU) ISSUANCE DATE hatarri as air contaminants.defined by tmBOILER- he Bay Area Air Quality Manageent isndcn COMP(OVER 100,000 B'I'U) ❑Yes ❑No NEW RESIDENTIAL MECII. SQ.FT. I have read the hazardous marorials requirements under Chapter 6.95 of the PAID California Rerun&Safety Code,Sections 2"(15,25533 and 25534. I understand that WIN,building does nm currently have.mnanL that it is my responsibility to notify me JUN 29 1 occupant of he real 'r i Is st be net prior m iesumee of C lieat of Occup //� II y Owner -zedagent Da TOTAL: ISSUL6A I' OFFICE