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24568 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILD ING-ELKCI RICA L PERMIT NO. APPLICATION/PERMIT PLUMBING-MECHANICAL. esti 2 4 5 6 8 BUILDING DIVISION IIUII,DING PROJELT IDENTIFICATION V BUILDING ADDRESS: ,,/' \\ A``JJc VA�Y NO. 'ATIONSUBMITALDATE O S 0`\ C\ `\1 `s f�UNIT# 1.01'# /�� /c ( iNS NAME: PIIONE: CONTRACT'OR'S NAME LIC NO: L .7— 7eQ L-I C#fvr t SU �� < 7 �1 bb RTArrs caNTRGLa ARCHI'IECLhNG EE : LIC NO'. DRESS: Ou© '•'� �' 0 Q011 1�F� R2 Jtr5,' J,c ct 52Jc�i CONTACT: PHONEQTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO C((J ,' I ,��J-�' (—fIVJ -.677_04�4 BLDG ELECT PLUMB MECH Lla O PERMIT ISSUANCELK El El IJ aJp rl/ LICENSED CONTRACT'OR'S DECLARATION APPLIANCES-RESIDENTIAL. JOB DESCRIPTIONpp.Z, Iherehyaflirtn that l am licensed under mvisi.m.17 Chapter 9(cnmmencin,with 00 Scaftare And)effort. onJnf the Nosiness and Professions Q.de,Ander kens 's PANELS ' /r_p{.^ azo fall lar,CI.. effect_ r/A—_r_]VG Ztp Date Classes C"An, Lia U1-10001 MPS m<y Uam S/f[:f Ci3 Cnmr 201-IIXNIAMPS 1"',z ARCf11T[ SD C ARATION $Q. .FLOOR ARNA $/SQ.FT. ZOy-• I understand my Plans shall be u ed m pu mrecords. OVER IOW AMPS OZ—O 1=.r2 SIGNS ELECTRI AL F j Licensed Profeuional pilK1< OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MIS XO per,O I hereby affirm that 1 atn exempt from the Com mame,License Law for the m !! m�w~i following reawa(Smion]01 L5.Business and Professions Cale:Any city or countyTEMP.MBTERORPOL -ST. y.<] which requires A pemtit m amAlmcl,aper,improve,demolish,err repair any strvemm >- prior to its issuance,also requires the appl icam forsuch permit o file asignedstmemeat POWER DEVICES ty oa'�p that he is licensed prmant to the prnvlsinmofthe Commemis License Law(Chapter - dmxo� 9(eammenc ing with Section 9000)of Division 3 of the Busi ness and Professions Cade) SWIMMING POOL ' TRIC VALUATION W_m or that he is exempt herefrom and the basis for Ne alleged exemption.Any violation of OUIIETS-SWITCHES-FI%TURES F Z Q Section 7031.5 by any applicant fora permit subjects the applicant to A civil penalty of .Q E20 not marc Nan five hundred dol l...($5001. Wf—C ❑ Lasowncro(Ne n ycmp y g NEW RESIDENTIALELECIR FT. props y.orm to<eswithwa esastheirsole<ompcnsation, —SQ. STORIES TYPE CONSTRUCTION a3— wifid.gic work,and the..,amis not imendedmaffesd fmaule(Sec.)044,Business , and Profession.Cade:The Commmara License law does not apply to an owner of C f C a t 5 -a Property%hobuildaorimpmvesmereon,and whodoes suchwork himmiforthroagb his on employees,pmme videcl that such imMovenroarenot imenaedoroffemd formle.If, OCC.GROUP RES.UNITS however,the building or improvement is veld within one year ofecmplction,the owner- TOTAL: huilder of 11 have the burden of poising that he did not build or improve far purpose of e). ❑ 1,asthe project Ne(Sec.70,14. .B�si usivelycorofesions with Th Contraonto QTY. PLUMBING PERMIT FEE RooD'/.ONE qpN consLicense oes not pp[yoas,oBusinessandy whobioms Codep The flacon,and License LawdfOrsucapplymanmwncon=locrtywuobdpuorimprova flacon,and PERMIT ISSUANCE wed contracts forsuch projecm with a convacmr(s)licensed Oursuanno the Commcmr's License Law. ALTER-DRAIN&VENT-WATER(EA) FEE SUMMARY ❑ 1 em ncmpt under$m. ,B&P C fm Nis reason BACK MOW PROTECT.DEVICE OUTSIDE FEES SANITARY yN Owner Date DRAINS-FLOOR.ROOF,AREA,COND. RECEIPT# WORKMAN COMPENSATION DECLARATION SCHOOL TAX YN v<i effrn butlhaveecenificmc of consem mself-insure,nrncertificme of pl%TUR13S-PER TRAP kLC[IPfp Workers'Compensation lnsurnmeeoraeenifiedcopy Neroof(See.380,Lab CJ which PARK FEE Y_N Pompsell toy" d r IF permit. on C. t` ...Q GAS-IiA.SYSTEM-1 INC.JOUTLfa'S REIMS' N Comp;tny�-dl �a+( BUILDING DIVISION PEES ❑ Carib- copy is hereby famished GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE 9t Certified copy ie filed withthe city inspection division. GRFASIIINDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE COMPENSATION INSURANCE (This section neednot be completed BIN,Permit is fere.,hundred dollars l$IW) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE r los) I cerify that in thep,riforrnnei,of the work for which this permit is issued.I shall WAT12R HEATER WNENT/ELECIR not employ any Person in any m•inner.s t as to become subject m the WorkeWorkers' PAID z Gmgmn.nuan Laws of Cald"Ania, Data WATER SYSTEMOREATING Applicant Date RecviPt p Q z 0 NOTICE TO APPLICANT:If.of,,,making his Certificate of F-xcmption,you should NEW RESIDENTIAL PLMB. SQ.IT. I" TOTAL: lq become subject to the Worker'.a Compensation provisions of the Labor Cede,you must 7 forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE LU Q CONSTRUCTION L ENDING AGENCY SEISMIC FEE Z) z I hereby affirm that Nem is a construction lending agency for the performance of U O the work for which this permit is issued(Sec.309],Civ,C) TOTAL: ELECTRIC FEE Leader s Name 0 V Lender'.Address QTY. MECHANICAL PERMIT FEE PLUMBING FEF. 1 dean y that 1 have read his application and state tum the above in Nrmalinn is correct.l Agree to comply with all city and county ordinances and stale laws slating to PERMI'TISSUANCE MECHANICALFEE H ( t buddingamstruction.and hereby aothorim representatives of this city to enter upon the J z uMw,nona ned property for inspection purposes. ALTER OR ADD TO MECH. CONSTRUCTIONTAX (We)agree to save,indemnify and keep harmless the City of Cayenino against liabilities.judgments,costs and expenses which may in any way.cane Against said City AIR HANDLING UNIT(TO 10.1100 CFM) in consequence of the granting of this permit. AIR HANDLING UNIT(OVER 10.000 CFM) Signature of Applicam/Contrecror Date F.XI IAUST HOOD(W/DUCT') PAID HAZARDOUS MATERIALS DISCLOSURE IIEATING UNIT(TO IW,OW BTU) Dam Rc¢ipta Will the applicant or I'mure building txeupaat store or handle houms ous material as donned by the Cupertino Municipal Crde.Chapmr9f 2,and the Health and Safety HEATING UNIT'(OVER 100,000 BTU) I, L. Cede,Section 255J2(a)1 ❑yes (]� VENTILATION FAN(SINGLE RESID) Will Neapplicanwrfmum buildin8 by the Areequa Air Quality Management BOILER-COMP(JHP OR 100,000 BTU) ISSUANCE DATE va.doistric'vus eu contaminan�¢1,u�d/e�iyN by the Bay Area Air Quality Menagcmem BOILER-COMP(OVER 100,000 BTU) ❑Yes o NEW RESIDENTIAa_SQ, " 1 have alai the fetyClocrardd.mined..5505,255 3 under Chapter ells6 95 id Ne r.a.��Calilomia❑eA1Nlaincecoquaven It-5505,25533 and 25514. IundernanJNat ,#PF181993 fthe buildingdocsnotcurznnly have i tenay6 rhinitis my rsuaneoil. enobly thetuft t of the tyuiremc rich see Ter to issuunce�fa Cenifieute o[ oe -� CI1 Yact 11L rho mil,cat EISSUEDRY: NV OFFICE