26726 I
APPLI'ANT TO FILL-IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CIT ,OV CUPERTINO _ BUILDING ELECTRICAL FERMI NO.
'' APPLICATION/PERMIT PLUMBING-MECHANICAL 26726
�C n C
BUILDING DIVISION ' 'BUILDINGPRO]EC'TIDENTIFICATION• - Gv Gv
BUILDING ADDRESS: SANITARY NO, APPLICATION rS�rUSBMITTTAL DATE
907 S•„ ste.11-i-ng UNIT# LOT 1
OWNERS NAME: PHONE: CONTRACTOR'S NAME: LIC NO: {l l l
Mabel , N/C CONTROI.#
_+ARCHITECT/ENGINEER: LIC NO: ADDRESS: ❑
l
CONTACT: PHONE: QTY. 'BLECTRICPERMIT^ "x fq c'Fgg,a BUILDING PERMIT INFO
a BLDG ELECT PLUMB
PERMIT ISSUANCE ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
mwz Ihvehy affirm that lam licensed under pr..mons.fChapter 9 Orro menring with
td00 Section 7000)of Division 3ofthe Businessand Professions C.de,and my license is in PANELS
C W fail force and effect.
I¢,2W License Class C_4Z C_",It 1 UP TO 200 AMPS
ra ce Date Contractor A A A F I,r n a C 201-1000 AMPS
F y ARCI IITHCTQ''S DECLARAI ION S Ff.FLOOR AREA $/SQ.FE
OztG understand
z O yr Q 1 my plans shall be used as public records. OVER 1000 AMPS
F.,E•W SIGNS ELECTRICAL
.`..J.II censed Professional
�ty�,� Limam6 OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MTSC.
°uOp,F i hereby affirm that 1 am exempt from the Contractors License law for the
W 3 C m following reason.(Section 7031.5,Business and Professions Cade:Any city or county TEMP.METER OR POLE INST.
,11¢ which requires a permit to consumer,alter,improve,demolish,or repair any structure
KWP-:� prior ro its issuance,almoo,nres theapplicam forsuchperocam file a signed statement POWER DEVICES
K O p that he is licensed pursues to the provisions of the Contractor's License Law(Chapter
0.yo�5 9(commencing with Saction 9000)of Division 3 of the Budinss and Professions Cade) SWIMMING POOL ELECTRIC VALUATION
W�,m or that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 1031.5 by any applicant for a permir subjects the applicant to a civil penalty of OUTLETS-SWITCHES-FIXTURES
not more then five hundred dollvs($500).
E� I,asnwnernf the n NEWRESIDENTIALELECfR _SQ.(T.
W:m ❑ propc yrs is mamployed arofwed hostile
cam.Business STORIES TYPE CONSTRUCTION
a3— and dothewons Cde: structure istorsutdetlerawdoes of apply to an Business
and Professions Code:The Contractors License Law does not apply to,I owner of
mvnimywhoboilds orimproves Hereon,and whndoes suchworkhimselfor thranghhis
cora ear,thewildingedaatsuchimprovemwithin s earofidmplefor,theorer-If. OCC.GROUP RES.UNITS
M1uilder ,,theavet a burimprovementissoldwithinoneyear ofcompletion,purpose f TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
asps) - x.
❑ Las owuwofaepropeny amexclusivelyrontrasmg with hwmed con¢ecmrs to QTY' ' :PLUMBINOPERMIT- - R XFEH FLOOD ZONE APN
construct'he project(Sec.704 .Buainese and Professions Coda)The Contractor's
License Law does not apply to anownerofproperty whobuildsorimproves,hereon,and PERMIT ISSUANCE
who cnatmets foreuch Imports withacommmor(s)licenced pursuant t.the Counselor's AL'T'ER-DRAIN&VBNT-
License Law. WATER FEE SUMMARY`
❑ 1 am exempt under Sec. B&P C for this reason BACK FLOW PROTF. ICE OUTSIDE FEE
SANITARY Y N
Owner Dare DRAINS-F ,ROOF,AREA,COND. RECEIPT#
WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN
❑ I hereby affirm that l have a certificate ofcompatto self-ircum,ors certificateof FI ES-PER TRAP FEE
Workera Compensadem Insurance ora certified copy rheres'(See.3800,Lab C.)which PARK FEE y N
Pars Wl employ ,' RECEIPT#
olicy# �I tk GAS-EA.SYSTEM 1 LETS ' BUILDING DIVISION FENS
Company - 0 O .SII an GAS EA. 4(EA PLANCHECK THE
❑ Certified copy is hereby fumishetl.
)7 Certified copy is Bled with the city Inspection division.
USTRL W Hi1ETHR EFAA GRADING FEE
CERTIFICATE,OF EXEMPTION FROM WORKERSGREA RAP SOILS FEE
COMPENSATION INSURANCE
(This section need not be completed ifthe pamnit is forone hundred dollars(5100) SEWER-SANITARY STORM 00FT. ENERGY FEE
or leas.)
I certify that in the performance or the .,it for which thispetmit isissued,Ishell WATER HFATGR WN /ELEC3'R
not employ any person in any manner so as to become subjen to the Worker# PAID
Z Compensation Lowsof Celifomia. Date ATER SY RREATING Data Receip,#
Applicant
CNOTICE-TO APPLICANT:If,after making this Certificate of Exemption,you should NEW—RESIDENTIAL PLMB, SQ,FT. TOTAL:
p] become subject to the Worker's Compensation provisions of the labor Code,you most
fir ; forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE
z CONSTRUCTION LENDING AGENCY SEISMIC FEE
1 hereby affirm that there is a construction lending agency for the performance of
U O as work for which this permit is asued(Sea 3091,Civ.C.) TOTAL: ELECTRIC FEE
tr Lenders Name
U0 Lender.,Addrea, QTY.t c * j^.MECHANICALPERMIT,'t3 f` .,FEE-., PLUMBTN FE
U I certify that I have read this application and sale that the above informations { `'" ' ` - I
cnrtect. Iagneenicomph,with all city andemnty oNiwncesard state laws hearing,o PERMITISSUANCF. NEED FEE
tmovngchumnac[ingand herebyauthotize r,owenmtives of This cityto emerupon the CONST 10 TAX
Uz uMve(mentionedpsave,indemnify
inspection purposes. ALTER OR ADD TOMECII.
(We)agree at save,indemnify and keep harmless the City of Cupertino against
incoities,judgments,coarsing ex this permit. may in any way uccrueagainn said City AIR HANDLING UNIT('1010,000 CFM)
consequence of the grunting of,his permit.
' AIR HANDLING UNIT(OVER 10,000 CPM)
Signature of Applicam/Contract., Date EXHAUST HOOD(W/DUCT)
PAID
I IAZARDQUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date Receipt#
Will l the applicant or future building occupant start or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety HI2ATING UNIT(OVER IW,OW BTU) TOTAL:
Cede,Section 25532(a)?
❑Yes C3 No VENTILATION PAN(SINGLE RESID)
Will thea licalarfuche buildinocipantuseequi BOILER-COME LHP OR 100,000 BTU) L ISSUANCE DATE
PP 6 h patent Quail,
L'o
art contaminums as relined by the Bey Area Air Quality Management BOILER-COMP OVER 100,000 BTU
( ) P A I D
❑Yee ❑No NEW RESIDENTIAL MECH. S TT
Q DEC 13
have revel rhe Safety
materials re05,255 3 under Chapter fl95 of the 1994
California Health&Safety Code,Scelia to 25505,25533 and 25574.1 understand that
if building does not currently amnant,Nati,is my responsibility t0 notify the �/'y ur
6 g&uircmems must he met poor to issuance of a Certificate of 1 V VI„tn I J U
y.1M10 tad agent Dat TOTAL ISSUED BY:
OFFICE