27713APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINOUIL"INU. RLEUMI rr:RMIT No.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING -MECHANICAL ��']q O
BUILDING PROJECT IDENTIFICATION 1 1J
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Ty, t;k I Y ti L�CTRICPERMIT FP.E
BUILDING PERMIT INFO
BLDG ELECT PLUMB MEGA
PERMIT ISSUANCEEl
F-1
LICENSED CONTRACTOR'S DECLARATION
I herebyalftrm nthl am licensed underpmvisionsofQapter9(commencing with
Seaian70(shid Division 3 of the Busines,tnd Professions Code, and my license is in
full force and effect.
APPLIANCES - RFSIDENTW.
PANELS
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OVO —D
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License Clasx Li.. #
UP TO 200 AMPS
F? ex.
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Date Comnna
ARCHITECTS DECLARATION
I understand my plans shall be used m public records.
201 - IODO AMPS
OVER 1000 AMPS
SQ. FT. FLOOR AREA
$/SQ. FT.
SIGNS ELECTRICAL
P4
leccnsal Professional
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C Cmdras ON
OWNER -BUILDER I am vacant,
from
I hereby affirm thin I am exempt from the Gonion Co License Lew for the
following recon. (Saban 2031.5, Business and improve,
de Professions Cade: Any city or county
which rite iso a n permit re .ire t eL altar, improve.h permit
or repair any stractudinformed
prior min issuance, also requires the applicant farsuch permit to Lice se La (Chapter
that he is licensed pursuant to the provisions of the Contractors License Lew (Chapter
9(commencing with Section 7")of Division 3 of the Business and Professions Code)
SPECIAL CIRNIT/MISC.
TEMP. MEIER OR POLE INST.
POWER DEVICES
SWIMMING POOL ELECTRIC
VALUATION
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or that he is exempt herefrom and the basis for the alleged exemption. Any violation of
applicant Section 7031.5 by airy applicant for a permit subjects the applicano a civil penalty of
not more li.n five hundred dollars ($50B).
❑ I,usownerofahepropny.ormymploymwithwMesmffieirsolecomNnsation,
will dothework, and the struaurcisnot intended oroffeed forsale(Sm. 7W. Business
Of1TLE1'S-SWITCHES-FTXTURF.S
NEWREIDENTALELECTR _SQ.T.
STORIES
TYPE CONSTRUCION
and Professions Code 'Me Contractors License Law dao not apply to an owner of
TieWk
papery whobuildsor improves therean,and whodas such woramenselfor through his
own employees, provided that such improvements are not inteadedoruffered inside. If,
vU CIY pX
OCC. GROUP
RES. U ITS
however, he building at improvement is sold within one yerrofcompletion, the owner.
builder will have the burden of proving that he did not build or improve for purpose of
QTY. PLUMBING PERMIT - FEE
sale.).
❑ [,as owner ofthe property, and exclLSively contracting with licensed contractors to
I1.00DZONE
APN
construct the project (Sec. 7044, Business it Professions Code:) The Convectors
License Law does not apply to an owner of property who builds or improves thereon, add
PERMIT ISSUANCE -
whoconniesforsoch Projects with a lemracter(s) licensed pursuantmthe Cmanaor's
License Law.
ALTER (' )
FEE SUMMARY
.
❑ 1 um exempt under Sec. , B & P C for this reason
BACK FLOW PROTECT. DEVIC
-SIDE
SANITARY Y N
RECEIPT #
Owner Date
DRAINS -FLOOR, ItOOF,A LSO
WORKMAN COMPENSATION DECLARATION
IhertbY effinn that lhaveacenilicem nfconsena to selLinsure, ort ceni0cam of
Workerserebya affirmIhvea aacertiof consent to offgnsurs, ace CJ which
HOOLTAX YN
RECEIPT#
FIXTURES - PFR TRAP
FEL? Y N
GAS-EA.SYSTH I C.40 LETS .
e0
rs all employee's underahis pc.i,.
Pal icy p
RECEIPT#
BUILDING DIVISION FEES
Company
GAS - RA. SYS ,MOVE 4 :A)
[PPARK
ANCHE ME
❑ Cerifiedcopyishrebyfumished.
GREASFJIN US9 W 1 CEPTOR
ADE FEE
❑ CcnifiM copy is filed with Ne city insparoon division
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
GREASE
IL PEE.
SEWER- SANITARY,QTORM PA. 20X1Ff.
RGY BE
(Brix section need not he completed ifthe permit is foronehundred dollars p0f(0
orless.)
WATER HFATER W/VENT/ELECTR
I cerifythat in his, pecf...fthe work far which this .it is issued, I shall
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not employ any person in any manner so re to become subject to the Worsens
Compensation Lawsof California. Dam
WATER SYSTEMIMEATING
\
AID
Date Receiprp
NOTICBrFO APPLICANT: If. after mAin this Cmifcate of Exem i n
g pro ,You should
become subject o the Workers Compensation provisions of the Labor Cade. you must
forthwith comply with such Provisions or this permit shall be damcd invoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that hen iso construction lcndingagmey for the performance of
the weak for which this permit is issued (Seca 3097, Ci, C.)
tenders Name
NEW RESIDENTIAL PLMR. SQ>PT.
TOTAL:
BUILDING IEE
SEISMIC I'EE
TOTAL:
-
ELECTRIC FEE �•
Address
Lender.TY
Q. MECIIANICALPERMIT FEE
PLUMBING FEE
I eemify that I have read this application cad same door the above Information is
correct. I .,room comply with sell city and.auany oofrence,tnd,hro laws reale w
building construction, and hereby authorize representetives mitts city to enter upon the
madve•mcmioned Property for inspection purposes.
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F"
U 2
PERMIT ISSUANCE
MECHANICAL FEE
ALTERORADDTOMECH.
CONSTRUCTIONTAX
(We) agree to save, indemnify and keep coo a d, the City of Cupertino against
Iiabi If nes, judgments, costs and expenses which may in any way accrue against said City
AIR E IANDLING UNI 'I'(TO 10,01) CFM)
scy ftbc grunting mit.
AIR I IANDLING UNIT (OVER 10,1X1(1 CFM)
EXHAUST HOOD(W/DUCD
PAID
m DA
Sig u t/ontructor Daae
HEATING UNIT (TO f10,fX0 PTU)
I IAZARDOUS MATERIALS DISCLOSURE
Date Receipt #
Will the applicant or fulure building occupant onto or handle hazardous orders)
as defined by the Cupertino Municipal Cade, Chapter 9.12, and the Heath and Safety
HEATING UNIT(OVRR 100,000 BTU)
TOTAL:
VENTILATION FAN (SINGLE. RISID)
Code, Section 25532(a)f
❑ Yes 13 No
a Tulare bindening by the Bay equipment .alit Managemenes t
Will tair concominottants
huarJous air conraminame as defined by the Bay Area Air Quality Management
District?
BOILHR-COMP(3HPORIW,=)BTU)
ISSUANCED TE
ase as 8 D
I+ (,,
BOILER -COMP (OVER 100,000 BTU)
❑ Yes ❑ No
1 onread the hazardous materials requirements under Chaptcr 6.95 of the
DECDE1e 19"
NEW RESIDENTIAL MECH. SQ. FT.�g
California Health & Safety Code, Sections 25505.25533 oil 25534. I understand Nat
ifthe building does am currently have o learnt, that itis my rex,mobilityto notify the
acupeat of the regi icendmis which mus be met prior to issuance of. Certificate of
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C�11 /tt fur
V Ckw/�H/Ihyl
Occupancy,
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ISSUED BY: V—
Owner nr umhorized agent pare
TOTAL: