28237 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO B H.>INc-F.LKCTRICAI. - PERMITNO,
APPLICATION/PERMIT 1'LUMIIING-MF-CHANICAI, l�-8237
O 2 3 7
BUILDING DIVISION BUILDING PROJECT IDEN'1'IF'ICA-TION G o
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMI I'1'AL DAT Ii
Zb30O STEVE$- C _"7C DCl/Q ulvrr« 3� Fc.e LOT» r`/'y�
OWNIM NAMli��� PI�ONI���_��� CONTRACT' 'SN E: LIC NO: •�
O N/C CON TRol.»
ARCjjIE GIC OADDRESS
oik,o T^ii� I ❑
8
CGN'TACI: PHONE
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QTY, ELECTRIC PERMIT FEE OUILDING PERMIT INFO
x/A4 BLD ELE PLUMB MECH
PERMIT ISSUANCE
LICENSED CONTRACTORS DECLARATION APPLIANCES-RESIDENTIAL
M9z I hereby affirm that lren licensed underpmvisionsofChapter9(commencing with JOB DESCRIPTION
900 Section 7000)nf Division 3 mine Business and Professinns Code,and my license is in PANELS
ty fuel farce and efPoCL / 4 �j—
<z�v fall to Clmc Lic.p UP'T0200AMPS L
m y Date Comramor 201-1000 AMPS
ZO,Z ARCHITECTSDEC"RATION OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.FT.
O Z—❑ 1 understand my plans shall he used as public records.
Qyt� Licensed PmPossional SIGNS ELECTRICAL
C0.' OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
�O U I hereby affirm Jim I ren mama,from Tho Contract Lc,me Law for dm
n13JC)o¢o� u
following renn.(Section 7031.5,Business and Pollessions Cadc:Any city or county TEMP.METER OR POLE INS'1.
4J m.] which requires a permit to construct,alter,improt demolish,or repair any swnum
d¢7 prior to its lsvuance,also requires the applicantfor.such permit.,Ito a signed statement POWER DEV ICES
W, 0z that he is licensed pursuant 1.the previsions m the Cmanatimr's Lice t¢e Law(CTapmr
xoW 9(sammencing with Section 7000)of Division 3 of the Raciness and Mission,
Cale) SWIMMING POOL ELECTRIC VALUATION
m_ o pr that he is eserommenuman and tine Nevis forth,alleged extortion.Any sun]dimnnl' OUThLTS-SWITCHIiS-FI%'TURES
ZG Section 7031.5 by amy applies.,for apermit subjects the...heard to u civil penalty of
$$ not mare than five hundred dollars($500).
C� ❑ hnsowncroftheprnperty,nrmyentploymewithwug,snxtheiumlecnnqunsutlnq NEW RFSIDIiNT1A1.ELECTR _SQ.FT. STORIES TYPECONSTRUCDON
a3— will Jothe work,ant)the samrmrc isnot intendedmoffered for sale(Sec. Bminers
and Professions Code:The a Common License Law does not apply to an owner of
property who huitdsorimprovex thereon,unit who dors such workhimsclforthrough his
employcesm
.provided that such improveentson,not intended proffered Tarsale.Il; OCC.GROUP RISS.UNITS
n9� 1,mmvncr.fda,
owever,the building or improvement is sold withinone ye rrofcompletion,the owner- TOTAL:
uilder will have the burden of proving that he J
(lit)not build or improve for purpose of
se).
property,amcesimivclycutmmcting with liccnuacommnars to QTY. PLUMBING PERMIT FEE FLOODZONE APN
omuuer the project(Sec.7,14,Business and I'rofexsion,Cale:)'The Contractor's
License Lawdessoot apply m an ownerofpropeny who builds orimproves Barium,ad PERMIT ISSUANCE
wh rec ntiocts forsuch projects with a contractors)hemsed pursuant to the Commences
ALTER-DRAIN&VENT-WATER(EA)License Law. FEE SUMMARY
❑ I tun exempt under Sm B ffi F'C for this reason BACK FLOW PROTE(Z .DEVICE O IDE Il:LS
SANITARY Y N
Owner Dom RF.CEIPf»
COND.
WORKMAN COMPENSATION DECLAMATION JzjHMz 'I. REA, SCHOOL TAX YN
❑ (hereby affirm then havaacenificate ofwnum mulf-insurt.ora uV
ERT AP UCHI1T»
Wnrkcrs'Cnntpensmion lnsurmtco oumcni0ed copy thoronf(Sec.3g00,LuPARK FEE YN
ars oil employee's under this permit RECIJI'1'»
Policy p BUILDING DIVISION FEIS
Company nfmnnumpt
❑ Certified copy is hereby furnished. PLANCHEICK FET!
❑ Certified copy is filed with the city inspection division. R. GRADING FEE F
CERTIFICATE OF EXEMPTION I-MOM WORKERS' SOILS PEP.
COMPENSATION INSURANCE
lThisyation need rat be usmplemA lfthe permltlslin one bunolred MEA.200FT. ENERGY FEE
or Ices.)
1 rectify that in the performance ofthe work for which this permit is issued,I s al
ret employ any person in any m as m become subject to the Workeri PAID
z Compensation Taws of California. aDale so F N Date Receipt»
O O Applicant
NOT ICE TO APPLICANT:11,after making this Cenificam of Exemption,you should - - Q� TOTAL:
f^
became subject to the Workers Compensation provisions of the LuMrCWe,yoat
tai 7 forthwith comply with such previsions rabic carnia shell be deemed revoked. BUILDING FEE
1 [] CONSTRUCTION LENDING AGENCY S17ISMIC FEE
z Ihereby affirm that is a comtruction lending agency for the perform TOTAL: ELECTRIC FBE
U p the work for which this crand is issued(See.30D.Civ.C.)
Ixndcr's Name PLUMBING FEIi
C F Lender's Address - QTY. MI?CHANICAI.PERMIT
U I certify that I have read this application and state that the above information is
OWa torten,Ja•rec amore wiN all cit dcount ordinances and sou,laws rclatin• MECHANICAL FEF.
6 PY Yan y bw PF.NMIT ISSUANCIi
_ Z amideng-mentaounion, herebspecti np purposes.
ivesof Niscity toemerupon the CONSTRUCDONY
U z above-mentioned property save,indemnify and purposes. ALTIiR OR ADD TO MECH.
(We)agree to save,indemnify end keep harmless Ott City of Cupertino against
liahitities,judgonents,combam ' m ac
l expcnuswywoycme...mote AIR IIANDLING UNIT(TO 10,000 CFM)
in cqu eof thG gmntin of i PcrtniL 9
City
INO
//G❑❑(Y(Y/te�/ll 1. AIR IIANDLING ONIT(OVIiR IgOfNt CPM) CITY OF _
Sigigon pplivmd/Co!meat Date EXHAUSTHOOD(W/DUCD ' ID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,"BTU) 5.
Will the nrplicum or fumm building acupum store nr handle hazardous material
as defined by the Comedian Municipal Cole,Chapter 9.12,and the flmhh and Safety HEATING UNIT(OVER 100,000 BTIf) TOT
Coda Section 25532(u)?
❑Yes yd No VENTILATION FAN(SINGLE RESID) 'T
Will NI applicantorfumm building by the muse Area Air Quality
Mwhichemit
BOILER-COMP(3HPOR 1110.0008'I'U) ISSUANCE DATE
InteractionIN
air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,(X10 BTU) Q; INSPECTION DEPARTMHNi
District? ❑yes p No
NEW RESIDENTIAL MECH. SQ.1-T. /IIT/ f1! (k11�NQ
I have rend the buambous materials requirements under Chapter 6.95 of the LIIIJI S!D Wi
Califnmia Health&Safety Coda Sections 25505.25533 and 25534. I understand thin
if the building does not currently have a tenant,that it is my responsibility m notify th
me
occupant or the requirements which must he met prior to issuance of a Certificate of
.Occupancy.
Owner nr authprizaA ngmt Uate TO I'AL: ISSUED BY" OV
OFFICE