22607 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PER.WTNO.
Building Address: y
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_ CITY OF CUPERTINO-BUILDING DIVISION 18xr ,
coetrad ams: Lic.Nm: _ APPLICATION / PERMIT
TUF
BLDINGFLECTRICAL-PLUMBINGMECFIAMCAL CATEGORY CONTROL M
Architect/Enginwr. Lie.No:
QTY ELECTRICr PERMIT FEE BUILDING PERMIT INFO
Add...: eT PQRMITISSUANCE ❑ Inj ❑ ❑
LmthatI CONTR order SDBC ATION
1
ICF�
I hereby
ad
withSetion70 taut) imsion3ofthe ur nr aidnsof Cnions (e,andm MPLIANCESRESIDENML JOB DESCRIPTION
I[.a (Section]?(Dema Divfect' (the Bualnemand Pio(esalon.Ceade,and my
ilcenalln(ul roe a4ldd(ed. PANELS
Clam Lk.# .S 7 r� C`
Date $`"�aSr`4/ Contractor_�f4aOT7sW ) 0200 AMPS �l
ARCHITECTS DECLARATION 301-1000 AMPS
FO±9O Zp I understand my plana a hal be used as publlcrecords OVER TIDO AMPS pSQ.FT.FLOOR AREA $/SQ.FT.
F o�j Licensed Pm eealm /�ul SIGNS ELECTRICAL N �j A PI L E D '
G V /
6 OWNEReBUILDER DECLARATION Spp.CIAL CIl2CUIT/M]SC O n r..s �'�`
Z f,rr/: Iheeebrvuug. Shot cd..m3LS,Bxempt fmmthe ConrefenibLlanae Law for city or 1\V(71 FLLJ C
o aourywreason.(SMion 7011 S,Bualnen and Profeaion.Code:Mydtyor J
Fz� countywhlch requlresa permit to construct,alter,Improve,demdbh,orrepalr TEMP.METER OR POLE INST. D TE �U��
oAga anyseucture prlorto its lsseame,aborequlrealheapplirant for.uch permit POWER DEVICES �^J
file a signed statement that he la licensed pursuant to the provisions of the —_
7k Contractors Licence Law(Chapter 9(commencing with Section 7000)of Divi- SWIMMING POOL ELECTRIC VALUATION
ti�OS Mon3ofthe Buclneasand Pmfenlom Code)orthat heisexampttherefmmand
the basis for the alleged exemption. Any violation of Section 7031.5 by any
0
applicant fees permit subjects the applicant to a civil penalty of net more'
ban OUTLETS—SWITCHES-FIXTURES
$ fiv�I,undred dollars($500). NEWRISIDFN'DALELECTR SQ.I"I', SfO1tIF5 I'E'EE
CONSTRUCTION
�n as owner of the property,or my employees with wages as their sole
eampensadon,wllldothe work,and thestmMm la nm Intended or offered for
C O sale(Sec 70K Business and Pro atedom Code:The Contractors License Law
$ does not apply to an owner of property who bulli'or improve thereon,and OCC.CROUP RFS.UNITS
whodon ouch work himself orthrough his own employees,provided that such
Improvement'are not Intended oroffered formle.IL however thebullaing es TOTAL:
ImprovementL wldwithinoneyearofcmmpldlogtheowner-buederw0lhave
the burden of proving that he did not bund or Improve for purpose of sale.). QTY. PLUMBING PERMIT FEE FTADD ZONE APN
Luh L as owner of the property,am exclusively contracting with Ikenxd PERMIT ISSUANCE
contractors to construct the project(Sec.7044,Business and Profeasktu Code:
The Contender'.Limn.law doe.not apply to an owner of property who ALTER-DRAIN k VENT WATER(EA)
Wilde or Improves thereon, and who contracts for such ploje Is with a
cactor(s)licensed pursuant to the Contractor's License Law. FEE SUMMARY
1 am exempt under Sec B k15P C for this reason BACK Ff.OW PROTLCT.DEVICE
DRAINS FLOOR ROOF,AREA,CONTI. SANITARY Y N
' Owner Date RECEII'Tp
WOl.that COMP B outifi ON of e.w.A'FION FD(TURESPFR TRAP SCHOOLTAK Y N
01 hereby affirm that T have• Ica mate of consent to pytheurc,or RECEIPT#
3800,UbC.Worken'Comperuatlonlmunna ora certlfkd eapythereof(Seo. GAS F.A.SYSTEM.I INC.4 OUTLETS
380B Lb C.I PARK FEE Y N
I'oliryj RECDING PT
DI X
GAS.G.SYSTGI-0VER 4(EA)
Com ray BUILDING DIVISION
Certified mpy b herebytumecity GRFASE/INDUSTRL WASTE INTERCEPTOR PLANCHECKFEE
Certified mpy b filed with the city inspection division.
CERTIFICATE OF EXEM PFION FROM WOR KERS' GRF-ASE'IRAP IPAID
COMPENSATION INSURANCE SEWER.SANITARY-STORM EA.20OFT. Date Recei t#
Rxd W
(This need racompleted If the permit b(Drone hundred dollars
($1I nlfyth ini WATER HEAT�Iy/V�,/ELECTR ENERGYFEE Y N
Icenot thatothe persnIaofthewmrkfo as to bthispenmtlablued,
I shall not employ any person In any manner w m to beanie subject to the WATER SYSTEM/TREATING
Worilcout Compensation Laws of California, Date PAID
Z O NOTICE TOAPPLICANT.If,akar making
omthis
Compensation
of Exemption,you NEW RESIDENTIAL PLMB._�bT. Date Recti t#
should become subject to the Workers'Cmmpematlon proWlora of the Labor TOTAL:
N Cod,you must forthwith comply with such pre bions orthla permit shall be
LLIm
j 'deeed revoked.
BUILDING
ClL F3 CONSTRUCTION LENDING AGENCY SEISMIC FEE
CLI hereby affirm that there is a construction lending agency far lM pedorm-
of TOTAL: ELECTRIC FEE
o O La.dae he work for which this permit lalawed(Sec.3097,Civ.C.) l
O Ianaer.Adde PLUMBING FEE
LL 0 L) I<naersnthatI QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W Icenifythatl have readthkappllatlmnand etatethatthe above Information
It. Ie earned.I agreetocomplywith all cityand county ordinances and datefaws PERMIT ISSUANCE FEES PAID:
W relating tobullding construction, hereby euthorbareprxematives of this
N Z city to enter upon the above-mentioned property for inspection purposes. ALIEt ORADDTOMECH.
(We)agree to save,Indemnify an d kap harmless the City of Cu Fort Ina Date Recei t#
V against llabNties,pdgments,cons and expense.which may In any way accrue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL:
against said City In consequence of the granting of this permit
AIR HANDLING UNIT(OVER I Boon CIM) CONSTRUCTION TAX
Sr#fiatureoTATpll ontr.our )� Data EKHAUSTHOOD(W/DUCIT CONSTRUCTION TAX PAID:
7ARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous HEATING UNIT(TO 100,000 Bran Date RCCCI t#
materia l'as defined by the Cupertino Municipal Cade,Chapter 9.1 2,and the
Health and SatietyCodlon 25532(a)7 HEATING UNIT(OVER 100,00(1 BTU) TOTAL: l
❑ Yes No
Will the appllan rFadure building occupant use equipment or devices VEMILA11ON FAN(SINGLE RESID) ISSUANCE DATE
which emit hazardous air contaminant as deflmd by the Bay Area Air
Quality Management District? BOILER-COMP(3HP OR 10({007 BTI!)
�Yn o
avereadthehan amaterlala requirement under Chapter 6.95 of BORER-COMP(OV[R 1fD,000 BTU)
the California Health Sa sty Code,Sections 25505,25533 and 25534.1
understand that if the building does not currently have a tenant,that it is my NEW RESIDENTIAL MECH. SQ.FT. +} ��+�
responsibility to edify the occupant of the rcqulnemenis which most be rant
R MM11
prior to issuarcLoij,Certificate of Occupancy.
Owner or autho gent Date ISSUED BY:
TOTAL:
OFFICE COPY
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2145 OLD MIDDLEFIELD WAY, MTN. VIEW, CA 94043
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Basket U. S.A Title
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Apple Computer HANDICAP "PARKING STALL HANDICAP PARKING. STALL
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