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26920 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OFCUPERTINO BUILDING-ELRI AI, PERMIT NO. APPLICATION/PERMIT PLUMBING-MECHANICAL TI !�6 O BUILDING DIVISION BUILDING PROJECT'IDENFICATION G v BUILDING ADDRESS SANITARY NO. APP/PLICATION SUBMITTALL,DATE: 2 UNIT LOT# Cp RRS NAME: PU0jRACEQRS NAME: LIC NO: V �vQ4)dNtk nS;XSIA'r�DNG 13�7(ol`jU p� +tlQcil>RC1CI1 , y12 4 N/C CON TRUN,# \RCHI'I'ECgPNGINEER: - LICNO: HESS: l3Z(S rc ccC-k.Gt, Cv no GLS CONTACT: PHONE: QTY. ELECTRIC PERMIT EEE BUILDING PERMIT INFO B#NIL,.D��G ELECT PLUMB MF.CH PERMIT ISSUANCE 11 �f' LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL Metz I heebyoffirm Nat lam licensedmuler panow,mnaofCTapmr9(commenct,with JOB DESCRIPTION �q00 Sectors.T0110)of Diviaion3ol me Business and Professional Code,and mylicemeie in MANGES �S � C full force and effect. S FZw License Class Lic.N IIP T02W AMPS N 6 y Dae Coneraceor 201-1000 AMPS SQ.Ff.FLOOR AREA $/SQ.lel'. Fyz� ARCHITECTS DECLARATION OVER 1000 AMPS 1 understand my plana obeli M oseJ as public rcconks. `Oa C z_o LSC N/I.11�7\ SIGNS ELECTRICAL Licensed Professional Oit I and exempt to.ER DECLARATION SPECIAL CIRCUIT/MISC. d Oa V 1 hereby affirm that I am exempt Fran me Convaetnr's License Law for the y)30.y following.,,asa permit toco31.5.Business and Professionsh,le:Any city orcoumy TEMP.METER OR POIF.INST. Fp�O� which to its an permit to gimes the mplic improve,such permit t,ore a signed any structure 2W}� pnmrmilc iasuanec,also requires the applicant For such permit to fileenigned alatement POWER DEVICES ,W<O that he is licensed pursuant to the provisions ofthe Convenor's License law(Chapter et e� 9(commencing with Section 7000)of Division 3ofthe Businesimd Pmfesaione Cade) SWIMMING POOL ELECTRIC VALUATION or that he is exempt herefront and the basis for the alleged exemption.Any 4immlmro of �zG Section'/031.5 by any applicant fora permit subjects the applicant m u civil penalty of OU'I'hBTS-SWITCHGS-PIXTURfiS mol mart than five hundred dollaa($500). NEW RESIDENTIAL F.LIiCTR S FT. 50 ❑ I,uaownmaf Neprnpenysrmy employees wiehwagesmtheirsolecompensxtion, Q STORI' TYPECONSTRUCITON y m will it.the work,and lhestrnalmaix not imandedmnlfered for suk(Sec.90LI Business and Professions Code:The Contractor's License law does nM apply to an owner of ,Ta,my ohs buildemimpmveathereon,bad whodaessvch work himeelforthroughhia OCC.GROUP RES.ON[PS awnom Imeco,provideddid such improvements are not intern doroffnol formic.If, however.the building or improvement is sold within one yearofcompletio t,the ownef- T ' builder will have the burden o'proving that he did not build or improve for purpose of 6-5 Jule.). ❑ Lasowner aftbc propcny,amexclu.dvcly contracting with licensed eontrectora to QTY. PLUMBING PERMIT FEE FLOOD ZONE APN construct the pmjea(Sce.TOM),Business and Professions Code:)The Conwears License law does not apply toommenerofpropeny who buildser impasses thereon,and PERMIT ISSUANCE If who contracts for such prob Is with ucoulreamds)licensed pursuant to the Canlmmnrs License Law. ALI HR-DRAINA,VEN -W CR(EA) ITEESUMMARY ❑ I am exempt under Sec. ,B&P C for this reason BACK RTE OW PROCT. E OUTSIDE FEES SANITARY Y N Omer [);anRECEIPT# WORKMAN COMPENSATION DECLARATION DRAINS-FLOOIt,R v RP.A,C SCHOOLTAX Y N -e ]e lhcmhy emtm thmlhavearenificam ofconsemmulGinsurc.ore certificateof FIXTURE$-PER TRAP - RECF.IPP# erkeri Compensation Insurance or a certified copy radical.(Sec.3800,Latin C.)which PARK IEE Y N t n all employee a under this permit. GAS-EA.SYSTEM-1 INC.6 U' Eh F.Clil '# Pull,It BUI DI ,'ION FEES Company GAS-FA.SYSTEM-OVER4( PfANCHECKF . ElCenifed copy is hereby famished. ❑ CeniOed copy is file)with the city impaction Division. GREASEITNDUSTRL WASTE I ?RCF: GRADING rE �, C17R'I IITCATE OF EXEMPTION FROM WORKERS' GREASETRAP IF SOILS Pt '1 COMPENSA'T'ION INSURANCE th V Mois section need not becompletediftheperin isformuldindraddollas($IW) SEWER-SANITARY-STORM It 200Ff. ENEEGY FE, mleas.) I certify that in the performance of the work for which this permit is issued,I shall WATER HEATER W/VF.NT/CLECTR nal employ any px,,,on in any m as r become subject to the Workers' PAID Compematiou Lawaof Califomia. Date so WATER SYSTUMTREATING U R.\dN O ,Z Applicant z7C) NOTICETO APPLICANT:I La flat making this Cenificuteof Exemption, .to should NEW RESIDI'NTIAL PLMB. SQ,IT. 1'O'fAL: P ^ becomesubjen to the Worker's Coa,mandoa provisions of the labor Cale,you muss ai 7 forthwith comply with such provisions oat this permit shall be deemed invokedPE". BUILDING -/ 4L1 CONSTRUCTION LENDING AGENCY SIi1SMIC F Q I hereby affimn that them is a conawnion lending agency for the performance of U O the weak for which this permit is valued(St 3(19],Civ.CJ L ELF CFE: I V. Lenders Name Landers Addres, QTY. MECHANICAL PERMIT EEE PLA E13 U 1 coni fy that 1 have mad this applicaion and more that the above information is W correct. l agree to comply with all city and county ordinances unit slate laws reining to PERMIT ISSUANCE MECHANICAL FE ybuildingconnonoinn•tmd hereby authori.erepreaentativesof thus city,,enter afraie V Z moss-aentioned prepeny,for institution Indian.. ALTER OR ADD TO MECI. CONSTRUCTION AX (Wc)agree to save,indemnify and keep harmless the City of Cupertino against Iiabilirics,judgmenLs,cases and expenses whichmay in my way accrue against said City, AIR HANDLING UNIT(TO HL"CFM) on eyuence of the gmnling of mix permit �. r' G �SAIR HANDLING UNIT(OVER 10.004)CFM) .pudda a Appliemt/Contract f m EXHAUST HOOD W/DUCO •rnlD HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO I110,000 BTU) I Ru. Will the applicant or or Gaonbuilding rd,Caperre o,and Matto asmaterial as defined by the Cupertino Municipal Cale,Chapter Y.12,anJ the Ilenhh and Safety HEATING UNIT(OVER I00,000 01'U) TOTAL: Cade,Section 25532(a)?" 13 Yes ❑Not VENTILATION PAN(SINGLE RfSID) Will Iheepplicenmrfumrcbailding acvpam useequipmcm ordeviceswhich emit BOILER-COMP( HPOR100,0(gI PTU) ISSUANC DATE azardom air atmaminaats u defined by the Bay Area Air Quality Management BOILER.COMP(OVER 100.000 BTU) p� /Y district? ❑ trict7 r AID Yes 13 Not NEW RCSIDEN'1'IAL MECII. SQ.Ff. I have mad the hamNoua mamnals requimments under Chapmr 6.95 of the `,ill Nor Califmtin Health h Safely Card,Sections 25505,25533 and 25534. 1undersand Nat �jr Ib r if the building does not currently have a tenant,that it is my responsibility r nobly the aceupam of the milli a ucal.which must be met pour to issuance of x Certificem of /s ry,1 Occupancy. V'r f UF- cu, I O Owner or authonmJ agent Date 0 Al: ISSUEDITY OFFICE