19465APPLI4ANTTO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
. Building Project Identification - ..
Be, gAddrsis:
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x619 sfevP, LL)o 64 90hc
PIAMITNO.
19465
w e ame: - Phone:
b pe e- 0/CJ — O
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CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION I PERMIT
,
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Contracts Name: uses#.:
— 6
BUILDINGELECTRICALPLUMBINGMECIf MCAL
CA BY CONTROL a
Architect/Eagit.e _ Lic. No:
QTY " •, ELECTRIGPERMJT r 1�" IFEE "
••
1 , �'� ;BUILDING,PER�MIT INFO
Address 31e, `
`�
IMEL .
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PERMIT ISSUANCE 2- 0
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9 (marroursu,
Ingwlth Sect1on7000)o(I%Welon3o(the8ueln.sand Pounced ... Code, mol my
license Is In full force and dfect,
Limnac Clan N Lt.
Lt.
APPLIANCFARESIDENTLAL
1
PANELS
JOB DESCRIPTION
te
Da - or
v"t rV
�
H)1-1000 AMPS
OVER1000AMPS
ARCHITECTS DECLARATION
I understand my plans shall be used u public records.
SQ.FT.FL RARE B/SQ. FT.
i
SIGNS ELECTRICAL\,
Licensed Professional
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OWNER-BUILOER DECLARATION
I herebyaflmothal lam exempt from the Contractor. License Law for the
following reason. (Section 7M S, Business and Profession. Code: Any city orons
oentywhich requlresa permittocoutrun, alter, Improve, dernelish,orrepair
any structure prior to its issuance, also requlrea the applicant for uch permit to
file a signed statement that he is licensed pursuant to the provisions of the
Contractor's License Law (Chapter 9 (commencing with Section 7000) of Ono.
-
a
SPECIALCIRCUfT/MLSG .
t
( TEMP.ME['E@OR['OLE INST.1 s n•uri
FEWER DLYICFS,
NG POOL 6LEC'�R C
- VALUATION
'
sion3o(the Busmen and Professions Code)orthat hebexempt the re(romand
the basis for the alleged exemption. Any violation of Section 70315 by any
applicant fora permit subjects the applicant to a civil penalty of not room than
five hundred 'dollars ($500). 1
❑1, as owner of the property, or my employe. with wages as their sok
qWIMMI-- r^
V f
O ET'SSWTT'CFTES ES
WREST RNTIAL ELECTR 4si
STORIESTYPE
CONS'DtUCTION
s
compensation, willelothe work ancithe structure is eet inumaded or offend for
sale (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of proerty pwho builds or Improves thereon, and
whod..such w.rkbimeeiforthmugh his.wt employe., provided thatsuch
Improvements are not Intended m offered for sale. If, however, the building or
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TOTAL: VO
.
OCCGROUT'
RIS. UNITS .
improvement issold within one yearofcompletlon, thcownerbuilderwlllhave
th,s.p°rden of proving that he did not build or Improve for purpose ofule.).
<_1L as owner of the property, am exclusively contracting with licensed
matraclors to construct the project (Sec. 7044, Business and Professions Code:
Qj'y, "PLUMBING PER IT - 'FEE0
LO
-FOD TONE
APN
PERMIT ISSUANCE
The Contractor's License Law does fiat apply to an owner of property who
builds or Improv. thereon, and who contracts for such ptojams with a
co,,ctoKs) IIm.sed p..u.mt t. th. Contractor'. Lice.. Law.
I am exempt under Sec. B k P C for this mason
ALTER -DRAIN &VENT -WATER (EM
-
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
no ITS I DT FIzIzq
DRAINS FLOOR ROOF, AREA, COND.
pp(•(TTRES PER TRAP
SANITARY Y_ N_
RECEIPT s
Owner Date
WORKMAN COMPENSATION DECLARATION
❑rm
I hereby affithat I have a cartifica[e of consent to selmnsure, or
ers•
certifluteofWorkCompenntlonlnsunnceoraceAlfledcopythereof(Sec.
3800, Tab C.)
Policyp
SCHOOL TA% V_ '
N
RECEIPTNM
GAS E.SYSfTIN-1 INC.40IJTLE7S
PARK FEE Y N
RECEIPT 0
GAS. E. SYSTEM -OVER 4 (E)
Can-
om y
BUILDING DIVISION PEES
MCertlflcd copy's herebytthe cied.
❑Certified copyis filed withh thty inspection division.
CREASE/INDUSTRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF EXEMPTION FROM WORKERS'
PAID
SEWER-SANTIARI'-STORM EA zoom
COMPENSATION INSURANCE
(Thlssection need nor M completed Ifthe permit h forons hundred dollars
Date Recti t#
WATER HEATFRW/VENT/ELECTR -
ENERGY FEE Y N
'
(81 I0)orlyth
I ltnor that the wok smit Loved,
WATER SYSTEM/TREATING
o anyhe so as tobeco become
p recd, I an
I shell not employ any person in any manner w u to become subject to the
ubjec
Workers' Compensation Laws of California. Date -
PAID '
Applicant
NEWRESIDENTIAL PLMB. SQ.FT.
Dale Remi t#
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
TOTAL:
should became subject to the Workers' Compensation provisions of the Labor
Code, you most forthwith comply with such provisions orthi. permit shall be
deemed revoked.
BUILDING
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SEISMIC FEE
CONSTRUCTION LENDING AGENCY-
Iherebyafnrm that there is a construction lending agency for the perform-
once.(the work for which this permit tv irsued (Sec.3097, Civ. C.)
Lenders Name-
Lenders Address
TOTAL:
ELECTRIC FE
Z .Oft
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QTY. ', •� �MECHANICAL,PERMIT,a' . 1', FEE','
PLUMBING FEE
_
I cartifythat I have road thh,app8cationaod statethat theabnve Information
ucerme. I agree to complywith all city and county ordinances and gate laws
PERMIT ISSUANCE
MECHANICAL FEE
FEES PAID:
relating to building construction, and hereby author@n representatives of this
city to enter upon the above-mentioned property for Wpectlon purposes.
(We) a to five, i an d keep harken the CI
gree fy p City of CuFenian
ALTER OR ADD TO MECH. -
Date Receipt#
SUBTOTAL'
eV
ares, band exactsgwhkh may lnsay wayacrne
against said City
against said City in consequence .(the granting .(this permit
AIR HANDLING UNIT (TO 10,000 CFM)
AIR HANDLING UNIT (OVER 10000 CFM)
CONSTRUCTION TAX -
_
Signature of Applicant/Contractor Data
IXHAUS'r I IOOD(W/DUCT)
CONSTRUCTION TAX PAID:
HALA R DOES MATERIALS DISCLOSURE
HEATING UNIT (TO 100,000 BTU)
Will the applicant or future building occupant store or handle hazardous
material as deo ned by the Cu pectin. Municipal Code, Chapter 9.Iz, and the
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Date Recei t#
HEATING UNIT (OVER 100,000 BTU)
- TOTAL:
"
,IiD
Hes lth and Safety Code Section 25532(a)7
❑ Yen ,I+�—J, No
VFNILATION aAN(SINGLE RFSID)
ISV$MDATE
Will the applicant°r fuW. building occupant use equipment or d evices
which emit hazardous air contaminants as defined by the Bay Area Air
Quality Management District?
have read ar
4Y""° of
JAN 03 1950
BOILER -COMP DIIP OR 100,000 BTU)
BOILER-COMP(OVFR 10(1,000 BIL)
It
Health Code,
fetmaterl Sectioul 25505, 5533 and 2M34.
theerstan
NEW RISIDFNf1AC MECFi. SQ.FT.
t lith building not correctly a tenant, tha it4my
responsibility to notify the occupant ofthe requirements which must be mat
'
City (If C(Inoft(RO
prior to issuance of. Certificate of occupanry.
Et
{ _)f, -
Owner orauthorized agent Date
TOTAL: -ISSUEDflA
OFFICE COPY .