22382 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY yc
Rulldln Project identification PERMIT NO.
Building Address:
3 00Uk Ap6plorn. u 7 >✓T 22382
rc a sine: F More: -
CITY OF CUPERTINO,BUILDING DIVISION
• Contractor's Name: Lk,Nor APPLICATION /PERMIT
B(JADING-ELECTRiCALPLUMBINGMFLHANICaL CATEGORY CONTROL Y
'AmhRM r: L/EngfneeNa
QFY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address PERMITIS61LEANCE ❑ ❑ (d( El
CONTRACTORS DECLARATION IAJ
I heebyaffirmthat l am llcemrdumerp.bloraof Ch.pter9(.c, APPLIANCES-RF_4DF.NITAL _� t p DESCRIPTION
Ingwith Section7000)ofDNblon3 ofthe Busiweand ProfesalonsCode,and 1
llanse bIn fullfo a ddf1R PA�'DS I ✓11 /e�
Lbws,Ch iL . II1�
Date Comncto 1 .
ARCHITECTS DECUBATION
{Q++WailW O I understand my plarn stall be used u public record& O 1000 SQ.FT.FLOOR AREA S/SQ.Fr.
E y Limned Professional MGNS�' AL I^/
«<<L I� J
' �< OWNER-BUILDER DECORATION Rep
l QGCS
IM1ereby affimntlut lam e:tmptfmmlhe ComrMor'aLberue[aw la the SI'ECIALCItC[IT/h95L {{�� \
69Fpppp foliowing...5,ction7015,BuainmandProferbraCode:Myckyor TEMP.METER ORPOLEINSP. I"e✓`✓YII
�'y 5y� muntywhich rnrylrnapemUttomnetrutl,alter,4nprne,demalbhor repair
any Nructumprbrtolbbsuame,abo rnryunthesppllrant(a inch permkto POWER DEVICES lta•^Q
rN1 tQj Ola a signed statement that he b limned pursuant to the provisions of the
ww Contractors License Law(Chapltr9(commendngwith Sectbn700)ofDvi-
30�ee' on3ofthe Blosndd
us . Preaniora Code)orthat he bmwm
esept lhereard - SWIMMING POOL ELECTRIC VALUATION
the hub for the alleged exemption. My violation of SMion 70O1S by any
appear'tforapermftmbj arc cappBcanitoadWipevltyo(na mmtlan �FDSFLCIURFS
c Bndred dollars MM.
I,as owner of the property,or my employees with wages u their aok NEW RE9DENTIAL EI.ECIR SQFT. STORIES TYPE CONSIRUCITOt.'
I.%� mmpeneatlon,will d o the worh,and the structure is not Intended or offered for
Ga p2 dale(Sec 7014,to sl and Professions Cade:The Comrado unme Law
pr$ don oessucy roan owrcrolpmpertywb Wlldsorlmpmvnthdth.tsndwho OCC.GROIIP RES.UNITS
G impmvessuchw =ffittededoroffe Mfow .I1,how,pmvdedthstwrch
Impmvemewam notinte omyearofccffar dale th M1owever,thtbulldingoe TOTAL:
_ improvemem badd wXM1N orcytarofcoenpklbM1the owner-bullderwW have
t)AjZudlenofpmvingthrthedd int baud or f'^P'o"'�ot Wrpoae of we.). QTY. PLUMBING PERMIT FEE
U L as owner of the property,am exclusively contracting with Ilansed FLOOD ZONE APN
contract.to mratsud the pro)M(Sre.70K Bustnmard Professions Code: PERMrr ISSUANCE
The Cmmmdor's License Law don not apply to an owner of property who ALTER-DRAIN k VENT-WATER(EN
Wu or Improves thereon,and who mrtlrada for arrth ptojeds whh a
c7atTactec(a)Boemed pursuant to the Contractds Lice.I.. FEE SUMMARY
Lf I am eampt under Sec B 4 P C for thin mason BACK FLOW PROTECT.DEVICE OUTSIDE RES
•
Owner
DRAINS-FLOOR EA,ROOF,ARGOND. SANITARY Y_ N Date RFCEPTIf
WORKMAN I have. SATION f DECLARATION FDCFURES PERTRAP SCDOi,TAX Y_ N_
1 hereby orfir.kers that I have•adulate of consent d copy
(S
d eofWorken'Comperaatlm Insurance oraadBled mpythertof(Sec. RECFJPrY
380D,Lb CPARKFEE Y_ _
Polky0 Z6C/� 09
RECEIPT#
GAS U.SYSTEM-OVER 4(LA)
Camps y !` Pf k BUILDING DIVISION FEES
}yC��CC.ertified copy filed'herew th the
GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
ertNed ropy b(Lied with the city inspection division.
CERTIFICATE OF EXEMPTION FROM WORKERS GREASETRAP PAID
COMPENSATION INSURANCEg}yEp-SANITARY.SEC E.A.X%ET. DatC Recti ted
(1'hbsectbn need nd be completed Ithe pemdt b faorc hundred dollars
mED)
mcklyth WATEREEFATERw/vENT/ElrrrR ENERGY FEE Y N
]a not empal bthe peroan Zany nuhe wait forwhichcodeemutctbo the
1 shell not employ any person b any mannerat u to become subfttt to the WATFRSYSIFM/TREATING
wolCompenaatbn Laws of Cnllfomb.Date PAID
NEW RESIDENTIAL PLMB. XT.Applicant
Z p nonceTOAl'PLLCANrr:u,.Rerda)dn twcertuiateorEaemmppttb Date Recei t# '
N ahould become subject to tine Warkera Complmatbn provbioraorthe Labor TOTAL:
_ Code,you Trust forthwith comply with such provbons orthb permit shall be
Uj ] -deemed revod.
akeCONSTRUCTION LENDING AGEJtO' SEISMIC FEE
I hereby affirm that there b a coratructlon lending agency for the perform- ELECTRIC FEE
7 Z anaofthc.,kforwhbhthb peroutb issued(Sec 3097,CW.C.) TOTAL
U O Lender's Nam PLUMBING FEE
LLI— LenderSAddmts QTY. MECHANICAL PERMIT FEE MECHANICALFEE
OW Indifythstlhavereadthbappl tbnandebtethAthe above lnfomatlon
0 bcormct.1&greetocomplywith&]]cityand countyodinancesandsum,laws PERMIT ISSUANCE FEES PAID-. n
>_ 4 malingtobuikibgmnstruction,and herebyauthorlu repmaerauvnofthb
F z city to enter upon the abovo-rrcntbrcd property for Inspection purposes. ALTERORADDTOMECH. Date ReCCI ted
_ (We)agree to save,Ind emr ify an d keep hamd�the City of Cu pert Eno
galnstlbbilltka,/dg.nts,cm and ea Per.which may many wayacaut AIR HANDIJNG UNIT OO 10,000 CFM)
agave Is. Iryth nseque kid the m dew Troll SUBTOTAL:
�/f�A ��/9 AIR 11ANDUNG UNIr(OVFR 10,MCFRU CONSTRUC170N TAX
Signature of APE a/Contractor T�e EXHAUST HOOD(W/DUCT � CONSTRUCTION TAX PAID:
A=DOUS MATERIALS DISCIbSU E
Will the appeant or future building occupant store or handle hazadous HEATING UNIT(TO 100,000 BTU) Date ReCCI Ig
material..defined by the Cupec ins Municipal Code,Chapter 9.17,and the
Heahh erd Safety Code Section 255374)7 HLATING UNIT(OVER 10,00 6TIJ) TOTAL:
❑ Yn No
Will theappliantture building occupant use cquipmot or devkaes VENTILATION FAN(SINGLE REED) ISSUANCE DATE
which emit havdoud air cantaminsms as defined by the Bay Arta Air
Oumity,Mansgemem Dict 7 BOIIXI COMP OEIP OR 10,00)BTU)
S+ Yn ��f cNto
F1
vomia the
ealth&dwu mstedab requirementsunder
an 25534495 of BOfLFRCONP(DVFR IO,000 BTII)
ted Gluomb at Ifth A Safety Code,St cu rr 75505,75533 and 75534.I
understroponaandytonthe balding donnot he mquiremen whichCthat b rnet NEY:ftEEgDIN17AL MECIi. SQJ7
rnmo p i.9 y to Nally the ampant d the mqulrcmeme which Nast h met
prW ly Luys a dl' tdOcwparuy. I
U'r.er or au ud age Ste ISSUED
TOTAL
OFFICE COPY