27842 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO A PERMIT NO.
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL 2784,2
- BUILDINGPROJECT.IDP-NTIFICATION '
BUILDING ADDRESS: I�/+� /� .j/.` �.s�J �//� 7A( SANITARY NO. AP%]CATIONSUBMfRALDA'1
,m 1 0/ I �,n 0 UNIT# / /OLh a LOT# V
S E: r IC NO
V :
NIC CONTROL 0 IOn Homes - 606
CHITECUFNGINEER: Ll O: ADDRESS:
El
CONTACT: PHONE: .r - '. . - _ ,BUILDING!PERMITANFO
QTY. ELECTRIC PERMIT Y a REE - .
ICH
PERMIT ISSUANCE B W PXLUMB Dr
LICENSE CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
ZWz caIhereby000offnn thmlaimlicenudunderprovisiansofCTapta9(mmmencingwith p TOB DESCRIPTION
WOO Sion 7 )of Division 3 of the Business and Professions Code,and my license is in PANELS � /
K W C full tome and effect. / I / J
;<Z, License Class Lic.# UP TO 200 AMPS VVV rrr�rrVVV/
m6d Data Card rac.er 201.IBM AMPS
FyZ ARCHITECTS DECLARATION SQ.FT.FLOOR AREA E/SQ.FT.
OVER 1000 AMPS
J C I:0 1 understand my plans shall be used ss public records.
W SIGNS ELECTRICAL
Licensed Professional //o
OWNER-BUILDER DECLARATION SPECIAL CIRCNT/MISC.
06 V I hereby offrm that I ore exempt from the Com odns License law for the
3 Na following mon.(Semon 703 t.3.Business vW Profmsiona Code:Any city o county TEMP.METER OR POLE INST. ;3 Cry
1 Om J which requires a Permit to construct,miter,improve,demolish,or repair my sa error
}2 priarm its issuance,also requires the applicant perturb Permit to rile&signed commandPOWER DEVICES
j 0O that he is licenud maxam 1.the provision of the Connaer«'s Licanu Law(Ch&pter SWIMMING POOL ELECTRIC
-aof' 9(commendng with Semian]OOfq a(Division3of the Business end Professions Code) VALUATION
Om or heir 1.5 by heafrommd the Permit nheasegWpplica exemption.Any v Flatly of OUTLETS SWITCHES-FDnI)RES /�U
5=¢ Section 707LSbyanndred applicant for apennin subjects the appfrannoecivil pevlry of 7
not more the five hundred dollen(f500). NEW RESIDENDAL ELECTR _SQ.FT.
C�� ❑ I,uownero(thepropenY.ormyemploywwithwagesvtheirmlecompemedm, STORIES TYPE CONSTRUCTIO
y will do the wok,and thestmctum isnotintendedoroffered forsak(Sac.70a4,Husirwt
and Rafessiuns Code:Th<Contractors Liam Law does not apply ro an owner of
property who buildsmimproves thermn,andwhadoessuchwok himselfathrough his
C.GROUP RES.UNITS
nempl0yees,pingar i prover improvemen.arcmt earn Moplesin,forsownlL
huilder ,ill have the arden of proem issaidhe di inoneyear of completion,thrpose er.of TOTAL: ��gµ
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I,es owner oDhe pmpeny,aimaxdmively<ontmcungwithlianudconuemonm QTY.,h-` . .PLUMBING'PER MIT;'�£`'.-;,y is�;FEE DZONE APN
construct the pri(Sec.7044.Business and Professions Code)The Contractor's IiiiiiiI
Liceme Law d«snot upplymanownerofproperly who buildsorimproves thermn,mdtff PERMIT ISSUANCE
who conaac.forsuch projects with acenteaogel licensed punumumhe Connector's ALTER-DRAIN&VENT-WATER(EA) { � .P,2„
I7MMARY,`.'r.�,,a; -8 .
License Law.
❑ 1 em exempt under gee, ,B&P C for Nis rcuson BACK FLOW PROTECT.DEVICE UT 1
SANITARY Y N
ser #
WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF,AREA,GOND. SCHOOLTAX RECEIPT N
❑ Ihereby offrm Nemlhaiveacenificem of consent to selGinurc,mecenificate of FIXTURES PER TRAP RECEIPT is
Workers'Compensation lnsuence or a certified copy thereof(Sec.3800,Lab C.)which PARK FEE Y N
covers all employee's under this permit. GAS-EA.SYSTEM-1 INC.4 OUTLETS RECEIPT#
Policy It BUILDING DTVISTON FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE O
Cl Certified copy is hereby furnished.
❑ Cmifhdcopy is fled with the city inspection division. GREASFIINDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERSGREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This cation need not be completed ifthe permit is farone hundred dollars(SIM) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE
or leu.)
I certify that in the performance of Ne work for which this permit is issued.Imail WATER HEATER W/VENT/ELECIR
not employ my .on in my manner so as ro bar.subject to the Workad PAID
Compentanionlawsof Colifrmia Dote WATER SYSTEMiTREATING DaneR' as
z Applicant
zCz�-i NOTICE TO APPLICANT:lf,after making this Certificate of Exemption,ya.should NEW RESIDENTIAL FILMS. SQ.Fr. tj TOTAL:
[" (q become Subject o the Worker's Compensation Provisions o'the Labs,Code,you must
forthwith comply with such Provisions or this Permit shall be deemed revoked. BUILDING FEE Os�
kI.1 SEISMIC FEE
[� CONem is a construction 10th LENDING AGENCY
z 1 hereby hich t that there s& d(Se.3 97,Gia agency for the performance f
the work for which this perms is aimed(Sec.309]Cty.CJ TOTAL /710ELECTRIC FEE If 70, QS
I p t r V FEE PLUMBING FEE
O Lenders Address QTY / t MECHANICAL PERMIT i FEE ,sir 70
T comfy that I have maid this upplication and months,the&have information u m MECHAMCAL FEE
correct.I agree to comply with all city and county ondinsuces and state laws relating w PERMIT ISSUANCE
rh buildingcom union,and hereby authorize rtprcuntutives ofthis dry roamer upon the
U z above-mentioned Property for inspection purpura. CONSTRUCTION TAX ALTER OR ADD TO MECH.
(We)agree to save,indemnify and keep hmmleas the City of Cupar im against �''
liabildin,paigmen.,cos.mile xpenuswhich may inany way accmeagainatsaid City AIR HANDLING UNIT'(TO 10,000 CFM) a . Og
meon .�ragmen of thegmunds,inng of this Permit. AIR HANDLING UNIT(OVER 10,000 CFM)
Da
SigVVmo ApplicanJComtmt I Dote EXHAUST HOOD(W/DUrn
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(T0100,000 BTU) Data Receipt#
Will the applicant or funds,building occupant stem or handle humble.material HEATING UNIT 100,000 BTU) TOTAL:
as defined by the Cupenino Municipal Cade,Chapter 9.12,and the Health and Safety
Cade,Section 25.532(a)? VENTILATION FAN(SINGLE RMID)
❑Yea ❑No IS�DAyC® �'E
Will theapplicniorfummbullding«cupmsuseequlpmnt ordeviceswhichemlt BOILER-COW ORP OR 100,000 BTU) /1 Dt
azammus air cammminmb as defined by the Bay Area Air Quality Management BOILER-COW(OVER 100,000 BTU) �AgA 6]%
District? ❑Ya ❑No NEW RESIDENTIAL MECH. SQ.FT. APR R 2 a 1995
I have read the hazardous materials requirements under Chapter 6.95 of the ' 1r
California Health&safety Cale,Sections 25505,25533 and 25534.1 understand Nm V t'Ut.
if the building Aoes not currently have a tenant,that it is my responsibility no notify the
occupant of them ircm<ma which must bw ren prix to. ace yf a Certificate of
Occupancy. �Jy� _-/A`
Owner or thorized gent Ler / �f�J4-J Dam TOTAL: ��Os SSUED BY:
OFFICE