22946 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Pm en Identification 7 PERMIT NO.
Baao3; v;A o�aY � e 22946
A
CITY OF CUPERTINO-BUILDING DIVISION
traitor.Name: 11e.No APPLICATION /PERMIT
--S5�'S\ BUILDINGELA—IRKALI'LIIMBINGMOCHANICAI. CATEGORY CONTROL 9
Arthlten/Engineer. IJr.No:
�'fY `J3lo\c
QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO
Add. PFRA9TISSVANt'f ❑ ❑ � ❑
LICENSED CONTRAROr pr DECLARATION
IhertbyaHhm that fDivilcm3ofthe erprwWmnofadpt<r9(mmmm< MPWANCfSRF51DENTIAl pg�rK
I�n.I,Iwith full to.
efli 3otth<Busircaaandlho(mlauCode,and
eny
Baru Isla full fora and d PANELS
Glass L
Date n k.le
a JJ
Dale Contractor —UP TO 2201
ARCHITECT'S DECLARATION 371.1000 AMPS
µqqµ!! 7Q I understand my plaeu.hall be used u pubbe nmrde. OVER Imo AMPS SQ.FT.FLOORAREAf/SQ.FT.
E dp�� Llacwed Profe®tonul SIGNS E EC T ICAL IN
6^� OWNER-BUILDER DECLARATION 9'FLIAL CII(CNT/MISC
hereby+( mWtlame scop (mntheConl ctor.LanseLw(athe U T E R
pO f ntywhre reu(S ap7(DItomu maand ,mpe edemle kydtyar �+
O 2 F.p TFAIP.METER OR IDLE INST.
F�g� countywhkh mrylnm+permHtomrWron,alter,lmprove,demolish,orrepalr
mytlructurt prlormib Lsuance,oleo requW the appllontfasuchpermltb POWER DEVICES
Ne a Kgned staterna,m that be W Ibensd punumt to the provislov of the
ruc Contranorb Lbeae TawnDupter9(commeneingwithSection70MofDlvl-
F, IL
�Oe abn3ofthe Bueinmmd ProfmbnsCode)orthdhel+eamptthemfrom+rd SWU.1h9NG POOL FlECTRIC�_ VALUATION
�n•]] the b+eb for the alleged exemption. Any violation of Section 7MI5 by any
epphcant furs permitabject+the applicant to a dAl penalty of not more than 0UTLETSSW11LF)6FD(T1JRES
tivffundred dollars MM.
I,as owner of the property,or my empleym with wages as their sole AEW RENTIAL F.LFZ"fR SQPI'. STORIES TYPECONSIRUCHON
rompevation,will dothe work and the.shore la not Intended or offend for
Dvle(Sec 70K Bualma+rdl Professions Code:The Co Manors license law
�5$ dm notapply to m owner of property who builds or improves thereon,aM OCG GROUIs RFS UNITS
whodoessuchwork hbroselfa through hieown employee,provided that such
Improvement,as not Intended or offered fee vale.If,however,the bu lkling or TOTAL:
improvement beoldwWln ornyearofcompledor9Ur ownarbuBderwW love
t rdafpraArgthathead rotbadd orlmprw<r«pnrpo.enf.ale.I. QTY. PLUMBINGPERMIT FEE FLOOD7DNE APN
Lm
I,as own,of the property,set excWhely cnetracting with licensed
mntesel..to construct Ute project(Sec 70G,Buvinm and Pefmbv Code: PERMIT ISSUANCE
The Commences License Law don not apply to an owner of property who ALTER-DRAIN&VENC-WATER(EA)
builds or top.therech on,and who contracts for supl stent with
lieer d pursuant to the Cmtnnne.Lkrnse law. BACK FLOW PROTECT.DEVICE FEE SUMMARY
LJ I+m exempt undo Sec B k P C for this reason
. Owner E
DRAINS FLOOR,ROOF,AREA,GOND. SANITARY Y_ N_
WORKMAN COMPENSATION DECLARATION011" R�FRT a
❑1 hereby affima that I hater+artllinte of...t to self-Wort,or• FTJ[il1RF_S PER TRAP � SCTiOO.TAX Y N
certificate of Workmnu
ers'Copetlon Insurance ora eertiftd ecopy thereof(See. RECmxI'a
35m,Lab C) GAS EA.SYSTEM-1 ING40UTLETS PARK FEE Y_ N_
IblkyI GAS F.A.SYSTF OVFRl(Flt) ir
BUILDIRttRCDIVISION FE TS
Wined copy is herebytumiehed. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCIIECK FEE
edited ropy b need with the dty lest division.
CERTIFICATE OF EXEM PTION FROM WORK ER S' GREASETRAP PAID
COMPENSATION INSURANCE SUWER-gAN1TARYSTOgM�pDrp Date Remi Ile
(fhlssectbn need nn Rth .�k
IONtdfE hundred down
(53f10)ml WATER I-IFArFR w/vF2.1T/EI,Fr1R ENERGY FEE Y_ N
I ythat in the which this pemdt V loved,
1• not empby pe n Ia to become eub)cd to the WATER S��/.REA.DNO PAID
W kers'Com
O Z A Brant NEW RESIDDITIAL PLMB. SQFC. Date RCmI tit
Z NO m nR1W CertBlcateof EiemppttbRyou
.hale Iect to the Workers''Comperdatlonprovhbnsofthe Labor TOTAL:
V! Code,you fodhwlthmmplywlths apmvi mortMapen tshallbe I
EE
W j deemed ked.
'
CONSTRUCTION LENDING AGENCY SEISMIC FEE
Ili Ihereby of .that there ba mestmetion lmding agency for the perfomf TOT : �• ELECTRIC FEE
= ante of the work which this permft f.Lswed L5ec 3097,Civ.C.) _�
U O 1<Mer.N.me PLUMBING FEE
LL H Lendee.Add. QTY. MECHANICAL PERMIT FEE MECHAMCAL FEE
OW ladLfythelldvereadthksappllatbnardnate Uutthe+bave WorrrWfon
d beerrect.l+greetocamplywRhallcNyardmuntyaedlnmmmd statelit. PERMIT ISSUANCE FEES PAID:
N retailing tabuildlegconstructlon,+M hereby auNarize repasentativnofthis
Z dtytoenterupon the abovamentlonsd property for Wpectbn purpose.. ALTTRORADDTOMECH,
(We)agree to ease,IMemrdfy an d keep harridess the City of Cupertino Date Receiptif
U aga Wt LabWttn,}adgments,cost.and expenses wbirh nay N anyway+mue AIR HANDLING TWIT DO 10,"CFM) SUBTOTAL•
Id ti mnercryeneeof ted grantd thispe It.
Z %k/ al AIR HANDLING NIT OVER 10,(00 CFM) CONSTRUCTION TAX
yCONSTRUCTION TAX PAID:
SlgruWreAppEaM/Con War Date EXI IAf157 FK70D(W/DIICD
HAZARDO SMATERIALS DISCLOSURE
Willtheapplkant or/utun bulldingomipant etorc or haMbhawdms HFATINGUNTTOO I00,=BTU) Date Rmci tic
matertal as de0nd by the Cupertim MuMdpal Code,Chapter 9.1;and the
kk�.It.o SafetyCade�La—�Sd�uetlom2S532WI HEATING UNIT(OVER 10D,000 B1U) TOTAL:yes,
Will the applicant a fuMne building ncvpant um equipment or denim VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
whichemithv rdowairm Ul ntsasdennad bythe Bay Ams Air
® Qu IltyManagementDittrin7 BOILFR-CVMP0HPOR100,0WBTIn P A I D
Yn ❑I�No
Ihave read the h.wou.mtc a6 q remnbund,,Ch.pt,r6.95of BOR.PR-GOMP(OVER 1m'"BTU)
IMCGIBomla Health&Safety Code,Se t.o 25505,25S33and2-5SM.1 NOV _ ����
uMc ardthatifthebuildingdon mmnllyhaveatenani,thatltbmy NEW RESIDENTIAL MECH. SQFT.
rnpciri to notify the oo vpam of the requirements which must he met
prior to Issuance of a Certifinte of Occupancy.
Clf�y OF�%UPEHTIIiv
TOTAL
Pvncrmaulnrrl .gent Rate ISSUEDBY: �a V�✓� Y a
OFFICE COPY