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25097 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO AIm.DI.I'fr-U.,FRICAI. .PERMITNO. 25097�O 9 APPLICAT N/PERMIT PLUMIIIN'G-MECHANICAL. L BUILDING DIVISION BUILDING PROJECTIDENTIFICATION BUILDING ADDRESS: I/ ///� SANITARY NO. APPLICATION SUBMI TIAL DA'IE �I1VE H701 P UNIT# f/0 LOT �? OWN' S P' I ,., I �/1vs ' PIIONI?: CO QIpRy M�. Ire_. L O l , (/vL1'11"/ fjJilyT//Ip,{./ i`F/L/f 1/`/�rl//'1' //� /�1 'J N!C CONTROL. RCI 2 I I: . . / el 80: C? ADgW p N/ VL V` cGNT�.cr: WI � 4 PHGNI':( BUILDING PERMIT INFO QTY. ELECTRIC PERMIT FEE B DG [CECT PLUMB MECH PERMIT ISSUANCE /S0e ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RBSIDENTI GK'G Iherchyafr,.that lam licenxdunderprovisiomsof Chaprer9(commmcingwiN JOB DESCRIPTION iWOy]OE Section TXIO)of Division 3 ofthe Business and Professions Cade.and my liana is in PAN EQVL1 Licemefall firrecandcflcc UPT PS FZttr License Class Lica m=y Date 201. S SQ,FT.FLOOR AREA 9SQ.Fr. ZQNZ ARCHITECTS DECLARATIO Qy OZ-0 I understand my plans shall be used as public records. ryF; G S •LECTItI o r/ oZ Q �„� LlwnsW l'mfcsaionul OWNER-BUILDER DECLARATION ECIA CUIT/MISC. KOyU I hereby affiw that 1 am exempt from the Gonion C's License Lew for the followW 3 a ya which reaporreason. pecodino emost. alter,land Professions h,de:Any city or county TEMP.METER OR POLE MST. do,t regisms n Pewit to conmmm,,fic improve,demolish,or repair any swaure priorwib issuance alsoregniren the applicant fur such pcwiuo fileasigncd ammmmt POWER DEVICES ¢O that he is licensed pursuant to the provisions oftne Contractor's License law(Chapum C� SWIMMING POOL ELECTRIC es.or 9(mtmnmem,with Section 7")of Division 3ofthe Business and professions Code) VALUATION O l M,o or that he is exempttherefrom and the basis for the alleged exemption.Any violation of t: OUTLETS-SWITCIIES-FIXTURES Z Q an Section 703 IS by y applicant for a permit subjects Ne applicant civil a il penalty of o not mom than five hundred dollars($50J). NEWRPSIDFNTIALELECTR _SQ.FT. XO IS I'YPH CONSTRUCTION C-. ❑ I.asownerofihepmperty,ormyemployecswithwagesusthcirxolecompensadon, y3,., will Jothc work,andNeswmumisnot inrendMorofkrtd forvle(Sec.]044,Busirress and Professions Code:'Fr,Contractor's Limme Law does not apply m an owner of property whohuildsor improves therena,and whod«s such work hirnxlformmugh Ns wn<mployeu,pmvidedthat such improvementsere not intended orofferrd foraale.IL OCC.GROUP RES.UNI'S however,Ore building or improvement is sold within one year ofcnmpletion,the owner- TOTAL: builder will have the burden of proving that he did trot build or improve for purpose of sale')' ❑ Las ownenJ the Pmlreny,am exclusively convecting with licensed contractors to QTY. PLUMBING PERMIT PEE n,00ZOZONh APN_. consumer the project(Sec.7064.Business and Professions Cash:)The Contractor's Liunx Law doesnotapply tonnownerol'propeny whsbuildsor improves mention,and PERMIT ISSUANCE wEmommucts rorsuch projects with.comracmr(s)(named Eptionamn wine,C.6bacurr's 1nI IpC RAI V WA ) FEE SUMMARY License law. II f1 ❑ 1 am exempt under Sec. .B&P C for this inr;E c Bt4C!l LOw P OT i E 1C,f: OU'TSIDI:FCIS SANITARY YN Owner Date 't I m RECEIPI'p WORKMAN COMPENSATION DECLARATION \ - Jt01 S FLO 00 SCHOOLTAX Y N ❑ Ihemby eRwtnmihave ecenificme of comm milt-inren xni su .o0cam P of Int RECEIPfp Workers Compensation Insurance m irccnified ropy Ncomf(Su.3800,Lab C.)which. - `- I PARK FEE Y N covers all emptoyce's under this permit. I�,r._— G - - NC.40IffLEI'S -1 RECEIPT# Policy N BUILDING DIVISION IZES Company AS-'©C.-SPSPEMaV1FR 4(EA) �. PLANCHECK FEE Ey� ❑ Cenlfied copy is hereby famished. - .G Certified copy is film with the city inspection division. GREASMNDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS FEE COMPENSATION INSURANCE (Ihissection need not lx completed ifthe permit is far one hundred dollan(SI00) SEWER-SANITARY-STORM FA.200IFT. IR6ERGY FEB or less.) I certify that in Ne performance of the work for which this Permit is issued,i shall WATER HEATER WVENDELECTR 2:ff not employ any person in any manner so as to become subjest to Ne Workm' PAID�_Ll '(� pe Comnsroma awsof Califomiaam. DWATER SYS'TIimnBEATING (late Receipt 0 zZ Applicant NOTICE TO APPLICANT:If,after corking this Cinificate of Exemption.you should NEW RESIDENTIAL PLMB. SQ.FT. 'r01'AL: F-' .�-, becomesubject to the Worker's Comperrr this provisions) ,eLabor Code,you must a > forthwith comply with such provisions or this permit shall b<Jxmed invoked. BUILDING FEE O a d0 0. (] CONSTRUCTION LENDING AGENCY SEISMIC FCE s 1 hereby affirm that there is a construction lending agency for the perfmmanee of U Z TOTAL: ELECTRIC FEE U p the wan for wmen this parch is sasses(g«.3097.cis.c.) O 1 0 U Lendeea Name PLUMBING FEE LenJc/s Address QTY. MECHANICAL PERMIT FEC U I ccnity Not I have rud this application and state that the above information is MECHANICAL FEE >1 W correct.legrec ns comply wiN.11 city.nJ ammyoNinences and stare laws relating to PERMIT ISSUANCE P! building convection,and hereby amhoriu representatives ofthiscity to enterupon the CONSTRUCTION TAX Uabove-mentioned Property for inspection purposes. ALTER OR ADD TO MECH. (We)agree m save,indemnify and keep harmless the City of Cupertino against iabilitics.judgmcma,costs andexpenxawhich may in my way accmeagainat said City AIR HANDLING UNIT LQ I0.00(1 CFM) in conscyuence of the granting of this permit. AIR HANDLING UNIT(OVER IQ(g0 CFM) Signature of ApplicanUCommetra Date EXHAUST HOOD(W/DUCq PAID IWA ARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date R.i,l#— Will tne.pplicurn car future M1uilJing nccupam stare^rM1andlehezardnus material TOTAL: Q 2.7 as definul by the Cupcnioo Municipal Code.Chapter 9.12,andth,Health and Safety HEATING UNI'I'(OVIiR If#),WO BN) ,J Cade,Sections 25532(a)Y VF141ILATION FAN(SINGLE RESIDE ❑Yes ❑ No ISSUANCE DATE Will Neapplicwmrfmurebuildingmeupantuxeyuipmenmrdevlceswhichemit BOILER-COMP OHP OR 10C."BTU) zardaus air contaminants us defined by the Bay Area Air Quality Management BOILER-COMP(OVER 100,000 BTU) uv m? ' ❑Yes ❑No NEW RESIDENTIAL MECH. SQ.f4. I have rid the nvardous materials rcyuiremenls ander Chapter 695 of be IWAY 2 5 1993 California Health&Safety Code,Sections 25505,25533 and 255M. 1 undmmnd that if the building does not currently have a tenant.that it is my responsibility to notify the CIIIf Ur wren niru occupant of the rcyuiremems which must h met poor m issuance of a CcrtlBcom of Occupancy. Owner or.uNorizcJ ngem Date TOTAL: ISSUED BY: