21622APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Buildfing Pro en IdentifleaHm LO
Building Addras c7
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21622
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CITY OF CUPERTINO-BUILDINGDIVISION
APPLICATION / PERMIT
BIIR.D ELECTRICAT PLUMBINC-MECHANICAL
I +-r 1
Contractors Name: (� Lie.
CATEGORY
CONTROL
ArhXect/Engleeer. Llc N ig
(3Ci 6� L O C
TY ELECTRIC PERMIT FEE
BUILDING PER}MMIIT INFO
Add.
PERMITI.SS'UANCE
®® 1p LJsI
LICENSED CONTRACTOR'S DECLARATION
I Mrebyafftrrn that l am lleensed under provisions &Chapter9(mmmer
Ingwlth Sectlon7000)of Divblon3 oftheBuslwaand Psfesel¢u Code, and my
APPLIANCES-RESMENTLAL
JOB DESCRIPTION
Ikese loin fu8 for¢and dfect.
Lleesc Chas Lk.s
PANELS
/ �^
Data Contractor
V 1 r lr
AMPS
ARCHITECTS DECLARATION201-1000
1 uMeenta d my plaru shall be used as public records.
Licensed Pmfeasbral
OVER I" AMPS
SQ. FT. FLOOR �AREA
S/SQ. FT.
SIGNS ELECTRICAL
SPECIAL
OWNER-BUILDER DECORATION
Ihembyaffirmt tlam emptfromthe Contractor.Ll¢r wf¢the
1Y'
��1+.{1..� ,- r4lj'
following muai.(Section 7015, Buames and Profeabra Code: Any city or
CountywM requbeape tomvlmu Ater,Improve,demo h,orr"r
any stnuelurt prior tow lmra me, also requires the appll rat fee ouch pemJt to
0k a signed awnerent the he b B¢naed pursuant to the provisions of the
TFN.P METQtO
POWER DTVI
N,- `
.
SWIMMNGPOOL
1SSwfICFffS FlXfIJR
Contractors Lkese law lChapter9(commsencing with Section 9000)of DM-
alon3ofthe Businmand Prof mCode)orH heberemptthertfmmaadPjjft
the bub for the alleged eaemptbn. Any viedelon of Section 9m15 by any
nt fora peJt subjectithe applkciroompUTLE
appeaperant to a civil penalty d not room than
VALUATION
five hundreddellare(5500).
F_1 1,as owe r of the property, or my employees e u with wagtheir sob
NEW RESIDENTIAL ELECTR SQ.FT.
-STORIES
TYPE CONSTRUCTION
mmpenaatie, wW do the wcA4 and the etmnu e b rot W ended or offered for
.vk t5ee. 9011, Busies and Professions Cade: The Codractora Doo. law
docs sat apply to an owner of property who builds or improves dens, and
who doessuch work himself or through hisown employed, provided that such
OCC.GROUP
- R6. ANTIS
improvamenta are not Intended mof(cred for sale. It however, the building or
TOTAL:
improvement YwW withinoMyearo/completbn,thewmer-buUder will have
QTY. PLUMBING PERMIT FEEFT.00D
tlys,IIundenofprovingthathedm notbuuaorimprmvefenpurpmeofsale.).
Ll L as at of the,property, am e.haivaly ewtracting with licensed
contraetora toeeabuC the pmjea(See 90W, BuaWm and Profmbs Code:
TONE
AM..
PERMIT �IIANCI?
The Contractors LI¢se law don nct apply to an owner of property who
builds or Improve thereon, and who rontram for such Miner, with a
e�(Tactor(s) limned pursuant to the Contraaoe: Lim. Law.
Lf 1 am exempt order Sec B k P C for this masonOUTSIDE
ALTER -DRAIN &VENT -WATER (EN
FEE SUMMARY
BACK FlDWPROTFiT. DEVICE
DRAINS FLOOR, RCGP, AREA, OOND.
SANITARY Y_ N_�
RECE11•T aRATION
Owen Date
WORKMAN COMPENSATION DECORATION.
ECO
❑I hereby a(fkm that have • ¢mlliute d consent 10 sail -Insure, or •
mrtNcee ofWorkers' Compesatlon lsuranee or.¢rt8fed copy thereof (Sec.
3800, Lab G
FLX7l1RES PER TRAP
SCHOOLTAX Y_ N_
gpL�. N
GAS U. SYSTEM -1 INCA OUTLETS
PARKFEE Y N
RECEIPT 1
CAS U. EA
SYSTEM -OVER 4 ()
CoCom nV IJ\ V r
BUILDING DIVISION FEES
ECertllled copy In heed with tlehN.
�CerHfied ropy b filed with ed sty Ispenbn dfvisim.
CREASE/INDUSIRL WASTE INTERCEPTOR
PLANCHECKFEE
GREASE TRAP
CERTIFICATE OF EJ(FMPTION FROM WORKERS'
COMPENSATION INSURANCE
(fhbua neednot Mcompleted BtMper tbf¢orahundreddo8an
PAID
Date Recd IN'JtTJ�
g}y�yVNTpARY STORM FA ](KFC
WATER HEATER W/VENT/E].ECTR
ENERGYFEE Y N
($100)mlmJ
1 ¢rtify that b the pe formunre of the week for which tints permit I. faed,
WATER SYSIELd/TROT[NC
1 shag not employ any pero in any manner so as to become subjeet to Ue
Workers' Compesatblawn of lawof California. Drta
PAID
Apphant
NOTICE TO APPiICANT:E, after coking lhb Certifiale of Exempt lon, you
NEW RESIDENTIAL 7'IMB. SOFT.
Date Recei t%
TOTAL:
.hold become wrbied to the Worker' Compewtbn provislos of the Labor
BUILDING FEE
Code, you moat forthwith comply with such provbbs or this permh shall be
deemed revoked.
CONSTRUCTION LENDING AGFTCY
SEISMIC FEE Q
l hereby afirnthat then is a rostmction Lead Wgagency for We perform
ante of the work for which this pemdt b bec3 ued(S,CN. C.)
Lender, NamePLUMBING
lenders Adams
I mdlfy that I have read this appBadonand state that theabove Information
bcorteet.I.greeto comply whh.B city and county oreinanm and state law.
TOTAL
ELECTRIC FEE
FEE
QTYJ MECHANICAL PERMIT FEE
MECHANICAL FEE
PERMIT ISSUANCE
FEF; PAID:
mlating to buiWing mstmaim, aed Mreby authorize mprecnUHvn of this
Illy to mterupantM above-mentioned Property !¢WpectWn purpose.
(We) .gree to save, BdemN/y an d keep hamJes Ne City of Cupertino
ALTERORADDTOMECH.
Date Recei t4
SUBTOTAL:
agoistlbbWtle,odgmente,m.teandexNe whkhrruylnanywayaarue
AIR HANDLING UNIT CFO 10,000 CFM)
.galst sued City in rosequ end d the granting d Ws permR.
T1.T-I ` I l.i C,
MR HANDLING UNIT (OVER 10,000 CFM)
CONSTRUCDONTAX
to,
Si fApp yZARDOUS
EXHAUST HOOD (W/DUCT)
CONSTRUCTION TAX PAID:
-
FIASARDOUSMAT. IALS DI
E WWthe efined or ythe u¢buinoM oavpa Ccdt hhurd le hazardous
tstore or ha
defined by the Cypen25S MuNdpal Code, Chapter 9.tj and the
material and
Lkabh and sarety code senior 2ss37(.)7
Ye No
Will the tun building oavpantuae ordevkcs
ROCeI til 1�660&
HFATBtC I1NIT (IL3100,000 BTU)Date
HEATING uNrr (OVER 100,000 gran
TOTAL.
VFNIIUTION FAN 6INGLE rfic1D)
ISSUANCE DATE
haz. ed ,a the Bay
hkh eManagment akriet? nbude0red by the Bay Area Nr
�u Ilty Management Dlrtrk[7
L� Y. ❑ No
�'/AI®
BOILER -COMP OHP Oft 100,IXq BTU)
BOTLERCOMP(OVER 100'" BTU)
Ihave read the h rdwa materials requlremenb underChapter 6.95 of
ted C+Warnb Health & Safety Code, Sectbs 75505, 75533 and 25534. I
understand that lithe buildingdoea em currently have a tenant, that It b my
.1 �rsJ4��
_
NEW RMDFlNIAL MECH SQ}.
reposWllfty to nalfy the arupant d the requinmente which mat be mel
prier to Loran¢ ora C<Nffatc of Oavpanry.
Cro T>a,
ISSUED BY: .. (4f 011"r.
Owne th g t
I D e
1
TOTAL
OFFICE COPY