21629 _APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project IdentificationLcr1_ ,3S_0PER.MITNO.
Oullding Address: -
qoZ W ooe� f Iz u< cow czTe PLFH , lee cLT f 21619
C�� CITY OF CUPERTINO-BUILDING DIVISION o
Contead'a(w'ame: Lle. APPLICATION I PERMIT
1 Q OCA BUILDINGELECIRICALPLUMBINGMFI:HAMCAL CATEGORY CONTROL Y
Archkea/Ggi neer. Llc er
1 BUILDING PERMIT INFO
Q ELECTRIC PERMIT FEE
Address FERMI T ISSUANCE y�l 19
LICENSED CONTRACTORS DECLARATION L)"J
'withSylon70tlutlam Bcen3oftheuncle,pmvWmuafChapter9(mmmm APPI.IANCESRF_SIDFMIAL OB D6CRll'ITON
IngnaeIsI full 7000Iof D affect fthe Bualrcna�an,d.,Profeam«uCode,and my
Yonas Is �eand affect ��v`—^L•� PANELS Is F1.Jw
DataLibaeClas UCY [_
Drte Comnaor UP IQ 2DO AMPS
ARCHITECT'S DECLARATION 301-1W0 AMPS
re I undentard my,plans ehsB he used as,pubbc me order OVER I"AMPS SQ.FT.FLOOR AREA $/SQ.FI.
Le LI¢nrd Professional SIGNS ELECTRICAL
�< OWNEReBUILDER DECLARATION SPOCIALC RCUIT/MISC
2t, eherebyason. that I 7MIS,ptfromthe GodrWoriUvnx Law fee the
oo qqqqqq f ntywhkhmqu(Sape? to Busine.and l'mfmbaC lr h,o ityor
mMr
FZ t' munrywhlcF requlmapermkdomvWd,aldm,Mprove,drmolbh,ornpalr IFMP.MECPR OR POLE IN57.
anyem=mpdmtolb Wuame,al requlmtheoppllantfmsuchper to POWER DEVICES
r. file•signed statement that he as boenaed pursuant to the provisba of the
Ojw�n ContnctoraUcense Law(Chapter 9(commendng with SMbn 70M� DTvi- gN'ATh4NG POOL fl-ECfRIC VALUATION -
sbn3ofthe Busin.smdP mbmCade)orthehebmiempttherefmmaM
_ the basis for the alleged exemption. Any violation of Seabn 70115 by my
I�}5 <Oe
applicant lots permit subjects theapplfcant too dvil penalty or not more than OIIi7-EI'SV✓[7C1{ESpLYTURps /J
E Iudredddlars($M. NEW RESIDENTIAL ELECM / as 111, 0
�n N Ni,..owner of the property,or my empbye.with wag.a theb sole �'�' CONSTRUCIION
t mmperaatlon,wllldothewmkandtheurvlurcbrot WeMedor off,mdfor
S O sale(Sec 7D1t,Buslnev ami Professions Cade:The Comradore Uaroe lanes
Pj$$ dm not apply to an owner of property who bulldsor impro"es therm,and C-C)MJ0_1j TF
.GA -ITS
G0.. who domsuchworkhlmreBmthrwgh hisownempleyers,provided that such 09/
Improvements are not Intended oroffercd L
forsale.If,however,the building or TOTAL.
lorpmvementbsoldw hino rarofcompldb,theowar-builderw hove
try�u rd en of ptowing that he dm not buua or improve for purpose of sale.). QTy. PLUMBING PERMIT ,SEN
LJ S a owner of the Property,am ercWslvcly carr ng wain li meet
contnctm to mrWruct the project(Ser.7044,Bualn.n and Pmofeobmu Code: PERMIT ISSUANCE
The Condndor'a Lio ere haw do.no apply to an owner of property who MSR-DRAIN kVENT-WATER(EAU
butch or Improv.therto, and who coronas foe such Pv*ta with a
ryWfaaar(s)Ibaed pursuant to the Contractor's L mux,law. BACK FLOW PROTECT.DEVICE FEE SUMMARY
LJ 1 am exempt under Sec B k P C for this rtaon
DRAINS FLOOR,ROOF,AREA,CONT. SANITARY Y_ N_
Owner Date RLCTIFTT Y
WORKMAN COMPENSATION DECLARATION FIXTURES PER TRA SCHOOL TAX Y_ N
ex,riffi❑I hereby•form that 1 have o ceduranc of caauent to ora RECEIPT Y
3K0,I bof Workm'Compemeatlonlaunncema cemWkd copythrreof b'ec.
3800.Lvb CJ GAS—EA.SYSTEM-]BJCY OUTLETS PARA IEE Y_ N_
Pdky Y RECEGAS EA.SYSTEM-OVER Y(FA) Y
Cnm nv )ti..T�- V 1 BUILDDINGING DIVISION FEES
certuled copy is hereby b,mbhea. GREASE/INDusiRL WASTE wrERcEProR PLANCHECK FEE
ed ropy is fliedwith the my lrepe hon divtalon. -
CERTIFICATE OF EXEMPTION FROM WORKERS GREASE TRAP PAID
COMPENSATION INSURANCE SEWEWSAMTARYSNRM EA.200Fr Date Reuel t# '71�
(r)or1 ion need nUhecompkled if the permR Is for one hundred dolls,
D1 l0ftdyrJ WATM EEATMW/VENT/ELFGTR ENERGY FEE Y N_
Iartily thatothe person,
toaofthewmk for tohthispemdtb bared,
1 oc], not employ tlo pawn f any mann.so a to bemma subject to the WATER SYS 12d rMEATING
w«lira e«npeaatbn taw.ofOWamb.Tale PAID
Z O NOTICE TO APPLICANT:B,aflermak]ngthb Ce Jrateof Eaem�pttibo,you NEW RIDDINTIAL I'LMB. SQ-FT Date RCOCI t#
H-✓A should become subjectbdhe Womken'Compeaatlm provisba afthe Labor TOTAL:
_ Code,you mud forthwith comply with such provbbvorthis permit shall be,
� ] deamed revoked. BUILDING FEE
a p CONSTRUCTION LENDING AGENCY SEISMIC EEE
lhercbyaf0rtnthatthercbacorelroalon lendingage fortheperform sl
Z ace of the womkfor which this pe bIssued bee.3097 11h.C.) TOTAL ELECTRIC FEE �y
02 I<nder•Nama � PLUMBING FEE
LL f lender's Addm '1` QTY. MECHANICAL PERMIT FEE
O W I oertllythat l have mad thisa pB.tbnand state thatthe above Information MECHANICAL FEE
brornat.l agreeto comply withal]city and county ordinances and late laws PFRMrI.'SUANCE FEES PAID:
} 1 relating to building rorWrudion,and hereby authorize representatives of this
F N ay to enter upon tedabowmentbxed property for bespeak.panrpa�. ALT7RORADDTOMEGH.
greoea
unify(We)ae to we,i demfy an d keep harmless the City of -7p inn Date Recei t#
() ago fret liabilities,)udgmenls,code a ad espenses which may In any wayacome AIR HANDLING UNIT(TO 1OX00 CFM) SUBTOTAL:
aga Wt said City In consequence of the granting of this par nit.
AIR HANDLING UNIT(OVER 10,000CFhn CONSTRUCTION TAX V> t
Slgatvrc of Ap cant/ amradm V Nue
EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
A HA3ARTOUS MA ERIALS DISCIASU E
Wllltheappllont orfuturebuildingarvpantatomorhandle haw cxu HEATING UMT(T0100,000BTTn Date RCcci t#
material as defined by the Cupertino Muddpal Code,Chapter 9.1;and the
I leallh and Salcty Cade SectRHEATING Section 7a](a)7 HTING UT(OVER 1 ,00)BTI, OTAL:
❑ Y. No
WBlthe appLamm wmrc ildtngo patuseequipmontordrvkes VFNDLATION FAN(SINGLE RF ID) IkUNM DATE
which emit haramdous air contaminants.defined by the Bay Area Air 1
Quality Management Dbtr4tl7 BOILER-COMP DHPOR 100,000 BTU) B 1 4199
Y. [:3 No c
have rad the harandous materials rofulmovenb under Chapter h95 of BOILER-COMP(OVQR I00,000 BTU) 1
the California I lealth k Safety Code,Sections 35505,5533 and 35538. I
u�dmtaM(land i(the buBdingdaes not amently haveatenant,that let fs my NEWRFSIDFNTTALMECH. SQFT city �lnnt'iw'�
respoa@01ty to ndrcq
tfy the occupant of the ubemerds which must be met
qf
priorto issuance cuaiCer}rtiflateofoc Nosy.
Owneragent \ Dite
TOTAL ISSUED BY:
OFFICE COPY