26327 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO Bmr.DTNTrE1:ECTRrcz r1DUOITNG.
BUILDING DIVISION APPLICATIONIPERMITPLUMBING-MECHANICAL CO
BUILDING PROJECT IDENTIFICATION v J
27
BUILDING ADDRESS: SANITARY NO. APPLICATIONNSUUBsMH�TALDATE
. 16 UNITp LOTH
OW P NAME: /s f�.p lgp{p CONTRACTOR'S :� LIC NOlia : N/C ^\'CONTit/O'L NF`'—``T�
RCI IITECT/F: GINEFR; lL.a LIC NO: AD ESS: ❑ / ��
ONTACT: PHONE: Qom. PERMIT*,-'CLECTRIC PERMIT FEE BUILDING PERMIT INFO
� '; Ads- •A .`✓ gLDCr EX P UMB K-,CH
PERMITISSUANCE pLQf�
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
mdez Hicrebyafftrmthat lam,icenudunderprovisionsofaapw9(commencingwiN
Poo Section 7")of Division 3 ofthe Busineas and Professions Code,ad my license is inpANpy$
fall force and affect. ^
Fm License Class Lic.p f. UP T0200 AMPS D
Hot L Dale Conoactm 201-IOW AMPS
ZOF4 S FT.FLOOR AREA Q.FT.
y� ARCHITECTS DECLARATION OVER Io00 AMPS
O Z—O I understand any plana shall be used u public recoNs.
Licensed Professional SIGNS ELECTRICAL OOC
�Yd6 OWNER.BUILDER DECLARATION SPECLV.CIRCUTTMSC. Ise •••
I hereby affirm that I am exempt from the Contractors License Law for the
tr13 a H following reason,(Sedan 7031.5,Business and Profusions Code:My city rummy, TEMP.METER OR POLE INST.Rr which require n prmit to construct,alter,Improve,demolish,or repair any structure
T�
prior o its issuance,also requires the applicant for such Permit o file a signed gammon POWER DEVICES
ty p Op Nat he is licensedpursuant to the provisione of the Contractor's License Law(Chapter
n K 9 with Snddon70(p ) SWIMMWG POOL ELECTRIC
ew cousin
heis a.m )he DivisionJoftheed amaand Anyvona Code UA ON
y_y onhm h703exempt Nerefromend the Davis far Neallegedexempti to chrilpdRon of S-SWITCHES-FIXTURES
QSeaion7WLS by any applicant fora permit subjttathwpplicentdacivil peaWryo
O not more than five hundred dollars($500). NEW RBS AL ELECIR _SQ.PT. STORIES TYPE CONSTRUCTION
M pro [3LasowncrofNepmperry,ormyemployeea withwagesutairaalecompewdon. -
'�+ will do the work,and the ammum is not intended or offered for sale(Sm.704,%Business /
and Profttsiona Cale:The Commctors License Law does not apply men own.of .d
property who builds or improves thereon,and who does such work himadfor through his OCC.GROUP RES.UNITS
own employees,provided that such improvements are not intended or offered for We.If, -
In
owever,the buildingor improvement is soldwithin one yearofcompletion,the owner-
builder will have the burden of proving that he did not build or improve but pure of
ale].
❑ I,unownerofthe pmpeny,emexdusivelyconrecting with licevedcontrenon to QTV.' M NG EMIT FEE FLOOD ZONE. APN
construct the project(Sec.7W4,Business and Profasiamc Code:)The Contractor's ..
License Law does not apply to an ownerofpropeny who builds or improves thereon,and PERMIT ISSUM
whocomaca forsuchprojauwiNacomrictor
License Law.
n (,)licenced pts' anrtNl to noanor's ALTER-GRAIN&V AMR(EA) FEE SUMMARY
❑ i am exempt under Sec. B R P C far thi BACK FLOW PROTECT.DEVICE T E
SANITARY Y N
Owner Dau DRAINS-FLOOR,ROOF.AREA,GOND. RECEIPT#
a W9 MAN COMPENSATION DECLARATION SCHOOL TAX Y N
Ihereby nt thatiheveecenificate ofmnum in self maceNfiurc EIPf#
-rken'Co nsmion lnsunmcc Ora ceniEM copy Hereof(Sal lg00.Leb CJ which MIXTURES
pP3t TRAP PARK FEEjj� N
coven aIle ployee'sundcrthisperm t- I GAS-RA.SYSTEM-I INC.4OUTLETS N
Policy N BUI 1 SON FEES
CompanF�RnFl
GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FE O
❑ Ceis hereby umishd.
❑ Ccis filed the ' 'v' on. GREASRDNUUSTRL WASTE INTERCEPTOR GRADINGf
IFI A ON FROM ORKE�S'/ GREASETRAP SOILS FBNSATIOQJH�RANT Ia(TIeed not pli diffli9rIfTor nehundred o (5100) SEWER-SANITARY-STORM EA.2OOFT. ENERGY TEE
or leaf �JI cNeperfom mofthewmkfmwMchNiepennitisiaud,1"1 WATER HEATER W/VENT/ELECTR
not emprson in any manner eo ea m become subject a theµ! n PAID
Compeof Califamia Date WATER SYSTEM/TREATING Dampplican
C' NOTICHTO PLICANT:IL afar ing thio 'f�of Exemption.you should NEWRESIDHNL%LPLMB. SQ.FT. TAL:
(A become subject o the Workers Compen rovisiom of the Labor Code,you must
E--' forthwith romp, Diane m this pmnit shall be dttmd mvokd. BUILDING FEE
Liz Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
z I hereby affirm that men is a construction lending agency for the performance of
the work for which this permit is issued(Sar.3097,Civ.C.) T L' ELECTRIC FEE
u" ~F Lenders Name
Leaders Aadea. QTY. MECHANICAL PERMIT FEE PLUMBING FEE
O L) I certify Nat I have ad this application and earn that the above information is V
HANICAL FEE �a
at'aa carat Island mromply with W cityandemny mdineocesand adds].we miafin,w PERMIT ISSUANCE
� Ln building construction,and hemby authema,«presenativesotlhisciry to emerupren the STRUCTION TAX
V above-mentioned property for inspection puryous. ALTER OR ADD TO MECH.(We)agree to save,indemnify and kap harmless the City of Cupertino against,iabilites.judgem a,cma anilexpenuewhichmayinenywayaccmeag'I stsaid City AIR HANDLING UNIT(TO IO,00inconyucnceothegamineoftNspermiL / AIR HANDLING UNIT(OVER 1S' nawfA VConumm1 Dam EXHAUST HOOD(WIDUC)AA
D N�IRIS DISCLOSURE A: eEHEATING UNIT(TO IOQOOO BTDatece' t LWillthe applicant orfwre building ocIALS sore OSUR ehexeNoua matedalHEATING UNIT(OVI?R 1(X1,000
as defnd by the Cupmim Municipal Cade,Chapter 9.12,end Ne Health and Safety AL'
Code,Section 25532(.)? VENTILATION PAN(SINGLE KESID)
❑Yca ❑No
ISSUANCE TE
Will theapplicanmrfmurcbuilJinga<up.ntuseequipmemmdevixvwhichemit BOILER-COMP(311P OR 100,000 BiV)
our air conaminand us defined by the Bey Amu Air Quality Management BOILER-COME(OVER[DO."BTU)
suicR
❑Yea ❑No NEW RESIDENTIAL MECH.—SQ.FT.
I have read the huvardom materials requirements under Chapter 6.95 of Nc L
Califmnie I leahh ffi Svfery Cade,gndtions 23505,2553]ad 25534.1 andenwM Net olra v
if the building does not caremly have a mmin.,hat it is my responsibility inanity the 1994
occupant of the requirements which must be met prior to issuance of a Certificate of
Occupancy. �.\.-��.�r�/�I'�
C:II T WLF.f I.
Owner ter nuNorizd agent Date T ISSUED BY'-'F t.-a
OFFICE