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24585 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO Hui L 1 F- -, a A PERMII'NO, APPLICATION/PERMIT PLUMBING-MECHANICAL /� A C O 5 BUILDING DIVISION /) BUILDING PROJECY IDRN"I IF'ICAf10N G 4 J 8 J BUILDING ADDRESS �/ UNITM LOTH SANPARYNO. APPLICATIONSUBMITTALDATE OW NAME: * PHONE: CO RA fOR'g NAME: LIC NO: o` '1 N/C CONTROL p •ARCHITECP/ENGINEER: LIC NO: ADDRESS: Y (� -� ''AA _ ❑ CONTACT: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO BLDG ELECT PLUMB MECH PERMIT ISSUANCE El El 14 ❑' LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION Azz I herebyaffrm that l am licenaedunderpmvisionsafChaptt9(commencing with Fsz�-00 Section 7000)of Division 3 of the Business and Professions Code,and my license is in PANELS 1 '•1 + 1/ pg ZDF fall fomeandaffect. - UPT02MAMPS �Y WW" AaL� vFi 6 4 Date Class Cocntrud10Z'1975' �Z q 7jµL(sa.a 201-1000 AMPS E-y Z /�� 3 ARCHITECPS DE LA ATION SQ.FT.FLOOR AREA $/SQ.FT. ZOrn— OVER 1000 AMPS OZ"O I undersand my plans shall he used as public records. _ SIGNS ELECTRICAL Igy Licensed Professional �d'6 OWNER-Bempt From the Contractor's SPECIAL CIRCUIT/MISC. OyV I hereby affirm thin 1 am exempt fare the Connector's License Lew for the W 3 m y following....(Section 7031.5.Business and professions Code:Any city mentally TEMP.METER OR POLF.INST. which inquires a permit to construct,altar,improve,demolish,or repair any structure primm its isauencgslso requires the apppeant forsuch,mishm file a signWmtemert - I E aQ p that he is licensed pursuum to the Provisions of Ne Contractors License Lew(Chapter d 9(commencing with Section7")of Division Sof the Business and Professions Code) SWIMMINGPOOL ELECTRIC''• ,� VALUATION nrmat he is exam t therefrom scrome basis for the alleged t An aline.of W_y p ge pion.Any S ]031.S blOUTL -SWITCHES-FIXTURES /DO ectiony any appicant(nrmpemtit subjects the applicvtuoucivil penahy a( J ©Sp not mom than five hundred Oollms(SSW). O is NF.W RESIDENTIAL ELE ❑ othe wnemndthe openy,ormyempindedor offered or salei(sole compensation. STORIES TYPE CONSTRUCTION d3— will dotbewons Cede: he Core mmeminmimuceE .docat not e(see 7f 004,miter ss of and Professions Cale:The Commcmrs License law Joa not apply to an owner of properly whobutIdaorimprovesch improvements whodos such work himselferthinugh his ownarty whecsprovidaltbmsuch impmvememslcome intended immiredfa(xale. is OCC.GROUP RES.UNITS however,the buildingor improvemem is mid within one yearofmmpletion,the owner- TOTAL: builder will have the burden of proving that he did nol build or improve for purpose of ale.). ❑ I.asnwnesofthe property.um exclusively contracting with lissmodemanactorx m QTY. PLUMBING PERMIT FEE FLOOD_ZONE APN consumer the project(Sec.7044,Business and Professions Cade:)The Corrosion's I.icense Lawdosnotupplytuanownerofpropeny who builds or improves thereon,and PERMIT ISSUANCE s� whocammen forsuch pmjects with acono-acmgs)licensed pursuunt to Contractors Law. Lice xe ALTER-DRAIN&VENT-WATER(FA) FEE SUMMARY C]tel ore exempt unde+Sm ,B&P C for this reason BACK FLOW PROTECT.DEVICE 51 E FF.FS SANITARY V N Owner Date RECEIPT N • DRAINS-FLOOR.ROOF.AREA.COND. WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN_ Ihereby rs'Conaffrmion Ins have.ceeemlcofcomento essid(Sce.3,m Lab C.)lar.ifwhich FIXTURES-PER TRAP RECEIPTg orker%Campensatinnlnsurencemecenitian copy Hereof(Sec.3g00,Lab CJ which PARK FEE YN arvem all em e's eRECENT'p y� GAS INCA OUTLETS Pompon J�oy�7aBUILDING DIVISION FEES Company T.{gf.4d--_4�g GAS PLANCHECK FEE ❑ Certified copy is hereby furnished. CenifieJ copy is fled with the city inspeainn division. GREASEANDUSTRL WASTE INTERCEPTOR GRADING HE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE COMPENSATION INSURANCE (This smile.clean not be completan iftbepema is far one hundred dollar,ISM) SEWER-SANITARY-STORM F.A.203FT. ENERGY FEE or leas) I certify that in the performance of the work for which this permit is issued,l shall WATER HEATER W/VENT/ELECB ,SD not employ any person in any manner sec as to becam kers subject to the WorPAID Comperammnlawxof Califomia. Dare WATER SYSTEM/IREATING Date Reoia# Q Z Appliesm Z 0 NOTICE TO APPLICANT:Items,making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: r � become subject to the Workers Compensation provisions of the Labor Code,you must a . forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING HE [� CONSTRUCTION LENDING AGENCY SEISMIC FEE I hereby affirm ihanhem is a construction lending agency far the pe(formance of V Z TOTAL: ,S(� ELECTRICHEO the wank ee for which this permit is issued(g .309].Civ.CJ Lcndera Name �" E= Lenders Address QTY. MECHANICAL PERMIT FEE PLUMBING FEF. SU271 certify that 1 have read this application and some that the above infematirm is MECHANICAL FEE se CL, ct.I agree to comply with all city and county ordinances and state laws misting to PERMIT ISSUANCE In building construction,and hereby autberize oTicaematives of this city to enter upon the CONSTRUCTION TAX V above- menti oned papery for inspection purpoaes. ALTERORADDTOMECII. (We)agree to save,indemnify and keep harmless Ne City of Cupertino against liabilitiea.judhmema.coats and expenses which may in wY way acctueugvnst said City AIR HANDLING UNIT(TO 10,(%10 CFM) mconzencemtb grand gofthis pcnait. 0010 AIR HANDLING UNIT(OVER 10. CFM) gnature of AFp¢am/C.rhvatar Data EXHAUST HOOD(W/DUCq PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100.000 BTU) Date Receipt Y Will the applicant or future building occupant store or handle hutrdous materiel HEATING UNIT(OVER 100,000 BTU) TOTAL: ZaJ us defined by the Cupertino Municipal Cole,Chapter 9.12,airline Health and Safety Code.Section 25532(a)? VFLATTON FAN(SINGLE RFSI D) ❑Yes ❑No ISSUANCE DATE Will theapplicunmr futurebuildingoocupent usampipmemordevics which emit BOILER-COMP DUP OR 100,000 BTU) Immodest,air commitments as defined by the Bay Area Air Quidity Management BOILER-COMP(OVER 100,000 BTU) B W District S ❑Yes ❑No NEW RESIDENTIAL MECH.—SQ.FT. 8 199, m 1 have mad the harmdous materials requirements under Chapter 6.95 of the Califomia Hea1N&Safety Cale.Sections 25505,25533 end 25534. I understand That CITY ,V,r ifthe building does not currently have a tenant,that it is my responsibility to notify the T! occupant of the requmpal which most be met prim m issuance of a Cenifcale,of urr`H jNV Occupancy. Owne(o(aud oozed agent Dole TOTAL: ISSUED BY: OFFICE