20878 (2) rn x uv^Bulldln I'Mca Identlikelm I'I[MIT N(O. O
Bu Oding Addrm.:
-<-,J. G
878
one: A t.
Grhuhns CITY OF CUPERTINO-BUILDING DIVISION
neap . .me: O'1k•N APPLICATION I PERMIT
BUILDINGELECTRICAl-MUMBINC-MECI IAMCAL CATEGORY
lted gl r. Lk.Na CON ROO J
v O f BUILDING PERMI"F INFO
ELECTRICP_ERMIT FEE ITSIS -71177.71-A
Addrtac PERMITISSUANCE IZ.� IJ
LICENSED CONTRACTORS DECLARATION juvyiyior J
I hahSeao irmlhat I am fDlvtimssdheunder DualmandPmieW=rode, menc MPLIANCESRESIDENML t1N Ul_xWl"710M1
I'emseI I.
7000)ol ddfW 3o(Ihe Bu4eumdProleulonsCode,and my
I license is In futl f and dfeR-C 2 PANELS [
LlcenrClsr Lk.I •�S - 1 3 �� �Y
Date G.ekader
ARCHITECPS DECLARATION 701-1000 AMTS
ceOZQ� l understand my plans she]be used as public am. OVERIODDAMM SQ.FI'.FLOOR ARTA S/SQ.FI.
Licensed Professl.al �•• SIGNS ELECTRICAL St
OWNER-SOLDER DECLARATION SPECLALCIRCUIT/MI.9C V (�
1 hertbyafOrm that lam eempl from theC mmoora Limine Law for the
pQ following reason.(Sedim 7015,Business and Professions Code.Any city or
Ct'u7 county which requires permit tocon•truct,Wer,bnpnwe,demolbh,orrapper TPMP.METIR ORIOLE INST.
any 4ruet es prior to lb Meme,also requires the applicant for•uch permit to POWER DMCES
file a signed statement that he b licensed pursuant to the provisions of the
q Contndar's License LW(Cha er 9(comerencin with Section of Divl•
L�05eon 3ofthe Buslnenand Profmloa Cade)orlhe he ls eeemptlhert(rommd 'MING IA70L ELECTRIC VALUNION
the basis for Ile alleged...mptim. My violation of Seabn 70315 by my 110 OUILETSSWITCHESFIXTURES / 6 A7
p
applicant fora Permit aubjeda theapphcant tea dNl penalty of nus nae than 61 !/
fiv=rundred dolke(fSM. NEW RESIDENTIAL ELECTR J 'SOFT. STORIES / 'IVI'E CONti1RUCIlUN
❑ �n 1,a owner of the pmpedy,or my employee with mgn u lhak sok
kZQt .1,&c. 0Kf1 inseaework.andlmo Cde:TheC ntract Mor cal. aw
F� ssle 6ea]01{,BuDleesand Professions Code:7ha Conkadofs Llcerue law
damned apply tom owner ofproperty who bulldsor lenprovnt1wreckand OCC.GROUP RIS.UNI TS
EEE
who don•uchwork hlmssUerlhrough hiaownemplayen,prwided thatsuch ^t�
ImpmveenUmnotlnlendedoroffemd(mssk.ILh.wever,the Wlldingm T S
Improvementkmidwlthl.ma yearofcomplatbn.theowner-bullderwillbaw
H�uden of proving that he did not build orimpmwforpurpoeofsale.). Q}'y, !'Ie =�6:; PLUMBING PER &FEE ET.WUTANE APN
LJ L•s owner of the property,am eschu wly mntnding with if...d PERMIT ISSUANCE
comndon to coaled tha pmleci(See 7011,BwNessand Prdealoa Cod..
The Contractors License Law don me apply to m owner of property who
Wilds or impProve thaaon,and who contra for Duch pto)em with a ALTER-DRAIN&VENT-
qagDctm(4licensed pemrmt to Ne CantndoY•Llcmae Law. BAIX FLOW PROTFlT.DEVICE FEE SUMMARY
LJ I am exempt under See B&P C (or this eemn "'c
1 Owner Doe DRAINS FLOOR ROOF,AREA,COND. t� SANITARY RECETPCX
❑ WORKMAN COMPENSATION DECLARATION Co pD(gURpg PER TRAP �(� SCI 1001,TAX Y-- N_
1 hereby dllm that I have a certificate of conrnt to rif•Iuurs,a• {. RECEIPT X
3radii800,IIab CI erken'Compensatlmlaurmesma certlfind copytheeof bee. GAS EA.SYSTEM-1 INC10UTLEM m PARK FTE Y_ N.
RECt7IT X
Peaky I GAS EA.SYSTEM OVER t(RA) BUILDING DIVISION ICES
Com ny_
Cedlfled copyk M1ercby(umiahed. GREASE/1NDUSML WASTE INPFRCEP'R7R PLANCI"IECK FEE
Cedlfled copy b filed with the city Inspection division. I
CERTIFICATE OF EXEMPTION FROM WORKERS' GREA'SE7RAP Zcu
PAID_
COMPENSATION INSURANCE b•EWER.SAN<TARY-STORMRA 700FT Dale Receipt#
ITNassdbn need not h cornpl4td Utha pentut k fmoe hundred dollen — —
(5100)mless.) WATER HEATER wIVFM/F7.ECTR 2♦co ENERCYFEE Y_ IN_ �(�r•OU
1 unify that M the performa WW
�nof the work for which s permit Ice ed,
I sha0 not employ my perwn In any manner n u to become sub)en to the WATQt SYSTEM/TREATING PAl D
Worken'Ccmpm&ffl nlaws.l Calif=la.Data
ZZ Applicant NEW RESIDENTIAL PLMB. SQ.FT. Dale Recei tN
O NOTICE M APPLICANT:U,.her maWng this Certificate of Exemption.you
should become subject to the Workers'Comperuatim provisions of the Labor TOTAL: -
F" N Code,you mntfmhwthcomply Mthmchpmvk morthkpermilWWbe
� deemed 1e„ek,W UJ-WJNG FEE
W CONSTRUCTION LENDING AGENCY SEISMIC FEE •2 L
a Z IherebyafBmthal them b a construction lending agency for the pedorrri TOTAL: ELL•CTRIC FEE
7 ane efthe work for which this permit is Issued 3041,Civ.C.)
OO lender'-Name .♦.. . . PLUMBING FEE D.®
F Lender's Adders QiY, a"N"?MECHANICAL PERMIT , FEE
U. W a
I dllythat l havereadthWpplicatlenand 4alethal themcw.MI. ttion �•, MECHANICAL FEE
O
6 lsconM.I.gree to comply wtlhall city and county.rdlnanon.nd palel•w• I PERMIT ISSUANCE 1'Za(r FEES PAID:
). N eeleing to holding mmlructim, nd hereby authorks repressamad sof this
F city to enter upon the above-menlloed property for impetlon pu an. % ALTERORADDTOMECH.
Z r ° �♦ Date Receiptl
(We7 tojudg ents, sand keep M1a whi the City y pertue1rus ----
L) agalns IUtln,Frdgmees, sand pen whl may ln.nywayamue AIR HANDLING UNIT(TO 10,000 CFM) SUBTOTAL:
.gal t d City N •equ oft •Permit.
fir
AIR SIANDLINC UNIT(OVER lO,WOCFM) CONSTRUCTION TAX
JI
JI1 nal App ant/ ontnn Da EIOLAl15'T HOOD OV/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hmrdws - HEATING UNIT(TO 100,000 BM Date ReceiptN
Material as defined by the Cupertino MuNtlpalCode,Chapter 9.17,and the - JJ �•
Health and Safety Code Seddon 7S537(a)I HEATING UNIT(OVER 100.000 BM TOTAL:1t-l=315
❑YesNo
WIIIIheappilcanla No IS occupant use equipment ordevlm VENTILATION PAN(SINGLE RFSID) ISSrUA/NCnE DATE
whichemit hazard.,air cuntarNanls a defined by the Bay Art•At,
Ou4By Mmagemod District? BOILER-COMPOI POR100,000BM 1
Yee n No
I INve readlhehaar�wa maledals requirements under Chapter 6.95 of BOILER•COMP(OVER 100,000 BM -.
the Callfomls Health&Safety Code,SMI.,2S505,75S33and 75531.I
understand that ifthebullding does not currently have a tenant,that Ills my NEW RESIDENTIAL ME(0q SQFT.
responsibility 1.really the occupant of the requirement,which must be nag
prim to la.m. I.Certificate cfOm,pancy. C�)t�,y�(if(11rinel'f�hgn� �T /UUU.,`,y„-••,���CSJ.
Ownerorauthortud agent Data TOTAL: ISSUED IIY:=_✓
OFFICE COPY