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27908 (2).` APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OFCUPERTINO BUILDING-ELFT FRICAL PERMITNO. APPLICATION/PERMIT PLUMBING-MECHANICAL O oO BUILDING DIVISION BUILDING PR(ydECT IDENTIFICATION BUILDING ADDRESS: S F-IL SANITARY NO. APPLICATIONSUBMITEALDATE UNIT# Y LOT# 14—w•- Y�• � OWNERS NAME: PH Ni !! CONTRACTOR'S NAME: LIC NO: WC CONTROL# # tt�4D3 DRESS: 1RCHITECT/Fl4 INF.E LI NO: ADDRESS: ildOrG is IL al sl c EJ CONTACT: PHONE: BUILDING PERMIT INFO 416-lew- joy QTY. ELECTRIC PERMIT FEE l pLpG ELECT P�L�U��I1B MECIi get. wofPERMIT ISSUANCE I,IE{]I LT LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL Oy.y I hembyaffirm that l nn licaused un&rprovisionsofChapter9(commencingwith FJ00 Section 7")of Division 3 of the Business and Professions Code,and my license is in PANELS Kf+l full Immoral effect. <Z License Class Lw+It UP T02W AMPS y6a Date Confirm 201-IOW AMPS F0ce ARCHITECTS DECLARATION SQ.PT.FLOOR AREA f/SQ.FT. 70y3 OVER 1000 AMPS . O N- I understand my plans shall be used M Public rttorJr. SIGNS ELECTRICAL Licensed Pmfessionnl �Q OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. R'Op�,U 1 hereby affirm that I am exempt from the Contractors License Law for the Iraay followingruason.(Smion]OJLS,Business and Professions Cade:Any chymmunly TEMP.METER OR POLE INST. which mcphas a permit t.constrvcL alcor,improve,demolish,or repair any emetine POWER DEVICES >� prior to its insuanee,alsorequires the applicant forsuch permino rile u signed naument s that he is licensed purmanuo the provisions of the Convectors License Low(Chapter iioLL 9(c pornmeing with Section]000)of Division 3 mine Business and Profeadons Cade) SWIMMING POOL EL E C VALUATION Wor pat he is exempt herefrom and the basis for alleged exemption.Any violation of Y Section]03 LSM1 an a ]'cent fora tsuM1 authee 1 u.ecivil telt f OUTLETS-SWITCHFS - �Z Q, Y Y red Penni j PP scan pe y o 1 nm more Nw BvehepTOPWY,ormySWL STORIES TYPEC STRUCDON O NEW RESIDENTIALE ECTR .FT. yw ❑ L the wrk.and the fpuny,strmyemployedor ofwedfutre,(Sm.compcnsiness 3. and JmhewoIX,Code The imaense Law future, Business a.r end Profassiore CWe:TTe Comaewr:License l.ow rices not apply to an owntt of pmpeny whobuilds orimprovesthereon,and whodoes such work Nmselforthroughhis OCC.GROUP RES.UNITS w onemployms,provided datsuchimprovementse a not]ntanJedoroffered forsale.If, w however,the building.rimprovement is sold within cote year ofe mpletion,theowner. JN1 builder will have the burden of proving thin he did not build or improve for purpose of L' s r.)+ . PLUMBING PERMIT FEE FLOOD ZONE APN C3 1,asowneroftheMNny,amexclusivelycontmaingwithlicemu cmmctomtu QTY - 357-;?.3-(7 construct the project(Sec.7044,Business and Professions Code:)The Cantmcknes License L.nwdraf apply man.wnerofprorwho bu peilds m imp rovesthcrcon,and PED RM 'ISSUANCE whocantracts forsuch projects with amminawds)licensed pursuanpo the Ciffrom ors ALTER-DRAIN&VENT-WATER(EA) License Law. FEE SUMMARY ❑ 1 am exempt under Sec. ,B&P C for this reason BACK FLOW PROTECT,DEVICE I SANITARY YN Owner Date pRAINS-FLOOR.ROOFAREACONDRECEIPT# WORKMAN COMPENSATION DE , , .TION SCHOOL TAX YN_ `— ❑ Iheicbiffirrnthatlhaveecenificate of coveraoul- urcmil'tmfiems of FIXTURES-PER TRAP RECEIPT# Workers Compensation lrmumnce oracenifcd copy rt.((Sa. W,Iab CJ which PARK FEE YN rs all employee's under this permit. GAS-EA.SYSTEM-1 INCA OUTLETS DIVISION IO# PnLby# BUILDING DIVISION FEES Company f GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK ME ❑ CetiferImpykiberebyfumished ElCenifiedcopyis Bledwiththeci;impeeti division. GREASFflNDUSTRL WASTE INTERCEPTOR GRADING PRE CERTIFICATE OF/so FROM WORKERS' GREASETRAP SOILS IEE t� COMPENURANCE (This senior remain be c.mpmit is for one hundred dallvn(fi ) SEWER-SANITARY-STORM EA.2WPf. ENERGY FEE orlexs.) I certify that in the performancofor which this permit all WATER HEATER WNENTAiLp not employ any person in any mo become Ne Wr a PAID C.mpcnseti.n Lews ofCelifomis, a WATER SVSTf?M/IRFATING Data R i N O 7-+ APPlicnnt z Q NGT]CETG APPLICANT:IL er rtwking th' Cerin of_ mption,y ushould NEW RPSID[?NTIAL PLMB. SQ.FT. TOTAL: .�., baome wM1jen m the Worker Compensmion p .abor Cod,you mus 1 fnNtwith comply with suchp visio.....his pe i WQI deemed my ed. BUILDING W A CONSTRU ON LENDI CY SEISMIC FEE r"r CTJfV V Z Lherebyaf5rmthuuhercisac. wetiealconin cyfarth perfmmmaof ELE O the work far which this Permit is issued c.309],Civ. L4 Lender's Name Lenders Address QTY. MECHANICAL PERMIT FEE P N 0 W 1 certify that I have mail tMe app=1ioo state thin the b.ve Info r al.Is .0 CAL FE Ilr torten.Ingres mcnmply with all city erW co umy dinencese Isete laws rtlaingw PERMIT ISSUANCE building construction,and hereby eothuriurepram i oaf acilywenterupanthe CO U 10 TAX V z above-memi.ned property for inspection pmp.scs. v ALTER OR ADD TO MECH. (We)ague to save,indemnify end keep harmless sty of Cupertino against liabdines,judgmeats,coxa andexpenes whichmuy in anyway acetneagamst said City AIR HANDLING UNTT(TO 10,000CFM) crow"ueneeofthegreati afthiI. yXsQ^r K/1- h6 AIR HANDLING UNIT(OVER IO,(IOO CFM7 SigrammeatziA641ccuoirmcm, I IIS IV Data EXHAUST HOOD HVIDUC11 PAID HAZARDOUS MATERIALS DISCLOSURE HEATING"IT(TO 100,000 DIU) Date Receipt# Will the applicantorfuture building.ccupsim more or handle barardoua material HEATING UNIT(OVER 100.000 BTU) as defined by the Catoctin.Municipal Come,Chapter 9.12,and the Health and Safety CWe,Seni.n25532(a)? VENTILATION FAN(SINGLE RESID) P A a ❑Yes ❑No # U IS ANCE DATE u Will theapplicanurfuturcbuildingoccupnnt meaguipmentmdevim which emit BOILER-COMP(JHP OR 100.000 BTU) T ) vNus dr crmaminanls.defined by the Boy Arcu Air Quality Management BOILER-COMP(OVER I 00,000 BTU) y O hum'? r. 11 Yea 131995 i YNo NEW RESIDENTIAL MECH.—SQ.FT. `/ I have rad the limendous materials reqm uireents under Chapter 6.95 of me U`�Cfj California Health&Safety Code,Sections 25505,25533 and 25534.1 understand tha U if the building does not currently have a afford.that it is my usp0nsibilny to county the occupant of the requirement which must be met prim to issuance of a Certificate of Occupancy. Owner m milimpred agent Data TOTAL: ISSUED BY: OFFICE