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26019 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO111JIIAIM:- TRJC, ELECA1. PERMIT NO. 260-1-9� O�� APPLICATION/PERMIT 1'LUMBINC-MECIIANICAL BUILDING DIVISION BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: C SANITARY NO. APPLICATIO///NSUBMTTI'AL DA Y/a� a/UNITN I '''��� LOT4 II OWN' NAME 1 IIONE: CONTRACTOR'S NAME: LIC NO: J Y �S NO Z NIC CONTROL. ARCIII TIiCT/IiNGINIiIiR: LIC ND'. ADDRESS: ❑ CONTACT PHONE: Q'IT. ELECTRIC PERMIT FEE HUILDING PERMIT INFO BLDG ELECT PLUMB MECH PERMIT ISSUANCE ❑ 11 El LICENSED CON'TRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL TOB Dpt(1R n=z l hereby affirm that am liansMunderprovisionsofChapttt9(commencing with V 4100 Section 7000)df Divieon 3 of the Busirr,,md Professions Code.and my license is in PANELS FFp--z W full for"Cand lasserect. h /� 1 FZyI License Class Lic.p UP T0200AMPS w<y Doc Contractor— 201-1000 AMPS F'yz ARCIII T ECT'S DECLARATION ( SQ.FT.MOO AREA $/SQ.FT. O h— OVER 1000 AMPS 0 Z I understand my plans shall be used as public records. <l a !(Y p p.mk� SIGNS ELECTRICAL „kp Bp... �QY�,J Licnhsnl Prolksxional tow, OWNER-BUILDER DECLARATION SPECIAL CIRCUR/MISC. n © T X Oa 1 hereby from the T am exempt from the Contractor's License Law for the ,tl r 1 m3n-rn fullowiugrevsnn.ISectix,7031.5,Business and Prateseions CWe:Any city or county TEMP.METER OR POLE INST. which rquires a permit to construct.ober,improve,demolish,m repair any structure ,WW :; Isidro,its ismmmaUe mquimstheapplicral former permitw st file.signcdmemcrn POWER DEVICES DA E WCQp that he is l icansed pursuant to the provisions of the Gmu-utor's License Law(Chapter as C V(commenc with Section 7000 f Division 3 ofthe Business and Professions Code SWIMMING POOL ELECTRIC 04 mg wi )u ) VALUA�](l' �^'y ceche h7031.5 exempt therefrom and the buisfor the ce,al leged r,fia exemption,Any violation of C{/ rya Section 7031.5 by any opplicvm fnrapermit subjects Ncalplicum toaaivil pcnahy of OUTLETS SWITCHES-FIXTURES eQ ,ter i2p not ere than five hundred dollam(5500). NEW RES IDENTTALELECTR _SQ.FT. net I,asowneroHM1eproperty,ormy<mpinytawith wagesavheirsolecompenxation, STORIES TYPE CONSTRUCTION ,u 22 willdr work,and the structure is not imandedoraffered forsnle(Sec.7lMq Business and Pro essions Cade:The Contractor's License Taw does not apply to an owner of Irdpeny who builJs onmproves thereon,and who ores such work himulf onlwtgh his own employees.Provided the such improvcmcrosam notimenchdor altered barter.If, OCC GROUP RES.UNI'IS however,the buildingor improvement is sold within one ye rrofet mpletion,the owner- builder will have the burden ofproving that he did not build or improve forT A . puryd of six ale.). ❑ liaise ownerof the lmleny.amexclusively contracting with licensed convectors to QTY. PLUMBING PERMIT FEE FWOU GONE APN construct the project(Sec,LVW,Business and Professions Code:)The Convectors PERMIT ISSUANCE. I.iccnwLawdoes not apply to an owncref,sopery whobuildsorimproveathercon,and wh.w..lowsf..such projects with a convuemr(s)licensed lur,aamudba Coolant.,x ALTER EA License law. ( ) FEE SUMMARY ❑ 1 am exempt under Sec. ,B k P C for this reason 1BTSIDP PFF,S ACK PLOW pRO'I'F.CT.DEVICE Y N Owner Dee RECEIPT p DRAINS-FlOOR.ROOF,AREA,COND. WORKMAN COMPENSATION DECLARATION SCHOOL TAX YN ❑ Ihcreby Wfnnthelbavencr,titratenale..nlmsel6inaur,draabC.),wiof RBCBIYI'4 WorkeFIXTURES�PER TRAP covers a'Cmployee ionlerthis eoracenifed<opY thcrtvf(Sec.3800.Lab C.)which PARK FEE Y N covers all lmpluyMsunder this Thcrmit. GAS-EA.SYSTEM.?INC.4 OUTLETS RDIVISION Policy X BUILDING DIVISION IDES Company GAS-FA.SYSTEM-OVER 4(EA) PLANCHECK FEE ❑ Certified copy is herby famished. ❑ Cenif W copy is feted with the city inspection Jivisinn. GREASIVINDUSTRL WAS9'E INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS GREASE TRAP SOILS PEE COMPENSATION INSURANCE (T his section need not he completed Hire permit is for one hundred dollars(SIM) SEWER-SANITARY-STORM EA.200FI ENERGY FEF, or less.) I certify that in the perfonnanceofthe work for which this permit is issued.Ishel WATER HEATER WNEN`fHLECTR not employ any person in any manner so as to become subject to the Workers PAID p Comensationlawsof California. DateWATER SYSTEWMEATING Date Reecipt4 0 z Applicant z 0 NOTICE TO APPLICAN'1':If,after making this Certificate or Exemption.you should NEW RESIDENTIAL TIME, SQ.IT. TOTAL: F (q become subject o she Worker's Compensation provision of the labor Code,you must a ; forthwith comply with such provisions mthis permit shall Mdeemed residual. BUILDING FEE r) CONSTRUCTION LENDING AGENCY SEISMIC FEE Is 1 hereby affect,that is a constitution lending agency for the pecf arrence of TOTAL: IiLI!CTRIC FEF U O the work for which his pc.it is Issued(Sec 9097,Civ.G) C� I<ndds Name OF Landei s Address QTY, MECHANICAL PERMIT FEC PLUMBING FEE U I certify Bar 1 have rad this ulflication and ,are that the above information is correct. l agree to comply with all city and county ordinances and state lows relating to PERMIT ISSUANCE MECHANICAL.FEE I-' buildinklemswaion,and hcmbya dram.reprscruidsaxediisaity to en¢rupen the CONSTRUCTION TAX U z above-mentioned peapeny for inspection purposes. ALTER OR ADD TO MECII. (We)agree to save,indemnity and keep h:umlcea the City of Cupertino against Iiabilities.judgmenu.costs and expenses which may in any w.;Y ccoeaLinslsad City AIR HANDLING UNIT(TO 10.000 CIM) in conuquence of the graming of this permit. //-Jj' �e_ms— AIR HANDLING UNIT(OVER Myth)CFM) ,Sigratureof Applicant/C ntmir � lam EXHAUST HOOD(W/DUC l C PAID HAZARDOUS MATERIALS DISCLOSURE r HEATING UNIT(TO 100.000 BTU) Data Receipt Will he...heard or future building occupant atomm handle hazardous meenal as defined by the Cupcnino Municipal Coda.Chapter 9.12,and the health and SaNty HEATING UNIT(OVER 100.100 BTU) Code.Section 25532(a)? VENTILATION FAN(SINGLE RESID) 13 Yes O No ISSUANCE E Willthea licancarr future building coca BOILER-COMP(3HP OR IW.tK1UBN) Pp Wmuucquipmem mdevices which emit haaard.us air commninuns as defined by the Bay Area Air Quality Management BOILER-COMP(OVER IIq,M BTU) PAID Distncl ❑Yes ❑No NEW RESIDENTIAL MECH. SQ.PT. I have mad the lana..tori materials requiremerns under Chapter 6.95 of the JAS! 18 1994 California Health&Safety Code,Sections 25505,25533 and 25534.l understand Nat if the building docs not curendy have a board.that it is my mepnnsibilny to notify thmm e ,rcupunt of the requirements which toast be ren prior Id issw ace of n Croofio[ rOecapanry. CfI/Y\�JU�.tuurrtc Owner.,tathori'eed agent Date TOTAL: ISSUED BY. OFFrCr