24937 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
BUILDING.ELRC'I RICAL PERMIT NO.
CITY OF CUP ERTINO APPLICATION/PERMIT PLUMBING-.MECHAN'ICAL 24937
BUILDING DIVISION M BUILDING PROJECT IDEIFICATION
BUILDING ADDRESS: //�� SANITARY NO. APPLICATION SUBMITTAL DATE
U 0 UNITN 1.01,
OWNERS NAME: PHONE I '1 CONTRACTORS NAME: LIC NO:
cis'' S R 57 I(S$01.� l51 �GZ S77 "rc CON-11101.4a
CHITECT/F,N (NEER: LIC NO: ADDRES ^, N ,1� El CONTACT: PHONE. QTY. ELECTRIC PERMIT' V FEE BUILDING PERMIT INFO
B ELELT PLUMB MliCll
PERMIT ISSUANCE ❑ ❑
LICENSED CONTRACTORS MCIARATION APPLIANCES-BESIDES'1'[A]. JOB DESCRII'I'ION
OKZ 1 humhyaflimuhw Jun licemedtioder provision,ofChnpmr9(unnmcneingwilh ^ q
�tJ00 Sedinn]IXNBnI'Uivision Jul thcBusindsuvd Prnfexxinnx Cudc,anti my license isin PANELS If/- 'C S�1d�+ . /t, R-x ,l A'^/�
ceU� full forecandefle 1. C_ / % i4__ i/1 UNI C'a'
Liteeme C' Lic.N S] 77 UPTO 200 AMPS
I,Q a. Dae- Contractor 201-I"AMPS
ZONZ ARCHITECTS DECLARATION OVER 1000 AMPS
SR IT.FLOOR AREA SJSV.IT.
O Z-O 1 understand my plans shall be used as public records. t
m m
SIGNSELECTRICAL -W
Q Y f J Licensed Professional
K
edQ OWNER-BUILDER DECLARATION SPECIAL CIRCU117MISC.
KOatJ 1 hereby ifGrtn that 1 am exempt butane Contractors Liceme law,for the
W 31'-vFi following rtmmn.(Section]OILS,Business and ProfnsionsCWe:Any c"'c'eoumy TEMP.METER OR POLE INST.
F 0< which requiresrostructurea permit to consumer.alter, demolish.or repair any structure
KWQ7 prior to its issuance.also requires the applicant for such lcmriuo life a signed statement POWER DEVICES
,CSO that he is licensed pummrt m the Provisions of the Contmcmes License Law(Chapter
p'K M PTI 9(commencing with S,,Ii.a 70DB fDivision 3uf Ne Bmineas and Profteoionn Code) SWIMMING POOL ELECTRIC V UATI�
WMro ar that he in exempt therefrom and the basis for Nc alleged exemption.Any viulwionof n
FZ¢ Sectimi703156yunyepchiant fora pmoul.uhjco,the applicant to u rMl penalty of OUTLEI'g-SWI'fCIII. -FIXTURES ' //{ ax�
Omlhnn live hundisddollun(S5W), v
C o n❑ Ltisownerof Neprnperty.nrmywtployeexwi0t wugeemnc�irsulemmpca.aduo, NEW RESIDENT Al. SV.FT. STORIES TYPE CONSTRUCHON
y, 22 will do the work,and the structure is not intended ornffemd forsalc(Sec.744.Business
anti Pnrlesoons Cotle:The Contractor's License Law dues not apply to an owner of
property who buildaorimprovesthe¢on,and whod,easuch work himself.,through his
own employed,provided that such improvements are not intended coffered forsale.If, — I' ! /- p t RES.UNITS
however.erwill have
the burden of,mentlshat one build or impose for Ihdses,of \; TOI,A _ - u
\V�
builder will have the burden of proving that he did not build or improve for putµrx of g a l
role.). T m V 'I
❑ I,er he prjeNepmperty.amastiasis and oifeitiions with Eac contractors to QTY. PLUh1BING PERMIT OU%ONE APN
unstruct the project(Sec.ly oano Bunions arta pwhob builds
CWeO Toe Comranoh
Licatatrawdod nouppjects with
the Norton,and PERMIT ISSUANCE
who
ense1contracts.for such projenawiNaconrnetor(s)Iianxd pursuummthe Con4acmh ALTER FEE SUMMARY
License law. IFA)
❑ 1 am exempt under Sec. ,B&P C for this mason BACK MOW PROTECT'.DEVICE OUTSIDE FEES
SANITARY Y N
Owner Doc
WORKMAN COMPENSATION DECLARA"PION DRAINS-FLOOR,ROOK,AREA,COND. RECEIPTNSCHOOL TAX Y N
I hereby tiff nn Nut i have a ecmfiede c f ceraenno self-inxum,or a cenifcute,f RECEIPT N
n ,'C..... talion lnsurvnaeor ecmrificd ropy Nurof(Sec.JXOU,huh C)which FT%TURES-PER TRAP PARKpEE Y N
exult ayplyy,:cIz5piillppyy{, `_ RECEIPT
folic N—W C 1 VVLV GAS-IiA.SYS'11iM.I INC4OUFLET5
Y BUILDING DIVISION PIiGS
Cnmpen Gqq GAS-EA.SYSTEM-OVER 4(EA) PIANCHI!CK FEE
❑ Cemfcl ropy is filed
the W.
❑ Ccnifed copy is filed wish the city inspection division. ORF- SE/INDUSTRL WASTE INTERCEPTOR GRADING ITE
CERT IFICATE OF EXEMPTION FROM WORKERS' GREASE.TRAP SOILS Jet
COMPENSATION INSURANCE
(This section need not be completed ifthe permit is for one hundred dollars(SIM) SEWER-SANITARY-STORM EA,200FT. T:NIiRGY FEE
Icss.)
I certify that in the performance of the work for which this permit is issued.)shall WATER HEATER W/VENT/ELECIR
nor employ any person in any m n m become subject as the Workers' PAID
Compensaion Lawsof California. Date su WATER SYSTENITRFATING Dote- R_4ptN
Applicant
O NOTICE TO APPLICANT:If,after makingthis Certifcae,f Exemption.youdimAd NEW RESIDENTIAL PLMH. SQ.FT, TOTAL:
F (q becomesubjeel to the Workers Compensation provisiomofm
the Labor Code,you ust
C4 forthwith comply with inch provisions or this permit shall be deemed revoked. BUILDING F "In
L.. Q CONSTRUCTION LENDING AGENCY slilswi
Uz I hcmhyaflirm that Nnrciso,ors1m flonlerdingagcncy fin thep,foracnce of
Q the work lin which Nis permit is lsx.cd(Sec.3097,Civ.C) 10 FAL: E :C IC ANL
I<nder'n Name
OF Lenders Addicts QTY. MECHANICAL PERMIT FEE PLUMBING FHE
W I cer ily that I have need m
orthis application and state that the above information is MECHANICAL FEL correct.l.'asst,cmi with all city and county ordinances and state laws rclaing to PERMIT ISSUANCE
h" buildingcon.siruciion,and hembyauthonwmpmsentarlvesofibisciiyiocmeruponthe CONSTRUCTION TA
V Z above-mentioned pmpeny for inspeetiun purposes. ALTER OR ADD TO MECH.
Appliewm/Commelo,
ee m,save,indemnify and keep h.i,,s the City of Cupertino against
ment,,cosHand dpenms which may in any wayaceme against said City AIR HANDLING UNIT(TO IotIOO CFM)
attract,in of the S.ming of this permit.
/ AIR HANDLING UNIT(OVER 10.0010 CFM)
Dam EXHAUST HOOD(W/DUCry PAID
HAZARDOUS MATER S DISCLOSURE HEATING UNIT(TO 100.010 BTU) Dac Reccip:Y
Will the applicant or future building nccupam stem or handle haramous material HEATING UNI'1'(OVER IINI,(q(1 H'1'U7 IOTA '
as relined by the Capertino Municipal Cod,Chapter 9.12,and the Health and Safety
Cu.lc,Section 25532(u)?�
❑Ycv Nn VENTILATION PAN(SINGLI?RE51D) as
Willtbc upomarimm,;is de rsed by the Bay Are.Air Quality Mw..eate,
BOILER-COMP dHP OR 10 0.001)BTU) ISSUANCE DA
anbms air cnnmminuntt;is ddined by the Bay Arco Air Quality Mumgemrnt
lct'l BOILER-COMP(OVER IlX%M0 H'1'U)
v
�
11 Yea NEW RESIDENT AL MECH. SQ.FT.
PA 1 D
1 have mad the haru,u
ds material,mquimmenu under flamer 6.95 of the
California Health&Safety Code,Sections 25505,25533 and!25534. I understand Nn
Blue building does not currently have a noan,Nat it is my responsibility tnnmify the APR u 1
Occupancy.of N<myuiamems which must ed met prim m issuance of a Cenifcate of i
cy. ..
I
Owncror a.thomed agent Date TOTAL: ISSUED
OFFICE