27288 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING RI AL PERMITNO.
APPLICATION/PERMIT PLUMBING-MECHANICAL. A n O O
BUILDING DIVISION BUILDING PROJECT IDBNI'IFICAI']ON L Loo
BUILDING ADDRESS:I � �\ SANITARY NO. APPLICAF[OONNSUBMITI'ALDATI OC / ` —w—w?O W U Tp LOT
E: C RACTOR'S NAME: LIC NO: • .J —`
\` gVRL' N/C CONTROL#
•ARCHITECT/ENGINEER: LIC NO: %REBS: t ElT,
CONTACT: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
ELECT' PLUMB MECH
PERMIT ISSUANCE
LICENSED thCONTRACrOR'SDECLARATION APPLIANCES-RESIDENTIAL DESCRIPTION
OC7 (hereby affirm Nm I amlicensed under provisionsof @wade. (commencing with
W 00F� Secfull fore and of effect. on J of the Business and Professions Cede,and my license is in PANELS< cd roll tome it effect.
IQ,ZW Licena�,Cls Cie DPT0202 AMPS
so% Uute`� 4 ondactor 201 m 1"AMPS 4S
71- ? ARCHITECTS DECLARATION OVER 1000 AMPS SQ.FT.FLUOR AREA $/SQ.IT.
0,p 1 understand my plans shall be used az public records.
w , SIGNS ELECTRICAL
Lilword Poicssional
C�Wu OWNER-BUILDER DECLARATION SPECIAL CIRCUUOMISC.
I hereby affiem that I am exempt from the Contractor's License Law for the
u134y following reusna(Scctian703 1,5,Business and professions Code:Any airy or counryTEMP.METER OR POLE INST.
F"a Jwhich mpermit to a permto construct,alter,improve,demolish,or repair any structure
Hca prior o its issuance,also requires the applicant for such permit to File a signed statement POWER DEVICES
IyCOp that lie is licensed pursuanno the provisions of the Contmctora License Law(Chapter
e
'Sca 9(commencing with Section 7")of Division 3 of the Business and Professions Cade) SWIMMING POOL ELECTRIC VALUATION
_y or that he is exempt and the basisfor the alleged exemption.Any violation of
W RESIDENTIAL ELECfII
F_7_>' Section
not more 7031,5 an five hundred dollars($500).
by any applicant for a Permit.subjects thpenalty
e applicant to a civil of OUTLETS-SWH CLIPS-FIXTURES
th
��G
C ❑ Lasowncmfthe propcny,ormycmployees wiNwagesasthcirsolecompenaation, NEW SQ.FT. STORIES TYPE;CONST RUCTION
will do the work.wal be uncom is vmimemed moffened for sme(Sec.70,14.Business
and Professions Code:The Comraeor s License law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided than such improvements we not inamiledoroffered formic.If,
OCC GROUP RES.UNITS
however,Ne builtlingor improvement is sold within one yearofcompletion,the owner-
builder will have the burden m 'n that he did not build or int TOTAL:
prong prove for Ouryox of
❑ 1,azowuerofihepropeny,ameaclusivelyconimciing with licensedconamerrsrn QTY. PLUMBING PERMIT FEE PLOOD_ZONE APN
construct the project(Sec.7016,Business and Professions Code:)The Commiserates
License Law does not apply to an ownerofpropeny who builds or improves Nereun.and PERMIT ISSUANCE
whocomracts for such projects with acontmemr(s)licensed pursuant to the Contractors ALTER-DRAIN&VENT-W
License Law. (EA) IEE SUMMARY
❑ 1 um exempt under Sec ,e&P C for this reason BACK FLOW PRO EVICF, OUTSIDE FEES
SANITARY YN_
Owner Dam PRA OOR,ROOF.AREA,C RECEIPT
ND. #
WORKMAN COMPENSATIONUECLARATION SCHOOLTAX Y N
❑ Ihertby affirm that lhav<acenificam ofconsent o self-bosom,ora certificate of FIXTURES-PER TRAP RECEIPT#
WnRers'Compensaion lnsurancc orocenifiedcopy NertnflSec.38M.Lab CJwhich PARK HE Y N
casters all employee's todemhis permit, GAS-EA YS I S RECEIPT#
olicy# BUILDING DIVISION FEES
Company2Cert GAS- . -OVER 4(E PLANCHECK FEE
❑ Certified copy is filedwf dnecid. /
❑ Certified ropy is filed with the city inspection division. GREASE/1 D 9STRL JASICOF14CHPOR
GRADING HE
CERTIFlCATE OP EXEMPTION FROM WORKERS' Rt�- TFR
SOILS FEF.
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollar($100) SE -STORM .200FT. ENERGY FEE
or less.)
I renifdau bathe scrtomanceofthe work for which this permit is issued,Ishii][ WANG LECI'Rnot employ any persn in any manner so sa m become subject ro Ne Workrs PAID
z CompensationlawsnfC.alifrmis. Date WARATING Date Kenn,#
Applicmt
z 0 NOTICETOAPPLICAN'f:If,after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMIL SQ.FT TOTAL:
become mbjec,farm Workers Compensation provisions of the Labor Code,you must
7 forthwith comply with such provisions or this permit shall fie deemed revoke, SELH�RIC
E
p,a Q CONSTRUCTION LENDING AGENCY
z 1 hereby affirm that there is a construction lending agency for rhe performance of
U O the work for which th is permit is issued(Sec.3097,Civ.C.) TOTAL: B
lscrull Name
O0 ULower's Address QTY. MECHANICAL PERMIT FEE EEI certify that I have read this application and state that the above information isrormct.lugreemcomply with all city and counry ordinances and state laws relutingto PERMIT ISSUANCE. FEE
... (n building construction,and hereby awasriu representatives of thisciry,to wacrupen the
U Z above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. CONSTRUCTION TA%
IWO agree m e damnify and keep harmless the City of Cupertino against
lmaires,jud is,costsa d expenses which may in my way accmeagainst said City AIR HANDLING UNIT ITO 10,000CFM)
veque cofrhegmai gtifth, emit.
AERHANDLING UNIT(OVER W.000CFM)
Sigjw4u0`A,qRas.VCmyDate EXHAUST HOOD(W/DUCq
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT TO 100,IXq BTU) Date Receiptb
Will the flan applicant or future building occupant some,or handle hanumdraus
and
az defined by the Cupeninn Municipal Code,Chapter 9.12,and he Health and Safdy I HEATING UNIT(OVER 102,1100 BTU)
Cure,Section 2553$0)7
ID Yes 0 N VENTILATION FAN(SINGLE RFSID)
DOILER-COMP(JHP OR 100,020 BTU "ISSUANCE DATE
Will theapmountains s building by Brent use Area
Alun�n=d�w
Management )
husmdovs air comuminwts as Jcfuhcd by We Bny Arca Airunagemcnt BOILER-COMP(OVER 100,000 BTU)
Dis;ri[f! NOV 151994
❑Yea ❑No NEW RESIDEMI'IAL MECH.—SQ.IT. (�y
1 have mad rhe limandous materials requirements under .95 of the C11Y UI- (al,/Y
Calirnrnia l lealth&Szlbly Code,Section 25505,25533 and 25rsmnd Nat QI'1I11vu
if tM1e hoisting Aces nal currency have atenant,that it is my respnotify Nerecupant of the requirements which must he mer prior to issuaifiewe ofOccupancy.Owner m authonud agent ate TOTAL: ISSUED BY:
OFFICE
ADDITIONAL PERMIT FEES
BUILDING PROJECT I DENTIUCATION VALUATION
BDIIO�NG
bj
AOD.Ess -5OT e1 '^�jT
OANEFS �J T/V/� {(Y'n/(f
FEE SUMMARY
CONiFa iOPS E
BUILDING
AMl' � PLAN CHECK
ronre Acroes vf � A FEE
ADDREu
93 4r— s P"Dn SEISMIC FEE
CITY. ELECTRIC PERMIT FEE
UTLETS-SWITCHES-RECEP ELECTRIC
IGHTING FIXTURES
PPLIANCES-RESIDENTIAL PLUMBING
PANELS MECHANICAL
SIGNS
SIGNS TRANS. TOTAL
SPECIAL CIRCUIT
EMP.METER OR POLE INS. PERMIT VALIDATION
MOTORS SEE FEE SCH,
O SERVICE CHANGE
Z Z
F 0 T
Lu > OTY. PLUMBING PERMIT EE ISSUANCE DATE
W BLDG. LEL - PLG. ME H.
Z) 2 ALTERDRAIN&VENT-WATER IEA.) ❑ ❑ ❑
V O BACKFLOW PROTECT.DEVICE
LL I
O IU DRAINS-FLOOR,ROOF,AREACOND.
} N GASFIXE .S SYSPERTEM.
TRAP
� Z GAS-EA.SVSTEM.I INC.40UTLETS
U GAS-EA.SYSTEM-OVER4(EA.) `
INDUSTRIAL WASTE INTER.
LAWN SPRINKLERS-1 INC 5 V.B. �\
LAWN SPRINKLERS-OVER 51EA.1
SEWER-SANITARY.STORM EA.20011/
WATER HEATER W/VENT
WATER SYSTEM
WATER TREATING EQUIP,
CITY. MECHANICAL PERMIT FEE —/'J T✓�J{`/�J,.
ALTER OR ADD TO MECH.
APPLIANCE
AIR HANDLING UNIT(TO 10DOOCF.M.)
AIR HANDLING UNIT(OVER 10MC.F.M.)
EXHAUST HOOD(WITH DUCT)
HEATING UNIT ITO 100,000 B.T.U.)
HEATING UNIT(OVER 100,000 B.T.U.)
VENTILATION FAN(SING LEI
BOILER-COMP(3 H.P.or 100,000 B.T.U.) I
BOILER COMP(D—,100,000 OTU)SE E FEE SCH.
TOTAL