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24746 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CPCYEADDRESS ERTINO IsII.DI\.-ELLCTRICAI. PERMITNO. APPLICATION/PERMIT PLUMBING.-MECHANICAL. A A BUISION BUILDING PRf1JEC1'IUE\fIFILATHS 4 LF BUILDING A SANITARY NO. APPLICATION SUBMITTAL DATE Idw CsTi4T0s /-r UNIT# LOT# 2-r-Yj OW SNA Fi: PHONE: CONI ACTOR'S NAME LIC NO: Q/ .2-4 N/C CONTROL,p ��733 wJ rJakre+ L cc s u ' VR HITECDENGINEER: LIC NO: ADDRESSEl: 6cIS 5Rril o.4rc Awe- YKob CON'T'ACT: PHONE: BUILDING PERMIT INFO - QTY. ELECTRIC PERMIT FEE BLDG ELECT PLUMB McE-C�H PERMIT ISSUANCE ❑ ❑ T LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL LOB DESCRIPTION pyz Ihercbyaffinn thmlam licensed underprovisionsof Chapmr9(commenekngwah [+CL[) Section AKl(B of Division 3 of the Bminess and Prul'v,mrs Codc.an^y license is in PpNLs1.S TUU TUR mrceund of r. �i f U 5is y6y DataLican Cygif ss _ J G CoLucnt#ractar-(CII J H NTheai/1 2BIUP�T200 AMPS I000 AMPS rY2�k,elC� Z O'z A WITECTS DECLARATION OVER I000 AMPS Q F R $/SQ.FT, O Z o,O I understand my plans droll be used as public records. G--a F j SIGNS ELF,CfItICAI. k� Licensed l'rofcssinnal E �y.1✓=Q OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. W1 hereby affirm that I am exempt from the Cosions o License law for the '1 Lta•m following reason.(Serino 7031.5,Business and Professions Code:Any city or county "1'EMI'.METER OR POLE INST. F u-0< which marinas a permil to recollect.alter.improve.demolish,or repair any structure 7E E°'}5 prinnoitaissuance,also rebrires the applicant for such permit to fileusignedmatemew POWER DEVICES ty�j C 0O that he is licensed pursuant to the provisions of the Contractors License Low(Chapter as 9 with Section 7")ofDivision]of be Business and Professions Can,) SWIMMING POOL ELECTRIC (commencing xi Y V ) ON W_m othmM17031.5byanyrecruit rcfromorforthe basis ermitsrtheal legal exemptttoaciAny 1parraionof OUTLETS-SWITCHES-FIXTURES .� `0,L E Z a Section]Ol l.5 by any applicant dor n permit subjects the applicant a civil permhy of nm mme than five hundred dollars($500). C � ❑ LaxnwnernDhepn' n y p y g pensalion, ER�ID�TIALELEM 5 .FT. pc y,orm em to ceswith wa es avheirselecom Q STORIES TYPECONSTRUCION i3— will do the work,andme structure is net inecndelwOffered forsake(See 70ta,Business stud Prefcsiom Code:The Comercu''n License Law does net apply 1a on ewnef of property who builds or improves thereon and wh rdocs such work himself m through his own employees,provided that suchimprovemcnts are not intendederoffrrcd forsale.If, OCC.GROUT' RES.UNITS however,the barldingor improvement is sold within one yewofcompletion.the owner- TOTAL builder will have the Nuclear of proving that he did not build or improve for purpose of sale.). ❑ 1,uownerofthepmperty,umexclusivclyeanuactingwithlicenscdconnacionto QTY. UMBINGPERMIT FEE OCODZONE APN nonsinuct the project(See.]M4,Business and Professions Code:)The Commemax License Luwdocs not apply to anownerofpfopeny who builds or improves therroa.and PERMIT ISSUANCE whecootractsfor such projects with acontmemr(s)licensed pursuant to the Contractors Lknove Law. ALTER (EA)) FEESUMMARY ❑ I am acmpt underStt. ,B&P C for this mason BACK FLOW PROTECT.DEVICE OUTSIDP FEES SANITARY Y N ,owner Date RECEIPT'# \ WORK MAN COMPENSATION DECLARATION DRAINS-FLOOR,ROOF,AREA.COND, —SCHOOL FAX Y N ❑ I hereby affirm that l have a ecnilicote of consenuo self-insare,oracertifscateof FIXTURES-PER TRAP RECEIPT# Wiukers'Comw petion Insurance oramnificd ropy thereof(Stt.J81X1.Lab CJ which PARK FEE YN 4I7.4 -fivers all cmplyy 's�p<Iwyt':�gme1 �{, / GAS-EA.SYSTEM.1 INC.4 OUTLETS RECEIPT p ti,1 Policy# /� L /r0 J O Z ( BUILDING DIVISION FEES D Ccrany - ed' ✓—� - GAS-EA.SYSTEM OVER 4(EA) PLANCHECK FEE ❑ Certified copy is bcrdbyth the city Certified copy is flet with the city inspection division. GREASFANDU$TRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS ME COMPENSATION INSURANCE ('ITtisxectiun need net he complete)if the permit is[or one hundred dollars($100) m less) SEWER-SANITARY-STORM EA.200 p. ENERGY FEE I certffy that in the performance oflha work for which thix permit is issued,Ishall WATER HEATER W/VENT/ELECFR not employ any person in any manna(so 10 become subject to the WorkersPAID Z Compensation laws off 'fo �y(1,� WATER SYSTENUTREATING Date Recciptp Q Applicant z O NOTICE TO APPLICANT:If.after making this Certificate of Esemplion,you should NEW RESIDENTIAL PLMR. SQ.FT. TOTAL Hbecome subject to the Wader's Comper,inow provisionsof the Labor Cede.you ace, > forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE CONSTRUCTION LENDING AGENCY SEISMIC FEE z 1 hereby affirm that there is a construction lending agency for the performance of L) Q the work for which this permit is Issued(Sec.309].Civ.C.) TOTAL: ELECTRIC FEE Lender's Name / O F Lerdcrs Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE I certify that 1 have read this applicatilamon and sthat IM1c above information is MECHANICAL FTE O F 9L. correct.l agree to comply with all city and county ordinances and state laws mlaling to PERMIT ISSUANCE 0 building construction,and hereby oullorimreprcscnmtives ofthiscity tnentcruponthe J U Z above-mentioned property for inspection proposal. ALTER OR ADD TO MECH. CONSTRUCTIONTAX (We)agree to save,indemnify and keep harmless In City of Cupertino against - Iiabilities,judgments.costs and expenses which may in any way accrue against aid City AIR HANDLING UNIT(TO 10.000 CFM) in canuquence of the granting of this permit. AIR HANDLING UNIT(OVER 10."CFM) Signature.(Appiie.w/Contmctor D:nc EXHAUST HOOD(W/DUCT, PAID HAZARDOUS MATERIALS DISCLOSURE t HEATING UNIT(TO IM.W BTU) , Date Receipt# Will the applicant or Of...baJaingoccupant uI aer handle haaacdeusmammal as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 100,0100 BTLA TOTAI.:A p Code.Section 25532(a)7 El Yet 1:1 No VENTILATION FAN(SINGLE RESTD) BOILER-COMP(3HP OR 100bb0 B UU ISSUANCE DATE Will menpphe:mrnr ratarenaileing eepapam trsee9aipmentnmemeeawnieh emh � ) L w u 6azarJeud air corwarinanp u def by be Bay Area.Air Quality Management BOILER-COMP(OVER 100.004)BTU)) .'DillrieRd FEB , 41993 h1 „mss', NEW RESIDENTIAL MECH. SQ.FT. a\ 1 have read the I'loodnus material,receircments under Chapter 6.95 of the Califomia Health&Safety Code,Sections 25505.25533 and 25534.1 understood that CI�Y VI v, LLltt uvy if be building does nor recently have a tenant,that it is my reaptmsibility m notify the veupant of the rcyuircmems which must be met prim or oweance of u C,mEvom of Occupmmy. 000 Owner or uuNenud ii'm Data TOTAL: 6- (7Q ISSUEUB 7tL.(/CIC. OFFICE