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26451 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY -E - PERMIT NO. 26451� ��� CiIl [ F CUPERTINO APPLICATION/PERMIT PLUIL"INc-MECHAMCAI. INC.DIVISION BUILDING PROJECT IDENTIF'ICAI'SON BDDRESS: � / ��{$��.� SANDARYNO. APPLICATION SUBMITTAL DATI 3 3 A/ NIT# LOT at OME: PF{fal .� a O ACfO@'g AME:s I 1 � (�D T$' 1( 'N` N/C CONTROL=# AS GINEER: LIC NO: AD R (�,�.�He�(y1��[,� 113_T 13 t4tDo d Dr Rrole 94 AVTTAACL Pro �f QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO �G� `l—"�G P PERMIT ISSUANCE ' B� ELECT PLUMB MECH LICENSED CONTRACTOR'S D[ A ATION APPLIANCES-RESIDENTIAL GCZ I hereby affirm that l am licensed underpRvisionsof Chapmr9(commencing with JOB DESCRIPTION �s1,00 Serious 700(b.1'Division 3 ofth,Business and Professions Code,and my late.is in PANELS W'u B Band effect. <,— UP IIP TO 200AMPS _ en,G'y ate Cunlraelor�a[ 201-IMAMPS ZOyz ARCI{ITECTSDECLARA OVER 1000 AMPS SQ.FT.FLOOR AREA $/SQ.Er. O Z t O 1 unJeraanJ my plans shell be used as public records. F, F•m SIGNS ELECTRIC Q Y j Licensed Profexiond ory.CQ OWNERBUILDERDECLARATION SPECIAL CIRCUIT KOaU I hereby affirm that 1 am exempt from the Conlrecmrs Licenu Law for the m3 ay following rea,son.(Section 7031.5.Business and Professions Code:Any cirymcounty TEMP.MEfER INST. h'.LLJ� which rcyuircv a permit to cmwwcl,altar,improver,demolixh,or repmr any swcturo Kn<� prionn its issuance,alsoreyuires the applicant mrsuch pmanitte,file a signed moment POWER DEV W K Q O that he is licensed pursuant o the Provisions of the Contractor's License Law(Chapter dXe� 9(commencing with Sio,mn7000)of Division 3 ofthe Business wal Pmfessious Cade) SWIMMING POOL ELECTRIC VALUATION Ip_w or that he is exempt therefrom and thth e basis far e alleged exemption.Any violation of lFZQ Section 0031.5 by arty applicant for a permit subjects the applicant to.civil penalty of EIS-SWITCHES-FIXTURES � C notmmemanfivebandreddnEars(S50(0). W m ❑ l.asowneroflhe t NEW RESIDENTIAL ELECTR —SQ.FT. proper y,nrmyemployeeswitbwagesaslhdram.compensation, STORIES TYPB CONSTRUCTION a _ will do-the wons Coale:and heContisnotintendese La c doesed not apply.?044,Business and Professions Cade:The Contractor's License Lew does not epPly to an owner of p nywhobuildsorimpmvesthereon,aodwhodoessuch work himslfor0vough his own employees,Provided that such imprevementsmenotimendedoroffered forsde.If, OCC GROUP RES.UNITS however,the building orimpmvemem is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve for purpose of 'tilt.). ❑ I,eowneroflhepwpeny,amexclusivelycontractingwimticensedcontracwnw QTY. PLUMBING PERMIT FEE FLOODZONE APN o iamt the project(Sec.7044,Business and Pwfesimis Code:)The Conuacwrs Licenu Lawdoesnolapplyl-an-wowifloperrywhobuildsmrimpwva Hereon,end PERMIT ISSUANCE whecantmets forwch projects with aconm earrO)licensed pursuant to For Cemen tori License Law. ALTER-DRAIN&VENT-WATER(EA) PEE SUMMARY ❑ 1 am exempt under Sec. ,B&PC for this reason BACK FLOW PROTECT.DEVICE OUTSIDE FEES SANITARY Y N_ Owner Dao DRAINS-FLOOR,ROOF.AREA,COND. RECEIPIYI AAM I WORKMAN COMPENSATION DECLARATION RATION SCHOOLTAX Y N ❑ Thereby affirm thallhavicecenifi<am ofconum to self-insure,ore«nificam of Workcrs'Compensution lnsumnce nracertifirA co thermf(Sec. FIXTURES-PER TRAP / RECEIPTp PY PARK FEF, N ars ell em playee'sandenldx c GAS-EA.SYSTEM-1 INC.4 OUTLETS eC k PolicyM L I I ION FEES Company GAS-EA.SYSTEM-OVER 4(EA) PLANCI ❑ Certified copy ish rtby famished. w ❑ Cenifiedcopy is 1'i with the ciry impel ndivisi n. GREASE/INDUSTRL WASTE INTERCEPTOR GRADIN CERTIR An r ORKERSGREASETRAP OM 1 N SOILS FEC (Thissectionneedn lace di the,manitisforonehund dYYrtx($Iugh SEWER-SANITARY-STORM EA.200FT. or lesl ENERGY FEE s /� I certify that in me pe . o e xR��or whty/ ni Ord,I shell WATER HEATER WIVENT/F.LECTR not employ any person in m y m t "A1 tat to the Workers' PAID 176Compensation laws of Cdifo la, ate WATER SYSTEM/IREATING 7-. Date Serve r 0 Applicant 'Z 0 NOTICE TO APPLICANT:If,aftXQa1d.,this Cenificate NEW RESIDENTIAL PLMB. SQ,FT. TOTAL: ^� Ge, become subject to the Workers Com a bat Cade,youmust forthwith comply with such previsions or this permit shall be doemed revoked. BUILDING FEE ►� per, Q CONSTRUCTION LENDING AGENCY SEISMIC FEE z work far which that them is aswdl(Sec.3lending agency for the performance of (, O the work far whicM1 this pertnit is issued($a.3(19],Civ.CJ L: 0,`— ELECTRIC PEE Lenders Name 0 U tenders Address QTY. MECHANICAL PERMIT FEE PLUMBING FEE Gn I certify that I have read this application and state that the above information is correct. I agree to comply with all city sand county ordinance and slate laws nelaung to PERMIT ISSUANCE MECHANICAL FEE _ building construction.and hereby aothonre representatives ofthis city to enter upon the U Z dbe,e-mamboed prm,dy for inspection pwpamc, ALTER OR ADD TO MECH. CONSTRUCTION TAX (We)agree to save,indemnify and keep beardless the City of Cvpenino against Iiabililies.judgmenn.costs and expenses which may in my way accrues don said Ctry AIR HANDLING UNIT(TO 10,000 CFM) int uein olibel, migofthispermit. AIR HANDLING UNIT(OVER 10,000 CFM) Sig meof App lb,m Coanchor Dale EXHAUSTHOOD(W/DUCT) PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 1000)0 BTU) Dale ReceiplM Will the applicant or future building oecureant store or handle hazardous material m defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety HEATING UNIT(OVER I 011,00g)BTU) TOTAL: Code,Section 25532(a)? ❑Yea 0 N VENTILATION FAN(SINGLE RFSID) Will the apBOILER-COMP QHP OR 100,0011 BTU) ISSUANCE DATE plicantorfurore building occupant useeyuipmcmordevices whichemit pp AIM I hazardous air contaminants as defined by the Bay Area Air Quality Management BOILER- ( P A t District? COMP OVER 1 W,WO BTU) ❑Yes ❑No NEW RESIDENTIAL MECH, SQ.FT. I have read the hazardous n-len-a rnyulrcnmmta under Chapter 6.95 of the AUG 1 g �ggq Califomlu Health&Safely Code,Sermons 25505,25533 and 25534. 1 understand that if the building does rwt currently have a tenant,that it is my responsibility to notify the occultist of the requirements which must be met Poor to isms ve of a Cenificate of CI I Y Vf NUf CI'11 f d Occupancy. Oarm,or anlboosed agent Date ISSUED BY: OFFICE