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25842 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINOBUILUR li.1,r,MHHUAL FERMII NO. APPLICATION/PERMIT PLUMBING-MECHANICAL 2 arm V 842_ BUILDING DIVISION BUILDING PROJF,CT IDEN'rIFICAI'If1N BUILDING ADDRESS: SANITARY NO. AH APPLICATION SUBMTAL DATEi Ik3© U.rrr x LOT a IO - ♦ HO NTRA LIC NO: 1111 (Q"1 'SN E NIC CONTROL N Aft WCOARCCI II'IE '/L2NGI EI4R: LIC NO: ADDRESS: ❑ Nq'AM: PHONE: BUILDING PERMIT INFO QTY. ELECTRIC PERMIT FEE BLDG ELECT PLUMB MECH PERMIT ISSUANCE eA ❑ ❑ LICENSED CONTRACT'OR'S DECLARATION APPLIANCES-RESID17N'FIAL pyx JOB DESCRIPTION I hereby offimt that fern bectionsfunderprovisionsof Chapter mmarri encingwith �OO Section 7").(Gordon 3o1'the Business and Professions Code,end no,license is in PANELSs.l tyF full force and effect. \/ U U UP TO 200 AMT'S F<,ZUJ Dole Clues LIoN vs j y Dam Commcmr 201-Food AMPS SQ.FT.FLOOR AREA $/SQ.IT. F on ARCHITECTS DECLARATION OVER 1000 AMPS 70o,— 1 undenund my plans shall be used as public records. �ae ((��� of—p tl�' ALED IN y F w SIGNS ELEM RICAL < =< Licensed professional172 E es. OWNER-BUILDER UECfARAT10N SPECIAL CIRCUIT/MISC. n L� �'''a E O W U 1 hemby affirm that I am exempt from the Contractors License Law for the 1/I E�4 It, following rcasoa(Section 7031.5.Husinns and Professions Cute:Any Cry Is,county TIiMP.MCTIiIt OR POLE INST. E , a I—a 0< which requires a permit to consumer,alter,improve,demolish,or repair any structurePOWERDEVICES RC7� prior to its issuance,also rcquirestheapplica^t patriarch r peoiuo file.sigredatmemeot Wa <O tont he is licensed pursuant to the provisions of the Contractors License Law(Chapter (� a a p K SWIMMING POOL ELECTRIC _ 0 9Uutheis xempth Suairearand the Division tef office exemption. Any iolaCode) VA.UA ON w^y or that M1c is exempt tlrcmfmmanJ the basis the alleged exemption.Any violation of OIITLEI'S-SWITCHES-FIXTURES F Z< Section 7031.5 by any applicant for a permit subjects the applicanno a civil penalty of 9Sp n���ttyyyQQQre lha^fee M1unJred dollars($500). NF,WRESIDPNTIALELECTR _SQ.II'. �F� ' oc'-w^efufthe property,or my employees with wages as their sole compensation, STORIES TYPE CONSTRUCTION d3— 1/if]deo she work,and the swcmm is not intended oroffcred our safe(Sm 91Ja4,Business and Professions Code:'Me Contractor's License Law does not apply so ar owner of nopeny who builds or improves thereon,and who does such work hrmaelfor through his employees,provided thatsuch improvements an,not imendedoroffered forsale.IL OCG GROUP RES ON[IS however,the buddingor impmvemerrt is sold withi^one yearofcomplecon,the owner- 1 builder will have the burden of proving that he did not build or improve for propose of .sale.). QTY. PLUMBING PERMIT 17EE FLOOD ZONE AI•N ❑ I,asowncrofthe property,am exclusively contracting with licensed contractors m consumm the pmjett(Sec.7Of4,Business and Professions Code:)The Contractor's license Lawdacs gat upplytuwownerofproteny who builds orimpromodoecon,.nd PERMIT ISSUANCE who contracts bno.ch NrjeetswilhacttrImnnr(,)licensed pursuant In the Convectors License AI TEE-DRAIN&VF.N'P-WATER(EA) PEE SUMMARY Law. Eli am exempt under Scc. .B&P C far this reason BACK FLOW PROTECT.DEVICE OUT7FE FE SANITARY Y N Owner Date DRAINS-FLOOR,ROOF.AREA,COND, RECEIPT. WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y ❑ Ihembyaffirm that l have acenificam ofconsent roself-insum.ora ceniftcarecd FlXTVRES-PER TRAY PARK P Worker%ComPensmion Insurance orarenified rnpy tberrof(Sec.3g00,Lab CJ wM1ich PARK ME Y N covem all employedmi ,under this pert. GAS-EA.SYS fEM-1 INC.4 OUTLETS RECEIPT p PolicyN BUILDING DIVISION FEES Y GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FTE Certified copy is hereby famished. ❑ eftibed copy is filed with the city inspection division. GREASEINDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERSGREASETRAP SOILS FEE COMPENSATION INSURANCE (ITissectio.amedoot becompinted if the permit is for one M1unJred doll ars($100) SOWER-SANITARY-STORM HA.200FT. ENERGY FTSE or less.) I certify that in the Performance office work for which this permit is issued,I shall WATER HEATER WNENT/ELECfR oat employ any ,.in to ony manner so as m become subject m the Workers PAID Compemmion6owsef Califomia. Date WATER SYS'I CMITREATING Dam Recclpt4 z A licant Pp NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: Z� 0 NOTICETOAPPLeWork WoIf.rker after Compakingensation this Certificate of of Lalcor Exemption, you mind F•+ � beaionthc reply theesuhpr Csionsrthis permisiaall liceemed evoked. must BUILDING FEE F� > forthwith comply with such provisions or this permit shall b<JeemnJ revoked. 0. (� CONSTRUCTION LFbIDING AGENCY SEISMIC FEE I hereby affirm hat there is a construction lending agency for the Performance of � Z the work for which this per is issued(Sec.3097.Civ.C.) TOTAL: ELF.CI'RIC FEE U O Lender's Name D"' F lcnaer'.nddrcss QTY. MECHANICAL PERMIT FEE PLUMBING FEE V 1 certify that 1 have read his application and state that the above information is MECI IANICAL FEE correct.lugrecmcomply with all City and county ordinances and scale laws rclmingm PERMIT ISSUANCE (•-' buildingamw ction.andhemhyautho wmpmenutivesofthiscitytoenlerupondte CONSTRUCTION TAX U Z alwve-mentioned progeny for inspection purposes. ALTER OR ADD TO MECH. (We)agree to.cave,indemnify and keep harmless the City of Cupenlno against liabilities.judg nts.con.andexpenses which may in any way acermagainst said City AIR HANDLING UNIT(TO 10.001 CFM) consequence of the granting of this pe..1. AIR HANDLING UNIT(OVER 10,00(1 CFM) St P ic.nUn actor Date EXHAUST HOOD(W/DUCT) PAID I IAZARDOU5 1ATERIALS DISCLOSURE HEATING UNIT(TO 100.000 BTU) Dam Receipt is I I 52ATERIALS DISCLOSURE Will the applicant or future building occupant store or handle lueardous material fIFATING UNIT(OVER 100,000 PTU) az dcFoeJ by the Copinion Municipal Code.Chapter 9.12,and the HWth and Safny O L Code,sectio^25532(.)^ VENTILATION FAN(SINGLE RESID) ❑Yes ❑No ISSUANCE DA'I'S Will the applicant rn forum buildingoccupantuseequipmcmardcviuswhichemit BOILER-COMP(3HP OR 100,0010 BTU) p� hamstrings air Communities as defined by the Bay A.Air Quality Management BOILER-COMP(OVER 100.000 BTU) N'Y 0 k`I Di,oimpp V7 ❑Yes 0 N NEWRESIDENTIALMECH. SQ.FT. 1 have mail the hasardoas materials requirements under Chapter 6.95 of Ne UtV { Calihtmla Health A Safety Code,Sections 25505.25533 and 25534. 1 u^Jerund that ) if the building does not curcntly have.tenant,that it is my responsibility to notify the occupant of the requirements which must be met prior to issuaame CITY of a Cenificam of V Ur�t.�+.f�ry Ostapancy. vV+ly ` Owner or nuthonrcJ agent Dam '1'0'1'AL: ISSU1?D Hy: OFFICE