26290 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY Pf;RMI"1'NO.
BOBIWIST.-4a..1,'1.1, AL
CITY OF CUPFR'TINp PLUMBING-MECHANICAL.
IIUILDIN(:DIVISION APPLICATION/PERMIT n BUALUB.\"1 PR(IAF.CI'IUEpTIFlCAIIO\
GC /� ���� ll ��q-�/ SANITARY NO. AI'1'LICATION SUBMITTAL UAII
BUILDING,;2/ FS--j GAkI/te&J ` -1`16 UNIT# C
S JJ LOT
OW '.RS NAME:
PHONE: CON'IR C'OI NAM" LIC NEI NIC CONTROLX
R 4 J 141
MICHUBeCT/ENGINEion. LIC NO'. ADDRESS:
El
IIC[4A,,,zI3 ME k BUILDING PERMIT INFO
GNT]Q PHONE: QTY. ELECTRIC PERMIT FEE
nTC CBL : 1?L PLUM MliCll
CG
yob' as3 -vssz PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DISC IPI'ION
I hereby affirm rom 3 oft
a Buss n ss provisl.ms o ce Cade.and
(commencing with --
QWzWOO S«tionereby affirm that
13ofcesed Business and Profess ions Cade,,(cmytinting is inwith PANELS
fWF hurt force and effect/ UIT02WAMPSA
a 7 WVW License Class Lie.X 201-10(10 AMPS
Vi60• Dula Conrusum SQ.Ff.ROOft ARE $/SQ.FT.
I on j ARCHITECTS DECLARATION OVER I A ��
ZO—O 1 understood my Plana shall M used as public records. �/`r\
OZtW SI S L .0 -
<,�, Licensed Prdeaionul s ;. LCIRCUIT/MISC.
RR�KQ OWNER-BUILDER DECLARATION
K
Oi U 1 hereby affirm that 1 am exempt from the Contractors License law for Ne .MP.METER OR POLE INST.
W' O, following reaon.CSernon'1031,1,Bell and Pmfcaions Code:Any cirymcaum
F4 < wM1ich requireaa Pe.nilmronswcl,almr,impmve.demolish;or rtPtufr amY sawn POWER DEVICES
K2� priormns ismunee,uls.re9uiresthe ePpli<rnlfor such pertnino Eleesigned slate rnt
WyWpC that M1e is licensed pursunnnolhc Movisions of the C.nwcmr's License Law(Clan SWIMMING POOL ELECTRIC VALUATI09
m eLL 9(mmmenctng witM1 Scninn70W)of Division3of rite Business and Pmfcsvlous C.dcI �l B
_ nr that he is exempl therefoom and the basis for the ullegee exemption Any violation.( VTLEI'S-SWITCHES.FIXTURES
FZ�- ,anion]031.5 M1y vny applicant torn permit suhjecros the npplirem loucivll penalty of
Q nm r M1anfvehunJmd J.Ilars(SSW). NEWRFSIDENHALELECB _SQ.FT. STORE' TYPF.CONSTRUCI'10.
-ON I, er.ftbe prnpcny,ormyemployttswith wagesastheirmlecompemailon.
W3, Ido cwork,and the nmaurt isnotimrndcd.roffemd forale(Stt.7f144,Business
a d Iiofusiuns CNe:lTe Convenor s Li¢nse Lvw rices not apply m rn
Ow net of RES,UNITS
p spenywhnbuildsarimprovestberron,and whndcessuch work himsdfnrthmughhis OCC GROUP
employees.provided that such improvemcnlaertn.limendceor uffercd Towle.If, '—
however,We handing in improvement issold within one year of completion,the owner- T
builder will have the burden of pooling that he did not builds improve for purpose Of AI'N
sele). QTY. PLUMBING PERMIT FEE PLoOU ZONIi
❑ Las ownerofthe Pmpeny.mneaclusivcly comrneting wish licrnsedomminn man.
constrict the project(Sec.7044.Business and Professions Cale:)The Contractors PERMIT ISSUANCE �'•
License law docs on,apply to an owner of Prupeny w ho bu ilds or i m proves thereon,tura(
wh.comvcuf...chprojects with a communalist licensed Pursuant to the Colonel ALTER-DRAIN&Vpf-WATER(EA) FEESUMMARY
License Law. ,0&P C for this reason O .1 FEES
[j 1amexemptunder Sec. BACK ROW PRO'I ECT.DEVICE SANITARY Y_N__
RECEB'PK
Owner Date DRAINS-FL ,ROUT,AREA,COND. SCIIOOLI'AX Y�N—
WORKMAN COMPENSATION DECLARATION HECEIIT X
�❑ Thereby affirm that l have a cenifiem ofca..sem to self-insurein a ccnificale of FlXTU -PER TNA PARK IEE Y--N—
Jorkom Compensation Insurance of Rcomfied copy famod(Sce.3800.Lab C.)which RECEIPT#
covers all employ.,under this Permit. G -EA.SYSTEM-1 INC. ULETS BUILDING DIVISION FEES
Pohcy,0 GAS-FA.SYSTEM-OVER 4(FA)
PLANCIIECK FEE
CompCey
❑ rtified copy is hereby furnished. -
❑ CenifeJcapy is fled with the city nspenioo division. GRIiASE/I DUSIRLW IEE
C• OR GRADING
CER'T'IFICATE OF EXEMPTION FROM WORKERS' GREASE SOIISFEE
COMPENSATION INSURANCE 1
Obi,seen..need not becomplead ifthe Permit is for.rte hundred do ($100) SEWE ANI -. LVKM .200FT. FNCRGY IEE
a Less) ,RHEA /VENT .LECfR
I cenifythat in the performance of the work for which this pe usued.I shUl PAID
net employlany person in ony manner,,as m here.subject rs the Wmkea' A S ,M/I'RP ING Date RmelptX
Compensation Lowsof Califomia Dole -
O z Applicum EW RES DENTIA 'LMB. SQ,FP. TOTAL:
z0 NOTICE 10 APPLICANT:if,if ere m.king this Certificate of F;xemNinn.yr should
rybecome subject mlhe Wmkee's Compensation provisions oflhe labor Code,y. all BUIfAING
> f.nhwiN comply with such provision,or this permit shall be domed revoked.
SEISMIC FEE t
111 Q CONSTRUCTION LENDING AGENCY
z Ihereby from lhmthere is.construction lendingegency for Ne performance of ` ELECTRIC FEE
U O the work for which this permit is issued(Sea 3I197,Civ.C.)
Ixneers Nutnc FEE PLUMBING FEE \
R. IsodelsN ,,a QTY. MECHANICAL PERMIT
U 1 tinnily that I have read this application and sum that the above mutual is MIiC11ANICAL FEE
>113d correct.Iagree m comply with all city and county ordinances and laws rel Pn the PERMIT ISSUANCE CONSTRUCTION TAX
F-' � building cons.ucmion.andhercbyvumhorixmpmwnutivesofmhisciiytocnter upon mite AL'ILR OR ADD TO MECII.
U Z, abace-mrntiarcd pmpeny for inspection purrysses.
(We)agree to save,indemnify and keep harmka dm City of Cupertino against AIR HANDLING UNIT(TO UL000 CFM)
liabilities judgmcros,costs andexpcnses which mvy in any way Uccrve egaina said Cily
infthegrvnling of bispermit. AIR HANDLING UNIT COVER I'.—CFM)
m�coub � Dnm�
EXHAUST HOOD lwlUUCI') PAID
Signature of ApplaamAohmanor BEATING UNIT('(0 100,000 BTU) Dam Rttclin#
HAZARDOUS MATERIALS DISCLOSURE
ous
Will the theapplicant or
C.,in.Mun building Cecil hapten 9.o,handlehawdh end Saety BEATING UNIT(OVER IOD.O(p BTU)
a defined by 125 3200?no Municipal CWc,Chepmr 9.12,and the Itrahh end Safety
Code,Senior 255J21e)? VF;NTIIATION FAN(SINGLE RESID) ISSUANCE DATE
❑Ye, ❑No
BOILER-COMP(JIIP OR Ifq.IXlO BTO) Ip pi1 p
Will thcnpplicanl nrhmure building occupant ueeequipment ardcvices which emit
h.dons air canmmiaamI as defined by the Bay Are.Air Quality Managemem BOILER-COMP(OVIiR IIg1,W0 BTU)
,via? R 15 .1994
S ❑yes ❑Na NEW RESIDENTIAL M[iCH. SQ.FT.
'1 have read the hazardous materials reyuiremems under Chapter 6.95 of the
California I Icallh&Safety Code,Soctions 25505,25533 and 25534. I understood that Ur Lha
if the building does not currently have amount,that it is my responsibility t0 notify the / 11`( Ur Is,
ecupam of the requirements which muss M met prior In romance of.Certificane of V
Occupancy.
Owner or uutbotizN vgcm
Dec L: ISSUfiD BY:
OFFICE