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26336 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO H ILIM O-ELKCTRICAL PERMIT NO. APPLICATION/PERMIT PLUMBING-MECHANICAL n[5 Q �] C BUILDING DIVISION BUILDING PROJECT IDEN'TIPICAI'ION L v J J o PerLLDDIING ADDRESS:/ SANITARY NO. APPLICATION SUBMITTAL DATE �/1V©/ a.J✓/V,V/�//LG UNIT* f1 LOT JIVY1 "� ERS AMF PHONE: C _ CfOR'SN LIC NO: N/C COMI'ROL N �A1011 �gCT GINEE jv3 t• DR �� �'d� aN ❑ CONTACT: PHONE: Gy�//V zma*wl QTY. ELECTRIC PERMIT IME BUILDING PERMIT INFO O `.BLL EL PLUMB PERMIT ISSUANCE Y ❑ t LICENSEDC NTRACTOR'SDECIARATION APPLIANCES.RESIDENTIAL '--1 Matz IhcrebyafOrm dim l am licensed unde TivoedOneufaripm,$)ro^mmencidgwith OB DESCRIPTION P02 Section 700E)of Division 3 of the Business and Professions Code,and my license is in PANELS full force end effect. ^�' FEW hicereoC cs Lic.' / UPT02fp AMPS �� N m6y Dam Convector 201-1(100 AMPS F A CHITECFS DECI. ATION a SQ.PT.EL AREA S/SQ.Ff. ZOy� OVL'R Imp AMPS OZtzD lundenwnJ my plum shall be used as public rccnrds. sr� F^ ; SIGNS F.1.13CIRICAL \\V 4y6� J I:mcnsul Professional SC)wu OWNER-BUILDER DECLARATION SPECIALCIRCUIT'/MISC. KO a F1 hereby amen that 1 am exempt from the Contractor's License Law for to W13 vn followingrcasom(Section 7031.5,Basinessand Professions Code:Anycity or county TEMP.MET ER OR POLE INST. ��0ys which requires a Permit to construct,alter,improve,demolish,or repair any structure WWY2to its issuance,arm requires the applicant mrsuchernitto file a signedstatement POWER DEVICES prior t PP P ya'jKasp 9(comthat he is dicing with Suunnothepmvisio^snf the Contractor's and Prel.awrs Cods) a L�o4 9(commnscidg with Section1011lpof Division3ofine Boniness and Professions Code) SWIMMING POOL ELECTRIC ^^ VALUATION ortbm he is exempuherefmm and the basis for theitimod exemption.Any vimmio^of IAL ELECfR UTLETS-SWITCHES-FEXIORES an FZQ Section 7031.5 by yapplicant fora pctmi,mijecds^n me applieoa<ivil penalty of $$''yyyy EIn t mom than five hundred dollars E$500). ' . go I,as^w^ pe ernftheprony,ormyemployeeswithwagesmtheirwlecompensationNEW RESIDENT, SQ Ff. STORIES TYPECONSTRUC(ION p22 willda Nework,and the structure isnot intended oroffered forsale(Sec.10G1.Business and Professions Code:Tion Contractors License Law does not apply to an owner of Propcny whobuildsorimproves thcrcou,and who does such work himselforthmugh his OCC.GROUP RES.UNITS own employees,provided thatsuch improvements stent intendedoroffenallimwle.If, however,the building or improvement is sold within one yearaf completion,the mener- builder will have the burden of pmving that he did not build or improve for purpose of sults). ❑ I,asowneroftbe property,am exelusivelyconuaciing with licensed contractors to QTY' PLUMBING PERMIT FEE FLOOD ZONE APN construct the project(Sec,1044,Business unit Professions Code:)The Contractors PERMIT ISSUANCE License Low docs not apply mm an owner nfppcny who builds or improves thereon,and whocontmctsforsuch projects wiNo contractor(sHicensed punuanutahe Comractors License Law, ALTER-DRAIN&VENT-WATER(PA) IMESUMMARY ❑n1 am exempt under Sec. ,tl&P C for this reason BACK FLOW PROTECT.DEVICE SANITARY OUTSIDE —N— o,wnu Date RF.CBIPI'* DRAINS-FLOOR,ROOF,AREA,COND. WORKMAN COMPENSATION DECLARATION SCHOOL'1'A% Y N ❑Workers reby Compennn thmlhave cora crcteofcarromit opythmuf(Sinsure,0,aaC.)which RECEI p Warkers'Compensation Insurance oracenlnul copy thereof($a.3g00,Loh CJ which FIXT S P .. PARK FRO Y N emonsall employee'sugper�tl " . .d y GAS�FA.SYSTEM II UT IR RF.Ch fp Policy* O ✓'+J 2 7/T�� / Gp� B D GDIVISION ' Company GAS- '.SYS ;lll(W R (HA) PLANCHECK F>i 2 ❑ Cenified copy is hereby furnished. Certified copy is fled with the city inspection division. GREASF WASTT GRADING FE' CERTIFICATE OF EXEMPTION FROM WORKERS' ORIASETRAP �I SOILSFEF COMPENSATION INSURANCE (This section need not be completed ifthe permit is for one hundred dollars($1011) SEWER-SANITARY-STORM EA.20111 PNCRGY lees.) I certify that in the Performance^f Ne work for which this permit is issued,l shall WATER HEATER WNENT/ELECTR `1i NJ not employ any person in any manner so as to become subject to the Workers' PAID Z Compensationl.nwsof Califmuia. Dud WATER SVSTENWMATING Date Reerip* Applicantif zO. 0 NOTICE TO APPLICANT:If.aits,making this Cenificmeof Exemption,youshnuld NEW RESIDENTIAL PLMB. SQ.IT. L NITOTAL: Vn become sobject1.me Workers Compensation provisions ofthe Labor Code,you must � ; forthwith comply with such provisions or this Permit shall be deemed revoked. BUILDING FEE 0. (� CONSTRUCTION LENDING AGENCY SEISMIC FEE Uz I hereby affirm that there is a construction lending agency for the perfnrmance of TOTAL: ELECTRIC FEE O the work for which this Permit is issued(See3091,Civ.CJ launders Name U Lender's Address QTY.- MECHANICAL PERMIT FEE PLUMBING FEC 1 Gentry that I have reed this application and emit abut the above infnnnmion ie correct.I agree to comply with all city and county oninanca and sm'emmulmingto PERMIT ISSUANCE MECHANICAL F E huilmagconstruetion,and hereby aothorize representulivev offhis cifymendr upon de CONSTRUCfIO TAX above mentioned for V z property.indemnify keep mu ALTER OR ADD TO MECII. (We)agree to Env d indemnify and keep may in the Cny n(Cagain t said City liubilities,jud costs expenses which may in nny way merue against eeid City AIR HANDLING UNI"f(TO 10.000 CFM) in mit ceFf earthis veh. - AIR HANDLING UNIT(GVHR IBM CM) Sm Iicam/Cu o Date EXHAUST HOOD OYMUCO PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,00)BTU) Date Receipt* 77the applicant nr future building occupant store or huddle hazardous material 111iATING UNIT(OVER I OQIM10 BTII) TO 1.: m defined by the Cupertino Municipal Cods,Chapter 9.12,uncithe Ifici th end Safety Cale,Section 25532(a)1 ❑Yee ❑No VENTILATION PAN(SINGLE RESID) Will tbeapplicam or Padre builJingoccupam useequipmcmordevias which emit BOILER-COMP(SHP OR 100.000 BTU) ISSU C ATff . hazmdous at comamin em;as defined by the Bay Arm Air Quality Management BOILER-COMP(OVER 1011,000 BTU) District? CIp Y,,, EIs No NEW RIiSIDFN'I'IAI.MECII. SQ.FT. rs_/Q/ e9 I 10 have rued the hazardous materials requirements under Chapter 6.95 of the ,ry Y ' California Health&Safety Cale,Sections 25505,25533 and 25534.1 undentand shut ifthe building does not currently have aboard,that it ismy responsibility to notify-te r / ticro,surn of the requiranenm which most M met Prior to issuance of 6 Cenlricute of IJ/ Occupancy. Owner or authorized agent Uam ISSUED BY: OFFIC