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28488 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL, PERMITNO. BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL 284,88 BUILDING PROJECT'IDENTIFICATI BUILDINGADDRESS: SANITARY NO. AP ATIONSUBMHTALDATE X00 fj Sv 14 1 '"^ b O /ER'S YHO ,. )MeyR(�CI'OR'S NAMGE: /^-1 LIC NO: - v{/ �(,/ •I..li G.TAfY WNTkLa�CfD7��Z 'NC CONTROL# ARCH CONT Px TECT/ENGINEER: LIC NO, ii)D„io OC l u� 1' K � ' CONTACT: • � ONE: /� � -AC BUILDING PGRMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) PLUMB x LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE ❑ I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION �OZ with Section 7000)of Di vision 3 of the Busiattliu l Pndesxians Cndc,undmyhcenscis - RESIDENTIAL O t PERMIT ISSUANCE —� W Lite end effect. '�� �U� License Class Liag ❑SFDWL ❑PLUMBIN RE-PIPE Date Cnnlracmr APPLIANCES-RP.SIDENTIAI. �Za ❑ADDITION ❑PLUMBING RE-PIPE I..7,� ARCHITECT'S DECLARATION PANELS ❑MUL'D-UNIT [I STRUCTURAL Z O 1 undemm�d my plans shall be used i s public reemi MODIFICATION OZ UPT02MAMP5' 4^Fq Licensed Professional El INTERIOR [I CHIMNEY REPAIR yx, OWNER-BUILDER DECLARATION 201-1000 AMPS IMPROVEMENT yyy� gm M 6 I herehy affirm that I ant exempt from lie Commnor's Llcenso Law for the OVEN 1000AMPS ❑BATH REMODEUREPAIR 0 DEMOLITION W 0'U aU following reason.(Section 7031.5,Business and Professions Cade:Any city Or county ❑OTHER which t to conswct,alter,int owe,demolish,or repair un .,In SIGNS ELECTRICAL requires a panni PY s no.,,,it,lsso.nce,.lsore9uireslhe...I esm fim,a,h perm..lilcusigncd sedcownt SPECIAL Cl RCUIT/MISC. } Nat he is licensed pursuant m the provisions crane Cormuna's License Law(Chapter9 �0 (commencing with Section 7000)of Division 3 ofthe Business and Professions Code)or TEMP.MEMR OR POLE INST. COMMERCIAL 6 e' Nat be is wunapl the donna and the hasix for the alleged exemption.Any virl rian IO of ❑NEW BLDG/ADDITION ❑DEMOLITN n m Section 9031.5 by any appli for a perom subjects are applicant e applicano.civil Penalty Of POWER DEVICES FNANT ❑FOODSERVICE 1g..., room than Gve hum dollars PROVEMGNT ESCQ ❑ I,asowncndthep olamy,ormy mnpIn with wages as their sale compensmion, SWIMMING POOL ELECTRIC, •CZCZ GCGC will do the work,and l esouclure is not marine flared for sale(See 7044,Business ❑OTHER W and Professimue Cod :The Conwcmb License sat apply to an owner ofETS-SWITCHES-FIXTURES a'3 propeny who builds it intpmw,,thereon,send who does in work himself or through his own employees rovided that such improvctmfs'hic n imended or offered for NEW RESIDEMIAL ELEC3'R SQ IT. saIs,ILhoweveeth huilding orimprovemem is m)tl'within nn a rofcompictusm,he - SQ.FT.FLOO AREA _ L FT. owner-builder will avolhemolenofpmvingth, In orimproveforpur- pose of ade.). : 21 El I,as owner n e"'arty.am c.cl.sivc sling wi licensed conduct,0 t T construct Ne pn est(Sea 9044,Business an c.f ay(ons Co •;7 TM10 pnan umrs - cemaslaadoc. ofapplytoonownerof 116 builds n improves Recent, id QTY •PLUMBING PERMIT FEE whocontrects t uch projects with a co densed rsuant to the Cnm. is" License Law, rs r e, PERMIT ISSUANCE ❑ Toro exam IunderSm. :/ ,B&PCfar rcuson s• AITE R- AIN&VENT-WATER(LAJ NALUATI N owner nate RKER'SCO ON DEC a,LAderm .ARA9*10 11 BA: P ECT.DCVICE Ihereby off oder pcnehy itFy eo( efollo gJeAamtieAr. ,J I have and will mains aCeri are id me ms if-ins fin W..kcr'x oro t DINS- ,001CROOPAREA,COND. STORIES 1'YPCCONS'fRUC'I'ION sation,as provided for M1y ion 3TX'lithe I n ante,f r the pedo n c work for which this perm it is is. d. �/ FXI E.S-PERTRAP 1 have and will muimtin Works' Co pensmi11n I n p by Se 39W ofthe Lab11r Code,for the Farm eofinewo Rinse h toil isi\i• - G -EA.KYSTEM-1 INC.40UTLCTS My Workers Compensation Insurance m c• and Pill y number OCC.GROUP APN Carrier. GAS-BA.SYSTEM-OVER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE GRCASEANDUSTRL WASTE INTERCEPTOR NV (This smtion need not M:cnmplmcm at if the peit is for one hundreJ At ars(511 BUILDING DIVISION F ;S or less.) GRI7ASE TRAP PLANCHECK FF.F. certify thatimhe perforation clans work fe which Nis annuls issuN,Ishall ;0."* npiny un permn in tiny 'arms,111.11.bcoa x he agYf ye yVoycy:C SEWER-SANITARY-S"ITIRM EA.200 FT, y u j nmpcn- ENERGY FEE yLk O sstrum L y a WATER HEATER WNENT/ELECTR PP GRADING PER tiNOTICE. AI IC NI. Luft cnificure of Hxcialson,you should WATER SYS'TGMfTRGTING ' abooms subject to the Worker's Co.,.e"o provisions of Ne Labor Cala you must SOLI S FEE Gt7forthwith comply with such provisions or this permit shall be deemed revoked. WATER SERVICE Q UO CONSTRUCTION LENDING dingaAGENCY NEW RESIDENTIAL PLMR. -SQ.PI'. PAID 1 herebynffrmthetmere iso d(See i30lending agency for the perfilrmancc of Receipt# W rr he work for which mis permit is issued(Seo.31199,Civ.C.) , 0 U 1<mderx Name TOTAL. fS.l Lenders Address TOTAL: IL 0. certify That I have reud ibis.pplicmion and smte that ahs uhnvO infonpadnn is RUI G ;E /a V) correct.l agree to comply with all city and county ordinances and state laws relating 1. QTY MECHANICAL PERMIT FEE U 4 building construction,and hereby authorize represeoatives of this city to enter upon the SEISM EF. above-nmntioned property for inspeJWILLCO PERMIT ISSUANCE(We)agree til saveInde nies heCiO.fCupcmn.r,mum ELECTRIC FIE aroy accmeagainst said City ALTF,R OR ADD TO MECH.incoraCil of thegmntin n thPLUMBINGAPPLIC NTL. ERSI. D. A 'fR ALL NON-POINT AIR HANDLING UNIT GO 10.000 CPM) ' SOURCI EGUL TIONS, 1110 IC LFEE y/7ry AIR HANDLING UNIT(OVER lq(IBOCFM) y NSiHU TION TAX ao Signature pp lean o 1.r .[)ate EXHAUST GOOD(W/DUC1) HAZARDOUS MATE ,. DISCLOSURE OUSING ITIGATION FEE Willthcopplienm orfumre building occupant samemiandle hazardous marnid HEATING UNIT(TO 11X,000 BTU) y a as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Cade,Section 25532m)1 HEATING UNIT(OVER 100,000 BTU) (�(/ ❑Ya ON. VENTILATION FAN(SINGLE REBID) PAS ,V Data Receipt# Will the air coma or allure building y the B use cu Air antQu lity Management which BOILER-COMP(3HP OR 100,000 BTU emitict? us air comaMnants as definW by the day Amu Air Quality Manegemem ) District? T ❑Yes ON. BOILER-COMP(OVER 100,000 BTU) (have read N<h.rardops maariuls reyuimnrnts under Chapar 695 of the C.li- AIRCONDITIONER ISSU NCEDA Temic Health&Safety Code,Sermons 25505,25533 and 2.5534.1 understand that it the NEW RESIDENTIAL.MECH. SQ.FT. building does not currently have a lemon,Nm it is my resgmsibility to purify the occupant of the aquirrmenas which must he met are to issuance of.Certificate of occupancy. Ow•nerorauthonu .gens Duo T ISSUED BY: OFFICE