27385 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY '
CITY OF CUPERTINOINH:61Nf°.--RI:aCTaICA, PHRMrr NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 27385
BUILDING DIVISION BUILDING PROJECT IDENG IFICA71ON
BUILDINGA DRESS.ct �� SANT
IARY NO. APPLICATION SUBMUTAI.DATE
UNIT I.OTp
ME: PHONE: CONTRA TORS NAM LU LIC NO: 7
NIC CONTROLN
'I "P 'I' > 'Nh rR I LIC NO: ADD sSS: El ADD
ONTAC7U - PH � BUILDING PERMIT INFO
04IN C 1� QTY. ELECTRIC PERMIT FEE
mill nL c ELECT P.LUp19 E I
PERMIT ISSUANCE � C�I�fI
LICIiNSIiDCORMAG OR'SDIiCI.ARATION APPLIANCES.RESIDENTIAL JOB DESCRIPTION
CetiIherehyaffirm that l am liceased underprovisions of Chapla9(commencing with
I400_ Section]0W)nf Dwismn 3.f the Business and Professions Cole,und my beers.is in PANELS
t W full force and effret.
F Zoo License Class Lic.# UP TO 200 AMPS 1
m6d Daw Comoro, 201.Io00AMPS
-
1 nn n ARCHITECTS DECLARATION SQ.FT.FLOOR AREA E/5 IT,
or,zo. l understand my plans shall be used us public records. OVER I000AMPS- A —may
<` SIGNS ELECTRICAL
, Licensed Professional
d U
OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
k0a 1 hereby at that 1 am exempt Contractors tM1eContractorsth
la License Law for e
Wer WF Iidlowingretem Section 7031.5,Dusimssand Prfiresine,Code:Any city.,county TEMP.METER OR POLE MST.
lN--� which amines a permit ro mostmn,alar,improve,demolish,or aped,any stmctnrc
priorbohs issuance,alsurequires lheapplicam forsuchpermiuo file a signed statement POWER DEVICES
0.0.0.0.0.0.00'' CC that he is licensed pursanmo the provisions ofthe Contnnor's License Law(Chapter SWIMMING POOL ELECTRIC
GCM,. or(but
commencing xe pttith Seefrom and the
Division Sof the Business and Any
Code) VALUgyON
w=y or0ion 7031.5 by any
f the basPermit subjects
tsthed exemption.Any violmi.n of
Senion]OJ LS by any applicnm fore permit subjats the applicant toecivil penalty of - ITfLETS-SWITCHES-FIXTURES l
not mom than five hundred dollats(3500). PI'..
e ❑ I.asownerofthepmpcny,ormyemploymswithwagaeslheirsolecompewtion, NEW RESIDENTIAL P.1,6CfR SQ. STORIES I TYPECONSTIUR7f10N
will dothe work,and the numemre is not intended oroffertd for sale(Sec.9044,Business
and Professiore Cale:The Contrecm/s License Law does not apply to an owner of
propertywho buildsorimproves thereon,and whodoes such work himself orthroughhis - OCC GROUP RES.UNITS
nemployees,providedthat suchimprovemems eanotinrcndedoraffead forsAe.IL
however,he buildingor improvement is sold within one yearofcomplelion,Iheowner- TO
build 11 have the burden of proving that he did not build or improve for purpose of
owner.,thepmperty,am cxdusivelycnnhncting with liansul contracmrsm QTY. PLUMBING PERMIT FEE FLOOD LONE APN
.nave, a project(See.7014,Business and Professions Code c uanors PERMIT ISSUANCE
License LawdocsnnlaMlyto nownernfprnpenywbobuildan proves Cher n,snJ
who contmns for such projects with acontmeror(s)lianse uammthe Con cools
license law. (CA)g1:fDRAIN&VENT-WATER FF17 SUMMARY
[:11 am exempt under Scc. B&P C for this F.R-
mon BACK FLOW PROTECT.DEVICE OUTSIDE FEES
SANITARY YN
Owner Date RECEIPT#
DRAINS-FLOOR,RMF,AREA,COND.
WORKMAN FietaritONDECLARATmN SCHOOLTAX Y N
❑ Iherc"Y'di mlhal ec rtifiooa of consent lu self-ir¢urc,nrnc<rtifica of RECGIPfp
FIXTURES-PER TRAP
Wnrkcrs'Compe �i nlnsurunce oraccrtifird copy Nercof(Sa.3800,Lub CJw 'rh PARK F13Ii YN
coversalle yeas under this pcnnit. GAS-LA.SYSTL'M-I INCA OUTLETS
RECEIPT#
Polley p BUILDING DIVISION FEfiS
❑Cannot ified copy is hereby famished GAS-EA.SYSTEM-OVER 4(HA) PLANCHECK FEE
Ce
❑ Ce ified copy is fled with the city inspection division. GREAS1YINDUSTRL WASTE INTERCEPTOR GRADING FEM
CERTIFTCAT60F F,XEMPOO FRO GRFASETRAP SOILS FEE
COMPENSATIONW r
(This ectionneedimahemmpl If 's ane hvndre d ($IW) SEWER-SANITARY-STORM EA.2WPT. ENERGY FEE
or less)
I cervi thatintheperk, enc for whichthie to .nod WATER HEATER W/VEN'I'/ELECIR ��
not employ try person in a as m to orkeri PAID
Compenmtio Lwsof Celifomia. Da WATER SYSTF,MGRPATING Gatst,,,,#) eipt#
O 2+ Applicant
Z O NO❑CE TO,PPLICANT:If,efts mak, I Tic Exemption,you should NEW RESIDENTIAL PLM. SQ.FT. TOTAL:
.�. hcntmembja tolhe Workels Com sen sof the Labor Cale,you must
fonhwith emn ywithsuch prov" vnahall be domed revoked. BUILDING FI
Wer Q- n SEISMIC did'
1 ENDMG AGENCY
Iheabya um Nape 'ser shSee 397,Cigagency for the perfomtwce.f
U O
the work for whi hthis parent issued(Seo,309].Civ.CJ
Lendels Name
U. F Lrmmr'a Address QTY, MECHANICAL PERMIT FEE Pw N IEE if
1..) I emify that 1 have reed this application and state Nat the above information is MECHANICAL F'
correct.l agree to comply with all city unit county ordinances and state lawa redwing to PERMIT ISSUANCE
F-' 00 building construction,and hereby authorize representatives ofthiscity termer upon the
ANTER OR ADD TO MECH. CONSTRUCTION A%
U Z abovemrmionul property far inspection pposes.
(Wv)gar h save,indemnify and keep hsnnlass the City of Cuomo.against 24
ludilities,judgments,consand cit mes which may an my way acerae against said City AIR HANDLING UNGG 010.000 CFM)
incnmcu vof tbo grmingof thio pemtit. AIR HANDLING UNIT(OVER 10,000 CUM)
tgnn
m. Appli / ommcmr - Data EXHAUSTHOOD(W/DUCT) PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 BTU) Date 'eipt#
Will the applicant m future building occupant store or handle hverdous material HEATING UNIT(OVER IM."B'I'U) TO
m defined by the Cupertino Municipal Cole,Chapter9.12,and the health and Safety
Cole.Section 25532(a)T
❑Yes ❑No VENTILATION PAN(SING LIi RFSID)
Will the opplicamorfmurehuilding wampum use equipment ordevirawhich emit BOIL,R-COMP(JHPOR I100,000071'IARSSVhN ILDATF
hazardous air comaminams us defined by the Bay Area Air Quality Management BOILER.COMP ISJOW BTU)❑'Yes L/
District, : APR 201995
Cl❑N. NIiW RF.SIDEN'Ih MUCH. SQ.UL
L
have read the hammoos miner m,re Fdaments under,Chapter,6.95 of ate Cl�� OF
_ ia llealth&gaiety Code.Sections 25505,2553Jand255J4. Lunderstandthat kP�
ilding does not currently have a anent,that it is my reeptmslbihiy to nosily the
of(he rcyuinmentx which n usl he met prior to issporm of a C nifieme of
rey. 06r aathorrrcd agent - - Data '( 1' ISSUED BY:
OF