27826 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO Bull,":11 EL.LTHI AI. PERMITNO.
BUILDING DIVISION APPLICATION/PERMIT PING FROMCP IDENTICAL 27826 7 8 2 6
IfUII.UINO I'R(FJEC'1'IDISN'I'IFICAT'ION G Gtr
BUILDING ADDRESS: Vita,
A P ./�s y/' SANITARY NO. APPLICATION SUBMMPPTAL DATE
90-386 V �W I r/o/ lin 0 UNIT# Alan �LOTN �q�+gJ;�.
ME-9A,6"
ERS NA.MFJU�FTs PHO CONTRACTOR'S ME: LIC NO: 1r
,s A,6" om DEs Wnag^ N/C CONT'll
•ARCHITECT/ENGINEER: .IC NO: (�V_x' ADDRESS: ❑
CONTACT: PHONE:
QTY. ELECTRIC PERMIT F88 BUILDING PERMIT INFO
BLDG ELECT PLUhI� MECIL
lee er PERMIT ISSUANCE IICpF(s' A'f�`l'r �(rY]( rLk7/
LICEN IDCONTRACTOR'SDECLARATION APPLIANCES.RESIDENTIAL JOB DESCRIPTION
M=Z I hereby affirm that l inn licensed underprovisionsufatfacr9(cmnmenciagwith
W00 Section 7")of Division 3 of Ne Business and Professions Cade,and my license is in PANELS
FyZ fuBfmaeand affect.
< Lll for ClassLia# UI'T02W AMPS
may
Data Cmmncmr 201-IOW AMPS
ZOyZ ARCHITECTS DECLARATION OVER PEN AMPS SQ.PT.FLUOR AREA E/SQ.Fr,
OZ-0 I understand my plain shall h used as public reomoda
f.y al SIGNS ELECTRICAL 93 5—
Licensed Professionnl 6
OWNER.BUILDER DECLARATION SPECIAL CIRCUIT/MISC. /./,J(
OyF I hereby am ffirThat I ma exempt from the Contractors License Low for the //V s
1+134,m following reason.S.ion)031.5,Business and Professions Code:Any city.,county TEMP.METER ON POLE INST.
f.5�g which requires a Permit o construct,after,improve,demolish,or repair any swctum POWER DEVICES
m Y� prior 1.its issuance.also na,mmslheapplicanl for such permit In tile.signedstammem
Op that he is licensed pursuant to the provisions of the Commerce.Licama Law(Chapter,
dyeW, 9(commencing with Section 7")of Division 3 ofthe Business and Professions Code) SWIMMING POOL ELECTRIC t VALUATION
;Z>
x Z_ Sethat hection?31.5 by exempt therefrom the Permit
tsthedexemant to Any civil Penalty
of OUTLETS-SWITCHES-FIXTURES 6'
FZ> Section?03LSvea hundred
($50rit suM1jects the epplicunnoacivil penahy of Ok
not mom Nan five hundred dollen(ESW).
❑ LasownerofNe property,ormyemplmyeeswithwagesustheirsulemmpcnsmion, NEW RESIDENTIAL F.LECTR —SQ.IT. STORIES TYPE CONSTRUCTION
will do the work,and the structure rands int=ndedoroffered forsale(Sce.7w,Businass
and Professions Code:The Contractor's License Law dates not apply to an owner of
property wh.buildsorimprovesthersem,and whoduessuch work himselforthraughhis
employees,provideJ Nin such impmvememsme not imm�hd.roflercJ forsule.If, OCC.GROUP RES.UNITS
however,the buildingor imProvemem is sold within are year.(completion,theowner- TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I,as owneroflhe Property,amexalusivdy convecting with licensed contmctorsto QTY, PLUMBINGPERMIT FEE FLOODZONE APN
comfort the project(Sec.704,1,Business and Professions Code:)The Combactars
License Law does not apply(ommwncrofpmperty who builds or improves thereon,and PERMIT ISSUANCE
who contracts for such projects with a contncmr(s)licensed pursuant to she Conuactoes
License Law. ALTER-DRAIN&VENT-WATER(EA) FEE SUMMARY
❑ 1 am exempt under Sec. ,B&P C far Nis reason BACK FLOW PROTECT,DEVICE. OUTSIDE FE
SANITARY Y N
Owner Data RECEIPTp
DRAINS-FLUOR.ROOF,AREA,GOND.
WORKMAN COMPENSATION DECLARATION SCHOOLTAX YN
❑Workers
Co pen thn Ins...crm.riamrirdopythrosd`Si um,m L.ICO)ahiof RECEIPI'p
FIXTURES-PER TRAP
Wnrken'C.mpensutl.n lnsumnae ora arti0ed copy thereof(Sec.3gW,Leb G7 which PARK FEE Y N
anvers all employer's under this Permit, RECEIPT It
Policy N GAS-EA.SYSTEM-1 INC.a OUTLETSRECEIPT
DIVISION FEES
Company GAS-EA.SYSTEM-OVFR4(EA) PLANCHECK FEE
[2D
Cmifedcapyishmi
erebyfushed.
❑ Certified copy is filed with the city inspection division. GREASFJINDUSTRL WASTE INTERCEPTOR GRADING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This seclion need not be completed if Ne peril is border,hundred dollars($100) SEWER-SANITARY-STORM HA.200FT. ENERGY FEE
tor less.)
I certify that in the performance of the work for which this permit is issued,l shall WATER HEATER WNENTMLECTR
nm employ any perm.in any mann=,an as to hcome subject m the Workers PAID
Compensation"assof CWifomia. Date WATER SYSTEMITREATING Data Receipt#
0 z Applicant
z2 NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
rIn hcome subject to the Worke/s Compensation provisiomafthe Labor Code,you muss
7 forthwith comply with such provisions or this Permit shall be deemed revoked. BUILDING FEE ' 7z/,
Lit o CONSTRUCTION LENDING AGENCY SEISMIC FEE , 70
1 hereby afFlr that hem is a construction lending agency for the performance of y
U O the work for which this Permit is issued(SIL.3097.Civ.C.) TOTAL: ELECTRIC FEE
Lender's Name z#
V. Lender's Address QTY. MECHANICAL PERMIT FEE PLUMBING PEE STP
U 1 certify that 1 have read this application and state that the above information is MECHANICAL FEE
/ &.01>" d correct.l agree m comply wish all city and county ordinances and sum laws relating m PERMIT ISSUANCE
building consvuctimn,and hereby eulh.rim representatives o(thiscity mcnteruprn the CONSTRUCTION TAX
U Z above-mentioned progeny for Inspection purposes. ALTERORADDTOMECIL 3491fiabolkJ
(We)agree nt save,s andexpe and keep mayinanyway
Ne accrue
against {,/
no,oilica,judgmems,cosnand of this Permit. may in any way accrue against suidCisy AIR HANDLING UNIT(TO IO,OW CFM) Hi a 7S6
in conseyue of the gaming of this peril.
�K__�i__ AIR HANDLING UNIT(OVER I U."CFM)
Sire ofA�talCu I Delc EXHAUST HOOD(W/DUCD PAID
HAZARDOUS MATIIUALS DISCLOSURE HEAPING UNIT(TO IW,"BTU) Date RecciP#
Will the applicant or future building occupant store or hundle hanrdaus mamdal
as darted by the Cupen'mn Municipal Code.Chapter 9.12,and the Health and Safety HEATING UNIT(OVER IN."BTU) TOTAL:
Cede,Section 25532(a)?
Cl Yes El No VENTILATION PAN(SINGLE RESID) p 63
ISSUANCE DATE
WillthcupplicanmrrumrcbuilJing.ccupum uxequipmem.rdeviceewhichemit
BOILER-COMP(3HP OR 100.000 BTU)
• Iosomal us air commandants es defined by the Bay Amo AU Quality Management BOILER-COMP(OVER IW,00)BTU) � p
Distrin't W
❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FT.
1 have read she haamd.us materials requirements under Chapter 6.95 of the IWAR 29 199
ifthe buil IIdlhb&Salary Cal=,Sections 25305,25533 and responsibility
1 understand thin
ifthebuildingdcesnot aunts whave ast be That is is myyssuaceoflu to madly Ne occupant of the requirements which man h met prior to issuance of a Certificate of coG (�
aa r !
pan=r.
Owner or amboriated agent Data TOTAL: ISSUED BY:
OFFICE