22062 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
Building m
P 'ed Identification PERMIT NO.
9 Rding Address: 22062
71
8 'd�ic�5 �✓ /zN
one:
LIf�NCITY OF CUPERTINO-BUILDING DIVISION
• ContraRor'e Na ' n // a: APPLICATION 1 PERMIT Z
O G T CO/lI S/ 7 Z�a r}O BU(LDING-ELECTRICALPLUMBINGMECIIAMCAL CATEGORY CONTROL N
hitect/Englae Llc.No:
• y/ "� QTY ELECTRICPERMIT FEE
y� BUILDING PERMIT INFO
Addroa/�'/ C�/•///y0 Uhf/� C�. PERMITISSUANCE
LICENSED CONTRACTOR'S DECLARATION J7S�
I hemby offirmthat l am licensed under provisions o(Chapmr 9(commune. APPLIANCES-RESIDENTIAL TOBDFSCRIPfION
Ingwlth Se ion7000)of Dlvielon3otthe BuNnessand PmfesslonsCode,and
license lsln fug and effect. PANELS .(''� +,`• \
Lken.e Claes �Lie N ZG Q
Date xl*;,/-G_LCoMnRar —UP TO 200 AhTS
T/ —7 ARCHITECT'S EC TION pl"1ro0 AMP"'
DVERIODDAMPS Fr.FLOOR AREA s/• .FT.
��ppuu O I understand my place shall be used u public records. SQ. eQ
Fi Licensed Pmf.ioal SIGNSELECTRICAL (1 t
<6 OWNER-BUILDER DECLARATION T
rn SPECIALCIRCUIT/M15C
7 y., owing yaxermthatiamexempt 31.5,B(mmthe Contractors Lkense LawAny cit or
following reason.(Section 7031.5,Business and Professions Code:Any city or
O county whichrc requires permit tocoatad,alter,hn W 772.1P.METER OR POLE]NST.
CSI" ty qu pe pmca.demsWkorrc Ir
anyatmmere prior statement
t that.a is lice red res pursue t to the
provisor ions;
of
a POWER DEVICES
(� file a signed Yatement shat he b licensed pursuant to the pmWlaa o! the
3w Contractor's License law(Chapter9(mmmendngwith Section 7000).(Divl- .
SOSSWIMMING POOL ELECTRIC
elon 3 of the Business and Professloa m Cade)orthat he is exempt therefroand VALUATION
the basis for the alleged exemption. Any violation of Section 7031.5 by any OITTLETSSWITCH6SFIXHIRES C'
ad mo0 2(,•(, l
65 applicant fora permiteubjecls the applicant to a dvll peltyotnre than t l
five hundred dollars($50Q.
I,as ownerotthe property, NE RESIDENTIAL ELECTR SQjT. STORIES TYPE CONSTRUCTION
7G p pelta,orh, employees wages compeneatlon,wild.Ihework and lheatamre b sat Intermed or o0emd for
O sale(Sec.70py BetsZoand Profassioa Cade:The Contractor's License Law
$ docs not apply to an owner of property who builds or Improves thereon,and OCC.GROUT' RES.UMTS
whodoeseuchworkhlmeelf orlhro.gh hlsownemployeas,provided that such
Impaverants are not intended oroffered forsale.If,however,Ihebullding or s TOTAL:
Imprevmrent bsold withinceneyearofcompletion,the owner-bullderwlll have
tlgprrden ofprovingthat he did not build or improve for purpose otule3. QTY. IS GPERMIT FEE
LL j I,as miner of the PmParty, FLOOD ZONE APN
p p rty,em exclusively contracting with licensed PERMIT
The Co ISSUA
ms to construct the project(Sec.appy Business and Profession Cade: y
The Contractor's Llceae Lw does not apply to an owner of property with
ALTER-DRAIN k VENT ATM MA)
lattice or imprwea thereon,and who contracts ice se I plolem with a
oBtr+ctarexemt pursuant to the ContractorsLicense Law. BACK FLOW PROTECT.DEVICE FEE SUMMARY
.c
[_jl am exempt under Sec B k P C for this rtason
DRAINS FLOOR ROOF,AREA COND. SANI'T'ARY Y N Owner Date RECEIPT p
WORKMAN COMPENSATION DECLARATION FIXTTIRFS PER TRAP SCITOOLTAX Y_ N
[31 hereby.(Ulla that I have•mnl0ote of consent to se141nwrc,ora 4 RECEIPT Y
3BW,iab
mnillWorkers Compewllonlmuranceoracertllbd copythareof(Sec. GAS EA.SYSTEM-1 WCAOUIT.EIS PARK FEE Y N
Abc.C.I
Policy N CAS G.SYSTQ.fAVER 4(EA) RECEIPT N
Com y B UILDING DIVIS ION FE ES
M dcopyb hereby(umlehed. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCI'IECK FEE
edlRed copy Is filed with the city inspection division.
CERTIFICATE OF UEM PrION FROM WORK ERS' CRESSE7RAP PAID _
COMPENSATION INSURANCE SEWER.SANITAIUY-SrORM EA 2WFr. Date Racal H (Sc
(Thisl...) need nal be complMed Itlhe permit later one hundred d.11an s`�'
($1W)oify that
WATER HEATER W/VENT/ELecTR ENERGY FEE Y N
Icertl(y that In the performance of thework(orwhlch this permit bluued,
I shall not employ any person In any manner so in 10 become subject to the WATER SYSIFIN/TREATING PAID
—
Z
I..Compensation Iaof Calitomla. Date
Z Applicant NEW RESIDENTIAL PLMS. SQFT. Date Recel t#
Z O NOTICE TO APPLICANT:](,after making thisCertificate of Exemption,you
Hshould become subject to the Workeri Compentatlon provisions;ofthe Labor TOTAL:
CCN Code,you at forthwith comply with such provision orthis permit shall be (�
j deemed revoked. BUILDING Q
LUCONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirm that them b a construction lending agency for the perfc mf ELECTRIC FEE
M Z arm of the work for which this permit Is lamed(Sec.3097,Civ.C.) TOT L: x L(�
Q O Lenders No PLUMBING FEE
IL I— Lamers Address QTY. MECHANICAL PERM IT FEE MECHANICAL FEE
OW I cenllylhat l have read this appBcetimond Methal lheabovelnfonatlon
a bmrme.I agreeto complywlth all dty and county ordinances and gate laws PERMIT ISSUANCE ql.i� FEE$PAID;
>. N relating to building commotion,and hereby authorize representa0vesofthis
I. Z city to enter upon the above-mentioned property,for Inspection purpose.. ALTERORADDTOMECH.
(W e)agree to save,Indemnify an d keep harmless the City of Cupedln. Date Recel t#
V
• t liabilities,judgments,malsand expense.which may In anyway acme AIR HANDLING UNIT CID 10,000 CFM) SUBTOTAL:
a al CI ns once. egnnt got this permit.l9 AIR HANDLING UNIT(OVER 10,0)0CFM) CONSTRUCTION TAX
Sig.affiri,fAppllnnt/ o dor Date / EXHAUST IIOOD(W/DUCT) CONSTRUCTION TAX PAID:
HA R OUS MATERIALS DISCLOSURE
Will the applicant at future building occupant store or handle haeardous HEATING UNIT(TO 100,000 BTU)
material as defined by the Cupertino Municipal Code,Chapter 9.IZ and the Date RCCeI t# t—
Health and Safety Code Section 75532(x)7 HEATING UNIT(OVER IW,000 BTU) TOTAL: (p
F1Yee No
Will theapplicant ar wmbuildingmc pantuseequlpmentordevicm VEMITLATION FAN(SINGLE REBID) IS ATE
which emit hazardous air contaMant.as defined by the Bay Area Air
Quality Management District? BOILER-COMP OHP OR]OO,IXp BTU) oi� ���
I Yes reNo t
haif.tread lthe hau o&y C.dri Sbdi. l255M, under Chapter 6.95 of BOILER-COMP(OVER IW,Ofp B7U) E
the
understand
t Health k Safety Code,Sections 755e5,have
a tenant,and 75536. 1
understand that notifyithe heocgdant oft emqulyrmat. hichthat It isat NEW RESIDENTIAL MECfI. SQ.77.
responsibility to Issuance
to notify the occupant of the requiremm�b which must be and "N%b'TY'"'eCRnL J
prior to issuance of a Certltlote of Ompanry.
Owner or authorized agent Data
TOTAL: ISSUED BY:
OFFICE COPY