24405 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO.
a24405
Building Address:
v ll+
wners are: hone: APP11CA LION SUBMI It AL DA IF
4t6710940 CITY OF CUPERTINO-BUILDING DIVISION
Contractor's Name; APPLICATION / PERMITLieu P-)l '3403 �0 2-
BUfLDING-ELECTRICAL-PLUMBINGMECt1ANICAL CATEGORY
Archite t/Engineer: Llc.No:
QTY ELECTRICPERMIT FEE BUILDING PERMIT INFO
Add. PERMITISSUANCE I 1�TI ❑
LICENSED CONTR under provisions
IMrcectionby rmthat l ivsionsed 3.(tha untrumislaneofChol...C(a,.d APPLIANCESRFSTDEMfAL OBD N
legwith1.1.fin7000)a Division oltheBukmssand Pro(eWonsCode,and my
I^
lianas le in full end effect PANELS
3 . PANES
Llcen CV LICY T
Date Contractor
ARCHITECT'S DECLARATION 201-1000 AMPS
tEN 5/sQ.FT.
2Z lundentand my piano shall be used sspubOcremrdd. OVER 1000 AMPS LSQ,FJ.dQORA
Z Licensed Prolesslonal
SIGNS ELECTRICAL E �1E6JJ\'
6 OWNER-BUILDER DECLARATION SPECIALCRCUIT/M1SC
�7 Ihereb afRrmlhatlam exeenpifromthe Contractor's L Code:Law fm the
qppppp following reason.Fectlon 7031.5,Buslnen and Professions Code:Any erty or
t" county requires permit tomntmct,alter,Improve,demollsh,oreeparr 7EMP.MBTER OR POLE INSf. I
anyetmcW prbrtoibbkaame,alsorequirestheeppllantforeuchpermltto w♦
ROWER DEVICE'
file a signed statement that hlicensed pursuant to the pmvialoru of the
e b VA
Ow Contractor's LicenseLaw(Chapter9(commencing O res SWIMMING POOL ELECTRIC
Yon3ofthe Buslnnsand Professi.r Code)orthatheisammptthomfmmand 1ALUA1,
p5F S the basis for the alleged exemption. Any violation of Section 7m L5 by an
jo
1;1 G sppllmntfora permit dubjectetheapplim.tloa civil penaltyofnat morethan U7LE7SSWHCFIFSHXTURES
Ivchundred
nerdelta.the pro NEW RESIDENTIAL ELECTS SQ.Fr. STORIES{` J TYPECONSTRUCTION
❑Las owner of the properly,or my emplbe oyees n with wages r their dole
ole 5m.70K
wmkanskovi Cd,:The Concedert Intended or offeredLaw
� sale(Sec 7044,Business and Professlov Code:7he Contractor's Llcerke Law
�$ don not apply to an owner of property,who builds or improves thereon,antl OCC.GROUP RES UNITS
whodaessuchworkhl Lforthroughhlsownemployees,providedth.tmch
Improvements are not intended orolfered forme.IL however,lhebullding or
Improvement b sold within omyearofcompletim,the owner-bullderw111 have
t e rden of proving that he did not build or Improve for purpme olsale.). QTY, PLUMBING PERMIT FEE PfDOD7DNE APN
Lj L as owner of the property,am exclusively matnering with licensed PERMIT ISSUANCE .mar
contractors to continuer the project(Sec.7014,Business and Professions Code:
The Contractor's Lim.law does not apply to an owner of property who ALTER-DRAIN VENT WATER(EA)
Wilda or improved thereon,and who contracts for such p ojem,with a - FEE SUMMARY
on}'E(dm(s)11...d Pursuant to the Contractor's License Law. BACK FLOW PROTECT.DEVICE
LII am exempt under See. B A P C for this reason
OwDate DRAINS FLOOR ROOF,AREA,COND. SANITARY Y N
ner BBC=Y
WORKMAN COMPENSATION DECLARATION IV(TURFS PER TRAP SCHOOL TAX Y N
QI hereby dorm that I have a certificate of concent to self-Inwm,or RECEIPT,Y
certificateofWorkers'Comperwtionlnurance ora certilled copyth..f(See,
3800,Lab C.) GAS CA.SYSTFM-i INCA OUTLETS PARK FEE Y N
polity Y REC ITT Y
Com an GAS PA.SYSIRM-OVER4(EA)
Y BUILDINGDIVISIO FEES
Certified ropy is herebyth the ad.city GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEtRemi
Certleed copy b filed with tiara city Irupenlon division.CERTIFICATE OF EXEMPTION PROM WORKERS' GREASETRAP PAID
COMPENSATION INSURANCESEWERSANITARY-STORM EA.200IT. DatC(Thlssection need not becompleted ifthe permit bforonehundred dollarsythWATER HEATER W/VENT/ELECTR ENERGY FEE /Y]artily that o the performance ny m work so asto b this permit c Wued, `(�y1 shall not employ any person In any nunner n es to become subject tothe WA77R SYRTEM/TRFAHNGWorkers'Compensation Laws of California. Date PAID
O Z AppllantZNOTICE TO APPLICANT:U,after making this Certificate of P.xemption,you NEW RESIDENTIAL PLM3. SQ.FL D hould become subjM to the Workers'Compemuation provisions olthe Labor
W Code,you mu at forthwith cemplywithsuch provblont orlhb perndtaha11b.
deerd revoked. BU
W
rcC CONSTRUCTION LENDING AGENCY SEISMIC TE
I hereby affirtnthat there Is a mntruction lending agency forthe perform- ELECTRIC FEE
Z ance ofthe work forwhlch this permit b bound(Sec.3097,CIv.C.) Sn
02 landae.Name PLUMBING FE —�^
IL F Lcnder.Addrx. QTY. MECHANICAL PERMIT FEE MECHANICAL ••E
O W 1mdlfythat l have read lhbappllatsuand statethatthe abovelnformation
1 ismrrect.I agree to comply with all city and county ordinances and Yate laws PERMIT ISSUANCE FEES PAID:
} W relatingtobulldingcontructlan,and herebyaulhmiaerepredentativeeofth]
(— Z city to enter upon the ab..meraloud propertyforbapection purposes. ALTERORADDTOMECH.
(We)agree to save,indemnify an d keep harden the City of Cupedlno Date Receipt#
V against liabilities,tudgmenb,mks and expensed which may in anywayaame AIR HANDLING UNIT CPO 10,000 CFM) $ TOTAL:
agdrut aid City m consequenceof the granting d this permit.
AIR HANDLING UNIT(OVER I0,000CFM) CONSTRUCTION X
Signature of Applicant/Contractor Data IXI(AUST HOOD(W/D(K)T) CONSTRUCTION T XPAID:
HA7AR DOUR MATERIALS DISCLOSURE
Will the applicant or furore building occupant store or hand Is harardom HEATING UNIT(TO 100,00(]BT"
materialas defined by the Cupedino Municipal Code,Chapter 9.12,and the Date RC C' t#
IImIth and Safety Cod a�+-S�ection 75533(.)? HEATING UNIT(OVER 100,000 BTU) T T
fI Yes u No
Will the appllant orfuture building occupant use equipment ordevices VENTILATION FAN(SINGLE RFS ID) ISSUANCE DATE
which Smit hazardous air contaMvnb as dented by the Bay Area Air
Quality Management District? BOILER-COMP OHP OR 100,000 BTU) 'P A 0 D
Yen 9 No —
havemta ralthhe a Safety
Code,Sections
25555533 and 25534.
of BOILER-COMP(OVER 100,000 BTU)
theerstand t Heathe lthbSafetyCode, otcurn75505,ve a tend,that 1 OCT 29 1992
understandthatI.rally
the occupant
of the require encs tenant that It boy NEW RESIDENTIAL hfECfT. SQ.Ff
responsibility to racily the ocmpant of the requirements which must be met
rior to lssuagFe ofa o! panty. CI\IIYY yU_k- GLJI
LJ1r
roraut re agent I Date ISSUEDBY: mal/�Kk
70TAL:
OFFICE COPY