26826 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO APPLICATION/PERMIT JuJI'IANG—AL PHRMTT NO.
BUILDING DIVISION PLUMBING-MECHANICAL
BUILDING PROJECT IDENOLCAI]ON
26826 6VL6
BUILDING ADDRESS: Gra ��'�'�'�{ s]�\� A c L e SANI'PARY NO, APPLICATION SUBMITTAL DATE
R 2-
LOT is -n_iWR
PN t.OIfsff $N,ME�7 o::6
� PHONI?: NTRACfOR'S NAME: LIC NO: I N/C CONROL#
ky
CRCI 1111CANGINHER: LIC NO: RESS:� W N ❑
4
'ONTACI•: PHONE:
t QTY, rLEC17RIC PERMIT PEE BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL 109 DESCRIPTION
ptyz, Iherebyafrirmthatlamlicens underpmvisionsof Chapler9(e mmencingwitM1
Vm0W0[ Section 7000)o(Divlsom Sof Nm Bmineesand Pmfeesions Code,end my license is in PANELS
,dE full force and eRect.
I,
to License Class Lic.e UPT02MAMN `
m<y Date Commnmr 301-IOW AMPS
Fy Z_ ARCHITECTS DECLARATION SQ.FT.FLOOR AREA f/SQ.FT.
O Z N❑ l understand my plena shall be mrd as public raords. OVER IOW AMPS _
F m F ul SIGNS ELECTRICAL
<Yj Licensed Professional
OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
KWW U 1 hereby affirm that I sin m N
exempt from Ca ractole Lt..Law for the
trl3¢y following easonSmile.7031.5.Business end professions Cade:Any city orcounty TEMP.METER OR POLE INST.
which inquires a permit to construct.ober,improve,demolish.a repair eny strumme
prior to its issuwce,also requires thespp4iturn I...ch permiao Gleaeignakuncmem POWER DEVICES
ty C p that he is licensed pe rsuaa to the provisions of the Contractors License Low(Chapter
R' e� 9(commencing with Section](N1of Division 3ofthe Business end Professions Cedm) SWIMMING POOL ELECTRIC VALUATION
WM,, or thin he is exempt herefrom and are bmisfor the alleged exemption,Any violation of OUTLETS-SWITCHES-FIXTURES
FZy Section 7031.5 by any applicant far a permit subjects the applicant to a civil penalty of
not more than rive hundred dollars($500).
❑ I,ns.wnero(theprsryeny,ormyemployaswith wegnas Mcirsole comperimina, NEW RESIDENT _SQ.FT. STORIES TYPE CONSTRUCTION
a3— will dothe work,end the structure isnot intended proffered fdrsule(Sm.ID44.Business
and Professions Code:The Contractor's Lican,Low does not apply to an owner of
pmpeny,who builds or improves thereon,and who dors such work himselfnr through his
own employees,provided that such impmvemalsam not intendcloroffered for sole,If. OCC.GROUP RES.UNITS
however,the building or improvement is sold within one yeurofeompletion,theowner- TOTAL:
builder will have the burden of proving that he did not build or improve for purpose of
sole.).
❑ I,as ownerofthe property,am exclusively contracting with licensed rontmcums w QT' PLUMBING PERMIT PTE ROOD ZONC APN
construct the project(Sec.7044.Husiness and Professions Cale:)Tin Contrador's
License Lawd.es not apply to on ownero progeny who builds or ire rmves thcse.n,und PERMIT ISSUANCE asassawsf
who contracts for such projects with a contractions)licensed pursuant(a the Contractor's
License Luw. ALTER A)
[ZEE SUMMARY
❑ 1 sin exempt de(Sce. ,B&1'C for,his reason BACK FLOW PROTECT.DEVICE OUTSIDE FRES
SANITARY Y N
• $- Owner Date RECHIPTp
DRAINS-FLOOR,ROOF,AREA,GOND.
WORKMAN COMPENSATION DECLARATION SCf1001.'TAX Y N
❑ Iherehy affirm lh.tlhaveacenifcatc of consent to sel0innum,ora ccrti0ce,e of /1� REC131PTp
Waken Compensation lnsurmnce nru certified copy thereof(Sec.3SW,Lnh CJ which FIXTURCS-PER TRAP L, PARK FEE Y N
..vert ail mmpinyee's under this permit.
." � -1 INC.40UTLE RECEIPT g
Ty Policy GAS-EA.SVSTIM
BUILDING DIVISION FEES
Company GAS-RA.SYSTEM-OVER 4(EA) PLANCHFUK FEE
❑ Certified copy is hereby,famished.
❑ Certified copy is filed with the city inspection division, GRPASEANDUSTRL WASTE INTERCEPTOR GRADING FEE.
CERTIFICATE OF RXEMPHON FROM WORKERS' GREASETRAP SOILS FEE.
COMPENSATION INSURANCH
(This section need not b,can,itul plate permit is for one hundred dollm($IN) SHWER-SANITARY-STORM EA.201 ENERGY PER
orlmssJ
I mil her in the performtrceifthe workfdrwhich,his permit is issued,l shall WATER HEATER W/VENT/HUX7R
not employ say permit ,n eny manner im as w become subject to the Wdrkrns PAID \ /�
Compensation Lowaof Califomie. Dude WATER SYSTEM/IRFATING I tete "� Recei g
0 z Applicant
z NOTICE TO APPLICANT:If,after making this Cadicale of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. U, V TOTAL:
(, > badme subject w the Workers Coons or this Previsions of the Labor Code,you mit
a > fonhwitM1 comply with such Provisions or Permit shall oddamed invoked. BUILDIbWER
CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z 1 hereby affirm that there is a contraction lending agency for the Perfamence of
U O the weak far which this pmmit is issued(Sec.31197,Civ.c.) ELF.CfRIC IEE
Lenders Name PLUMBING FEE
Q U Leaders Address QTY. MECI IANICAL PERMIT FEE
1 certify that 1 have mad this application and state that thea ve infant tion is
>• 0. correct Ire rawcom I thallcit dcount Nin and me laws ctrl. to PERMIT ISSUANCE MECHANICAL FT:E
n gyral yon y. g
U) building construction,and hereby aothmdre mpresentsti a hi . n nthe
U ,z above-mentioned property for inspection purposes. ALTERORADDTOMECH. CONSTRUCTION'/ X
(We)agree m save,indemnify and keep haemes If ninu g410.
liabilidia,j ems.. end ex set which may in enyw cuc est said City AIR HANDLING UNIT(TO 10,000 CFM)
on. of dh fing.f Nr omit,
n F AIR HANDLING UNIT R 10,000
ig o Appli. ontrecmr Date EXHAUSTHOOD
PAID
HAZARDOUS MATERIALS DIS SURE HEATING UNI ,000 B D.J. Receipt g
Will the applicant or future building occupied std rhuralchazurddmmatedal
asdefinedbydheCupenino MunicipalCW.,Ch.pmr9.l2,anddhellwlthand Safety HEATING 1 0 ER
Code,Sisal..25532(11)? VENTI pN(SIN RESID) u t
El Yes ❑ N.
. l
BOILER-CO (3 POR IW/XgI BTU) �/I�mY UAN ATE
Will theupplicantorlmure building occupamum equipmcmordeviceawhichemit �T Cl� r
loxadom air commitment,ss defined by the Buy Area Air Quality Manag maA BOILER-COMP(OVER 10(1,000 BTU) r Q7 jp
District? v7
❑Yes El No NEW RESIDENTIAL MECH.—SQ.PT. 's_ r
I have read the hazardous materials requirements under Chapter 6.95 of the �bU/.�•I///t/
Cnlifmmiu lleuhh&Solely Cale,$cai.ns 25505,35533
d25534. I un la vit d shat r I
if the building does not currently have a tenant,that it is my responsibility to notify the
occupant of the requircmen,s which must he net prior m issuance of a Ccnircate o[
Occupancy.
Owner m antlmdrad agent Dale TOTAL: ISSUED BY:
OFFICE