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28282nxz woo xVu �¢rQii Fez Z -M �Fa aW¢ O U 3w� COQ C4 Q c) P,oF14 �F^A 0 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING - ELECTRICAL PLUMBING -MECHANICAL APPLICATION/PERMIT BUILDING DIVISION BUILDING PROJECT IDENTIFICATION PERMIT NO'28282 L ^ 8 Z V Z BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE % UNIT # LOT # OWNFSdNAME: PHONE: CO RAC OR'S AME: LIC NO: L� -O IL N/C 0 CONTROL # ARCHITECT/ENGINEER: LIC NO: ADDRESS: CONTACT: PHONE: QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO ELECT PLUMB MECH PERMIT ISSUANCE ❑ LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and e 2 C License C_la�ssrLic. # o"6SI APPLIANCES - RESIDENTIAL JOB DESCRIPTION PANELS UP TO 200 AMPS Dale S Contractor ARCHITECTS D CLARATION 1W.({J,-r-n I understand my plans shall be used as public records. 201 - 1000 AMPS OVER 1000 AMPS SQ. FT. FLOOR AREA $/S. FT. Q SIGNS ELECTRICAL Licensed Professional - OWNER -BUILDER DECLARATION SPECIAL CIRCUIT/MISC. I hereby affirm that I am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county TEMP. METER OR POLE INST. which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement POWER DEVICES that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) SWIMMING POOL ELECTRIC VALUATION or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of -� OUTLETS -SWITCHES - FIXTURES not more than five hundred dollars ($500). [IS L as owner ofthe property, or my employees with wages as their sole compensation, NEW RESIDENTIAL ELECTR _SQ.FT. Q STORIES TYPE CONSTRUCTION will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, OCC. GROUP RES. UNITS TOTAL: however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or improve for purpose of QTY, PLUMBING PERMIT FEE sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to FLOOD ZONE APN construct the project (Sec. 7044, Business and Professions Code:) The Contractor's License taw does not apply to an owner of property who builds or improves thereon, and PERMIT ISSUANCE who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ALTER -DRAIN &VENT -WATER (EA) FEE SUMMARY ❑ 1 am exempt under Sec. B & P C for this reason BACK FLOW PROTECT. DEVICE OUTSIDE FEES SANITARY Y N RECEIPT # Owner Date WORKMAN COMPENSATION DECLARATION DRAINS - FLOOR, ROOF, AREA, GOND. SCHOOL TAX Y N iereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance ora certified copy ereof (Sec. 3800, Lab C.) which RECEIPT # FIXTURES - PER .CRAP PARK FEE Y N GAS - EA. SYSTEM -1 INC. 4 OUTLETS covers all emp�' ythis pe 1 -� Policy # / ,? RECEIPT # BUILDING DIVISION FEES GAS - EA. SYSTEM -OVER 4 (EA) PLANCHECK FEE COm�ny (Ce ified copy is hereby furnished. GREASE/INDUSTRL WASTE INTERCEPTOR GRADING FEE ertified copy is filed with the city inspection division. CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS FEE COMPENSATION INSURANCE .•-3`EW$R SFt'1CTARY"`STORM EA. 200FT. ENERGY FEE (This section need not be completed if the permit is for one hundFelll>�lars ($100.} or less.) ' I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner �o as to -become subject to the Workers' Compensation Laws of California. Date t.,, t �� a 2 A I WATER HEATER W/VENT'kLECTR PAID Date Receipt # TE S M/fREATIN%1'r ApplicantT�r SI AL PLMB. SQ. FT. T NOTICE TO APPLICANT: If, after making this Certift to of xem ti y s d become subject to the Worker's Compensatibn provision e ab e ut forthwith comply with such provisions or thjs permit shite re 1 / oel BUILDING FEE i TOTAL: SEISMIC FEE CONSTRUCTION BENDING AGENT w � I hereby affirm that there is a construction lemg agen the work for which this permit is issued (S 3097iy, C.) ELECTRIC FEEt Lender's Name •y - _ - = fie? � � "AL PERMIT FEE PLUMBING FEE Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE MECHANICAL FEE building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. CONSTRUCTION TAX (We) agree to save, indemnify and keep harmless the City of Cupertino against liab' i es,judgments, costs and expenses w 'ch may in any way accrue against said City AIR HANDLING UNIT (TO 10,000 CFM) in equence of the granti is i P AIR HANDLING UNIT (OVER 10.000 CFM) Signature of Applicant/Contract Date EXHAUST HOOD (W/DUCT) PAID HEATING UNIT (TO 100,000 BTU) HAZARDOUS MATERIALS DISCLOSURE Date Receipt # HEATING UNIT (OVER 100,000 BTU) IRTAV JqD Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)?() 0 Yes O --o NISSUANCE VENTILATION FAN (SINGLE RESID) DATE Will the applicant orfuturebuildin ccupantuseequipment ordevices which emit hazardous air contaminants as def by the Bay Area Air Quality Management District? ❑ Yes o I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that if the builifiV does not currently have a tenant, that it is my responsibility to notify the BOILER -COMP (3HP OR 100,000 BTU) k:--' Arr V `' ` 66AA i �g�� '�' '-' U_ C , BOILER -COMP (OVER 100,000 BTU) NEW RESIDENTIAL MECH. SQ. FT. occur f he require is which mu t7pri issuance of a Certificate of /b�.t,riet Occul t '��21ri ISSUED BY: Owner authorized agent Date TOTAL: OFFICE 7648 Xewcastle Dr. CITY OF SAN JOSE BUILDING DEPARTMENT PLICATION FOR!JDING PERMIT LL Date. t --•----------•-------------- 9-&-'z--- Permit No. -7, ---------- -------------- Application is hereby made for a permit to ----------------- ----------------------- a ------- / ---story, Type---------- --------------- ------ ------ Building A ------ to be occupied only as --- / --------- f � in accordance with Plans, Specifications and. pr6 -plaf filOct, rewif d i. Estimated Value of Improvements, ------------ It is hereby agreed that the requirements of the San Jose Building and Zoning Ordinances and all other laws applicable to the construction, location, and use of buildings within the City of San Jose, will be complied with. I certify that in the performance of the work for which this permit is issued I shall not employ any per. son in any manner so as to violate the workmen's compensation laws of California. 16155 Greenwood Lane.' JORNSOR Ho Er M Owner I ----------- - ------ Address ---------------- - --- - ------- - 16155 Gree Woo -1-3 By 4 2 -------- ------- ------ --------- Address --- -------------- ------------ ------ q z - --- ------ ---- aly -- - ----------- Agent Los Gatos, California Form 280-1 RECORD OF INSPECTION 4. Foun a aiihe��• • F 2 --------------------- -------- ✓ cco r. " " -------------- Finish ................ c E Gid 9 C, 7648 New Castle Dr. q Building Permit Confirmed ❑ Not Required __Q_ CITY OF SAN JOSE BUILDING DEPARTMENT APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT 7—r�— Date _ -------------- _------- ----------------- ------ 19.7 Permit No..---1D1�-V-----------------------' 6 The undersigned herU""w spector of the City of San Jose for a permit to install pthe reverse side. Exemption from requntractor's License is hereby claimed by undersigned: tatement filed Q-2 F/ 2 3 , Undersigned attests that his State of Californiapfr or'sLicense _ •C is in full force and effect and properly authorizes thitio , San Jose City Business License # I certify that in the performance of the work for which this permit is issued I s ll not employ any person in any manner so as to violafe the workmen's compensation laws of California. OWNER VA L_C O ADDRESS ?6 `f o�F A,&4-'C'A S -7 -4 -CZ Z? Lot No. USE OF BUILDING—r"- 280-30 UILDING rieo-ao Signed =` --------- 7648 -Few Castle Dr. Ace