27056 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
UITY OF
UUPERTINO BUILDING-EI.F. RICA]. PERMITNO.
APPLICATION/PERMIT PLUMBINGE TIICHANIFIC 27056
1{UILDINL'U[VISION BUILDING PROJEC"I'IUY:NTIFICA'1'ION
BUILDINGGAADDRESS:. - ��0/ SANITARY NO. APPLIC TIONSUB TITALDATE
R M5555 UNIT LOT#
0 NEE: PHONE CONTRACIOR 5 NAME: LIC NO: N/C CONTROLq `
eller- s �i
UiCIIITECT/ENGINEER: LIC NO: ADDRESS: ❑
u tiG
ONTACT: PHONE:
QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Zs�- J PERMIT ISSUANCE @}L� ELECT PLUMB MECH
❑ ❑ ❑
LICENSED CONTRACTORS DECLARATION APPLIANCES RESIDENTIAL
OKZ Iherebyaffinnthatl a mlicenudmderprovisionsof Chapler9(commencingwith TOB DESCRIPTION
WOO Section]000)of Division 3 of the Business and Professions Cade,and my license is in PANELS
I-W[F-� fu11 force and effect.
MVV --3� UP T02 AMPS
1<5 W ',umme Class pia.M
rn<y Uam ConTSD 201-1000 AMPS
Z Ov Z ARCHITECTS DECLARATION SQ.FT.IltPO EA SQ,FT.
OZ-0 I understand my plans shall be used m public records. OVER 1000 AMPS
r Int; SIGNS ELECTRICAL.
,1�W Licro'ed Poefevaidual
zf qm< OWNER-BUILDER DECLARATION SPECIAL CIRCUITIM]SC.
OW, 1 hereby affirm that 1 am exempt from the Connectors License Law for the
W3WrFit following match(Section]031.5.Business and Professions Code:Any city or county TEMP.METER OR POLE INST. n
F', which requires a permit m cum,.ue1.alt¢,imprnve,demolish,or repair any Amctam
�.¢� to its issuance,also re the licant for such tto file a si dstatemem POWER DEVICES
prior requires Pp pemri 6ne
W C OO that he is licensed pursuant the Provisram of the Contractor's License Law(Chapter
ddoLL 9(carromming with Section 7")of Division 3 of the Business and Professions Code) SWIMMING POOL ELECTRIC ALtuTtrut
W=m or that he is exempt therefrom and the basis for the alleged exemption.Any violation of /�V'�'
p.Za Section 9031.5 by any applicant for a Permit.cubjmty the appl lcual m a civil penalty of OLD LETS-SWITCHES-FIXTURES
t more than five hundred do[].($5010). NE RESIDENTIAL-ELECTR S .FT.
oc, ❑ I.aownerofthepmp ny,ormyemployeeswithwagesmthcirsolecomp matioo, Q IFS �,CO.NSTRUCf10N
will dothe work.and the shucture is not intended oroffereA forsale(Sm.9044.Business
and P vm1,im s Cale:The ConOators License law does not apply to as owner of
pmperty whobuildsorimproves thercma,and whodoes such work himselfor through his
cmpinyees,provided lhmsuchimprovemermarenol inleaJedoroffered Russia.If. C.GROUP RES.UNITS
however,the buildingor improvemem is sold within one yearofcompletion,the owner- TOTAL:
builder will have the burden of proving Thar be did not build or imprnve for purpose of
sale.).
❑ I,usnwncroftlot Propevy,am exclusively comatietlng with liceoacdennlracmrs m QTY. PLUMBING PERMITFEE FLOOD , E APN
construct the Project(Sec.9044,Business and Professions Code)The Contractor's PERMIT ISSUANCE
License Law doe a not apply to an owner mf propery who builds a improves thereon,and
whocontmctsfor such projects with recreational licensed pursuant to the Contractors ALTER DRAIN&VENBEA)Liccn,d Law. ) FEE SUMMARY
❑ 1 am exempt under Sec ,B&P C for this reason BACK FLOW FRUIT=DEVICE OUTSIDE FEES
SANITARY Y N
Owner Dam
DRAINS-ITOOR.0.00F.ARPA.COND. RECEIPTp
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
II ❑Workers
Coyaattiu Insave a urance
orama¢of eonsemmof(Semre,or Lab C.)amofwhich FIXTURES-PGR'I'RAP RECF.IPfp
Wnrkcrti Gompcnsmionlnaurana oracenifeJ copy nherco!(Sec.3g00,Lab C.)which PARK FEB Y N
cars.all employee's under this pemtit GAS-EA.SYSTEM.I INC.4 OUTLETS RECEIPI'N
Policy N BUILDING DIVISION FE-ES
Company GAS-FA.SYSTEM OVER 4(EA) PLANCHF,CK FEE
❑ Certified copy is hereby furnished.
❑ Cenificd copy is filed witM1 the city inspection division. GREASEIINDUSTRL WASTE INTERCEPTOR GRAVING FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASF,TRAP SOILS FEE
COMP17NSATION INSURANCE
('Ibixseen -odruabeeuntplmed ifthe p—mitis fmnme hindreddollam($IW) SEWER-SANITARY-STORM EA.200]T. ENERGY FEE
or less.)
I moue on in the performance of the work for vehichthn,permit is issued.l shall WATER HEATER W/VENT/ELECfR
not employ any person in any manner sat as ,Mcyo bjet,to a Workers' PAID
Cam fica � �e y'°-G`�}
O Z A ,wrualicn Lawes f 11�if�r`.�. 99 WATER SYSTEM(fREATING Date Reccipl N
Z NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you ould NEW RESIDENTIAL PLMB. SQ,FT. TOTAL:
(q becomesubjeet to the Workers Compensation provisions ofthe labor Cade you must
> forlhwith comply 1 with such provisionsorthis permit shall be deemed revoked. BUILDING FEE Imo'
6. Q CONSTRUCT ION LENDING AGENCY SEISMIC FEE
Z 1 hereby affirm that hem is a construction]ending agency for the performance of
U C) the work for which this pertrdn is issued(See.3099,Civ.CJ TOTAL: ELECTRIC FEB
Lender's Name
0 F Lender's Address QTY. MECHANICAL PERMIT FEE PLUMBING FIAT
U U I mm y that 1 have read this it,heatian and smm that the above information is MECHANICAL.PEE
correct.l agree to comply with all city wool county ordinances and sone laws relating to PERMIT ISSUANCE
f-' buildingeonsnunion.and hereby authorize representatives ofthischy memerupan the CONSTRUCTION TAX
U Z alone-mentioned properly for inspection purposes. ALTER OR ADD TO MECH.
(We)agree to save,indemnify and keep harmless the City of Cupenino against
Iiabililics,edgmeno,cos¢and expenses which may in any way wermagaimt said lily AIR HANDLING UNIT(TO 10,15)(1 CFM)
into xquenecoflhcgranli (this Permit.
AIR HANDLING UNIT
ST�gi i�/re of ApPLnmr/Comrunnr �L-- Dutc IO.oCFM)
%HA1Sf HOOD(W/DUCID
RAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,00(I BTU) Date RecciplN
Willlheapplicent or fuwm buiIn ng occuPantsmre or handle haaerdmas material HEATING UNIT(OVER IOO,IXO BTU) TG
3 JcOnN by the Cupcnino Mum IC odC,%xp:,9.12.and the Health and Safety
Calc.Section 255320tC VENTILATION FAN(SINGLE RESID)
11 Ye" o
LWISSUANCE DATE
W ill Ne applicant or futum building occupant use equipment or devices which emit
BOILER-COMP(311P OR 1010010 BTU)
hamideas air contaminam as d by the Bay Area Air Quality Management BOILER-COMP(OVER 100.0110 B'fU)
Dialricf! ` SEP 2 0 1994
❑Yes No NEW RESIDENTIAL MECH. SQ,FT.
I have read the hassrdous materials requirements under Chapter 6.95 of the CR Y Ur
California H dim,lth&Sa ca ard,havaions out.that j,, and 25534. ih1,to stand than VlJT'CfiljjV \�
eathebuiloffi Jam'not eurtenlly hove.ten ant,that j,is my¢slxmsibllll wifv(y the
nccupanl of N 9 m o w h must be met poi to isuavice o�nifica¢of
Ocu cf�
pan `re ` L_LIJ� � .L_G_ fls-1 V LYYN
Owner ser tM1 7 d agcm Ilene TOTAL ISSUED BY:
OFFICE