24773 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECT R[CAL FERMI"1NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL A �7r�
BUILDING DIVISION BUILDING PROJECT'IDENTIFICATION 4F I J
BUILD,IIN�GADDRFSS: (��)� /J SANITARY NO. APPUCATIONSUBMITTALDATE
7-7
1JCo ✓�/� - pe— LOT as 30
OWNERS NAME: PHONE: C OR'S NAME: LIC O:
s �/ NAC CONTROL#
1RCHITECP/F.NGINEER: LIC NO: / A RESS: ❑ ^ 1
CON CT. _ # ,LA / •,r �P ggq�9q Y. ELECTRIC PERMIT FEE LIl
�"ol 1 I/W/ BUILDING PERMIT INFO
BLDG ELECT' I U MECH
C PERMIT ISSUANCE
FO S. d
IICtNSEDCONTACTORSDFFI.ARATT(W APPLIANCES RESIDENTIAL
CKZ
O illkCRIPTION
flion 7(t1.ied
ofU is 33 I&Xtemess dPrf lid ylicense is I. PANELS
yV fullf d ffed' ib io ti UPT0200AMPS
FZ m License Cla 1'c N
m=y Uate n" - Taeuvacmr 201-1000 AMPS - S FT.FLOOR AREA $/SQ.R.
F m Z ARCHITECTS DECLARATION OVER 1000 Ah1P5 Q
oz-0
Z y 0 I understand my plans shall be used res public records.
lis, SIGNS EL AL
<Y7,, Licensed Professional
�yd'Q OWNER-BUILDER DECLARATION SP IRCUIT/MI .
KOM,tJ 1 hereby affim+that 1 am exempt from the Comm�ors Liver
law 4a the
r)3a at, following rtaun.(Session]031.5,Business and Professions Code:Any dry. o ty 'MP.Al IN '
F u'eco whicM1 requires u#.malt m consrvck alter,improve,demolish.of rtPa1, ower
5EVY� prior to its issuance.also requires the applicant for such peamiuo file a signal s1. 1 POWER E .S
u:C a C that he is licemscd pursuant to the provisions of the Comranor's Licenu I.ow tChipt
dao 9commencin SWImMI. ELECTRIC
9(commencing ]000)of Division Sof the Businu,and Pr.fessionsCWc) VALUAT'IOtf)'77
��
W=rn or that he is exempt herefrom and the basis for the alleged exemption.Any violatin,of OUTLET -SWITCHES-FIXTURES
t-.ZQ Senion 7031.5 by any applicant for a Permit subjects the applicant to a civ i1,peri—(of K&
OA1� .�
�yn< not more than five hundred dollars($500), .. -s w
cat ❑ 1,as owneroffie t ,orm employees with wa esastheirsoleclsm enaatinn, NEW RESIDENTIALELECfR _SQ.IT. STOR iS 'TYPE CONSTRUCTION
W.-� Pdopcctu Yccnt Y B P
y3_ will dnihewons andtherhe Constructure tractors
notintenenseded Law offered
not rsaid
16 ado44, gneros,',
sand Pndessions code: rhe C.ntmndr'a License Law does nrn apply Iti en owner of
property wbobulldsorimproves lhereoq and whodoes such work himulforthrqugb ljis' I. OCC.GROUP RF,S,UNITS
sen employees,provided that such improvementsum not intendedondfcred(ors:dc IL.
however,IM1e buildingod improvement is sold within one yearof completimi,the i+wri 4 1
builder will have the burden of proving that he did not build or improve far pmpise.'.f
sole.).
❑ I,ss ownerofthe property.am exclusively contracting with licensed contraa.(sm QTY. PLUMBING PERMIT FEE FLOOD ZONE APN
construct the project(Sec.70,D.Business and Professions Code:)The Contractor's PERMIT ISSUANCE
License Law does not apply tu an owner of property who builds or improve;thereon,wld
whocommais forsuch projects with acontrxctor(s)lice,ed pursuanno NgConvbhor s
Licenu law. ALTER- AIN& ATER(RAI FEE SUMMARY
W
❑ 1 am exempt under Sec. ,B&R C mr.thiyaason BACK FLOW PR .D! L OUI:SIDIi FEES
SANITARY Y -
N-Owner Date • RECEIPT#
DRAINS-FLR.OOROOF. D.
WORKMAN COMPENSATION DECLARATION - � SCHOOL TAX YN
1 ®0 Lherebyaffirrnthal l have a certificate electrical or a certificate of RECEIPT#
r FlXTURFS-PER TRAP
Worke,.i Compensation Insurance orueemifiW copy thereof(Sec.3800,Lab C)whieM1 PARK PEE Y N
caved,all emptor c undertbis permit. GAS-EA.SYSTEM-I INC.40JdH.l' RECEIPT#
Para BUILDING DIVISI FEES
+^Y GAS-EA.SYSTEM-OVER 4(" PLANCf1ECK Plili
crli cd«py ix Fere yUxjhed. �� te-W�11'0
Certified copy is film with the city inspection division. GREASE/INDUSTT RL WAS]1IN'1'ERCEVR GRADING FEE
CI?RTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP + SOILS FEB
COMPENSATION INSURANCE
(This section need not be completed ifthe permit is Found hundred dollars(1100) SEWER-SANITARY-STORM ISA.2X111. ENERGY FEE
or less.)
I ccnilythnt fade performance.of the work for which,his permit is issued.l shall WATER HEATER W/VENDELLCTR
em employ any person in any rinumn., o u to become subject to the Workers PAID
Z Compcnuti.nlavenf Califomia. Dates WATER SYSTEMITREATING Data Receipt#
Applicant
000 NOTICIi TOAPPLICANT:lf.aftermakingthis CeniGca¢of Exemption,yoasheuld NEWRFSIDENTIALPI.MB. SQ.FT. TOTAL:
(n become,ubjech n,the Workers Compensation provisions ofthe tabor Code,you mustlc�
Forthwith comply with such provisions mthis pard,shall be decnW invoked w BUILDING HE
G (� CONSTRUCDON LENDING AGENCY O SEISMIC
1 hereby uf0rmat ththere is a construction lending agency for the performance of
U O the vtmk for which this .it is issued(Sec.300,Civ,C.) TO ELECTRIC Z 'iss—%
Lenders Name —�
u' F L.ndres Address QTY. MECHANICALPERMIT FEE PLUMBINGF
U I ccnily that 1 have read this applierann and stere that the shove Information is MECHANICAL P
Wcont Ingrce m emnply with all city and county ordinances and state laws miming to FERMI'F ISSUANCE.
baddia,conionainn,rind hereby authorize repreuntmi veeof this dry to coca,.,at the CONSTRUCPIONI X
U z chosemantinncd properly]or inspection purpdus. ALTER OR ADD 10 MECH.
(We)ag mnify and keep harmless the Cary of Cupertino o,mrem
Iiabili' + nn,V`is dcx swIt It yin my way accrue against said City AIRHANDLINGUNI'i'(TOBIJXXICPM)
cn I.
r a ,g upemnil.
AIR HANDLING UNIT(OVIiR 10,000 CUM)
s rc.f AC nt/ mm�adr Dam EXHAUST HOOD(W/DUC)
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT�Od .000 B'IV) MVS,;7J3
rNCEDtATTE
J
Willthcopplicanwr future building occupant stored,handle hazardous ma¢ri.1 HEATING UNIT(OVER IW.IIW BTU)defined bythe Caliendo.Municipal Code,Cbaprer 9.12,and the Health and So cry
Code.Section 25332(aP❑Yea ❑No RESID)BOILER-COMP(311POR 10(1010 BTU)
Will the acontainants are building by the ay AreaAen or Qualitc Management
,fz
hazardous air contaminants as defined by the Bay Area Air Quality Manugemem .4Y�ERCOMPo0VERsIBlUW BTU)
"`° N DEPARTMENT
❑Y. ❑N NF.W RESIDENTIAL MECH. 5100; INSPECTI
I have read the hioddloov materials0requirementsder Chapter 6.95 of thebe, . UPERTINO,
if the
Health&Safety C I Sector,25505 25531 125514 1 :h dthat
ire holdingl ar currentlyhaveto oned o Y p :ildfily ofaC lily the h
cup t f theyuirt which ams be t prier m Lvs e r cert I nao nl �3
Occupancy. s
Owner or authorized agent Date "1'O'EAL: ISSUEDBY: g lir
OFFICE