23726APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY.
Building Project Identification
Building Address:
*Locq oPFl
PERMIT NO. //�
2 3 7 26
ars Name: one:
, A A
(/+�(�j
CITY OF CUPERTIN66UILDING DIVISION
APPLICATION / PERMIT
J��— 2
Contra 'Name: s��� /aa LIc.N.
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BULDING-ELECTMCAIIPLUMBINGMECHAMCAL
CATEGORY
CONTROL11
_
Architect/Engineer. Lac. N.
QTY ELECTRIC PERMIT FEL
-BUILDING PERMIT INFO`
,. q
Add r �r�,�p (J/j� 6
hfI
PERTISSUANCE r"
❑ 1C� �/T ❑
�s LYJ
LIC ENSED CONTRACTOR'S ECLARATI N.
Ihereby affirm that l am licensed under provisions of Chapter9(commnne
7000)afd affix n3dithe Busineseand Pro(essionaCode,and my
iicer.I in
R gwithS n fun f and dfect.
s Licit ct
APMANCES-RESIDENRIAL
JOB ON
i/ D6 L
PANELS
DateLlm
Date Contra—
UP TO 200 ANTSF
2014000AMPS
ARCHITEHITECTS DECLARATION
I understand my planaatollhe used as public records.
s
OVER 1000 AMPS -
$/SQ. FT.
SIGNSELECTRICAL{n,/
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
n,
Y V O P vf T E. R
SPECIALCIRCUIT/MISC
TEMP. METER OR POLE INST. DAT
following reason. (Section 7TI1S, Business and Professions Code: Any city or
r ntywhichrequimsapermfttomnstru"tegimpmve,demolbh,ormpair
anystmct mprortoitsbwance,a6omquimstheappBontforsuchperMtto
file a signed statement that he is licensed pursuant to the provisions of the
POWER DEVICES
-•--•(• I
y�
_
POOL ELECTRIC �s
OUILETSSWITCHFSHXTURFS Q.
16
Contractors License Law (Chapter 9(commencing with Section 7") of Divl-SWIMMING
slon3 ofthe Buaincssand Professions Code) orthat he is exempNherefromand
the basis for the alleged exemption. Any violation of Section 70315 by any
applicant for permit subjects the applicant to a civil penalty of not more t ban
PP Perms M PP P tl'
VALUATION
NEW RESIDENTIAL ELECTR SQ.FT.
dollars(S500).
flue 1, as pr. •'
I, as owner of the Property, or my employees with wages their sole
STORIES
TYPE CONSTRUCTION
'
compensation, will dothe r
kand Nes reh Contracted or.offered
Business and nse,Lafor
sale (Sec. 7064, Business and Professions Code: The Contractote License law
Code
does not apply to an owner of property who Wilds or improves themom, and
who does such work himself orthrough his own employees, provided that such
OCC.GROUP
RES. UNITS
improvements are not intended oroffered forwle. If, however, thebuilding w
TO
improvernnnt b sold within one yearofcompletton, the owner-Wilderwill have
the urden of proving that he did not build or improve for purpose of sale.).
F1 L as owner of the property, am exclusively =trading with licensed
wntr dm to mmtma the projed (Sec.70I6, Business and Professions Code:
QTy, PLUMBING PERMIT .FEE
ROOD ZONE
APN
PERMIT ISSUANCE
t •�
The Contractor's License Law does not apply to an owner of property who
Wilds or improves thereon, and who contracts fin such PW)scts with a
cgRS�act_ or(s) licensed pursuant to the Contractor's License Law.
LJ I am exempt under Sec. B & P C for this reasonOUTSIDE
ALTER -DRAIN & VENT- WATER (EA)
FEE SUMMARY
BACK FLOW PROTECT. DEVICE
FEES
DRAINS FLOOR ROOF, AREA, COND.
Fl)(TURFS PER TRAP
-
SANITARY Y N
RECEIPT I
Owner Date
WORKMAN COMPENSATION DECLARATION
01 hereby affirm that I have a certificate of consent to se1fAnsum, or a
mmficateofWmkers'Compensation Laurance me certified copythereof(Sec.
380, Lab CJ'
Policy If
SCHOOLTAX ,Y_ N '
RECEIPT M
GAS EA. SYSTEM -1 WC.60UTLE15
PARK FEE Y N
RECEIPT Is
—
GAS FA.SYSTFT4-0VFR4(FA)
Com ny
BUILDING DIVISION FEES
Certified copy is hembyththe cid.
CertifiedGREASE/INDUSIRL
�copy bfiled with the city inspection division:
WASTE INTERCEPTOR
PLANCHECKFEE
GREASE TRAP
CERTIFICATE. OF EXEMPTION FROM WOR KERS'
PAID
SEWER.SANITARY-STORM EA 200171.
COMPENSATION INSURANCE
CDdssection need not becompleted if the permit b forons hundred dollars
Date RCcei t#
HEATER W/VFM/E.ECTR
ENERGY FEE Y_ N_
(8100)orlem.) I
I certify that In the performance of the work forwhnch this permit is issued,
I shall no employ any prr in any canner so as to become subject to the Date
PAIDApplicant
SIDENTIALPLMB.SQFT.Date
Recei t#
NOTICE TO APPLICANT: I, after making this Cerfirk.ca( Exemption, youshould become subject to the Warkers' Compensation provisions of the Labor
$WAT�SYSTEM/TREATING
TOTAL:
BUILDING FEE
Code, you must,forthwith comply with such provnsnoro or this permit steal l bejK
deemed revoked.
CONSTRUCTION LENDING AGENCY
��as—�1�
A—/
SEISMIC FEE
Ihereby affirm that there be construction lendnngagency for the perform-
ante of the work for which this permit Is issued (Sec. 3097, Civ. C.)
lender's Name
Lenders Address
I omilythat I have mad thisapplication and state that the above information
ismrrect. I agree to comply with all city and county ordinances and nate laws
TOT
-
ELECTRICFEE
PLUMBING FEE
QTY. MECHANICAL PERMIT FEE
MECHANICAL FEE
PERMIT ISSUANCE
FEES PAID:
relating to building construction, and hereby authorize representatives of this
city to enter upon the above-mentioned property for Inspection Pu rposes.
(We) agree to save, Indemnify an d keep harmless the City of Cupertino
against llabNtisajudgments,cogs and expenses which may inany v.y.o.s
Dale RCCCiPt#
ALTER OR ADD TO MECH.
AIR HANDLING UNIT (TO 10,000 CFM)
SUBTOTAL:
al in conaeque the grant' oft eperout.
against ->127
.� R4IANDLING UNIT (OVER l0,000CFM)
CONSTRUCTION TAX
Sriftheia'ofpplr Date
EXHAUST"D HOOD (W/DIK
CONSTRUCTION TAX PAID:
HAZARDOUS RDOUSDOUS MATERIALS DISCLOSURE
Wialaadefinedtor future occupant hazardous
Dale Receipt
HEATING UNIT (TO 100,000 BTU)
rtbuilding
ode, hhand9.
nutedal as defined by the Cupertino Municipal Code, Chapter 9.12, and the
Flealth and Safety Code Section 75532(a)7
❑ Y. MN.
Will the applicant orfuhmv buildingoccupant use equipment ordevims
}IFATINC UNIT (OVER I00,000 BTIA
IOTA
VENTILATION FAN (SINGLE REBID)
ISSUANCE DATE
which emit hamrdous air rontamlnants as defined by the Bay Area Air
Quality Management District?
Ys 1-1 No
k'have read the h azardous materials mquirements under Chapter 6.95 of,
the California Health&Safety Code, Sections 25505,25533 and 25534. 1
understand that if the building does no currently have a tenant, that it is my
P�
r f D
BOILER -COMP (3I41P OR 100,0M BTU)
BOILER COMP (OVER I 01,M BTU)
NEWRESIDENTIALMECH. SQbT.
responsibility to notify the occupant of the requirements which must W reset
prior to issuance of a Certificate of Occupancy.
MAY {'
2
M 199,S
2
ISSUEBY. f '
b
f ITT". dam'
Owner or authored agent Date
-
TOTAL:
OFFICE COPY