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QANTTO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
IF tluildin a Idcntl(intiun
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PER%UT NO.
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23806
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CITY OF CUPERTINO-BUILDING DIVISION
APPLICATION / PERMIT
BLTLDINC-ELECTRICALPLUNBINC-\(ECIC\\7CAL
�_ � �
:.r'N Name: _ /
♦'T cXSf Jam'%lam !
CATEGORY
CONTROL p
Architect/Engineer. Lic, No:
ELECTRICPERMIT'. _FEE -
.. -
BUILDING PERMIT INFO ".
I c�,02Q'Pf
Address 7�
_,`7�Jf L/.f3%
SLUG LJ_�l t nor
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j 1/u_
` !PIILwT[SSL'ANCECIS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9(commenc-
ing with Severn 7000)0(Division 3 o(the Business and ProfessionsCode, and my
license is in full fo d effect.
License Class Lic.p D
onmtt J1 X I"Y� .lif'
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
! APPLIANCES -RESIDENTIAL
JOB DESCR ON
r
''` (��/w
s -V our
Sl 1 V lTl\ s[!
PANELS
1701-1000AMPS
OVEItimu AMPS
SQ. FT. FLOOR AREA
$/SQ. F(.
! SIGNS ELECTRICAL
Licensed Professional
-
t SPECIALCIRCUIT/MISCI^ �-
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or
�P. METER OR POLE
county which requires a permit torcestmet, alter, improve, demadish,or repair
any structure priortoibuwance,abo rcquirestheappBrantfor such permit to
file a signed statement that he is Ileeesed pursuant to the provisions of the
Contractor's License Law (Chapter 9(commencing with Section 7000) of Divi-
sion3of the Business and Professiora Code)orthat he is exempt therefromand
_ I
ppWER DE69CE5
^
SWg1MING POOL ELECTRIC
VALL�►TjQ.0
�
the basis for the alleged exemption. Any violation of Section ]031 5 by any
applicant fora permit subjecre the appEcant to a avil penalty of not more fluor
OVILETSSWHCHESFl fi7S C
/� %�VVV
�• J OV
NEW RESIDENTIAL ELLCTR SQ.FT.
five hundred dollars (5500).
f-11, as owner of the property, or my employees with wages as their sole
'TORIES
I
TYPE CONSTRCCTION
compensation,willdo the work and the structure Is net intended or offered for
sale &c. 7044, Business and Professions Code: The Contractor's License Law
�f
does not apply to an owner of property who builds or improves thereon, and
whodoessuchwork hineselforthiagh hisownempleye rs, provided that such
OCGGROUI'
RFS. UN IS
improvements are not Intended reoffered for sale. If, however, the building or
TO
Improvement is sold withlnoneyearofednpletion,the owner-budderwill have
thrdeno(proving that he did net build orimprove for purpose o(vle.).
r�uI, as owner of the property, am exclusively contracting with licensedPERMIT
to the project (Sec. 7044ss Professions, e , Busineand ProfeioCod
conmactors construct
_
QTY. PLUMBING PERMIT ): ' '.FEE '
FLOOD WNE
APN
ISSUANCE �.
The Contractor's License law does not apply to an owner of property who
Wilds or improves Merres, and who contracts for such project/ with a
contractor(s) licensed pursuant to the Contractor's License Law.
❑ I am exempt under Sec B & P C for this maxim
ALTER -DRAIN& VENT -WATER (EA) �
'.FEESUMMARY-�
BAC FLOW PROTECT. DEVICE
OUT51DE FEES
DRAINS FLOOR, ROOF, AREA, COND.
SANITARY RECIIPN
Owner Date
WORKMAN COMPENSATION DECLARATION
r-11 hereby affirm that 1 have a certificate of consent to self -insure, ora
certificate of W.,luma'Comperwncnlnsurance oracertified copythereof(Sec.
38M, lab C.)
FIXTURES PER TRAP /a
t
5CIOOLTAX Y N—
RECEPT N
GAS FA. SYSTEM -1 INCA OUTLETS
PATI Y N
RECEBT N
Polity N
Company
GAS EA. SYSTEM-0VER 4 (FA)
BUILDING DIVISION FEES
Certified copy is hereby famished.
Cenified copy is filed with the city inspection division.
GREASE/INDUSfRL WASTE INTERCEPTOR
PLANCHECK FEE
GREASE TRAP
CERTIFICATE OF E)(EMITION FROM WORKERS'
PAID
SEWER -SANITARY -STORM EA. 2MF`F.
COMPENSATION INSURANCE
(This section need nor be completed if the permit is for ane hundred dollars
(SIM)or less.)
I certlfythat in the performance of the work forwh::h this permit is issued,
Date Recei 0
WATER HEATER W/VENT/ELECTR
ENERGY FEE Y_ N_
WATERSYSTEM/TREATING
I shall nm employ any person in any manner so as to.become subject m the
Worken'Compensationhwsof CalJomia. Date
Applicant
PAID
Date Recei tk
NEW RESIDENTIAL PLMB. SQ.FL.
NOTICE TO AI'PLICANIL,ft, making this CertBicate of Exemption, you
should become subject to the Workers'Compensatlon provisions of the Labor
TOTAL:
BUILDING FEE
Code, you most forthwith comply with such provisions or this permit shall be
SEISMIC FEE GO
deemed revoked.
consrlcurnoe LENDING AGENCY
T i
ELECTRIC FEE �•
Iherebyaf8rmthet there is a construction lendingagency for the perform
anceofthe work forwhichehis comet uionaed(Sec.309],Civ. C.)
Lender's Nana_�[[ztj
w
PLUMBING FEE
..MECHANICAL PERMIT.'`. :FEE'
�' �
Lenders nddmss
MECHANICAL FEE
Icertify that l have read this application and state that the above informationFEES
ct. I agree to comply with all city and county ordinances and state las
is erew
'PERMIT
PnID:
ALTER OR ADD TOMECH.
relating to building construction, and hereby authorG.e representatives of this
city to enter u Pon the above-mentioned property for inspection pu rposes.
Date Receipt#
(We) agree to save, indemnify an d keep harMes, the City of Cu pent [no
gaim'*b�Btles,pdgnenu, consandexpense which mayinany wayaccrue
AIRt(ANDLING UNIT (I'Ot0,lg0 CFM)
-
SUBTOTAL:
AIR HANDLING U\TT (OVER IO,000CR)
GST HOOD (W/ DUCT)
CONSTRUCTION TAX !
t/sa'da�tymeonsSVu ce �f granting .nn is pemnR'
a l� �ucn�1�,)
r•1(j-��•/O�'.`�CONSTRUCTION
TAX PAID:
S.. core of Applicant/Contractor nOUS Dote
HAZn RDOUS MATER Al. B OISCLOSL'RE
Will the a ppika morfuture building occv pant store or hand lc hazardous
material as defined by the Cu penin. Municipal Code, Chapter 9.12, and the
Heahhand Safcty CcdeeryyStteaion35w320)?
❑ Yee ISI N.
Will the applicant or(unme building occupant use equipment.rdevices
Dale RCeei tM
TOT I %
IiFAT1.KG UMT(I0100,000 li'N7 !
HEATING UNIT (OVER 100,001) BTL')
I%TNIL\TION FAN(SINGLE RFSID)
-
ISSUANCE DATE
which emit hazardous air contaminants as defined by the Bay Area Air
Quality )lawgement District?
Ycs mxci
M1mr read the hazarpous mareriah requirements under Chapter 6.95 of
BOILER -COMP CHP OR 100,OM BTU)
! SOMER-COMP(OVER 100,000 BTU)
Calif.mla I lealth & Safety Code, Sections 25305, 25533 and 75333. 1
-round that if the building does not currently have. tenant. that it is my!
nabiliv to noire the occupant of the requirements which must be met
'u issuance o(a ifica p nxy. re
ISSUED UY:
NEW RESIDGNTIALw[CH. SQFT.1
nawhoriud agent Date
1 TOTAL:
OFFICE COPY