25732 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOJJU.DINI,-ELECTRI AI, PERMITNO.
APPLICATION/PER PLUMBING-MECHANICAL
BUILDING DIVISION BUILDING PROJECTIDENTIFICA'r10N J
732
BUI DR.S -A - SANITARY NO. TAPPLICA'UON SUBMITTAL DATE
UNLIT# 55 LOT# J
N ME' PITON 4,,'7,Z-&7m
ONT 'OR' N M LIC NO: .! �V
— 7 NIC CONTROL#
RC TECVENGINF,ER: LI O: ADDRESS: ❑
CO CI': ]/�J,1{gNE7C,�(/ BUILDING PERMIT INFO
'7 / QTY. ELECTRIC PERMIT FEE
BLIX; ELFtT PLUMP MECII
PERMIT ISSUANCE E
i El El
LICENSED CONTRACT 'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION
❑mZ IherehynfEmvhetlamlicereedund provisions of Chapere)(commencing wish
8100_ Slrion700(pol'Division 3 oldie Busine.aand Profession Code,undo license ix in PANELS
K' fullforocande
O1- �c UPT02WAMPS
FZ, License Class c '- Lic.M `�
e <e Dam Commcmr Jy7. 201-UW AMPS
F-yZ ARCHITECTS DECLARATION I R 4Q. Fl Al 4/S(].Ff.
ZOm— 1 demm�dmypimssha116euscdaspubliemcords. OVER TWO AMPS „ V ��, � t
OZ—❑ _
SIGNSELECIRICAL - t �1 I l
oe,,, [M Licensed Pml'caeional J I� t I
�%ne< OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
k060 I hereby affirm that I am exempt from the Contractors License Law for the 6
m 3 a y following reason.(Section 7031.5.Business and Professions Code:An t o M-MP.METER OR POLE INST. DATE
t-�C< which int a it to construct,alter,int Y city or county
riga peon prove,demolish,or repair any structure
5W}2 or to its issuance,elsom thea licant for such tmRleasi red atammem POWER DEVICES
poi quires pp permit g
'K<0a that he 9(comis licensed pursuant m000)the of Divisionns the Contractor's License Lawns Code) SWIMMING POOL ELECTRIC
mWn, 9that heir exempt
tSmurom and the Division 3 of thelleed exemption,s and
iota Cade) VALUATION
,.Z� Section 7031.5by themfromnt f the basPermitarthectl thedpplica ioo civil
of
Y Section]031 Sh OUThFTS-SWIiC11I5-FIXTURES
EZ< by any it sublecu the civil pcnahy of
CFSnot more Nan five hundred dollars(45W). STORIES TYPECONSTRUCIION
I,asownerofthc ny.mrm to«swithwa esustheirsolecom nation, NEW RESIDENTIAL[L[CrR —SQ.FT..
o ❑ Propc > YemP Y g a
air= will Pr lesions and the he Contracon tor's
License
Law
does of apply t oan Business T
and by vIIn ons Cede:The ves thereon,License Law ach not apply m an owner of
ownenywycei,Asorimproveuch improvements
are
nsuctendework himaelfonhmughhis OCC.,GROUP RES.UNITS
however,
NetnaeM1improv sold
within
it arcne Intendedproffered forsnn.then c.If.
budder will 11,
burimpmvemcnt isshat he ii not build or improeforp euwncr- TOTAL: rO
builder will M1uve the burden o(proving that he did not buil)or improve for purynu of
sat t.).
❑ I,asowneroftheproprny,ameaclusivelyconimciingwithlicensedcontrnetonm QTY. PLUMBING PERMIT FEE FLOODZONE "N
construct the pmject(Sec.70,4,Business and Profusions Cale:)The Contractors
License Lawduas not applym an ownerid Nopeny who builds or improves thereon,and PERMIT ISSUANCE.
who contracts for such prmoclL with it commatrr(a)licensed pursuant tothe Contractor's FA ALTER-DRAIN&VENT-WATER
License Law. (EA) FEE SUMMARY
❑ I amexcntpt under S«. ,B&P C for this reason BACK FLOW PROTECT.DEVICE OUTSIDE ZEES
SANITARY Y N
Owner Dae DRAINS-FLOOR.ROOF.AREA,COND. RECF:IPI'#
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑ I hereby affirm that l have ucenificate efconsetn to self-insure,ora«nhicmeof FIXTURES-PER TRAP RECI?IPr#
Workers'Cootpc e m Imporrme or aecnifccl y cT«r(S E.39W,Lab C.)whieh PARK FEC Y N
rs all em unde it. GAS FA.SYSTEM-]INC.40lpf1.ET5 RECEIPT#
pull I BUILDING DIVISION FEES
Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Certified<t h re fu t
!Ji
Cenifiedcupy is file withrhe city ins,«eon division. GREASEANDUSTRL WASTE INTERCEPTOR GRADING FIDE
CERTIFICATE OF EXEMPTION FROM WOR ' S' GREASE,TRAP SOILS FTE
OMPENSATION INSURANCE
(Thins«Bunn«d th<ompld ' the permit is to n ndred dollars($100) SEWER SANITARY-STORM FA.2WFT. ENERGYI'I41i
or leis.)
I certify thin eperfo c of work ich ex permit is issued,IshallWATER HEATER W/VE,NT/ELECRt
nm employ on in y mto a so as bee subject 10 a Workers PAID
Compensaf W Dole—Z am WATER SYSTEM/TREATING De Receipt If
O z Applin
z0 NOTICE TOA PLI' 1,ff.ufill nmkmg this Certificate of Exemption.you.should NEW RESIDENTIAL PLMIL SQ.IT. 'f0'1'AL:
(r r^ become subject m orka's Compensation provisions of the Labor Code.you must
04 5: forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FEE
G Q CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirm that there is a construction lending agency for she Performance of
U O TOTAL: ELECTRIC FEE /
tconstructionhe work for which this permit is isrucA(Sec.JW],Co.C.)
Lenders Nuns
Lcndcr's Address QTV. MECHANICAL PERMIT FF;B PLUMBING PER
O U I certify that 1 have read this application and state that the above information is MF,CHANICAL FEE
>" correct.I agree m comply with all city and county mAineq¢s and ionic laws relating to PERMIT ISSUANCE.
t: building construction.and hereby authmiu represemativesofthis city to enter uponthe CONSTRUCTIONTAX
U Z above-mentioned pruriency for inspection purposes. ALTER OR ADD TO MECIL
(We)u u save/ emnify and keep rte cess the City of opcnino ainst
Ilubilities' dgt cnu,e t nd cxpc wh' mo many wa agninat st City AIR HANDLING UNIT(TO I qWO CEM)
acne of N• r ring of a It.
a� // AIR HANDLING UNIT(OVER IQB(MI CIM)
gn a Ap anVComraa v to V EXHAUST HOOD(W/DUCT)
PAID
HAZARDOUS MATERIALS DISCLOSUR' HIATING UNIT(TO IW,OW BTU) Dae Receipt#
Will Ne applicant or future building occupant store or handle hazardous material 1113ATING UNIT(OVIiR 100.010 BTU) 'TOTAL:
as defined by the Cupcnmo yl i pal Code,Chapter 9.12,and the Health:ted Safety
Cede,Section 25532(s)'!k/ c1 VHNTILATION FAN(SINGLE RESID)
❑Yea JJg$tldpp
ISSUANCE DATE
Will the applicant a future building occupant use equipment or devices which emit BOILER-COMP(311POR IW.000BTU)
hazardous air contaminena as a fined by the Bay Arca Air Quality Management BOILER-COMPOVER I W,"BTU) P '
'District? 13M
Ycs n NEW RGSIDENTIAI.MECH. SQ.Ff.
I have re a hveMous tenula m os neer Chapter 6.95 of the �pY 261994
California He a Safcry C .S tiuna v 5 2 33 d 25534. l u man ohm
ifthebuildi d arm curve yh c an itis ryresporest ilii -ematif l
m reyu m ch st hr Pon ro iss nee
of nifir of ry IIS t
«cu P' cY. GI^' Ut vurrrA
r thnrine
afiK, VDrug, '1'OI'AL: ISSUED 1{Y:
OFFICE