23810 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Project Identification PERMIT NO.
: l
2s7�2Z L D 23810
caner�.aname. /�x� 7 •n1ona:
CeW'sNa • IG;<r aSP-37/Yl AI'1' lAllUll\�Vd1,a111N
rll[/ CITY OF CUPERTTN0.6UILDING DIVISION G
Comractor'e Na Lk.Nn APPLICATION /PERMIT.
V.) 1A/T6rM f74/04L :]a 461 BU[LDING-ELECTRICAL CATEGORY CONTROL«
' Architect/Englneer. Llc.No: L
QTY ;i',d . !; ELECTR_ IC PERMIT ) ,t�.PEE,ti' 'I . 'I;PUILDING'PERMIT INFO' 't
p/J YNT nLW CLU..I 1'LUMd R�
Address: X799�,(�•V('�'"�Q� S.V U J �/O �. PERMIT ISSUANCE
❑ ❑ ❑
LICENSED
hat Ia CONTRl under rovioc ARAT_I(ON
')hereby affirm that lam Hcenxd underprovlsloneo(Chapter9(rommenc-I MPLIANCESRESIDENITAL I -- JOB DESCRIPTION
)I conehSMlillfor a deffect. olthe Buelmseand ProteevoneC"e,and my I �a�
Licers is In full force and effect PAM]S ' �`i. I
License Class LIE.«
Date Contractor 1T TO IT li3P'S
ARCHITECTS DECLARATION L 1701-l"AMPS _ _
q�qv pZ I understand my plans shall be used as public re cords. - �OVERl"AMPS SQ.Fr.FLOOR ARE S/SQ.Fr.
Lc Z Licensed Professional _ SIGNS ELECTRICAL \ -\
ro OWNER-BUILDER DECLARATION 9'ECLLLCE{CUIT/MIST �•- ( I'�,I If I� �-
Ihcmbyaf @m that l am exempt from the Contractors License Law for th- til foilowl.gmason.(Section 7MI.5,Business and Professions Code:An ct or
prpTQ'1P.METCR ORPOLE INST.9 5 any atmtt d souor tolls that e Is also sed pursuant to the mvtstom ofN[a tgWF.R DE'VEC7:5 /q�
Gal (Ile a signed statement that he V licensed pursuant to the provisions of the [_�Cx
3 u,� Contractor's License Law(Chapter 9(mmmencing with Settle.7000)of Dlvl- SWIMMING POOL ELECTRIC DATE
� 5 don 3 of the Buslneas and Professions Code)or that he is exempt therefrom a nd ON�I
the basin for the alleged exemption. Any violation of Section 703IS by any OUTLETS-SWITCHES-FIXTURES V
G applicant for*permit subjectsthe applicant to a civil penalty of not more than
flue hundred tlolWn($500) NEW RESIDE SQ.FT. STOWFS 7Y1'ECONS'IRUCTION
7< ❑I,as owner of the property,or my employees with wages as their sole
compensation,will do the work and the structure is not Intend"or offered for
C sale(Sec.70a4,Business and Iho(emioru Code:The Contractors License Law
$� does not apply to an owner of property who builds or Improves thereon,and I I . '
who does such work himself or through his own employees,provided that such -
OCCGIiOl1P RES.GND S
Improvements are not Intended or offered for sale.II,however,the building or TOTAL:)
Improvement lssold within one yea rofcomplefo.,the owner-builder wEl' _ _
t rden of proving that he did not build orlmprove for purpose o(aale.). Q{4,, ; ''„ rPL&VIBiNd PERMIT i� :A TEE I FLOOD ZONE APN
{as owner of the property,am exclusively contracting with licensed
' contractors to mnatrutt the project(Ser.7074,Budnesaand N.fesions Coder PERMIT ISSUANCE x
The Cnomi nes License Law does not apply to an owner of property who ALTER-DRAIN&VENT-WATER(E)
builds or improves thereon, and who mntracte !or such poP,ects with a
�q➢2[actoKe)Brewed pursuant to the Contractor's License Law. i I FEE'SUMMARY Ir'
LJ I am exempt under Sec B k P C for thle reason I BACK FLOW PROTECT.DEVICE, ( r QI ITRI DE FEF9
Owner DRAINS FLOOR ROOF,ARE,COND. I
SANITARY Y N— I
Date RECEIPT p
WORKMAN COMPENSATION DECERATION IpDfTURIS.I'ER TRAP I �SCHOOLTAX Y N -�
❑1 hereby affirm that 1 have•mniumine of consent d aeif-inwre,or a RECEIPT«
38MUte of Workers'Compensatl.nlmuranre.rattrtllkd mpythereof(Sec. GAS EA. INCA OUTLETS
3900,Lab CJ I PARK PEE Y— N-
Po11ry _ - •rzECemr«
Cons any�.re�r .�igM(1 GAS E.SYSI'FM-0VERd(EA) 1
ffCerleed copy la Lereby fumished. I I I BUILDING DIVISION FEES
❑Certified copy b filed with the city inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR I PLANCHECK FEE
CERTIRCATEOFIXEMPTION FROM WORKERS' IGREASETRAP I PAID
COMPENSATION INSURANCE SEWER-SANRARY-STORMS 200Ff Date Recel
(Thlssection need not be comp]
COMPENSATION INSURANCE
It b(gone hundred dollars Pt#
($101))or less.) WATER NEATER W/VENT/Fl CCTR ENERGYFEE Y N
I cenlfy that in the performanm of the work forwhich this permit is Ensued, I —
I shall not employ any person In any manner so as to become subject to the I WATE({SYSTEM/TRETING ( PAID
Workers Compensation Laws of California. Daa
z Z Applicaro
Z O NOTICE TO APPLICANT:I{after making this CeKlflate of Exemption,you] NEW RESIDENTIAL PLMB.__SQ.M. I' I Date Receipt#
FN should become aubyct to the Workers'Compercut ion proWlons ofthe Labor i TOTAL:
Code,you at forthwith comply with such provisions or fhb pemdt aha116e IBUILDINC FEE
W j deemed revoked.
[L G. CONSTRUCTION LENDING AGENCY I I SEISMIC FEE .
Iherebyaf(irm that there V a construction lending agency for the perform, TOTAL:) ELECTRIC FEE
O ance of the work!or which this permit b tiou"(Sec.3097,Cv.C.)
U _ I.endere Name PLUMBING FEE
U. F Ia"era Address - )QTY. "MECHANICAL PERMIT ' '•'(', 'FEE.: IMECHANICAL FEE
O W Ittrtlfythal]have rcadthisapphmtionand Oatethattheabovein formation f
a Iscormd I agree to comply withal]city and county ordinances and state lawah PERMIT ISSUANCE -FEES PAID:
} W relatingto ullding mmtruction,and hereby authorim representatives of this FFF I I .
F Z cltytoent upon the above-mentioned property far Wpeceon purpaxa. ALTIRORADDTOMECH.
V - ) to save,Indemnify an d keep harmiess the City of Cupertino Date Receipt#
agal t bllit J. cats, vandex cars which may In anywayaml;tl AIR HANDLING UNIT CFO 10,ODO CFM) I I SUBTOTAL: I
at en o(the gr�preciting of this permit
Ia 1 � AIRHANDWNG UNIT(OVER I0,000 CFM) I �CONSTRUCTION TAX
Ig lure Appli tr - Date EXHAUST HOOD EN/DUCT) I CONSTRUCTION TAX PAID:
H O S MATERIALS DISCLOSURE - I
Will th appllca to building ocmpanfstoreorhandleh-ardour x HEATING UNIT(TO 100,000 BTU), G RCCelpt#
materials defined t Cupertino Municipal Codr,Chapter 9.lZ and the
Health and Si(etyC rra-5Iection 75537(a)7 FISTING UNIT(OVER 100,000 BTU) `r)7JKa TOTA L:y I'•K•
❑ Yea IJ NO
Wl crith hamoousair future
contaminants campart use the equipment
Bay Arco Air
VENTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emithagement iitrict? wnb as defined by the Bay Area Air !,
Quality Management Dktdct7 I BOILER-COMP(3t0'OR]W,IXq BTU)
I Yea 1�No
have read ealtha et materialstions 25505, S33anh255M,.95°( BOILER-COXIP(OVER 100,Of108'IUI ,
the
ersta dt at ift the building Code,Sections 25505,h ve a tend,that I p
understand that It thfy the nec does oft a currently a tenant,most dumy NEW RFSIDFN77AL METH. SQ.IT.� sY
ropy to Iso llama a Ceheompantofthe requirement which must be met ( JU
prior t.ILVUanre of a Certificate o(Occupanry. AIe`; �
Owneroraulhonud agent Date _ I ^ I //�xI ,V O
I$t1Eb
OFFICE COPY