28353 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO - B1U,DI G-ELF,C'IRICAL PERMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL 28353
BUILDING DIVISION BUILDING PRO]E(TTIDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATIONSUBMITTALDATE
`L{/•'•Vl/•I,VqO NIT It LOT N
O NA E PHON17: RACTOR'S NAME: LIC NO:
N/C �ONTROLM
L Ti NGINEBRA
. : hIC NO: D RI3SS: l/—VJII/g/r/V/I1
CONTACT: PHONE: QTY. ELECTRIC PERMIT_., FEE BUILDING PERMIT INFO
•�W6AI �� aI Q�� PERMIT ISSUANCE B_ LUG ELECT' PWMB MECH �
LICENSED CONTRACTOR'S DFCLARAI ION APPLIANCES-RESIDENTIAL �IyTThY JOB DP.SC PTION
Ihereby affirm,lim lam licenserop
nderrtsm.nsofChapur9 Ridermncing with
MU❑ Secdorceand)uf Uivision7of the Business anJ professions Cada,and myliccnsa is in PANELS ��
F�W full force and effect. UPT02MAMP5
W C se Lic.p
co Dam—� Convector 201-IOro AMPS
FZ CHITECPS D,'LA I • cC/ SQ.FT.FlAO AREA $/SQ.FT.
O Z
OVER 1000 AMPS
ZO�p 1 unAersmnA my plans shall be uuJ as public recSNs. �O `�
<,7-1 SIGNS[LECfItICAL `7
QY�,, Licensed Profctomted
OWNER-BUILDER DECLARATION SPECIAL CIRCUITO
�¢ /MISC.
KO a V 1 heresy ufftm the I am exempt from the Contractor's License Law for the
m3¢vFi following rcawn.(Section]031.5,Business and Professions Cade:Any city or county TEMP.METER OR POLE INST.
f't='"J which requires a permit to co omod.eller,improve,demolish,nr rcpsir any stmcwm
EW>2 prior to its issuance.also requires the applicant for such permiuo file a signed 9atement POWER DEVICES
WK a0LL Om that he is licensed pursuant to the provisions Of the Convaclnrs License Law(aspect d KO9(commencing with Section 20DO)of Division 3 of the Business ani Professions Code) SWIMMING POOL ELECTRIC ^ ALUATION
W_y Sectio 7031. by
refromandthe Permit
toechects the
to civil
5E< Sectioare.h Sby any nS500).tsubjeasthe applicant toa<ivil pcnalry of UTLEIS-SWITCHES-FIXTURES
ce z Q not mom than five hundred Aollars($500).
ad'I'-o ❑ othe wrk.andcpstruct.ormyemploy«swhhwagesusale(Sce.compensation. NEW RI3IDIiNT1ALELECTR STORIES TYPECONSTRUCION
3= will Professions
and the The Careianmimendese La doncedf forsale
apply to an owner
and property
wsion.v Code:The COnvacmi s adwho Law does not apply to an owner of
propertywyees,pdsm improves t suchawn,andwnodocssttrnwork nimfErcil trough his
hoemployeeaprogioried tprovehimprovementhinsect intended the.e.If,,. OCC.GROUP RFS.UNITS
wever,theave a burden improvement ishathwithinorteyear Ofcomplve far the Sween TAL
builder will have the burden of proving That he did not build nr improve for purpose of
ale).
❑ I.--�-�l-fthoject propeny,amexduss and otnfosiions Code:)
QTY, PLUMBING PERMIT FEE I1,00D ZONE MN
arena for project(Sea. onotelct, neem ss and Pneywhobuild Cade:)The COnmmmds
License lawdmsnm upplyman ownaofpropenywhS builds orimpmveslhcmon,add f:RM ISSUANCE
who contracts for such projects with aamtractons)licensed pursuant mthe COnmuctor's ALTER-
RAIN VENT-WATER EA
FEE SUMMARY
Liccnu law. ( )
❑ I am escarp unto S«. ,B&I'C for this reason BACK FLO PROTECT.DEVICE OUTSIDE FEES
SANITARY Y_N
Owner Date DRAINS-- R.ROOF.AREA., OND. RECEIPT#
WORKMAN COMPENSAT SCHOOLTAX YN
❑ Ihertby affirmthalhaveucertificoleo consent to ulGinsurc.oracenificamof FIXTURES-1 ?RTRAP RECF,IPTk
Worked Comprnwtion ltvumnce oro cenifi copy the reof(Sec.3g00,Lab CJwhich PARK FEE Y N
covers all employ«s under this permit. St HA.SY E -IINC40UTLEI'S RE,CEII b
Pnlicyk �r BUILDING UI VI. ON '
Company ,AS-I7A.SYS M-OVER4(BA) PLANCHECK PEE
❑ Ceniried copy is hereby fumisheA.
❑ Certified copy is filet with the city inspec'on division. SFO U TRLWASTEINTERCEPTUR GRADING PEE.
CERTIFICATE OF EXEMPDO PROMWORKE GREA TRAP SOILS FEE
COMPENSATION IN.BRAN
(Th'n amino need not be complemJ if the pc io is for a red Sitarµ ) SE R-SANITARY-STORM EA.2IpFf. F.N[RGY FEEOr Is..)
I ccnify ohm in the performance of the workf which this mlisissued.l shall AIFR HEA TER W/V
anEN'DELECIR
not employ any person in y mmt
aer so as to become subj 1 m the WmkcmPAID
z Coin en<:eionl,uwsnf Califomiu. Date WATER SYSI EM REAL ING ale Receipt#
O O Applicant
Z NOTICE TO APPLICANT:ILafmr makingthis Cent mupof Exemption,you should NI?W RESIDENTIAL PLMB. SQ.FE
Fybemmesubj«uutM1C Worker's Compensation pmvisio sof.hc labor Code youm TOTA1,:
a , forthwith comply with such provisions or this permit sir be d«medrevokcd. BUILDI
fly, z
CONSTRUCTION LENDING ACE Y SEISMIC FEL
5 I hereby affirm then there is a contraction leading lending egenc rfarmance of
V O the work for which this pemtit is issued(See3097,Civ.C.) ELECTRIC PEE
f.rnAers Nm
uc
p U Lender's Address QTY. MECHANICAL PER MIT FEE PLUMBINGFF. sal
ccrti(y that I have mad his upnismimi and ,are that tiro aMrve infotmaoon is
rG" 600. comet. Iagree to comply with all city and county ordinances and state[awsrelatingto PERMIT ISSUANCE MECHANICAL FEE
F-' (A M1uilJing nmsvuaiaq and herchy aulhoriu rcprescmalives of this city memo open Sire
V z above-mentioned pmpcny for inspemion purposes. ALTERORADDTOMECH. CONSTRUCT NTAX
(We)agree to save,indemnify and keep harmless the City of Cupertino against
Iiubilities,juJgmems,costsand expenses which may in my waysceme against said City AIR HANDLING UNIT(TO W."CFM)
in�mprty of the gra n of Jti miil.
_ AIR HANDLING UNIT(OVER I0.000 CFM)
murex Apmn rector Dote EXHAUSTHOOD(W/DUCT)
PAID
HAZARDOUS MATERIALS DISCLOSURE HGATING UNIT(TO IUU.(IW B'I'UJ D Rettipt p
Will the applicant or future building occupant some or handle hvarAous solaria[
as relined by the Cupertino Municipal Code.Chapter 9.12,and the Herlth and Safety HEATING UNIT(OVER 101,000 BTU) I I
Code,Section 25532(a)P
CI Yes Cl No VENTILATION PAN(SINGLE RESID)
BOILER-COMP(31{P OR 100,000 BTU)) IS AN DATE
Will the aemaatiorfumrebuilding by the
Avipmir Q Aet,Management it pp RR
hnorioms sir mnmmimmn m ddined by the Buy A.Air Quality Managemcm BOILER-COMP(OVER 100,000 BTU)) P pq Q CS
❑Yes ❑Na NEW RESIDENTIAL MECII. SO,PT.
I have read the hazardous.materials requirements under Chapter 6.95 of the JUL � 4 1995
California I Inith R Safety CWc.Sections 25505.25533 aid 25534. I uncerstard that
if the building dies not curenJy have a Sanest.ohnl it is my responsibility m nmify the
ncupunt Sf the rcquircolem which must be met prior tr issuance of n Cenificae of CI I Y 'vr kNrc
OvOiPsoey.
OwneroramhomN agcm Dae Tvft,. ISSUEU BY:
OFFICE