24744 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELF.0 I RICA], PERMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING DIVISION BUILDING PROJECIADEN'OFICATION 24744
BUILDING ADDRESS: CAI
NO. APPLICATION SUBMITTAL ONE
2 I CAI UNIT# LOT# —2—S�
O ERSI ME: t�NF.: CONTRACT'OR'S NAME: LICNO:
C- +06 �3 CJS./ W �/a 7C-AA Me �JS9yS— N/C CGNOLOLa
41tCII1TEC'I'/EN(INE : LIC NO: ADDRESS: ❑
ab Us r�4lr� o ks Rwc 940
CONTAC7:g , - l iONE: BUILDING PERMIT INFO
bdi�'rT 4a� QTY. ELECTRIC PERMIT FEE
S69140-0' � PERMITISSUANCE 11 11 El
BLDG ELECT PLUMB MECII
LICENSEDCONTRACfOR'S DECLARATION APPLIANCES-RESIDENTIAL
I hereb (firm ohne lam license)under r ns of Chu ter9 commoncin with TOB DESCRIPTION
qqCZ Yu povisin p ( g
RSmion 7")of Division 3 of the Business and Professions Code,imAky license is in PANELS
full far.mtdaue / — --- F
u --24 S17S7LJ S urro2alAMPS /e �2n�scC
F Z W Liccns Lic.M T,
y,¢>y Dote L Contra NST r4.r b1 201-1000 AMT'S S FI'.FLOOR AREA $/SQ.PT.
ZOyb AR'HITECFS DECLARATION OVER 1000 AMPS Q.
O Z—❑ l understand my plans shall be used as public rtcords.
r l�n t W SIGNS ELECTRICAL
Q �.-.aJ L.IceasW Professional
$yd'6 OWNER-BUILD17R DECLARATION SPECIAL CIRCUIT/MISC.
OyF 1 hereby affirm that 1 am exempt 'from the Contmctols License law for the
u130y fallowingreasoa(Section]031.5,Business and Professions Code:Any city mcaunry Ti MEIt1R OR POLE INST.
y5 which requires a permit to construct,alar,improve,demolish,or repair any swcturc
P-7 prior o its issuance,al.sonequires the applicant for such pentdOo file a signed swament POWER DEVICES
Op Ihm he is licensed pursuant 1.the provisions.f the Contractor's License Law(Chapter TB�N
a o�' 9(c.mmen<ing with Sation]f100).f DivisionJof the Business and ProfessionsCare) SWIMMING POOL ELECTRIC /t� VALU TION
_y
or he is exempt therefrom audits basis for the alleged exemption.Anyviolatimt of Olyl'LETS-SWITCI{FS-FIXTURES / C�
E 0 Scction]0315 by any applicant for a permit subjects the applicanno a civil penalty,of (/
t mor than Bvehundrd dollars($500).
KK m n❑ 1,asowneroflhepropeny,ormyemployms with wagesastheirsolecompeasatimn, NEWRFSIDENT1ALL'LECTR _SQ.FT. STORIES TYPECONS'TRUCTION
y3i_ will do the work,and the structure isnot intended oroffertd for sale(Sec.]044,Business
and Professions Code.The Commem's License Law does not apply to an owner of
propery,whobuilds mimproves Nemom,nndwh,doeswch work hinnulfmdtrough his
own employees,provided that such improvcmcrosarenot itneadedoroftbred forsale.If, OCC.GROUP RES.UNITS
howevcgrhe buildingm improvement is sold wiNim oneyem'ofcompletion.thcowrar- TOTAL:
builder will have the burden mlproving that he did out build mimprove for imal of
sale.). D x�'I DP•CC•f Mr
E � AIN
,sum the Project(See.7041,Business and Professions CdeI100D 20❑ QTY. PL
License Low docs not apply roanow.c,.f property who builds or improves thereon,and PERMIT ISSUAN IN /I
who contracts for such pmjects with a conoacusr(s)licensed pursuant to the Contracmrn ALTER-DRAIN —WA 'rill 1�
License Law. FF.E SUMMARY
❑ 1 sm exempt under Sec. ,B&P C for this reason BACK FI. PROT CC t ID
D S:;LRT Y N
EFEES
Owner Daa RECEIPT#
DRAINS- -ROOF,AREA,COND.
WORKMAN COMPENSATION DECLARATION -- .S LTAX Y N
❑ ers'Co affm Insurance
onificate.fconunnreod'Saura.o,ecenifi which FIXTURES-PER TRAP RECEIPT'#
W.rkers'Compensation Insurance nreceniPeJ copy lhereef(Sj e.3800,L.1,17.)which PARK FEE Y N
coven all cny,10 q' du.Ih1c.7 s 3 O q / GAS-EA.SYSTEM-1 INC.4 OUTLETS BUILDINGRECEIPT
ECEI TO FEES
Policy M ! ::LL !! DD
Company T
❑ CenifiW copy ixhervby fumieheJ. GAS-EA.SYSTEM-OVER 4LEA) PLANCHF.CK FEE
Ceni HM copy is Pled with the city inspection division. GRFASIWNDUSTRL WASTE,INTERCEPTOR GRADING FEE
CERTIFICATE OE P-XEMPION FROM WORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE.
(This section need not becompleted Ron,permit is foronc hundred dollars(S10o) SEWER-SANITARY-STORM EA.200PT. ENERGY ELF;
less.)
I cenify,that in the perionmumce.fthe work for which this permit is iuuW,Ishall WATER HEATER W/VENT/ELECTR
not cmpt.y any person in any manner so as to become subject to the Worker,' PAID
Compensation Lawr�yyL�9Iifomf WATER SYSTEM/IREATING Data Reccipt#
Q OApplicaat_L�{,d-�
NOTTCETO APPLICANT:IL after making this Ccnificare of Exemption,you should NEW RESIDE- IAL PLMB. SQ.FT. TOTAL:
FrA become subject to the Worker's Compensation provision of the Lotter Care,you must _
� ; forthwith comply with such pmvisions.,this permit shall be deemed revoked. BUILDING FRE
PW. Q CONSTRUCTION LENDING AGENCY SEISMIC FEF.
.Z I hereby affirm that them is a construction lending agency for the performance of
V O the work far rich this permit is issued(See3097,Civ.C.) TOTAL; ELECTRIC FEE
Landers Name
Q U Lender's Address QTY. MECIIANICALPERMIT FEE PLUMBING FEE
I certify that I huvc read this application and state ruche above infnmation is
my' a comet.l agree to comply with all city and county ordinances and state laws medngm PERMITISSUANCE / -2U MECHANICAL ME „ Ofd
F-m building construction,and hereby authorize representatives of this city to enter upon the CONSTRUCT ION TAX
I_) 'Z above-mcmioned property far inspection proposes. ALTERORADDTOMECH.
(Wc)agree to save,indemnily and keep hmmless Be City of Cupertino against
Iiabi li ties,judgments,costs and expenses which may in any way accrue against said City AIR HANDLING UNIT GTO 10,000 CFM)
in consequence of the gating of this pT4rtmit.
^�,��/ 4Y AIR HANDLING UNIT(OVER 10.000 CEM)
/A/(�n�
Signature ofA'pplicon4Conwcar - Daa E%IIAUST II000(W/DUCp PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO IML000 RTU) Date Receipt
Will the applicant or future building occupant slum or handle hverJous mmerisl HEATING UNII'(OVER 100,000 BTU) TOTAL: 0•V
u defined by the Cupc Lino Municipal Cade,Chapter 9.12.and the Hmlth and Safety
Code,Section 25532(a)P
❑Yen ❑No VENTILATION FAN(SINGLE RESID)
BOILER-COMP(3HP OR 100,000 BTU) IUE D kTE
Will lheupplicam ur futurebuildingtsccupantuxryviptnenwrdeviceswhichemit I+SS �jANgC
hezvdous air comaminards as defined by the flay Area Air Quality Management lJOILP.R-COME(OVEER 100,000 BTU)
District? 41993
❑Ye_ rs� o NIiW ftPSID1iNTIAL MECH. SQ.fT. ,
1 have mad
ttthee/hatordom materials requirements under Chapter 6.95 of the FEBr s• t
if,he uil Health&Safe CWy have Sections that
t it I, y responsind bility
I undersmnd that CITY Ur k u r U
ifthebuilding Jutsnotmnts whaveoarum,Ie, army reuance ofla Certificate
the `jl1Y
cecupanr,.f the requirements which must M me prior to issuance of a Cenifimte.f
Occupancy.
Owner oramhorizedagcnt Date TOTAL; SSUEDBY: jnQ—
!>W71�'LIJU�
OFFICE -�