20015 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Buildin,Pro'ea tdeml(Iratlan _ ,a _ _/ -} Pf X PIX.WT NO.
o Bu0dIng Addns.: LY/�C e �C70� 1 YV-G 20015
2310(5 C) s S s
vwnzrXNAme me. A
CITY OF CUPERTINO-BUILDING DIVISION fr�
• naQ a /A_ Lk N APPLICATION I PERMIT G
W Ike PLUMBING-MECHANICAL CATEGORY CONTROL Y
Ardnn� 1 e—Ii—SQTY ELECTRIC PERMIT FEE BUILDING PERMITINFO
Addrr�uj- (�s c-1{_. PERMITISSUANCE ❑ ❑
LICE SEDCONTRACTORSDECLARATION
IAerebyam ffirthat l am licensed under prwLdore o(Chapler 9(cornme APPLIANCESRESIDENfIAL BDESCRRrT10N
ingwith Seabn 7000)ofDlvblm3dthe9uNrcssa(,n/d�ProlesionsCude,ud
IkcroebindfM. I C� PANELS
License Glc Y
Date Contractor UP TO 2DO AMPSF••(� �.
ARCHITECTS DE RATION 701-1000 SI ' l
2 I uMentuN my Plana.hall be used u pubhe needs, OVER 1000 AMPS SQ.FT.FLOOR AREA S/S}Q.FT.
O
Ll cruM Pmf.ional SIGNS ELECTRICAL
�< OWNER-BUILDER DECLARATION SI'FGIAL CIRCUIT/MIST
F, 7, 1hereby af0rm that l am exempt from the Contractor's LI¢nv law for the
Z9_ following maxon.healon 7015,Business M Professions Code.Any city or �{
O G ti TEIMP.MM LUZ OR POLE bNST. 1
FSI muntywhich requbnamtomna
Permit ttva,.Iter,improve,demoih)lorrepdr
anylwaurcprkxblb Lai eI,alwtequlnatuant to theIf¢wdi ,of to INYWER DEVICES
file a signed moment that he b Ibensed puna W to the provbbna d the
13�gContnaorh Gceroe law(Chapter 9(mt¢rcncing with Section 7000)of Lod- VALUATION
slon3dthe Babinec and PoieseloroCode)or'hat hebexempt'herefrom.rd SWIMMING POOL FIF.CT)tIC
Q+ the bills for the alleged bla
exemption. Any vtbn of Section 70315 by any
appBan'lora pemdt wb)nla the appltcsnttoa cidl penally dnot nnrctlun OUTIE SWITCHES FIXfURES
Q 0 undyed doll..(,S M.
1,u owner d the pmperty,or my employee with wagn u their sole NEW - STORIES iYl' mNSIRUCI'ION
mle(5,, tlon,wEldess.rd of.loe;Code.rehec Wended arotfneLaw �•\ 1� D
p axle Cies 701/,Buslres.td ltofesbro Cody.The Comnctors Ll¢nu law
93 don^ttapply to an owner d property who builda or lme prwthereon,anRj
d 1,V' - -
whodoesauehhhbr lfmthmughhlsownemployee,prvvldedthatwch OCC GROUP RFS.UNrlS
Improomenbatt rolint ended oro(fercd(¢sale.If,however,thebdMbg¢
lmpmvementb.odwhhlnonayearofcompletbn,tbeg ,-- lld<rwW M1ave
t"rdenof proving that he did em build or improve fmpurposeo(.ale.). QTY. PLUMBING PERMIT FEE .
LJ L u owner of the property,.m excursively contracting with IkeuM
rFTIJDD ZONE APN
PERMIT ISSUANCE
onntraaon to mvtruct the project(Sm 7014,Basin and Prdslona Code:
- The Crot.aorb Llmnso Law does not apply to an owner d property who ALTER-DRAIN VFM-WATER(EM
or Improves theeon, and who contracts Ina such plokcb with,
ry➢S[�am(.)B¢naed pursuant to the Contractus Ll¢nse Lay. BACK FLOW PROTECT.DEVICE FEE SUMMARY
L-f I am exempt under Sec B k P C for thl. reason
DRAINS FLOOR RODE,AREA,OOND. SANITARY Y_ N_
• Owner Dab RECEIPT
KM
WORAN CO]iPFNSAT_ DECLARATION
hereby affirm that I have•¢a10¢te,of concent to vJf-Inwrc,¢a FIXTUREe'PER TRAP Sa10pL TAX Y_ N
¢ted Workeri Comperwa In mma¢rtifdcopythetedt5ee RECEIPT 0
f35 ,lab 3 a� GAS E.A.SYSMM-I INCL OUTLETS PARK IFP Y_ N_
Pollcyl OI OV W GAS EA.SYSTEM-0VER4(Et) RECESTY
Com ny BUILDING DIVISION FEES
L_j Certffilki copy a herebyunhFM. GREASE/INDIISML WASTE INTERCEPTOR PLANCHECK FEE
I-JICenNed mpybflled Mth the tltylvpenbn dlvlelon.
CERTIFICATE OF D INIPTION FROM WORKERS' - GREASE TRAP PAID
COMPENSATION INE SL'WER- STORM EA 200FT Date Rani t71
(Thio seabn need n¢be completed if the permit
dt b f¢one hundred dour n
Rt Oo)¢Is) WATER HFATER W/VETT/ELECTR ENERGYFEE Y N
I¢rtl/y Lhatlo the performn¢dthewmkfgrwMch tMa pertNtbbwN,
1 shall n¢employ any pera¢m In any manner n u to become wb)ea to the WATER SYSMM/TREATING '
Workers cmnperoatbn Tawad Callf.ia. Date PAID
C' Z ApplNOTICE NEW REc3DEN'IAL PLNIR. SQ.FT Date Recei til '
Z O NDTICETOAIFL)C to the
f,after malcing a Cettdl¢e,la Exemption,
you
shoe, oubx�mmefeeth to theworken'au&p roe ln, orthbnao/theIl TOTAL:
W N dremedg,nvn,at/¢thwhh mnply with wch provf..bro orthb permit dull be U
W ILDING FEE
0 deemed rewked. .
11 CONSTRUCTION CaoNLENDINO AGENCY SEISMIC ECE
I hereby aorN' w there la a mmit l alxo lerulbg agent'for the perform
ELECTRIC FEE
7.Z uceer's Name whkhthb pemd'bbwed t5ee 3071,CIv.C3 TOTAL
LL O i<w,e,Aam PLUMBING FEE
0 Q lanIcr.AahatI QTY. _MECHANICAL PERMIT FEE MECHANICALFEE
O LU Irma. hrtlluve neadtM1bappBmtbnaM late'hrtthe above lnformatlm ��.T
(L hmingt building complywhh andhyrb muhothu,lnanmmllmtelaws IFRRilT ISSUANCE dl_.l./ FEES PAID'.1
nl.toenterulponli mrouvNgn,andhetebyavthor flop ne nb'Iposes, • r#IL�
Z w(W) goo,to line.,d*-mentioned pwpeay for Wpe Ch of Cu e. ALTER OR ADD TOhf1CH Date Recd to
V — (Wc)agrec'o nave InNfyand hawhelt the niu of Cu rtbg
agabutsaidC e, ,Costa. a run which In any wayamue AIRFIANDIJNG UNIT(7010,000 CFM) l IJBTO'Fi L:
agalmt wac en¢ t x m t pemat. '
AIR HANDLINGIIMT(OVER l0,000CFTD CONSTRUCTION TAX
Slg.tureStAppe¢nt/Conn.¢ , Date IX1iAUSTHOOD(VJ/DUCD CONST T9CTI.ON.TAX,PAID'
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future bu0ding oavPart pone or ha Mie huardous HEATING UNIT(10 IMODO BTI7) Date RCCeI IN
nuterbla,de fined byki'tItmoninainsa.defired
ertlno MurdaPal Code,Chapter 9.1 7,and the
liealthand SafetyCodn 7S537W7 HEATING UNIT(OVER 100,000 BTU) TOTAL: 0
❑ Ye
WOl the appllont obuildingoaupatutneequlpmenmdevl¢s VEIMATIONFAN(SINGLERFSID) ISSUATIC'E DATE
hloheMtluardoua bythe Bay Area Nr / t
lxyMarogemdnt BOR.FR-COMPOHPORIOO,OD0111U) sr U`
Yn �'�1i'B9U
i_ ufurcad the ha materials requirements
..25505,2Wunder ndChaper 2SSN.1 of BOILER-COMP(OVFR IO,000 BTU)
theentand t Heft Safety Code, oro 25505,8S33ua75hat it Cj It
resp.taM ttuctel(t bullding do d nentlyhe"which thatit
et NEW RESIDENTIAL MEC7i. SQ.F7 �9
PH.,to bllity' the oro PC ere Inc to whloh must timet
PH.,to y aCcr'�o! rips -
Ow or authorized agent Dab TOTAL, ISSUED BY:
OFFICE COPY