23297APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
Building Project Identification
PrK%UT NO.
Building Addmsx:
\)PR
23297
Ph
Ltttc -d7 Ca 9 CITY OF CUPERTINO-BUILDING DIVISION
Contrador'sName: Lie. No: APPLICATION / PERMIT
AM,ited/Engineer. Lie. Nor
PLUMB I'LECH
Add.
PERMITISSUANCE 9 S
LICENSED CONTRACTOR'S DECLARATION
I hereby affirnt that I arn licensed under Provisions ofChapter 9 (commate- APPLIANCES-RE51DENTIAL
ingwithS�ion7DOD)ofDi��on3oftheBuk�andPmf�onsCode, and my
L
Dg�Cormador up To no AMPS
OVED*
SQ.FT.FLOORAREA
$/SQ.Fr.
I understand my plans shall be used as public recards. —
OWNTER-BUILDER DECLARATION I t:
following mason. (Sceffion 7031.5, Business and Professions Code: Any cry or
L :6
TEMP.MWIAQRP0LE&4_q4_L!
anystructure prior to Its Issuance, alsorequiresthe applicant for so& permit to POWTRDEVICES
file a signed statement that he is licensed pursuant to the provisions of the
Contractor's License Low (Chapter 9 (conormancing with Section 70PO) of Ehvl� SW1Mhf1NG POOL ELECTRIC
the basis for the alleged exemption. Any violation of Section 7031-5 by any
applicant for a permit subjeclathe applicant to a civil penalty of nor room than OUTLET&SWTTCHE_`,FIXTURES
NEW RESIDENTIAL ELECTR
=.Party,
STORIES
TYPE CONSTRUCTION
_SQ1T.
or my employees with wages as their sole
-=Zwifl do the work, and the structure, is not Intended or offered for
mr5=� 7 Business and Professions Code: The Conteractor's License Law —
d net apply to an owner of property who builds or impron,a,t thereon, and
OCC.GROUP
RES. UNITS
who cloo,ssuch work himself or through his own employees, provided that each —
impammentrients are, not Intended oroffered for sale. If, howwar, the building or
IhLi�urcicrtitf that hic, did.. Wild Improve far
proving or purpose of sale.). CITY.
L_j 1, as owner of the property, am exclusively contracting with licensed PERMIT ISSUANCE
1�1 WNI
APN
a and Professions Code: L
Th, Contractor's License Law does nor apply to an owner of propeary, who —
ALTER -DRAIN & Vf� - WATER (EA)
0,
builds at imp. themon, and who cormarts, far each Inkjeals, with a
BACY FLOW PROTECT. DEVICE
ff,
DUTSIDF FEES
am exempt under Soc, � B & P C for this manion
SANITARY Y N
Owner Date DRAINS- FLOOR, ROOF, AREA, CONTE
MI hereby iiffirmi that I h. . candficam of comeent to in.., at .
RECEIPT N
certificate ofWorke�Coropereadionlesinteme, ora carflified! copy thereof &a. GAS_ EA. SYSTE2,4_1 INCA OUTLM
PARK FEE Y
Co
BUILDING DIVISION FEES
r7arfiffied copy is hereby furniahed.
PLANCHECK FEE
Certified! 6 filed the Impaction division. GREASEANDUSTRI. WASTE UaTERCEPTOR
I L-71 oo
F-1 copy with city
CERTIFICATE OF EXENIP"HON FROM WORKERS' GRIZASE TRAP
PAID
COMPENSATION INSURANCE EA.
SEWTIR-SANTEARY-STORM
Ila—te Recteipt#
(Hus section need sea be completed if the Ferraft is for am hu ndracl dollars
I cartify that in the Performance of the week for which this Permit Is isgied, WATER HEATER W/VENT/ELECTR
I hall not employ any Pa.. in any ...a, . . I. hearing subject 1. 1 he
WATER SYSTEM/TREATING
PMW :i�tpt#
W.,kcrs'C.mperxgi,g,L.w..fC.Hf.mai. Date
Applicso
N EW RESIDENTIAL PLMIL
Date
NOTICE TO APPILICANFE; U, after rru�lmg this Certificate of Exemption, you _SQ1T.
should became subject to the Worlors'Comparisation provisions of the a or;
IrOTA.L:
BUILDING FEE
Code, you at forthwith comply willigich ptavisict. or this permit halt be
deemed revoked.
CONSTRUCTION LENDING AGENCY
IV FEE I L,�
I hereby affim that there is a congtruction lending agency for the perform,
I camifythat I have mad thisapplicationiand state thatthe above information
FEES PAT?-,
as earned. I agree to comply with all city and county andmarece and gate laws PERMIT ISSUANCE
relating to building conatruation, and hereby subarea, representatives of this
cry to enter u Pon the above,encentionedl property far inspection purposes. ALTERORADDTOMECH.
jDate Receipt#
(Wr) agree to save, indemnify an d keep harmless the City of Cupertino
S BTOTAL:
against liabilifies, pudgereents, costs and expenses which easy in anyway accrue AIR HANDLING UNIT (DO 10,000CFM)
CONSTR UCTION X
in non can
PAT
LSEEISCLOSURE
rwintl
Date
WBIt a applicant or funumbuilding ox,capart slam or handle laccardous H�ATING UNIT (TO 100,M0 BTU)
Receipt# iaaa
material as defined by the Cupertino Municipal Code, Chapter 9.1 Z and the
'zo *>
Health and Safety Code Section 25532(a)7 HEATING UNIT (OVER 100,0W BTU)
Will the applicant or future building occupant use equipment or devices VENMLATION FAN (SINGLE RFSTD)
ISSUANCE DATE
which ermt hig,ardous air contaminants as defined by the Bay Area Air
Eavcm'd the h.Rus materials requirements under Chapter 6.95 of BOrLER COMP (OVM 100,000 BTU)
the California Health& Safety Code, Sections 25505, l!3533.nd 255M. 1
responsibility to ratify the occupant fthe rect.incericatswhich must he arce,
MAR
ISSUEDII
O-ner or authoricad agent Data
TOTAL:
OFFICE COPY