24440 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY
Building Protect Identification {I�' PERMITN
Building Address: I q�Y A 6 �s L 24440
ro one: q
Own CITY OF CUPERTINO-BUILDING DIVISION , L �j �
Can
a sN.mp: LIc.No- APPLICATION / PERMIT ^'�`
BUILDING-ELECT:ICALPLUMBING-MECHANICAL CATEGORY CO
ArcMtM/Englver. Llc,No:
QTY ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address
PERMIT ISSUANCE
—VIE PLU!,113
LIC ENSF.DCONTR under oDECLA RATION
Ihereby
ingwithSecti.o 70that) is Bcmced underptessanna of..d.,r9(rommmc- APPLIANCESRESIDENTIAL g un
limnw .Infulll to=andeffect. !the Buslnessand ProfessionaCode,and my I \1 'PNJa
Brence Is h full rmrce and effect. PANELS
License Clans Clea G �
Date Conhador - '
ARCHITECTS DECLARATION 201-100O AMPS
QZ I understand my plant adult be used v public records. OVERIOWAMPS SQ.FT.MOOR AREA S/SQ.FT.
O
(Cj Llrensed Profes,lovl SIGNS ELECTRICAL
OWNER-BUILDER DECLARATION SPECIAL CIItCNT/MISC I `eJ
Ihercbya(Imn that l am exempt form the Contractor's Licence Law for the
po following mauon.(Stolon 7ml S,Business.ad Profess Code:An t or
county whichcoquirea a permit to construct,alter,Imporve,demolish,or repair TEMP.METQt OR POLE INST.
¢y�.a any structure prior to its bsuance,aL,o require,the applicant for such permit to
x o'L V file a signed statement that he Is Iianse i pursuant to tbe pimbiov of the POWER DEVICES -rC ^ /^
RqOm Conorec 'a License Gw(Chapter9(mmmencing with Section 7000)of DWI- �4• J
[ i1 Won3oftha Bu,ines,and Profevlora Code)orthatheatexemptthereformand SWIMMING POOL ELECTRIC VALUATIO ate..
C5p1 X' the basis for the alleged exemption. Any violation of Section 7811.5 by an LOCC.GROUP `"�appliantforapermitsubje theapphcanttoadvilperaltydnd morethanUn-EISSWITCHF flue h1,as o nerdolof the pr). NEW RESIDENTIAL ELECTR SQ.FT. TYPECONSTRUCTION
, I,a,owner of the property,or my employees with wages ea their,olempensatlonwdldo the work,andthe structure is not Intended or offered for
vie7874 Ehot=,and Predmiora Cade:The Contratlols Limme Law
dos notapply to..owner of property who builds or Improves thereon,and RIS.UNITSwho doessuch work hlmseBorthrough his own employees,provided that ouchImprovements are not Intended oroffered for sale.Khowever,thebuildinger A
Improvementbsoldwithinomyearofcompletlon,theowner-bullderwllihaveanof proving that he did not wild or improve fou purpose of saga.). QTY. PLUMBING PERMIT FEEApN
rildsowner of the porperty,am exclusively contracting with licensed PERMIT ISSUANCE
ors to covimd the project(Sec.7074,Business and Protests: Code:
ntractors Llarew Law de es nest apply to an owner of property who ALTER-DRAIN k VENT-WgTIIt ffN
or Impoves thereon,and who contracts for such pAojeds with aorta)licensed pursuant to the Contractors License Law. BACK FLOWIPROTI!CT.DEVICE FEE SUMMARY
am exempt under Sec. B k P C for that reason
` DRAINS FLOOR ROOF,A N SANITARY Y N
a— OUTSIDE FI:
Owner Date RECEIPT If
WORKMAN mthat COMPENSATION DECLARATION
QI hereby affirm that I have o certificateconor concent to spythsere,ora FIXTURES-PER TRAP SCHOOL TA% Y_ N_
moo,ab of Workers Compevatlon Wurance ora rertl(led copy thereof(Sec. RECEIPT R
3500,Isis C.) GAS E.A. IM-1 INC.40UTLETS PARK FEE Y N
Policy N RECEGAS F.A.SYSTFM-OVER 4(FA) gN
I
Com any BUIL
0 Certified copy at hereby furnished
the city GREASE/INDUSIRL WASTE INTERCEPTOR 7ENERC
ANCHECK
Certified ropy V filed with the tlty inspection division.
_ CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP ID
COMPENSATIONINSURANCESEWERSANTIARYSTORM EA 2WFT to
Rhmscat.) need nes Mcomplded!(the permit bfou one hundred dollars
(41 Lti)orlemJ WATER HEATER W/VFNT/ELECT: FEE
I certify that In the per(onvnceof the work forwhlch this permit Is issued,
1 shall not employ any person in any manner an sa to bcrome wbjed to the WATER S,STVM/TREATING
Workers'Compensation Laws of Callfomla.Date PAID
O Z Applicant NEW RESIDENTIAL PLMB.
Z O NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you SQFT. Date Recei t#
CC — should become subject to the Workers'Comperastion porvisions ofthe Labor TOT L:
2 N
Code,you=at forthwith comply with such provtaions orthis permit shall be 6UILDI FE
W > rimmad revoked.
d f]
CONSTRUCTION LENDING AGENCY SEISMIC FEE
I hereby affirm that there Isa construction lending agency for the perform ELECTRIC FEE
M Z once ofthe work for which this permit is boated(Sec.3097,Civ.C.)
(,) O I<ndera Name PLUMBING FEE
LL � lenders AddreasQTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O ]O Irertily that have read thisappllatlonand state thatthe above information
CL Is corred.I agree to comply with all city and county ordinance and nate laws PERMIT ISSUANCE FEES PAID:
} W relating to wilding construction,and hereby authorise representatives of that
F Z city to enter a Pon the above.mentioned property,for Inspection purposes. ALTERORADDTOMECH.
aa—
Me)agree to save,Indemnify an d keep harmiev the Cityof Cupertino Date Receipt#
against liabilities,pdgmems,costs andexpence,which mayln anywan
R HANDLING UNIT Cf010,000CFM)
against said City) nwesnha grant) fou. LSUBTOTAL:
e ` 6o pammRHANDLING UNIT I,WOCFM) CONSTRUCTION TAX
Sig a fAppllamSig a /Contactor DHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCLOSURE
Willtheappliard or fuMUb ildingoccvpantsmreorhandlehazFATING UNIT 100,000 BTU) Date R
tergal as defined by the Cupertino Municipal Code,Chapter 9.12,a _
I lea It Yand Safety Code,Section 2553]00)? ATING UNIT(OVFR 10,000 BTU)
Will the applicant w❑future wilding occupant use equipment or dNTILATION FAN(SINGLE RESID) ISSUANCE DATE
which emit haardom air rontaminants as dented by the Bay Area Ai
Quality Management District? ILER-COMP PMP OR 100,000 BTU)
I Ye, n No
have read teeth& mty Goer,Se reons 2555,2553 aChapter. ILER-COMP(OVQt100,W0 BTU)the California It Ifth bSafetyCode, otcurr 2550.5,25537and25537.understand that if the building does not mrrently have atenanl,that lW:ESI DFNTIAL MECH. SQFTresponsibilityto notify the occvPant.fthe requirements which most bpriortofssuanmofaCertifioteofOccupancy. rc6
ISSUEDB
OFFICE COPY