20595 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY I
Building project Identification PFRtAT NO.
Building Addre>s: d 20595
�3 �o u► TS i? 2 P�
ane
Fi! E 64Lp P CITY OF CUPERTINO-BUILDING DIVISION
S G redo N ��/yay� Q APPLICATION / PERMIT
-"- " - �/+� '/ 2 BUfI.DINGFIFZTRICALPLUMBINGMFLIIANICAI. CATEGORY CONTROLY
A R / C e - f Lk,No:
J .J Qn ELECTRIC PERMIT FEE BUILDING PERMIT INFO
Address �� PFRMTTISUANCE ❑ ❑
LICENSED CONTRACTORS DECLARATION
I hereby affirm that l am licensed under provWms of Chapter 9(commm AI'PI.IANCFSRESIDENTIAL B N
Ingwith Section RI00)ofavbion3ofthe BuslneuwdPrdeadavCede,and try
L¢naels lLLGodL{ef PANELS
1S I rI�P�IY-yam _`
Date �Carrtratlnr -1000 AMPS
ARCHD CL A ON "`••NYY 1 _
OZ I understand my plana Jell be used as publlcremrdl. OVERIODDAMPS SQ.FT.FLOOR AREA S/SQ.FT.
LI¢racd Prolmbeal SIGNS ELECTRICAL 11 LED I N
�< OWNER-BNLDFR DECLARATION SPFLI,IL CIRCUIT/MLSC
ZF, y IherebyafOrm thatlameaemptfromthe mr .e.Lk¢ L,Wfmthe
OQ followbgnxaon.(Sectlmr 9015,Busiom ant Pmf®Iona Code:My city or
L t- TEMP.METER OR POLE INST.
�, cvuntywhkh rtqulrul pr tomvtruct,alter,lmpmve,demolbh,Orrepalr T
+nysMu pdm WiUL ame,alsorequlmtheappUwtfm.uchpemat to rowEa DEVICES rt p/
O Ne a stgncd statement that he b licensed pursuant to the provbbv of the
a� DATE
Cootramr,Lice.Ltw(Chapter 9(mmmrnWg with Section 7000)of Divi- SWIMMING POOL ELECTRIC
F•ib slon3 ofthe Buelnnsand Pmferbv Code).,that he Is exempt thenfromana A A ON
< the bub for the alleged exemption. Any Nolatbn of Section 7015 by any
O� 1pph.t for a permit subjedn theappllcant to.dvll penalty d not mon than 01177-E�SSlY17CF16FDCIURE"
By hundredioliu5(10)
s(S .
.- m I,as owner or the property,or my employm wkh wagn as their wle NEW RESIDENTIAL E.ECIR SQFT. STORIES TYPE CONSTRU.TTON
mmpesuatbn,willduthe work,andthestueun is not Intended or offend for
Ovale5M7DK BusvrexirI feasoea Code:The Comntlor.Ll¢velaw
cs� don not apply to an owner of property who bull"or lmprwes thereon,and OCC.GROUP RFS.UhTTS
whodoessuchworkhmro
lomaU orthrough hisownemploy ,provided that such
ImprovemeNs are rot Intended oroflered for sale.If,however,the building m T0"fAL
Improvement bnuld within oro yearofcomplelbr,the owner W BderwlB have
t ,den of pmvi.g that he did nut build or improve for purpoxoleale.). QTY. PLUMBING PERMIT FEE
11 4 as owner d the property,am excurBr
sively contracting with aved FLOOD ZONE APN
mntnct¢s to mmoract the project(Sm 9004,Rostrums and Pro(mbn.Code: PFRMUISiUANCE .
The Corunnor',Lkeve Law dm not apply to.n owner d property who
builds or Improves thereon,and who mntnds for such pRojem with a ALTER-DRAIN&VENT-WATERS
�QpI(+doAa)B¢rued pursuwttothe Contractd.Ll¢ve Law. BACK FLOW PROTLCT.DEVICE FEE SUMMARY
1_I I am exempt order Sec. B&P C for this recon
Owner Date DRAINS FLOOR ROOF,AREA, SANITARY Y_ N=
WORKMAN COMPENSATION DECLARATION RECEIT Y
J,,��f"h/ by atllrm that I have ¢nitivte of consent to mg-moure,m a FI%T11RES I'FR TRAP SQi00L TAX Y_ N
15'X aofWorken'Compevatlm I...or.caddiedcopythertrof(Sec. �To
38(D,Lb J GASEA.SYSIFM-1 IJC40U'1LEIS PARK FFP Y_ N_
mp l y Y v RECEIPT Y
CoyAS E.A.EA. Md(FA)
BUILDING DIVISION FEES
Cent `d'' GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
Certmed copy b filed with the city wpectIon dint int.
CERTIFICATE OF F1(EMPTION FROM WORKERS CREASE TRAP PAID
COMPENSATION INSURANCE. SEWEI45AM1'ARY SNRM EA ZtRIFT Date Re(xi t#
(TMs section nettd not becompleted lithe permit b f¢ re
om hundred doltn
O100Jof Ifie.)r1cm') WAT"ERHATER W/VENT/FLDCTR PNERGYFEE Y N
I¢ Ry that b the performance of the work for which thin pemdc le owed,
I shat not employ any person In any manner w an to become subject to the WATER SYS IMfTREkTINC -
Waken'Com,foubnLawaofGllfonia.Date PAID
O Z Applica
NOUCnt NEWRESIDINDAL PIMB: SQFT. Dale Reoei t#
Z O [MICE TO APPLICAM:If,aRer rvking thin Certificate of Exemptbn,yw
.hold become wb}ct to the Warianmbv
'Compeatlan provlaofthe Labor - TOTAL:
CC N Cade,you rru.t!¢thweh comply wlthwch prvWbv orthb permit shall be
] deemed revoked. BUILDING FEE
LU CONSTRICTION LENDING AGENCY EISMIC FEE
CL IhenbyafRrm that there ba conatructlm lerdingagency for the perfom_ ELECTRIC FEE
Z aore of the work for which this permit b t.ued 30ff9,Civ.C) TOTAL
U O lender!Name PLUMBING FEE
LL Benders Addma QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W I¢rtify thntl have recta thbapplbtbnaM.tat<tlut theabovewarrvbon L
boned.!agree to complywlth ail tlty.rd county ordWnmwd ylte laws PERMIT MUANCE FEES PAID:
r U) relating to Wilding covmor
tctIm and hereby authbe mpre ntatNe d thin
H N city to entor upon the abmrmentbvd property for tropectbn purp.. ALTERORADDTOMECH.
Z (We)agrec to Iful ify.n d keep hansdes he City of Cupmrtba Date RCCeI t#
U ,6a1vt BabWt a real expenau wh yin any.y.mu< AIR HANDLING IJNIT(TO 10,000 CFhD SUBTOTAL:
agaWt nand nettpr d gnntiry eperm+P AIR HANDLING UNTT(OVER 10,00 CITD CONSTRUCTION TAX
f ppllan o Dan, EXHAUST HOOD(W/DUCI) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DISCIASURE
Will the applicant or ftture Wilding occupant store or handle ha ardour BEATING UMTU0100,000 BTU) Date RCCeI t#
naterbl u defined by the Cupertino Municipal Code,Chapter 9AZ,and the
Fkoalth.rd Safety Code,�tI�on=(a)7 HEATIN'GUNTT(OVER IWODDBM -TOTAL: S
W Yee �M
Lith<appBant¢�uture Welding ocapant use equipment odevlax VFNTILATIONFANSINGLE RESID) ISSUANCE DATE
which emit h.,dousai ,ounansas deflood by the Bay Area Air
Quality Mawg<mcnt �7 BOILER-COMP PHP OR 100,00 BTU) PAID
F-1 Yo //
have read theh rmatedat rNuiremenbunder Chapter 6.95 of B011ER-COMP(OVER 100,=BTU)
the California Hahh&SafetyCode,Section 75505,25533 and 75534.1 1
undmtanl that if bu0dingdo mently have sten ret.that It tmy NEW RESIDENTIAL MECH. SQFT JUL 3 + 199
rupovbBit t d ythe ottvyy d ernryircmenb ch moat be met
pMrtob CertN EolD panty. J
of ^rt^nrfinn
_ ��3 l7 <•fS,i�h�f�
Date ISSUED BY: -1��QIN�I
TOTAL-
OFFICE
OTALOFFICE COPY