22362APPLICANT TO FILL IN INFORMATION WITHIN RED LINES —USE BALL POINT PEN ONLY
Building Pro ert ldendfiadon
Building Address:
F 7✓1a'>o�t- Cis; � r � F
PIX.WT NO.
,.. 22362
m : one:
rc�O
CITY OF CUPERTIN4BUILDING DIVISION'
APPLICATION / PERMIT
Contodar,Ners: IX. Nee
"
BUILDING-ELECTRICAGILUMBING-MECHANICAL
CATEGORY
CONTROL#
rchXna/Fsgineer. Llc No:
QTY ELECTRICPERMIT FEE
BUILDING PERMIT INFO
-
Address
❑ ❑ .K ❑
PEUUTISSUANCE
LICENSED CONTRSDECLARATION
under
I hereby aHlrmlh,t lam licensed M.3.fheB prov.dProChapter9(mmnd ro
Ingwlt sifull7000)v/DHlemiJo(the ButlnemandProfeaemsCme, and
I ��«C n/ullf Lie,#. 3
D>te-J7L�Gok„r nr N' -
ARCI[mcr DECUBATION
APPLIANCES -RESIDENTIAL
1 OB RIPIION
ands Dv?/e
PI V
PANELS -
UP TO 20D &MM
pl_ V(pS
luMe andmyplam WBbeumdnpubticremnla
0VER1000AMPS
SQ. FT. FLOOR AREA
S/SQ. FT.
SIGNS E DC[RICAL
Licensed Po fesiorul
SPECIAL CBtCUR/MISE
OWNER-11MLDER DECUBATION
IherebyafBrmtbtlamexemptfemnthe Comr taro Ll¢ruel,wf¢the
Il
TEv�.METEt OR RALE AST.
ppy7pR DEVICES
following reaaon.(SecUon 7m15, Bualneseal Pmf®lore Code: Any dty or
muntywhkhrequl aper Wmn Meter,Improve,demWh,orrgear
anyemdumprbrtoiub meal requl¢atheappU¢ kfmauchpemdtto
• signed statement the he h B¢roed porno. to the pro,ain. of the
Contntlor, Ldcense law(Chs Pln9(mmnendng with Seetbn 7D00) of DNI-
,bn3ofthe Busin®, dl'rofesbro Cade)orthatheberempttheretmm,M
C / rr
1sy _J
SWIN[NUNG POOL ELECTRIC
A/
V LUA TON ,
the beb for the alleged exemption. Any Wdatlon of Section 7W" by any
appB¢nt fora permk,abjecv tis appBrant to a d,11 peroky, does mom than
OII7LEISSVlI2HESFLYTURFS
_
NEW RESIDENTIAL E.BCTR
Bv�undred ddbra ($Sant.
I , as owner of the Property, or my empleyen wdh wages as their sole
mmpenteelaq willelothe work, and theauurnrre is rot intended or offered for
TYPE CONSTRUCTION
E
sale IS e, 70K Busbees and Pm!®torus Code: The Contractors Iona a Law
does not apply to an owrcr of property who builds or Imprwn thereon, and
who doesauehworkhlnseBorthmugh hl,ownemplo,ees, prwlded that such
impmv nuamw Mendedoroffert f¢,ale. If,however,thebullding¢
Lnprovement bsold rwkMnoneye, rofcunpletbr,theowner-W BderwBl have
TOTAL:
t"rden'afpenvingtibehedld nerbaudarlmpmweforpurpoeeaf.k.).
LJ 4 as owner of the property, ,m e.hush,ely mntracting with licensed
mntracturs to mretred the project(See. 7D14, Rushee$ and Profeubru Cade..
QTY, PLUMBING PERMIT FEE
PERMIT ISSUANCE
FLOOD ZONE AYN
.
The Contractor's Lken a Taw don not apply in an owner d property who
builds e or Improvthereon, and who coroners for seek p,*U with a
cilau'doral li¢rom pursow to the Contndars License law.
IJ I am exempt under gee B 4 P C for Nb reason
.AI.TEt-DRAA 4 VFNF-WATER (EA)
-
BAIX FLOW PROTECT. DEVICE
FEE SUMMARY
OUTSIDE MES
DRAINS FLOOR ROOF, AREA, COND.
SANITARY Y_ N_
RELFTPTI '
Owner Due
WORKMAN COMPENSATION DECLARATION
I hereby affhm the 1 have a mrtiR¢te of consent to m1f insure, or a
n1 cess of Workeri Compenvum lrouran¢¢a ¢#sled ropythemo((Sec.
3800, lab CJ
a TCZ-t.g�i 99
F0(TVRES PER TRAP
SCHOOf-TAX Y_ N _
- RFLmv1lf
GAS U. SYSTEM -1 AC4 OUTLIM
PARK FEE Y_ N_
RECEIPT0
cess EA. sys[PafovFR /(LA)
��+ ^r—�-
co����(IppC,m T���a75� f-i�idififfed.j/%F=64 BE
LA "Nedm
t,.3 .`riNed ropy b filed wIN the dty Iropectbn #talion.
BUILDING DIVISION FEES
CREASE/ADUSTRL WASTE INTERCEPTOR
PLANCFIECKFEE
GREASE TRAP
CERTIFICATE OF E[ENIMON FROM WORKERS
COMPENSATION INSURANCESER.SANITARY-SIORM
(this aedlon need eat b completed Btb b f¢orc hundred dollar
PAID
Date React t#
EVE.A.700FT
(f100)¢lev.> -
I f or le slut ti the pedomuna o(the w¢k for whidr th)s pent#, is fined,
WATER HFATEtw/vt:,NT/Ercm
ENERGY FEE Y N
I ahail not employ any person In Any manner n u to become subject to the
Workcri Campensatbn laws of California. Date
WATER SYS14d/'LRUnNG
PAID
Appllant
N'onel:ro AI'1'LICAFTT: If,,aer maldry tw centuleate of Exemption, yaa
should become mbjed to the Workers' Compereatlon provisions of the Labor
Cmeyou whh comply with ouch provbbro or thio permit shall be
deemed revoked.
km.
Dale Reoef I#
NEWRESIDFNTIALLLMB. SFT.
TOTAL:
B E
-
SEISMIC FEE1
CONSTRUCTIONLENDINGAGFNCY
Ihercbyafflrmthst there Is s construction lendlogager�ry for the perform
Lender. lv �rkfor whkh thio pemdtbbaed C+ee 3097,CIv. c.)
Lender,Address
I mrtlfy that I love mad thbappllatbnand rote thrtthn above inforenna.
bmrr.1:gmetocomplywhWdtyandmuntyordWn and Yatelaws
ctera,andhembyauthWipeoBonbtivnofthio
To'rAL:
ELECTRIC FEE
PLUMBING FEE cv
QTY. MECHANICAL PERMIT IEE
MECHANICAL FEE b
PERMIT L4UANCE
FEES PAID:
�QJ
•,
cityto enterupon to abo
dtyW) agree to she aWve-muify an d property for irep Con purposes.
(We) agree to vee, IrWemNty and keep Numbs the Cay of Coped W
ALTIX OR ADD TO MFLFL
Date ReCel t#
SUBTOTAL:
,,trot allies,pd nt., nor expdIrgwh�ouylnanywayaraue
gat city r,¢ granting of thio pent#,.
a �i
AIR HANDENGUMT (TO 10,000 CFM)'
AIR HANDLING UNIT (OVER I it" CFM)
CONSTRUCTION TAX
Signature of AppB /cant
EXHAusT Hoop (w/DLrn
CONSTRUCTION TAX PAID:
lABDOUS MATERIALS DISCLOSURE
HEATING UNIT (70100,000 ETV)
Will the appllal by the C.prtinoMorapantode, orbndiohavrdou.
r althlod da0md bye Solm2ra MuNtlp,lCode,Chapter 9.1 7, and the
I-kaXn.nd satdy cmc sedlan zss3zG)7
❑ You
Will the applloest m Wilding occupant uv equipment or d evIces
whkh emit havardcu, air conuMvnu ei deBrud by the Bay Area Ab
Date Racei t#
ttl:+Twc uNlr roveR taopao BTu)
TOTAL:
VENTILATION FAN (SINGLE RFSTD)
ISSUANCE DATE
BOILER -COMP PHP OR 100,0W BTU)
Qual ty Me ea oneI�y'atyd7
4 Ye �No
IK)ILER-COMP(OVER 100,000 BTU)
have read theh ,rmledaIs requimmenu under Chapter 6.95 of
the Callfomia Health 4 Safety Cme, Seetbro 75505, 755]3 and 75531. I
NEW RESIDENTIAL MEIN: SQk
understand that lithe Wilding does mt mrrenlly have a tenant, that It h my
reip-iudbilW to really the aapam of the requlremem, whkh roue be rust
prlorm dl t panty.
zDa(/I
SSU. D BY:
Ownerarautho
TOTAL
OFFICE COPY V