27918 PPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
ITY OF CUPERTINOI L :•ELECTRICAL PERMD F0.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL O
eIILDID•O PnOJBCIIUIEM7FICATIONc•"u.,,'r A o
R.DING ADDRESS:` /f/� SANITARY NO. APPLICATION SUHMOTALDATE
v - j✓�•/� ry^A e ' `!'d UNITY .LOIN IC-It
T _ JWNERS NAME PIONE. CONTRACTOR'S NAME: LIC NO:
� E lAkhd d N C CONTROL
•RCHITECf/FNGINEFR: LIC NO: ADDRESS: ❑
ONTACT: PHONE: 'a �.a i. r �- ..0 r ..p`}I11 &Fa,,�it;'iS ''t'I rSn ''+'•.'"BUB.DING PERMIT INFO -)
QTY.,T < - ELECPRIC PERMIT g i. , .yFPEEta.
I� DQ✓L rl JN611� D 1�) 235 1TJl.� `•, BLDG PLUMB MEC'H
�4 p C PERMIT ISSUANCE op
LICENSED CONTRACfOR'S DECLARATION APPLIANCES-RESIDENTIAL
❑CZ I hereby aRrn Jun lam liunzad under povisionsof Clapter5i(commencing with LOB DESCRIfRiON
1400 Scmion 7000).(Division 3 of be Business and Pmfessions Code and my liccnu it in PANELS
�jdUF
ce full farand effect U, License ClassLic.is UPTOMAMM
y« Date Contucmr. 201-ISA AMPS CLi
�NZ ARCHITECTS DECLARATIONSQ.FT.FLOOR AAEA 5Q.PT.
)Z_., l undersandmy plans shill be used as public records. OVER 1000 AMPS
:.I=w SIGNS ELECTRICAL
Littnsed Professianaf OWNER-BUILDER DECLARATION SPECIAL CIRCUTOMISC.
:O w F 1 hereby affirm that 1 ton exempt firm the Conmemr a License law for the
e O C following..(Sutton 7031.5,Business and Professions Cade:My ciry ar counry TEMP,METER OR POLP INST.
J which"trims a permit in sonamn,after.improve,demolish,or repair any structure,
}7 pricrmiu issuance.also requims the epplicantforsuch permit to file a aimed statement Po DEVICES
p
that he is licensed pursumuo the Provisions of Ne Contractors Licenu law(Clupur SWIMMING POOL ELECTRIC VALUATION
9l commencing wish Section 7")of Division 3 ofthe Business and PrefessiamCode)
XT•y or that he is exempt sherefmm and the basis for the alleged exempt:...My violation of OUTLETS-SWITCHES-FIXTURES a>•�
F Z Section 7031.3 by sny applimm Bar.permit,.bjau Ne mplicam sea civil penafryof
nil mom than five handrail dollar($300). NEW RESIDENTIAL ELECIR K -SO.FT.F_p ❑ 1,uownerofshepma .ormyemplay wiNw gesutMirulemmpens m, STORIES TYP CONSTRUCTION
�3=c will do she wmi thcswnum isimmu siorim.ffertd formle(Sm.706.Business
and Pmfaasiou Code:The Common's Licenu Law docs not apply to an owns,of
property wh.buildsmimproves thereon,and whodoc.mch work himulfmthro dildis OCC.GROUP RES.UNITS
ownemploy=,pmvid Nusuchimpmvemenuerenotimendedaraffendforsafe,If..
however.she building ce impmvemem is sold within one year of completion,the owner.
builder will have she burden of proving Nat M did not build m improve for purpou of _
cele.). -- �::i�g':, J.-wµ�a..✓G - ["�r.�, ,y. S*ar '"Zs
❑ I.asawner.fNepr.penY•am<xclusivelYcomm�ing wiNlicemad comm�orsm QT.Y•;4.s�}!{ ;PLUMBING PERMITy�-.y,,x4 ,' 7k FEB,,�T FLOOD NE pPN
construct Ne project(Sao 7044.Business and Professions Code:)The Contractors
Lieasiulawdoesnmapplytoenawnerafp ffywhobuildsmimpmvesN .and PERMIT ISSUANCE
whoconmeu fasueh prerjosiswith a conuana(s)IieenteC pursumt in the Contractors ALTER-DEAN&VENT-WATER(EA) •r•Ix.,i%-`i, x'%;!--.•.+w+Iw,e
Licenu Law. .. >a :FFEE SUMMARYt,`lam;
❑ 1 sm exempt under Su. .B&P C for Nis mmon BACK FLOW PROTECT.DEVICEWE FhhS
SANITARY Y N
DWM Date DRAINS.FLOOR.ROOF,AREA,COND. RECEIPTN
WORKMANCOMPENSATIONDECI.A
RATION SCHOOLTAX Y N
[IIhaeby affvm Wtlluveawtifinu of concerti.ulGinsurt,area,tifinte of FIXTURES-PER TRAP RE M
'N Workm'Com ansation insurance a a mrdfied copy thereof(Sac.3800.Lob C.)which PARK FEE Y N_
coversall anployas under Nis pamia GAS-EA.SYSTEM-11INC.4 OUTLETS RE IPTN
Policy N BUILDING D)VISIONZIFS
Court u'y GAS-EA.SYSTEM-OVER 4(EAI PLANCHECK FEE
❑ Cenifed copy is hereby fumiahed.
❑ Ceniftadcopy is fled with she city in ,on division. GREASFJINDUSTRL WASTE INTERCEPTOR GRADING
CERTIFICATEOFEXEM ONFROMWORKERS' GREASETRAP SOILS FEE
COMPENSATION INSURANCE
(This union need not be completed if she permit is farone hundrtd dollars(5100) SEWER-SANITARY-STORM EA,201317. ENER
or less.)
I marc f,that in the performance of the work far which Nis peon:,is ire WATER HEATER W/VENT/ELECM
nm employ any Person in am w as m become s ' she Wohers'
PAID
Z Applic inion lawn of Cafifomia. Date WA SYSTEFVTREATWG 61'. RaeiplN
AOTICEt
Z NOTICE TO APPLICANT:If.efts mak tittemea x -on,you should NEW FSIDENTLLL PLMB. SO.FT. TOTAL:
LI) become mbjaua the W.rker's Campematio isions of the labor Cod,you must
Y , forthwith comply with such previsions or do ,mit shall be d`�egW�rtv ed BUILDING FEE
1 CONSTR CTI IFN IN AGENC�y SEISMIC FEE
I hertby affirm Nat shoe i a comouni.lending agency for she pe .rmTitce of
J Z _ TOTAL: ELECTRICFEE
O Newark for whicF this permit is sued(sec.3097.Civ.C.)
Lender's theme 7777, PLUMBING FEE
Lenders Address QTY: ��"f,4CRAMCAL PERMIT- .'ar; PEEN`,
v I mrof,that I have,rad thus a,dionlon and eau that the idi Inf.amalan is '- L- 4=-�:i]�"
MECHANICAL FE
correct.l agru to comply wish aft cityand county ordinances and sone laws mining to PERMIT ISSUANCE
_ Z) building construction,and hembyamhoriu repreummlvesof this city to enter upon the CONSMUCT70NT
J Z above-mentioned property for impaction purposes. ALTER OR ADD TO MECH.
... (We)agree m save,indemnify and keep hamdess the Cit of Cupenino agunst
liabilities.judgmenu.csumdexpenus which may in my wryanx.,,tironsaid City AIR HANDLING UNIT(TO 10.000 CFM)
in emose enco of the granting of rmu n.
AIR HANDLING UNIT(OVER 10,000 CFM)
Signature of A,dic.tfCa r 'L¢F/ Date EXHAUST HOOD(W/DUCD PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(T0100,00)M) Dau Rae Ia
Will the applicant or for.building occupmtiameor handle hamrdous mnerial HGTING UNIT(OVER 10BIHA BTU) T L:
as defined by the Cupeniw Municipal Cade.Chapter 9.12,and the Health and Safety
Calc,Section 255390? VENTILATION FAN(SINGLE RESID)
❑Yes ❑No ISSUADICB.DAT6.
Willtheappleanmrfumrt building«cupantuseBOILER-COMPIiHP OR 100,000 BTU) 4Y 6 i1!/
equipment mdevim which emir
• hevudous a'u can a mama rta m defined by the Bay AAir Quality Manquaro m BOILER-COMP(OVER 100,000 BTU)
Dian? ❑Yes APR =7❑No 1995
NEW RESIDENTIAL MECx. SQ.FT.
I have read the nazselous arm did,requinm era under Chapter 6.95 of the CIT 'Jr
if
Hash&eafny Cody have
ate 255D5.25533 it is and 23334. 1 undersand Net
if Ju building t doe,rot currently have a tenant,tett fi is my responsibility ernotify she
oaupmn of the requirtmenu which nun be met prion.iasumco of a Certificate of
Occupancy. �xy`
Owner or authm red agent Dam TOTAL: ISSUED B +
OFFICE