20115 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
- fielding Pro'en Identification PERMIT NO.
Badding Address: 20115
wnera ants: one: A A A
1l CITY OF CUPERTINO-BUILDING DIVISION ql�
,on
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daenu.Name: Lic.No: APPLICATION /PERMIT ��`�'
BT,ILDINGaL TRICAL,PLUMBINO-MFGHAMCAL CATEGORY CONTROL N!;
- Architect/Engineer. Lk.No: J 1
QrY ELECTRICPERMIT FEE BUILDING PERMIT INFO
Address: PERNHISSUANCE ��eb jam `
LICENSED CONTRACTOR'S DECLARATION LSI ICT
thereby.
ffirm that I am licensed under provisions of Chapter 9(commenc APPLIANCES-RESIDENTIAL BDESCRIPIION
Ing with Section 7000)of Division ofthe Business and ProfessionsCode,and my
license Is in full force and effect. PANELS
Class Lk.p
Date
Date ContnRor UP TO 200 ANTS
ARCHITECPS DECLARATION 781-1000 AMPS
qa nt0 7 7
M77 I understand my plans shad be used as public record.. OVER 1008 AMPS SQ.Fr.FLOOR AREA g/SQ.FT.
z�(s Licensed Professional SIGNS ELECTRICAL
<6u�1OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC .�
t' a Iherebya(firm that am exempt from the Contractor's License Law for the
7
po following reason.(Section 7MI.5,Business and ProAny city orfession.Code:A
O L t. TEMP.METER OR POLE INST.
anystm�ntyhimpr Atli p ame,a n.tract,alter, aprove,de rsuch, er ttr
g.aa any structure tatemeita that he is
ursuantt the rOvedom of
POWER DEVICES
O�U file a signed statement that M b Ilmnsed pursuant to the proWiors o! the
Commences License Law(Chapter 9(mmnrnang with Section 7000)of Divi- SWIMMING POOL ELECTRIC
COs e1on3ofthe Businesaand ProfemiamCode)orthathelaemmptthemfmmand VALUATION
'.1 the Lams for the alleged exemption. Any violation of Section 7R)1.5 by any Vo OUTLETSSWITCHFSFIXTUI E5 �q Lf,&g
0 fiveapplicantdreddoll..taubjedstheapplkanttoocivilpenaltyofnotmorcthan
five hundred dollars(e pm NEW RESIDENTIAL ELECIR
7 ❑1,as owner of the property,or my employees with wage r thele sole �' .FG STORIES "[YI'E CONSTRUCTION
C < compensation,will dothe nd Pruf the stmde:Th Contractor's
orofferedLaw
5�O sok(Sea 7044,Bualnns and PMess!ov Code:The Contractors Llcenu Law
5$ does net apply to an owner of property who builds or improve thereon,and OCC GROUT' RESUNII'S
0. who doessuch work himselforthrough his own employees,provided that such
Improvements arc not intended oroffered for sale.I(however,thebeildingor TOTAL:
Improvement bsold within aneyearofeampletion,the owner-bt ilderwlll have
Fan of proving that he did not build or improve for purpose of sale.). QTY. PLUMBING PERMIT FEE FI,pO WNNE APN
a Owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE yI q
traRon to construct the project(Sec.7044,Business and Professore Code: 1 4 YJ
Contractor's License Law don not apply to an owner Of property who 1 ALTER-DRAIN k VENT-WATER(EA)
Wilda ro
or Improve thereon,and who contracts for such pRoject.with a
c?t dor(s)Ilcemod punuam to the Contractor'.Lt...Law. FEE SUMMARY
U I am exempt under Sec. B k P C for this mason BACK FLOW PROTECT.DEVICE
Owner Date DRAINS FLOOR ROOF,AREA,CONI. SANITARY Y_ N_
WORIOHAN COMPENSATION DECLARATION ^
RECEIPT
❑1 hereby affirm that I have a mrtif to of consent to eel-mmrre,ora 2 H%'NRES TRAPPER TR �R� SCHOOL TAX Y N
mnifirate of Workers Compensation Insurance ora conifled copy thereof(Sec. RECEIPT N
3800,Lab S C.) GAFA.SYSTEM-1INCAOUTLETS PARKFE Y N
Policy N RECEIPT p
Com any GAS EA.SYS!'EM-OVER4(EA) BUILRWEIPTDING VIBION PEES
�Certmed copy la bed with furnished. E U A PLANCHECK FEE
❑Certified copy la filed with the city Inspection division. YY
CERTIFICATE OF EXEMPTION MOM WORKERS' PAID_�—� J�b�6 ^�{�
COMPENSATIONINSURANCE �, DafC Recei t# ��aC
(Thlsaedlon need nu Wcompleted tithe permit la(orane hundred dollars "
(s1BB)armn.) wA �Fxw v
I certify that the performance of the work for which this permit is Issued, ENERGY FEE Y_ N
1 shall not employ any person in any manner so n t-become subject to the ''
WorlicantCompensation laws of California.Date WATER SYSTEM/TREATING PAID
C1 Z Applicant
Z Q NOTshouICE become,
APPLICANT:IL W.dkmakingpr. tt..cateo(.. ft eLyou NEW RESIDENTIAL PLMB. SQ,pT, Date Recei IM 7�e�
f Code,you
eforth to the Workers'such provisions
npmvbis permit s Lab be TOTAL:
WN Code,you must forthwith comply with auchprovbbre or this permit shall be
> deemed revoked. BUILDING FEE t
a o CONSTRUCTION LENDING AGENCY SEISMIC FEE ldo
I hereby affirm that there la a construction lending agency for the perform- TOTAL: ELE -FRIC FEE
O ance ofthe work for which this permit is ismed(Sec.3097,CIv.C.)
LL lender's NamAdd PLUMBING FEE
LL F cndelsAddre a QTY. MECHANICAL PERMIT FEE MECHANICAL FEE
O W Icertlfythat l have read this appdationand statethat the above Information
S ..vd.lagreetocomplywlthalldtyandmuntyon!Iran... gate law. PFRMTT ISSUANCE •L� FEES PAID:
} W relating to building corstmedun,and hereby authorize expeneentativn o(this
1— Z city to enter upon the above-mentioned property for Inspection purpose,. ALTERORADDTOMECH.
V — (We)agree to save,indemnify an d ep armless the City of Onpedin0 `•� Date Receipt#
agaWtliabi0tin,judgmenb,cogsan ewhkh may any ,wayaccrue AIR HANDLING UNff(TO 10,000 CFM) SUBTOTAL:
ty in mnseqft ting of it.
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
afApplicant/Gantt ue o D EXHAUSTHOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARD MATERIALS DISCLOS E
Will the applicant or future building occupant store or handle haiardous HEATING UNIT(TO 100,000 BN)
material as defined by the Cupertino Municipal Code,Chapter 9.17,and the Date Recel t#
11 111 dna Safety cion 75537G)t HEATING UNIT(OVER I W,000 BTU) TOTAL:
❑ 1 o a
Willthe applicant future building occupant use equipment or devices VFNIILATION FAN(SINGLE RESID) B9BN11'NG'F DALE
which emit hanedo air contaminants as defined by the Bay Area Air QQ'' __
Quality Management Dist 7 BOILER-CAMPOHPOR100,000BTU)
Yes 4 d trtstedab require erchap895 oBOILER COMP(OVER l00,D00 BN) aNyyS.� l ro-theCallornia!i0.ith SafeltyCodeto 50
5,25533 and 75534.!
understI nil thatathe Wildingdoe n oily have a tenant,that it is my NEWRESIDFNTIALMECH. SQ.I.7
rf.orto bllit red theoffaCertfil on
of vements hich mu the sap A„�,,,�t,.,-5
prior to tic ofd Certin eo parry. � Y.1,�'a�ENl'L—d (0Own u orind ag t D e
TOTAL: q�,WUEDBY:'
OFFICE COPY
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^ INVOICE wvaa Ho.
CALIFORNIA FASHION TILES, INC. 9542
IC #59�543t '
csr o-m+nor,cyrmvcf�'R9L�O��C
SAN JOSE, CA 95125
(408) a9j
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CUSTOMER'S ORDER SALESMA TERM
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- - 75737
POLY PAK (50 SETS) 7P737