S 2745 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING,.EI.EcTRICAL PERMIT NO.
BUII.DIN(i DIVISION APPLICATION/PERMIT IT'
UMBIN(UNIPIGHA,NICAI S 2745
llUll,UING PROJECT'1111tIN rHTcA'1'ION
Bit 1) 1 ESS: SANITAKYNO. APPLICATION SUBMITTAL DATE
OW 12, z
5 NAME: I `�/ I'IIONIi: CON'IR TOIt'S SAME. LIC NO: N/C CONTROL#
RCI 'E T (NEER; LICN)', ADDRESS:
W, ❑
f Q.� L
CONTACT: PIIDNIi: BUILDING PERMIT INFO
❑ Con athanl Fees Paid By Applicant(Initial) BLDG ELECT PLUMB MECII
LICENSED CONTRA(.TOR:S DECLARA9lON QTY. 17LECTRIC PERMIT' FEE
I heresy sm
oa Nat Into hceaxed under pmoniom of chapter 9 henwdng JOB DESCRIPTION
o
OWW aZ with Section 70o Division Td the lusinusand Prole,duns QNeand my lmonmci.s RESIDENTIAL'
F�� in full forte and effect. PHIRMI'I'ISSUANCE
wwr License Class Lia.n ❑SFDW'L ❑KITCHEN RFMODEI.
Q U AI'PLIANCILS-HCSIDEMIAI. ❑ADDITION ❑PLUMBINGRE-PIPH
N Q 6 Dan-TSConDEtnr
ARCHITISC9'S DECLARATION ❑MULTI-UNIT OMODLTDRAO
F�m I'ANIJS MODIFICATION
Z O to Z 1 understand mY Plans shall Fe used us puM1lic record,
OZ— UPTO 2(M)AkiPti ❑bYTERIOR El CHIMNEY REPAIR
F 4.1".,to Licensed POneasional 2111-I000AMPS IMPROVEMENT ASNJ'�(MING POOLS
<•1f_1 OWNER-BUILDER DECLARATION OVER 1O1LAMPS ❑BATH RFMODEL/REPALR 6 MOLITION
Q 1 Mrehy affvm that I am ucmPl four the Conwmmr's Liceme Law for the
{yj 3 p.U following reason.(Satins 9011.5.Business and Prdeuions Cale:Any city or county SIGNS IiLECI'RICAL ❑OTHER
m which requires a permit m mnswm,alae,.improve,demolish,cr repair any swctum ,v) Lo
F U'c6 pnmrm if,issuantt,alsn,eelimstvint,icalt bushel,pcunino III...gmedswmtnem SPECIALCIRCUIT/MISC.
that he is licensed pursuant to the provisions of the Contracutrs License Law(Chapter 9 _
�yp0 (commencing with Semion]WB)nf Divisinnl of the Business and l•mfcWmm CvIoTo, Tv EMETI!R UN POLE IN.ST. COMMERCIAL:
d D.aC that he is exempt Nercfrom and the hssiv fur the alleged exemption.Any vinlminn of ❑NEIN BLDG/ADDITION ❑DEMOLITION
^N Section 7031.5 byany applicant for a.croon mbjeen,beapplierim me civil pewlry Of POWER DEVICES
of me than five hundred olmlan(35fo Ili VEME 0
G ❑Las owner ofthe.ropmny,mmyempinyees with wags ax tbeirsole atmpcnvstian, SWIMMING POOL EL TRIC
or
F� will do the work.and thesom
ucrc isnot intended or offered forwlc(Sec.load.Business (]0
w�m and Professions Cale:The ContracttHs Licence law does not apply m an owner of OUI IA TS-SB'I'1' ICS-FI%TU
a 3^ Property who builds Of imposes Merton,and who does such work hitusetfor dtrougn
dionrin
his own employees,provided that such improvements am not intended or offered for NEW RE.SIDB IAL ELECTR Q Q. Allot AREA ' `t / FT.
sale.If,however,the building or improscomm is sold within one yearof completion,the
owner-builder will have the burden of proving that he did not build or improve for par.
oeole
I��°7�J rot the proanY.um exclusively connecting with licensed mmmmnrs to TOTAL: pV
fonswet the project(Sea ANY Nosiness and Premosions Cede)The Contractor's Li- of
crave Law does not apply ro an owner otpropeny who builds nr improves therron.and QTY PLUMBING PHRMH' FEE
who contracts for such projects with a contramob)licensed pursuant o the Commonest
License Law. PERMIT ISSUANCE
I am exempt under Sea ,li&P C for this mason
�— s I)u` Ala'IN-BRAIN&VENT'-WATER(EA) / VA.UA ON
Owner WORKERS COMPENS TI(L DI!CLARA'I'1111jjjlfff✓NNN BACK FLOW PROTECT'.DEVICE
1 hemby Onion under.cushy of Perjury r to nl the Inlhtwing dalnceinns:
❑I have until will mainmina CenilicntenfCansem tnselGinnumfnr Worker's Compete DRAINS-FLOOR,ROORAREA.CONO ST IES 'TYPE CONSTRUCTION
union,as provided for by Section 79(111 of the LuMm Code,for the perbo nonce of the
work for which Ibis permit is koftal, FIXTURES-PERTRAP
❑ 1 hove and will unchain Worker's Compenmtimt Insurance,as required by Section C••�
17!X1..fine l.abarCade.lits the perfnrmxnce ofthe work It,,which ilia permit is issncd. GAS-EA.SYS TE M.I INC.V OUTLETS OCC GROUP �AI�
My Wnrkc,"Compensation l ,omace canner fail Pulley another am. - J
Carricf: Policy No.: \ GAS-EA.SYSTEM{OVER Y(EA) p.
, CEIRIFICAI17OIT EXEMPI]ON FROM WORKERS' J
COMPENSSUON INSURANCE GREASI%INUUS'1'ItLWAS'IF iRCEIROR _ BUI_I:DIN_G DTVI 31O_N FEL IS
(Thi,araiun imcdna beentnpleted ifthcpermit isfomn,hundred dollar,1$11 N0 GREASE I'RAI'
nr less.) PLANCHECK PEE
I realty that In the purfnnnuacmtt the work fin fwndt,his......It's ismcd,(,hull SEINER-SAN I'I'ARY- .T'OBM EA.200 FT.
not employ any person in any manner tons to bccnlne sublet I It the Wmkcrs'ConmCt. ENERGY PEE
0 z autiun],low,of Coll m'vin.Dole WA'I'I!R 11 12A I I7R /VF,N'DELECTR GRADING FEE
7 Applicant _
Gy NOTICE Tea APPLICANI.IL uftcrmnkin,on,Ccrdpemoel Ifeantiun,yuu,huNd WATER 9Y3'I /flillA'I'ING
become suhjed to the Works/,C..... 0xallnn pmvivonx of the Lubm Code,you nluat SOILS FEE
forthwith comply with nnebFmvixinns nr this proud shall bedecnled revoked WAIT3R.'. VICE
0. Q
CONS'[RUCTION LENDING AGENCY NIIW ESIDEN'1'IAI.I'1,MH, SQ,19'. PAID
HE.fehy air nnthart there iso Cnntroaian lend lngngeney lire 0a, or lot ante Of Da RemnlptM
O O the work for whim this Iten tit is isttw(sea.inn.Cie,C.)
IJ+ U L.endmrs Name _ TOTAL:
WWW. Lender's Address TOTAL. BUILDING FEE
1 certify that I have read this application and mune Ilial the chose InBmnulin I i,
1F.to Comet.l agree In comply will]all city and county ordinances and eche laws ruhningt, QTY. MECHANICAL PERM IT FEE O
L) z building connrumion,and hereby umbnrix rcprcsemutises of lhix cirym cuur,u,mmm SEISMIC FEE
nMrvrmemioned Property fur inspection purptnex.
(We)agree m save,indemnify and keep harmless the City of Cupeninn against PIiNMI'I'ISSUANCE ELECTRIC FEE
liabilities,judgmems.coats and exp,mr,whichmay in any wayaccmc ugainmsaid Pity AUFHR OR ADD TOMECE.
in romeyucnce of the granting of chi,permit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNITf D 10,000 CFM)
SOURCE I!GULA'1'IONS. MECHANICAL FEE
A I R I IANDLING ON IT(OVER 10,M)CFM CONSTRUCTION TAX
i /
Sig re ApplicanUConuactor Date EXHAUST E(X)D(W/DUCIT
HAZARDO(15 All! ALS UISCLOSt1Rl! HOUSING MITIGATION FtG
X511 the aPPlicam nr furore huildin6' cupanl>lnre Or handle hazvrdnns minerinl HEAPING UNIT('TO IW,(NlllB
as defined by the Cupertino Municipal Cale.Chapter 9.12.and the Health and Safety
Code,Section 25552009 HHA'TINC,UNI'PPNER in) It'll))
❑Yes ellZ VIiMI1.AT1ON FAN($ GDate Rat at
REMD) PAID / d
Will the applicant or furore building st<cupanf use equipment or devicrs which
emit hazardous air contaminants as defined by the Bay Are.,Air Quality Management BOILER-COMP IP OR 100.000 HTlll
A,Districtals
❑Yes BOILER-CO '(OVER 1100,000 BTU)
-- - - I have real the hauudnos materials requimmcnn under Chapter 6.95 of the Calm AIR CO TIONI!R ISSUANCE DATE
fomia Health&Safety Cotte,Sectio,] 505,25517 nod255}0.1 undemand(bat ifthe NIi CSIDEN'1'IALMSCIL SQ.FT. `3— 9 O p
(wilding cine,sol currently haven tenant.Nat it is my responsibility mortify the acupam �J O 7
of the nems which must be ten.nor m wa...ce of a Ce irate t f spa
e
?LU,swilitioninabouta ager Dam 1 TOTAL: ISSUED BY:
OFFICE
ADDITIONAL PERMIT FEES
BUILDING PROJECT IDENTIFICATION VALUAT1oN
9VILDING
soDREs
-7 9V S
AANEF3
NPME
/ _\
Y2_9 g Y77 FEE SUMMARY
/1/ vNUNE TT vv
CDN TRACTORS BUILDING
NRME
LIC,NO ^. \ Z�Z 3 (n. PLAN CHECK
CONTRACTOR S FEE
ADDRESS
v"o"E SEISMIC FEE
OTY. ELECTRIC PERMIT FEE
OUTLETS SWITCHES-RECEP ELECTRIC
LIGHTING FIXTURES
PLUMBING
APPLIANCES-RESIDENTIAL
PANELS MECHANICAL
SIGNS
SIGNS TRANS. TOTAL Z,-5
SPECIAL CIRCUIT
EMP.METER OR POLE INS, PERMIT VALIDATION
MOTORS SEE FEE SCH.
O SERVICE CHANGE
Z Z
h— 0 TOTA
LU > OTY. PLUMBING PERMIT FEE ELECT,ISSUANCE DATE
W BLDG. ELECT. PLG. MECN.
Z ALTER-DRAIN&VENT-WATER IEA.)
U O BACK FLOW PROTECT.DEVICE
O L) DRAINS FLOOR,ROOF,AR EA,COND.
} y FIXTURES-PER TRAP
F ? GAS-EA.SYSTEM I INC.40UTLETS
V GAS-EA.SYSTEM-OVER 4(EA.)
INDUSTRIAL WASTE INTER. r
LAWN SPRINKLERS-1 INC 5 V.B.
LAWN SPRINKLERS-OVER 51EA.) ) -O
SEWER-SANITARY-STORM EA.200ft/ ,
WATER HEATER W/VENT
WATER SYSTEM
WATER TREATING EQUIP.
TQTAI
QTY. MECHANICAL PERMIT FEE
ALTER OR ADD TO MECH.
APPLIANCE
AIR HANDLING UNIT(TO 10(T10C.F.M.)
AIR HANDLING UNIT(OVER IOXC.F.M.) '
EXHAUST HOOD(WITH DUCT)
HEATING UNIT(TO 100,000 B.T.U.)
HEATING UNIT(OVER 100,000 B.T.U.)
VENTILATION FAN(SINGLE)
BOILER-COMP 10 H.P.OE 100,000 B.T.U.1
BOILER COMP 10—10000011TU1 SEE FEE SCI(.
TOTAL I