23406 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
redin Frn'ed idenitHa,ln. ,. )!l PERMITNO.
Building Add0_ rAA WF /i/ #T
23406 a.JJ�0
i uF u2 E � BLUD PI 4,E Fog sok Lo'
oars ame: one: -
CITY OFCUPERTINO-BUILDING DIVISION
Connttactar'sNameLic.No APPLICATION / PERMIT ' 3 l
0L/4 MA'-/R//&D SV917% BUILDING-ELECTRICALMUMBINGMECHAMCAL CATEGORY CONTROL#
Archlte_R/Engine. Lie.No:
7 ��.•, QTY"' !` ELECTRICPERMIT I„., t`;'IFCE�,1�'+)"I`-j' BUILDING•PERMIT INFO
Address (- / Sm PERMTISSUANCE
LICENSED CONTRACTOR'S DECLARATION" -
Iherebyaffirm that l am licensed under provisions of Chapter 9 frommosou, APPLIANCES-RESIDENTIAL JOB DESCRIPTION
ingwiih Sm1ion7000)of Dwision3ofthe Busisaand ProfesslonsCode,and my -
license Is in full orce and affect. - PANES
License Claw -/O Lie# {45 /7/ �s�s .
Date Contactor I'S •W
ARCHITECTS DECLARATION 201-10DOAMPS V �s
^olO I understand my plans shall be used as public rerords. OVER1000AMPS I R� g/c,R,FC.
Gap1�J Licensed Professional SIGNSELECTRICAL 1,1 T
�6 OWNER-BUILDER DECLARATION SPECWLCRCUIT/MISC YC-/ I
I herebyaffirm that l am exempt fromthe Contractor's License Law for the
() ,� following reason.(Section 70715,Business and Professions Code:Any cilyor
P9FZ coontywhkhrequiresaperMttacovtrod,alter,impmve,demollah,ormpair TEMP.METER OR POLE INST. DATE
q .a anystmct mpdor[olbL ancgaborequircstheappBcantforsuchpermtto ppy�g DEVICES
l` file a signed statement that he b licensed pursuant to the provisions of the -
FWS 3 Contractors License law(Chapter 9(commencing with Section 7000).f Divi- SWIMMING POOL ELECTRIC
I-, O sion3oflhe Businesaand Pro/emlomCode)orthat he R exempttherefmmand VALUATION
Q Et Y.' the basis for the alleged exemption. Any violation of Se Non 7031.5 by any '
G� OUTLETSSWITCIiFSEXI'URES
applicant fora permit subjedna
stheappllcamtoa civil peltyofnm..than
five hundred delta.($500). ,
000Z 1,as owner of the pro”, NEW REBID=Al,ELECTR SQFT,
Z ❑ p perry,or my employees with wages as their sole SfOIIPS 'TYPE CONSTRUCTION
� Q compensation,will do the work,and thestructure is not Intended or offered for
$ ❑
sale&c.7044,Business and Profewiom Code:The Contractor's Uceme Law
does not apply to an owner of property who builds or improves thereon,and
whodoessuchworkhimselforthrough hisownemployees,provided that such OCC.GROUT' RES.UNITS
Improvements are not Intended oroffered/orszle.If,howeveq thebuilding or TOTAL:
improvement issold Mthlnome earofcomploton,theewner-buiiderwill have -
thelurden of proving that he did not build or improve for purpose ofsale.). 'QTY. + • PLUMBINGPERMIT° '�' ITE.S I DWNE APN
L j L as owner of the property,am exclusively contracting with Iicenaed PERMIT ISSUANCE
contactors to construct the project(Sec.7014,Business and Profewlom Code:
The Cont.ctor's License Law does not apply to an owner of property who ALTERDRAIN&VENT-WATPR
builds or improves thereon, and who contracts for such pipjed -
a with a �
co dor(s)lianwdpu.uantto Mn Contadola License Law. FEESUMFLOW PEROTFf_T.DEVICE
Lj7 am exempt under Sec. B k.P C for this reason
Owner DRAINS FLOOR ROOF,AREA,GOND. SANITARY V_ N"
Date RECEIPTN#
WORKMAN COMPENSATION DECLARATION FI%TURES PER TRAP SCHOOL TAX Y N
❑I hereby dorm that 7 have o Insurance
nfra c of consent to pythm rc,or RECEIPT#
380cert0,Lab of Worken'Compensatlenlnsuranceora certl(kd ropythemof(Sec. GAS FA.SYSTEM.1 INCA i Poli lab G) PARK ETB Y N
-• p RECEIPTp
Co GAS EA.SYSTEM-OVER BUILDING DIV
1510NPEE5�CnNed
copy is hereby filed
the cid. GREASE/INDUSTRL WASTE INTERCEPTOR PLANCHECK FEE
LS�Ccnified copy V filed with the city Inspection division.
t
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP PAID
INSURANCE
NSURANCE SEWERSANITARYSfORM EA 200(-1, Dote Reeel t#
Ohlesectionneed not be completedpermit is(Drone hundred dolls.
(Si Immlewd WATER HEATER W/VENT/E.ECTR ENERGY FEE Y N—
I
employ
any perrtmnceoftmannerhe work so as to
eesmitls Weed, —
1 soak)not employ any person f any manner so u to becorre subject to the WATER SYSTEM/TREATING
Workcae Compensation Laws of CaOfomla.Date - PAID
—
z O NOTICETO APPLICANT:If,after making this Certificate of Exen,you NEW RESIDENTIAL PLMB._SQFI'. Date Rece1 t#
should become subject to the Werke.'Compensation provtstom of mptiothe Labor TOTAL:
CC i.
Codgyou must forthwith comply with such provisions orthls permit shall be BUILDING deerevoked.
(L med c CONSTRUCTION LENDING AGENCY SEISMIC FEE
.Ihembyaffirm TOTAL: ELECTRIC FEE
that there le a comtmction lending agency for the perform-
Z
once ofthe workfor which this permit is Issued(Sec.3097,Civ.C.) 6 •SFT
UO Land.,'.No PLUMBING FEE
LL r Lender'.Aaarcs. QTY. . ,MECHANICAL�PERMIT . ',FEE {, MECHANICAL FEE
O W I certifythat l have read thisappliationand statuthat the above lnfornutlon
1 iscorred.I agree to comply withal]city and county ordinances and dale laws PERMIPISSUANCE FEESPAID
>. relating to bullding constmNen,and hereby authorize reprconstatives of this
)— Z city to enter upon the above-mentioned progeny for WE, .purposes. 'ALTER OR ADD TO MECH. Date RCCeI [#
— (We)a fire to save,in I(4,an d keep harmiew the Ityof Cupertino
gainer']lab ,judgme ,met nes ax nxre Manlau naryway.mma AIR HANDLING UNIT fro 10,000CFM) SUBTOTAL:
gainst sal Ity In cons uence ntl (,his pe IL
AIRHANDLINGUNTT(OVERIa,mocrn4) CONSTRUCTION TAX -
Signatute of Applian/Contactor /I/ I Dote EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZA R DOLS MAT ALS DISCLOS URE
Wllltheapplia nt or future building occupant store or handle hazardous HEATING UNIT(TO 1 m,ODO BTU)
meted.]as defined by the Cupenlno Municipal Code,Chapter 9.12,and the D
ateRecel t#
Health and Safetyeode Section 25532(a)7 HEATING UNIT(OVER 100,000 BTU) TOTAL:
Yes rL{ysl No
.- Will the applicant o/titture bullding occupant use equipment or devices VFNTILATION FAN(SINGLE RESID) r'-p�-I-Ewhich emit hazardous air contaminants as defined by the Bay Area Air 7Quality Management Dist5rJd7 - BOILER,COMP OHP OR 100,000 BTM
4 Ys (r{NoF ave read the hazy usmaterials requirements undarChapter 6.95 of BOILER-COMP(OVER 100,000 BTU) ����the California l lealth k Safety Code,Sediom 25505,7557 and 25534. 1 unde.land lha titre build gdoes not currently haves meq that l/Rmy NEW RESIDFNfIAL MECN.' SQ.Ffr.pomiblllry rut Rha tpa orofI arequireme.a hkhmurtbemel ean 11140Owner rauthorL,ad gent w �NV'Y �
TOTAL:
OFFICE COPY