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27847 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO, DING-a" .ECPRICA PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL n�I O /1 �I BUILDING PROJECT'IDENTLFICAT'ION y �J L I v 4 r BUILDING ADDRESS: //'� / SANITARY O. APPLICA9'ION SUBMIT)'AL DATE go-3e.1 V;m PalawloS UNITM /Q11 LOTM © 7 OWN NAME: r PHONE: CONTRALTO ' NAME: LIC NO: N/C CONTROL y/nn oma -6000 r •ARCHITF.CDENGINEER: LIC NO: ADDRESS: ❑ CONTACT: PHONE: QTY, ELECTRIC PERMIT FEE BUILDING PERMIT INFO ♦1Ge C� Q/ro8 9Fs-6dG0 PERMIT ISSUANCE BLDG ELECT PLUMB Ml�iCftl LICENSE)CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL TOB DFSCRIPI'ION qWp�Z I hereby uffinn that l am licensed underprovislonsm Chapter9(cnmmencingwiN F-00❑ Section]lane f Division 3 of the Business and Professions Code,and my license is in PANELS S FD L <ZU Nil c firmLicense Clwd effect. 1a.,Zsu License Class Currencies UP TO 2M AMPS an Q� Date Contractor 201-1"AMPS Z�,Z ARCHITECTS DECLARATION OVER 1000 AMPS SQ.IT.FLOOR AREA SISQ.IT. O Z—O I undeatand my plans shall be used as public records. r 4�n,4] SIGNS ELECTRICAL hQ Licensed Profesrional a /D S that Ima-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. XOa tF; 1 hereby,affirm Net I am exempt oan the Connectors License Law(or the 3 0/L/,0 RI�O N following reason(Sutton consumer, ,Busiuss and improve. ion+demolish.or Any city or county TEMP.METER OR PoLE INST. 7 y which or to its iss a a permit m cornua,alma improve,h permittor repair any statement y00 thatheslicensed pursuant to Th thevisios of the CopermlOo File a License La sutement POWER DEVICES ty 00 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 4'apz- or(dot heir(commencingwith Section 0000)of Division Soflle ed a.ss to Professions Code) SWIMMING POOL If VALUATION ,!2 z, Scenes 7031. by y aefromandthe bermalss for bje is thedexempti to civil of OUTLETS-SWITCHES.FU(TURFS / �� 6/n3r Z,T Section T031.3 by mydredd.11.($pemcit subjects the applicant acivil petWty,of IL.�J O t more Nan five hundred dollar(5500). ,/ K papa y.ormyempl.yea with wagesastheirsolecompmsacion. NEW RESIDENTIAL ELECfR 5 .Pf. � � ❑ LasownentDhe n Q STORIES TYPE CONS'1RUCHON L will dolhework,and rhes a Cma snot License Law does r.apply 1.an Business and ertyPrefwh one Code:The veld mmu License Lew does not apply tom owner of pmpenywyeas.pdsorimpmvesthemon,and w Rion not work ormelfor pr oughhis wnemployus.pmvidedthat such impmvetrmnuere not immnded aroffertdforsde.If. OCC.GROUP RES.UNITS however,the building orimprovement is soldwithin one yearofcompletion,theowner- TOTAL: builder will have the burden of proving that he did nen build or improve for purpose of sole.). ❑ 1.as ownerofthe property,an exclusively comrutingwith licensed contractors to (TTY, PLUMBING PERMP' FEE FLOOD ZONE APN construct be Project(See.7044,Business and Profusions Code:)The Contractors Liunu Law docs not apply to an owner ofpropeny who builds or improves Hereon.end PERMIT ISSUANCE whoc.ntract.fasuch Projects with.connotations)licensed purearm to the Contractors ALTER-DRAIN&VENT-WAT FEE SUMMARY License law. (EA) ❑ I um exempt under Sec. ,B&PC for this mason BACK FLOW PROTECT'.DEVICE: OUTSUM- 99 SANITARY YN Owner Data RECHIPT N ROOF,AREA,COND. WORKMAN COMPENSATION DECLARATION DRAINS-FLOOR, SCHOOLTAX YN_ ❑ Ihcmhy affirm Natl have ecenificam of conunuo self-insurt,aec<ruficam of RECEIPTg Workers'Com nation lnauranceoracenifiedc FIXTURES-PER TRAP pe opy Nertof(Stt.Jglp,lab C.)which PARK FEE YN covers all employds undo this permit. GAS-PA.SYSTEM- INCA OUTLETS RECEIPTp Policy N BUILDING DIVISION FEES Company GAS-EA.SYSTEM-OVER 4(EA) PLANCHECK FEE r ❑ Cenified copy is hereby furnished. a ❑ Certified copy is filed wit the city inspection division. GREASIRANDUSTRL WASTE INTERCEPTOR GRADING EEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE COMPENSATION INSURANCE (This section need rambe completed ifthe permit is fa...hu.dreddoll.m(S100) SEWER-SANITARY-STORM EA.200FT. ENERGY FEE onus.) I cannily tort in the perfomtance of the work far which Nis pemtit is issued,l shell WATER HEATER W/VEWIL'LECTR not employ any person in any mauler sou to become subject to the Workers' PAID Z C.mpenation Lawsof California. Dae WATER SYSTEM/TREATING Data Receipt Applicant Z 0 NOTICE TO APPLICANT:If.after taking this CeriOcae of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: VI become subject to the Worker's Corepenution provisions of the Labor Code,you must a , forthwith Ned with comply with such provisions this shall be deemrevoked. BUILDING FEE / P. Q CONSTRUCTION LENDING AGENCY SEISMIC FEB Z 1 hereby affirm that there is a construction lending agency for the perfamanc,of V O the work for which this perm t is issued(Sec.3097.Civ.C.) TOTAL: ELECTRIC FEE Lender's Name PLUMBING FEE. [^ Lenders AAJrees QTY. MECHANICALPERMIT F81: U 1 minify that I have read this application and state that the above information is correct 1agree to comply with all city and county endurances and sum laws relacing to PERMIT ISSUANCE MECHANICAL FEE /6 F' ti buildingeorasnuccion,and hereby authorize repetworativesofthiseiry,to enterupon the CONSTRUCTION TAX U z abovo-mentioned property for inspection purposes. ALTERORADDTOMECH. (We)agree to ave,indemnify and keep betmleas the City of Cupertino against liabilities ju I menu,costs andexpenaes which mayinuny way ucmcagainst said Ciry AIRHANDLINGUNIT(TO IO,000CFM) Q in corset gran. of thio permit /0 1 ATR HANDLING UNIT(OVER 10,000 CFM) Sign ure oMp � —� Dam E%HAUST HOOD(WIDUCT) PAID HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO IOQOW BTU) Data Receipt p Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 100,000 BTU) TOTAL: f Coda Section 35533(a)? 0Yes 11 No VENTILATION FAN(SINGLE RESID) .3.2 Will the applicant rfuture building occuWmuse equipment ordeviceawhich malt BOILER-COMP(3HP OR loo,nlO BTU) ISSUANCE)IkATEI) • haurdous air canumincnts m defined by the Buy Area Air Quality Management BOILER-COMP(OVER 10(1,000 BTU) DiaOCT at 9�ct? 1995 Eli Y. EI No NEW RESIDENTIAL MECtI. SQ.FT. ials requirements under pter 6.93 of the Califomuve mad for Hcalth&SafcryCde,Secaus ttion,25505,25533 end 255341 understood that CIIY Ur- Gl• •I1AU if)hebvilding s noteunently have a tenant,that it is my responaibilityto..city the occupant of __qmr;;;pV,, nch must be,met prior to issuance fC71fierne of Occupu �. _ zo 4Z 01610 of Banhorized agent ✓ Date TOTAL: ISSUED BY: OFFICE