26348-USE
CITY OF CUPERTINO BUILDING -ELECT I AL PERMITNO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL, /� I� a54 o O
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BUILDING PERMIT INFO
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PERMIT ISSUANCE.
D LF.CT PLUMB MECH
El El
LICENSED CONTRACTOR'S DE TI
RAON
I hereby alfrmthat l em licenud underproviaionsm'Chaptert) mmundaramcm, with
Section 7")of Division Juf the Business and piefen,lboar Codgand my license is is
full force ff �g
License },a �Lie.
Data nmbcr �
Comtucmr
APPLIANCES -RESIDENTIAL
ppNgLg
UPT0210 AMPS
201 - IoOp AMPS
1 BDESCRLPDON
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1 understood my plans shall b, mind or public records.
SQ. FT. FLOOR AREA
S/SQ. FT.
OVER 1000 AMPS
SIGNS ELECTRICAL
Licensed Pmfexsmnal
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OWNER -BUILDER DECLARATION
1 hereby affirm the, 1 mm exempt from the Contractor's License Law for the
following rcason.(Section ]1)JL5, and Professions Code: Any city or county
which require a perosis to constrve,, alma. improve. demolish, m rcpav an swcrwe
Prior to its issuance, alsorequires rhe Applicant for such permit to file asigned statement
that he is licensed Pursuer to the provisions ofthe Contractors Licenu Law (Chapter
9bommencingwith Section ]00f)of Division 30111he Businessund Professions Code)
mthet he is exempt thercfram and the basis for lhealie ed exam tler.M
Section 7031.5h 8 P ld pedaianaf
Yaunpdmdicamrorapermit sabjectnhe applicannoecivil penilry of
nor more than five hundred dollen ($500).
SPECIAL CI trCU I 0
TEMP. METERO POLE INST ,T
PO WBR DEVI
"
SWIMMING POOL ELECTRIC
VALUATION
ODTLETS- WRCH -
NEW RESIDFNTIALELECIR_SQ, FT.
Po
a
❑ Luownerofahepro,ny,ormyempioyeeswithwug"uthcirsolec. ,iron,
wdl Jn lhework, andthe nrvcaureisnutimm�dedorof(eredforsele (gm. ]U6a Business
ora Cade: The Corrector, License Law dors not apply lf an owner of
and Property
propertyloy bs. mvidmpmvulhimpmvndmodoes amnsuch workoroffemthrough his
ownemployees,p Or upomchimprovemenaarene ieadoeumpletered thea alf.
however, ill have building
leburdenofFmem is hat he i in one year r improve on,
pur care of
bale.). will have rhe buNen of proving that he did not build or improve for purpose of
seleJ.
STORIS
TYPECONSTRUCI'ION
OCC. GROUP
RES. UNITS
^�
QTY. ' PLUMBING PERMIT FEE
PERMITISSUANCE
ALTER -DRAIN&VENT ATFR (FA)
BACK FLOW P TE
❑ I, re uwnerafthe Property, am exclusivelycontructing with licensedcontnanrs to
construct the police, (Sec. ]IWq Business and Prafesxions Cole:) The Contractors
License Law docs not apply us an owner ofpropwy who builds m improves thereon. and
whncontme,a been such projecta with a contrecmr(s) licensed punuam to the Contractors
License Law.
❑ I ren uempt under gee. B & P C for this renson
FLOOD ZONE
qpN
FEERY
T. ! MAFEES
Owner Date
SANITARY Y N _
'IPfp
WORKMAN COMPENSATION DECLARATIONDRAINS
sl herebyaffirm that l have a certificate ufemsem to self -in
ra Cmployee'snderhiscermit. ifedcopy thereof(Sec. 3800, Lob CJ which
or a sura0, Lab C,) which
cn.` all employee's under petrosa.
Policy p
- FLOOR, F,A ,GOND.
R[
SCHOOL TAX Y N
ECE M
FDCfURES - PER TRAP
PARK WE Y N
RE 'IPT#
GAS - FA. SYSTEM -I INC, d
ComUILDING
y
GAS - EA. SYSTEM -OVER
VISION FEES
ifieJ copy is hereby famished.
PLA CK
C,dfed copy is filed with the city inspection division.
GRFASEJINDUSTRLWASTDLNTERC- OR
G IN H
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
GREASE. TRAP
SOILS FEE
(Thissection neednm be completed ifthe pemtit is Talmo hundred dollars (5100)
or lees.)
SEWER - SANITARY - STORM PA. 200FT.
ENHRGYIEE
z
I certify that in the Perfomranuafthe work far which this permit is issued,Ishal1
not cropley any person In any manner so as to become subject to the Workers'
ComPeruccomn Lawsof Cnlifomia. Dam
Applicant
WATER HEATER W/VENT/F.LEM
PAID
Dare Receipt#
WATER SYSTBM/fRHATING
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P.`+ 4
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p. AGA
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NOTICE TO APPLICANT. If, after making Nis Ceniticam of Exemption, you should
becmme subject m Ne Worker's Compenantian pmvisiona of the Labur Code, you must
forthwith comply with such previsions or this permit shall be deemed meaked.
CONSTRUCOON LENDING AGENCY
1 hereby affirm thenhem is a construction lending agency for the performance of
the work for which this permit is issued (See. 3097, Civ. C.)
Undoes Name
NEW RESIDENTIAL PLMIL SQ. PT.
AL:
BUILD GHE ��
SETS CF'EE
TOTAL:
ELF. RICHE
Lenders Address
QTY. ', MECHANICAL PERMIT FEE
-
PLO BINGFEE
1 certify that 1 have read this application and state that the above information is
correct l agree to comply with all city and county ordinances and state laws relating to
building cormrulll and herchymthorim represemnivesofthie city m emerupon the
abovomeml propcny for impudon purposes.
(We to save, indemnify and kap Imes dens the City of Cupertino against
luddliti ,p Ements.cm dndeepensu whichmay in any way ecerueagaimt said City
in enttaf he oar efthispermit.
PERMIT ISSUANCE
MEC NICAL FEE
ALTER OR ADD TO MECH.
AIR HANDLING UNIT (TO 10,OWCFM)
CONS RUCfION TA%
AIR HANDLING UNIT (OVER 10,1X111 CPM)
PPs Date
EXHAUST HOOD(W/DUCT)
PAID
HEATING UNIT (1`0 1W,W0 BTU)
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant same m handle haurdous material
Date Reccipt#
TOTAL:
u defined by the Cupertino Municipal Code, Chapmr 9.12, and the Health end Safety
Cade, Sallon 25532(e)]
HEATING UNIT (OVER 100.000 BTII)
VENTILATION FAN (SINGLE RESID)
❑ Yes ❑ No
,jdlkmfingNl
Willtheapplicanrm future buildingmcupanmsecgoipmrnt ordevices whichemitr
air comsmmnaner as defined by the Bay Area Air Quality Management
a
BOILER - COMP (3HP OR 100,1X10 BTU)
SUANCE DATE
(I�a q D
BOILER - COMP(OVER 100,000 BTU)
if
❑ Yu ❑ No
of the
I have mad the hnvNo e, matioi s 55135, emrnu under Chapter understand
California Health & eSafetybaa Code, Sermons 25505, encem and 25574.1 undersand that
the building does not currently have a tenant, that it is my responsibility to notify the
occupant of the requiremems which must be mea prior m issuance of a Certificate of
Occupancy.
�rypY 05-1994
}y
CITY 1 Ur l#UPr� I. I Ily
H
NEW RESIDENTIAL MECIL SQ. Ff.
DY:
Owner or ae,horiacd agent Daae
TOTAL: ISSUED
OFFIC