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27655 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO mca7Rr:-eF,ECTRTCAI PERMIT NO. APPLICATION/PERMIT YING PROD CT IDENTICAL 27655 BUIhDINf.DIVISION HI111.IIING PROJECT IDENTIF'ICAT'ION BUILDING ADDRESS:�� [may) SANT I'ARY NO. APPLICATION SHRINE IT At,DATE 00-��� VU UNIT LOT 0 WNERS NAME: cPHONE: CONTRACTOR'S NA ME.//.4q LIC NO: t�✓ I . NPC CONTROLIV RCHITECI'/INGIN©: �dnO ;LIC N 7e0:�b/^ AD ESS: � ❑ coNTAcr: 3 QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO B1LCT �DG ELE - PLUMB� TIL FL PERMIT ISSUANCE —la LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DESCRIPTION ZWz I herchy xff rm that l am licensed underpmvisionsnfChapmr9(nraaam(((mencingga yOF full force it affectvision3nf the Business end Profcs,'onsC J ylia isi PANELS AMPS Roo F<ca.<zw Lmeam Lie.N - // yQd Date ��� Cunuaaor 301-1000 AMPS Fyz A CHITECI'S DEL ' /��� OVER IM AMPS SQ.17.ROOK AREA E/SG�iI'. ZOy'- IundemtanJ my plum xhull be u. ds puFllc rearMs. <_o g O Z C w SIGNS ELECTRICAL O <ast7 Licensed Professional y�Q OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. y `^ XOw, I hemby uf(rtn that I am enempt from the Contractors License Law for the rf /wan W 3 tL y¢ following reason.(Section 7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST. �W W F Vl O J which raffles a permit In crommo,site,,improve,demolish,m repair any struaurt 5!!j}.; trial its kotnmce,libm mocims the apphcam ren soehpetmit m Rlcasignedstatement POWER DEVICES W_ �pm that he is licensed pursuant to the provisions of the Comra<tors License Law(Chapter WIMMING POOL ELECTRIC c.jaM 9(commencing with Section 7")of Division Sof the Business and Professions Code) VALUATION W_h or that he is exempt therefrom and the basis for the alleged exemption.Any violation of //yo E-ZQ Section 7031.5 by sty applicant for a permit subjects the applicant to a civil Penalty of VREI'S-SWITCHES-FlJCRIRES '� 6(•�6 _o not mom than five hundred dollars($500). NEW RESIDENTIAL ELECfR SQ.FT. ❑ I,usowncrofthepfopeny,ormyemployeeswith wages as theirsolecumpensauon, SI O TYPE CONSTRUCT(ON ywill Jo the wurk,and the structure is not intendWoreffered for sale(Sec.Fan,Business and Professions Code:The Contractors License Low does not apply to an owner of property whomilds orimprovaa therwn.and whodues such workhimselforduaughhis ownOCC.GROUP RES.UNITS employeesilding elthanor vemeuch npmvuldwit arene ieandW andeti en,ficasuthea e. r- h wevewillhathe vl the bur den of pmentishat he idnnneyea or improve for theawnv- T L: , , builder will have the burden of proving that he did not build or improve for purpose of sale.). QTY. PLUMBING PERMIT FEE FLOODZONE. APN ❑ Lm owner ject(Smpenofl,Business an contfndingwiNlicemehennvacmrsto Licenseconstruthe does not(Sm.]fano Business and Profiessywho build orade:)The Contraction's License Licensefawdoes notaptly man owner ofpropcny whobuildsorimprovn thermal,and PERMIT ISSUANCE whocentracm for such pmjmts with acommucto(s)licensed pursuanuo the Contractor's ALTER-DRAIN&VENT-WATER JGA License Law. > FEE SUMMARY 01 am exempt under Sec. .B&P C for this reason BACK FLOW PROTECT'.DEVICE OUTSIDE FEES SANITARY Y N Owner Date DRAINS-BOOR,ROOF,AREA.GOND. RECEIPT# WORKMAN COMPENSATION DECLARATION SCHOOL TAX YN I family afOrm that have a ccnifiwa ofconunuo self-insum,or a ttnificate of FIXTURES-PER TRAP RECEIPT p WorkersCompensation lmurerceara cenifnedcapy dtereof(See.3800.Lab CJ which PARK FEE Y N coversallyy��PPl�g permitEC:IfT. PolicyM ytCd�ua' DOO2��0 GAS INC.INCn OUTLETS BUILDING D ISION FEES Company �Y9J�tihN� GAS-EA.SYSTEM-OVER 4(II) PLANCHF.CK FEE K❑ Cenified copy is herebyth the city Cenified copy is filW with the city inspection division GREASFJINDUSTRL WASTE INTERCEPTOR GRADING FEE �J CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP SOILS FEE r' COMPENSATION INSURANCE (Thisscction need not be completed lithe permit is for one hundred dollars(5100) SEWER-SANITARY-STORM EA.200177. ENERGY ME or Icss.) I unifythat in the perfommnempermit fthe work for which this is issued,l shall WATER HHATER WIN FELECi'R not employ any person in any mountain so as to become subject to the Worker' PAID Compensztionlswsof Califomia. Date WATER SYSTENVRLATING Rx<iptof O rZ Applicant Z � NOTICE TO APPLICANT:IL afar making this Cenificam of Exemption,you should NEW RESIDENTIAL PLM B. SQ.FT. TOTAL: f--� harmae suose, .,he Workers Comirmation provisions of the Lubar Core,you must F' forthwith comply with such pruvisiuns or this pemtit shall be deemed revoked. BUILDIN,FIiH �u 6w. QIi CONSTRUCTION LENDING AGENCY SEISMICIE Ihcrtby affirm is there is acamwec.3lending agency for the performance of U O ELECTRIC FEE Le'he work for which this permit is issued(Sm.309].Civ.C.) II---- Lenders Name PLUMBINGp i Lenders Address QTY. MECHANICAL PERMIT FEE iiall- 0 U I ccnily that I have read this application and mote that the above information is MECfiANICAI. -EF. correct.I agree to comply with all city and county ordinances and sum laws mining to PERMIT ISSUANCE (•-' p" building contraction,add hereby authorim mprevenotivesofthiscily to enmrupon the V] CONSTRUCTED TAX U Z above n'oncd props f rim tion purposes. ALTERORADDTOMECH. agme to C. nJ Iy and keep tonic, the City of Cupertino against him tiesludgmc ts, r ; xpenus wile yruany way accrueegeina said City AIR HANDLING UNIT(TO 10.001)CFM) in a aofthc gufthisvdit. _ AI HANDLING UNIT(OVER IBOOCCFM) S' tupplicanVComoor Data EX UST IIOODIW/DUCp namaf APAID HAZARDOUS MATE AIS DISCLOSURE HEING UNIT(TO IW,"BTU) Daec Date Reipt p Will thcapplicamorfaum building cupaiitstomorhmdlehatardousmatedal ){E ING 11NIT(OVLR IW,(XIU B'fU) 'roTAL: as defined by the Cupertino Municipal C e,Chapar 9.12,and the Health and Safety Code.Section 25532nd! V ELATION FAN(SINGLE RESID) ❑Yes ❑No ISSUANCE TE Will thcupplicantorftuum build' do I .c tordc hi<b<mit BOILER-COMP(3HP OR 100.000 BTU) yRtlPrrf/Ir� �y p zaJem'air conmminanta m AcL c t c s(Ake fir r agunent XO 100,gq BTU) I� % B p� �ISWcft "��•�s• V Cl Yes ❑No _.0 \ v NEW RIAIUENTIAL MECH. SQ.IIT. �B ///��� 1 have mad the hazardous lions 5505.255nts under 2t,1. I 6.95 oft Ab �I/ 'a�,a_ @lifomia I leshh&Safety CnJc,S tions 25505.25513 and 2553x. I un that (—�k.Nr//'" :,y7,��T./y+`aVWs�/�/ irlhelmdringdra,mncurmatlyhav oommam,thatiilsm pspwrmibl iti�notify the wapaat of ata re4abemems which m . bt'mL1 mmr to maaanae nr a cemreate or y'Ur�� Occupancy. u lP � T Owner or authorised agent Data4 ISSUED BY: OFFICE