26790(CITY OF CUP VISION
NO APPLICATION/PERMIT PLUMBING-MECHANICAI, I r',rxmr"'" 26790
BUILDING III VINIGN BUILDING PROJECT' IISY.N'I'IFICA'I'ION
110
MECH
ELECTRIC PERMIT IJEI?
owcrest u
BLDG ELECT [CT PLUME
iPERMIT ISSUANCE
❑ ❑
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LICENSCD CONTRACTOR'S DECLA TION APPLIANCES- RESIDENTIAL
Ihereby offirmthat lam licenseA unJerpmvisinns of Chepmr9(wmmencirlwith
Section ]000) of Division 3 of the Business and Professions Code, end my Brame is in PANELS
JOB DESCRIPTION
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NYlicensed
full force and effect. UPT02WAMPS
Licenu Class Lic. p
Date Contractor 201 - 11100 AMPS
SQ. PT. FLOO
ARCHITECTS DECLARATION OVER 0000 AMPS
I understand my plans shall be used as public records.
SIGNS ELECTRICAL
Prnfe,Nsional
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Lt] or,
OWNER -BUILDER DECLARATION SPECIAL CIRCUITIMISC.
1 hereby affirm that I an exempt from the Contractor's License Lure for the
following mann. (Section 7031.5, Business and Professions Code: Any city or county 'TEMP. METER OR MIT INST.
which requires it permit to construe, alter, imireve demolish, oc repair any awcture
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ty�no
n a.o�i
prio, 1. its iotirae, al so requires theupplicuns for such pernit1. Neasigred statement POWER DEVICES
that he is licensed purmanno the provision ofthe Contractors License Law (Chapter
9(commenting with Section 7000) of Division 3 of The Business and pregnancies Code) SWIMMING POOL ELECTRIC
VALUATION
F.a
arS^�-1
pec
p,
or that he is exempnherefrnmand the basis(mtheelleged exemption. Any A.Imma of
Seetinn ]031.5 by any aTTlicvnt torn pemtit subjects the applicant To ecivil Penalty of OUT LETS - SWITCHES - FIXTURES
nonn.re than Bvc hundred Jallan (55110). NEW RFSIDfIJTIAL ELECfR SQ .FT.
❑ 1,asownero0phepmay,ormyemploy swithwagumiheirsolecompensatim,
and Code: no arbaceT inten,rem Law du Por or apply I. an, B urines
. id Profession,
and 9'ho Conbereon, License Law dohs not apply T. an .wnu of
ly
STORIES
'TYPE
arofeshiobv ldso
pmpedy who builds ed that suroves chimor vementturelacho Aeess intend k himulfor th r mic. I ,
woe meffered formic.
aided that ne eared
OCC. GROUP
however, the builds a
however• the building ur den of proem is sold widtimre yemof c.mplee for the owner- TO
M1uilJcr will have the burden of proving that he diA not build or itnpmve far purpose of I
sale.).
❑ am exclusively nowner of the property, aexclusively contracting with licensed contractors to QTY. PLUMBING PERMIT FEE
FLOOD ZON
construct the project (Sec. 7014, Business and Professions Code:) The Contractor's PERMIT ISSUANCE.
License Law does not apply t. an .warier prnpery who builds m improves thereon, and
who contracts for such projects with a comewtoron licenced Trimmed to the Comremor's
License Law, ALTER - DRAIN& VENT- WATER HIA)
FEE SUMMARY
❑ 1 am exempt under Sm. , B & P C for this reason BACK FLOW PROTECT'. DEVICE
OUTSIDE
SANITARY Y P
Owner Data
RECEIPT#
DRAINS- FLOOR, ROOF. AREA, GOND.
WORKMAN COMPENSATION DECLARATION
SCHOOLTAX Y 1,
❑ Ihereby affirm that.) heveeunificne.frenum to self -insert, oraunificote of FIXTURES - PCR TRAP
Workers Compensation Insurance Ora cenj(�ylc ythe Sec .X00, ab wyaF
RECEIPT4
PARK FEE YD
owen, all em to ens under this permit. �(Ol 4y
p y GAS - EA. SYSTEM -1 INC.40UTLRfS
Policy p
RECEIPT' # _
BUILDING DIVISION FE
Company GAS - EA. SYSTEM -OVER 4 (EA)
❑ Certified copy is Jacoby mmished.
PIANCHECK FEE
GRADING FEE
❑ CeniReJ copy is EIcA with the city insphnian division. GREASEANDUSTRL WASTE INTERCEPTOR
CERTIFICATE OF EXEMPTION FROM WORKERS' GRHASHTRAP
COMPENSATION INSURANCE
SOILS FEE
ENERGY FEE
(This section readout he completed Film permit is income hundred dollars($IW) SEWER - SANITARY - STORM F.A. 2001ef.
or less.)
I rectify that in the performance of the work for which this Permit is issued, Imail WATER HEATER W/VFXDFLECfe
not employ any person in any manner so in to become subject to the Worked'
PAID
Z
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Compensation laws of Wlifomia. Dal.— WATER SYSTE3MfTRFA] ING
Dad Receipt#
Applicant
NOTICETOAPPLICANT:If. aftermAing this Certificate of Exemption. youshould NEWRFSIDUNT1ALPLM. SQ.FT.
TOTAL:
�+is�
becrmesubject to the Worker's Compensation provisions ofthe Labor Code, you must
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f.nhwith comply with such provisions or this permit shall be deemed revoked.
CONST RUCTION LENDING AGENCY
1 hereby affirm that There is a construction lending agency for the performance of
work for which This permit is issueA (Sec. 309], Civ. CJ
fenders Name
BUILDING FEE
SEISMIC EEE
ELECTRIC FEE
D.tr
P
0
Lender's A QTY. MECHANICAL PERMIT FEE
PLUMBING FEE
that above information is
I certify tont 1 have toed this application and mum that
comcm. lagrce to Comply wish all city and county mdinunces and slam laws relating to PERMIT ISSUANCE
building construction, and hereby authorize representatives ofthiscity to enter alum he
above-mentioned ro rt for tion purposes. ALTER OR ADD TO MECH.
1. pe ,i . mnify rpo
MIiC11ANICAI. ECF.
L!
H RWi
rA
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CONS'IRUCf10N TAX
(We) ague To cove, indemnify end kap hannlus the ity of Cu
AIR HANDLING UNIT (10 BLOOD CPM)
he granting frons pesmit.
It bit ies 'udgme I cos tsandexpensr.whichmaylw cc a(PI
AIR HANDLING UNIT (OVER 10," CFM)
PAID
Signature of ppicani/Conn Date EXHAUST HOOD(W/DUCO
Date Receipt #
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT (TO H10,00) BTU)
TOTAL:
Will the applicant or future building occupant pore or hurdle hummers material HEATING UNIT (OVER IOO,g10 BTU)
us defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(x)?
Cl Year ❑ No VENTILATION PAN (SINGLE RFSID)
BOILER- COME CIHP OR 1110.000 BTU)
Will the applicant or fmurc building ucupant ecu equipmenmrdevices which emit
ISSUAN E ATE
•
hazaAons air c.maramants as defined by The Boy Area Air Quality Management
BOILER - COMP OVER IW,000 BTU)
District? (
❑Ycs ❑ No NEW RESIDENTIAL MECH. SQ. FT.
[W 4Y
1 have mrd the hamolnus materials requirements under Chapter 6.95 of theCal
Cade, Sections 25533 and 23534. I that
if the building does not curedly have a amen. that it is my responsibility to notify the
JUL
19 A
r&Safety
racuoul at a remand
ucupam of the requirements which mum be met prior m issuance .f a Cmifiam of
To me,
OwripmTmy.
10/1 ly I Jti
r
ISSUED BY: U
Ownner or anthoriud agent Date TOTAL:
MECH