25991 APPLICANT-TO FI4,6 IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY •s-
CITY OF CUPERTINOstill
PERMITNO.
APPLICATION/PERMIT : BPLUMBING-MF.CHANICAI. 25991
� 5 ('�
PUIIdING DIVISION UIIAING PROJECT IDENTIFICATION G J J
BUILDING ADDRESS: - SANITARYNO. APP//LLI/ICC�►ATIONSUBMITI'ALDATE
1, 1 U IT# LOT# 1 V�
O SNAMF.: PI N^ 1' C OR'S LIC NQy N/C IKON IIITROLN
LJ
A / f/ENGINEHR: LIC NO. 9D •$$: ❑
/ 11 IVl
CONTACT: PHONE: V#'!4'A# t'tl.«8R-#ANS r. ",$, �{ +' #•• 'x 'i ,'vy,BUILDING'PHRMIT INFO
4 r. eLECTRI PHRMI x
ZV,.s. 36 "<BLDG ELECT PLUMB M. GCy
PERMITISSUANCE � El � rL,fL.,
LICENSED CONTRACTORS DECLARATION APPLIANCES-RESIDENTIAL
thereby [firm that am liawsedunder CRIPFI
CZ Ya provisions clamored and(commencing with -
00 Section 7000)of Division 3 ofthe Bmwessad profeselrns Cade,and mylicwee is in ppNBLg ' 1
�U full farce and rin Un1
zm uwnaeemsa�'1ie.#� UP To zoo AMPS
ZO�y Dnte ARCHITECT'S DECLARATION /LL OVER IOOOAMPS
MPS Vr S AR Q. .
F or Z �N+
OZ"O lunderstand my plans shall be used as public records.
I r.45 j SIGNS ELECTRICAL
q'y , Iocawa Punas.... 21 O k())skr--s
Syx�U OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
wgqOyF. 1 hereby alliin that 1 am exempt from the Commences License Law for the
3u•to following reason(Section 7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE MST.
�; which requires a permit to construct,altar,improve,demolish,or repair any structure
�>+ Inform its issuance,also requires the applicant for such permit in file a signed statement POWER DEVICES
eL that he Is licensed pursuant to the provisions of the Contractor's License Law(Chapter
01119 hommencing with Section 7000)of Division 3 of the Business and Professions Code) SWIMMING POOL ELECTRIC ATION
1y,_y or that he is exempt therefrom and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES-FIXTURES
l- Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of UVV
not more than five hundred dollazWHO). NHW RH9IDP,NTIAL eLHCTR S .
y ❑ I,asownerOfthcproperty.ormyemployees with wegesas[heirsolecompensatian. FU
an. Q STORIES TYPE CONSTRUCTION
y wit l do the work,and the structure is not Intended Or offered for sale(Sea.7044,Business
and Professions Code:no Ciernmemr's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himacl f or trough his
own employees,provided that men improvements we not intended or offered for sale.If, OCC.GROUP RES.UNITS
however,the building orimprovemem is sold within one yeurnfcompletion,the owner. TOTAL:
builder will have the burden of proving that he did not build or improve for purpose Of
sale.).
property.am exclusively cert licensedwnvect0 t y t as owner n QTY y, e f 'PLUMBING PERMIT' r $z 1 FEE - FLOODZ
❑ ONE APN
x d _
oformed the project(Sec.7(14q Business end Professions Cade:)The Concessions License Lawdoesnmapply wan owearofpropeny whobuildsorimprovestereonand PERMITISSUANCE
who contracts forserh projects wipmearearadma)hance,edpmseantwme Condemors
License Law. ALTER (CAO
'.:FEE SUMMARY` -
❑ 1 ren exempt under Sea. B&P C for this reason BACK FLOW PROTECT.DEVICE OUTBID EES
SANITARY Y_N
Owner • DamDRAINS-FLOOR,BOOP,AREA,CONU. RECEIPT#
WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y
Irs reby Compensator that lhave.minate.,ifiwme ifie ancient
,therof(Sesare,Or Lab C.)cate Of FIXTURES.PER TRAP RECEIPT#
kers'Compensationlnsuranceoracenifiedcopy thereof(Sec.3800,Lab C.)which PARK FEF. YN
st
covers all employee's under INslmatmY.�D�.aII GAS-LA. PER
M-I INCA 'LETS RECEIPT#
puny VAn' 1IUU��11 DD, II BUILDING DIVISION FEES
Confined copy is hereby famished. OAS-HA.SYSTEM-OVER 4(EA) PLANCHP.CK NEB
Certified copy is fled with the city inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR
GRADING FEH
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASETRAP
SOILS FEE
COMPENSATIONINSURANCE
(This section needing he completed ifthelaboad is Cocoa.hundred dollars($100) SEWER-SANITARY-STORM EA,200FT. ENERGY FEE
or less)
I certify that in the performance ofthe work for which this permit is issued,I shall WATER HFATER W/VLNT/ELECTR
not employ any person in any insurer so as to become subject to to Workers' PAID
0 z CCoopmpenss[tion Laws of California. Data WATER SYSTEMTRF.ATING Data Receipt#
y NOTICE TO APPLICANT:If,after making this Ceniftcate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
F `rA becomesubjed to the Worker's Compensation provisions ofthe Labor Cade,you must
forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING PHP.
a5 CONSTRUCTION LENDING AGENCY SEISMIC FEE
f D z I hereby affirm that there is a construction lending agency for the irmformanc f thew TOTAL ELECTRIC FEE
Lead Name.s3097 C
frot"R yuVl(Sar. iv C) p rc 1. a" �, ' PLUMBING HE
t O F LeaderAddress - Q7�'.$X,r A 3 MEC N AL FL+RMIT?x 5 FH .
U I certify that I have read this all city
add
end stab that the above refs rtum a "' ""' "
acored I agree eoustrmcomply heeywity and countyordimrs ofthd stateto
sr upon the
P M SU CB D MIiCHANICAL FF.E
abovengconstructiomand herebspecti npce reores. fives of tis city go enter upon the CONSTRUCTION TAX
(, z above-mentioned property fm inspection purposes. A ADO TO ECH.
(W e) go save,imla=y,and keep harmless to City of Cupertino eg.I. a,
Iiabilitiesj menu,coms andenpens whichrnay in any way accr agai tsaid Cjty AIRH DLING UNIT t ,000 CFM)
I n cnn: of the granting of,._
f t s -
1 '/* AIR H DLING UNIT(OVER IQ00)CPM)
Signator n pplirwg/Contmemr DV Date EXIIAUSTHOOD(W/DUC19
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100,000 ETU) Dote Beceip,a
Will the applicant or fumrc building..Ponts,.,a or handle hazardous material HEATING UNIT(OVER 100,000 BTU) TOTAL:
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(¢)7.
11 Yes ❑.NO VENTILATION FAN(SINGLE REBID)
aBOILER-COMP(3HPOR Bifocal �1/FrM I9pyU�ANCP.DATE
Will tit commuchu fomrc claimedlifin,by the Bay Area Air
Mange ant d01 I/V Q" B F1
/ .varus air comaminwu as defined by the Bey Area Air Quality Management BOILER-COMP(OVER 100,000 BTU) Cl
Vic[!
x ❑Yes ❑No NEW RESIDENTIAL MECH. Sc,.PT. CITY
- 719 1y ��
1 have read the hazardous materials requirements under Chapter 6.95 of the CII Y
California Health&Safety Cade,Section 25505,25533 and 25534.1 un lcommd tet Uh LV
if the building does not currently have a tenant,that it is my responsibility to notify the
cupant of the requirements which must be meg prior to issuance mix Ceniftcate of f'l I�t• )
Occupancy.
Owne,mica oriudagem Data TOTAL: ISSUED BY:
OFFICE