26639 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
BUD PERMIT.10, 26639
CITY OF CUPERTINO I'LE'A BI.\G-ELECTRICAL
L C TRICAL.
BUILDING DIVISION APPLICATION/PERMIT BUILDING PROi[PEN TIFTCATION
BUILON/G1G ADDRESS: L / 1^1 \ �{ s SANITARYNO. (AP_PLICATIOO/NSSUBM'ITTAL DATE
21 o,+ J h- O G UNITn LOT
OWf�R.l'NAM6: PHONE; GO. ;OR'S NAME: (e2 LIC NU'.
NIC CONTROL a
HITECT/EN Y ER: LIC NO: FSS:
I �1 15gZ O I /L. 44� /Yl/ 1 f
I A DNO`I 1(D
QTY..,_ �S_ .-- BUILDING PERMIT INFO
L 'rELECTRIC PERM IT. FEE _
l I `I' B ER PLUMI� MECH
3 L �o�'til v OPERMIT ISSUANCE �+ (yplT\.
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL TOB DESCRIPTION
p y.Z (hereby affirm shatlam liccnxJ undaprovisions of CTapmr9(commrncingwiN
',�_'CC Section]tX1bmt Division 3 of the Business and Professions Cotli and my license is in PANELS
Q V F full force and effect. UP TO 200 AMPS
Lic`nx Clas Comracmor 301-1000 AMPS
TF.CTS DECLARATION SQ.FT. 00 AREA SISQ.FT.
OVERIOX)AMPS ^ .t, yrs
Z_C 1 unJersund my plains shall be used as public rxoNs. I t /A ��
_yFw SIGNS ELECTRICAL IY J vin
Licensed Professional �1
=cyV OWNER BUILDER DECLARATION the SPECLM.CIRCUTT/WSC. 1�-two ] �1 �.s �
1 hereby aRmh that 1 am Hemp from the Contractor's License law for the
�•' �7
j following (Section]031.5,Business and Professions Code:An TEMP.METER OR POLE(NST.
Q ¢aeon. Any or
which rcyuires is permit m construct,aloe improve,demolish,or repair any swemm
J c-,}; prior m its issuance.also rmiires thenpplicant for such emfileasigned smumem POWER DEVICES
+Y C`p that he is licensed pursuant to the pruvisimet of the Commences License law(Chapin SWIMMING POOL ELECTRIC VALUATION
_LL Business with Section Division 3 of the Busincod Professional Cade)
u_y SeJimmi31.by Wertfromanf the permit
subjeasehedeplicar an.Aivilpiation
FZQ Section ID3l.S by my applicant faro pemiuubjecu the applicant ioacivil penalty of OUTLETS-SWITCHES-FIXNRES
p Q not more Nan five hundred dollars($500). NEW RESIDENTIAL ELECTR _SQ.Ff.
'r=o ❑ Luewnerefiheproperty,ermycmpleYmwiJh wagnutheirulcmmprnudoa. STORIES TYPECONSTRLCDON
y�y' will do the work,and the simmurt isnot imm�deJ proffmdforsale(Sec.]014,Buxinm
and Professions Code:The Contractor's License Law does not apply to an owner of
Progeny who builds orimprovee thereon,and whoduusuch work himulforNroughhia
mv
cmPloYers.ProvidcJ thin such improvcmcnrsurnotinundedweffcned fm sola.If.. OCC.GROUP RES.UNITS
however.lhe buildmilorimprovement issoldwiNinoneyeuofcompieden.O owner-
builder will have the burden or proving that he did nom build or improve for purpose of
sale.). .. ,e
❑ L as owncrofthe property.am exclusively contracting with licenudconvars
aoto QTY.=•i;::'•PLUMBINGPERMIT(.+ ,.'FEE FLOODZONE APN
mntruct the project(Sec.7016,Business and Professiom Code:)The Contractor's PERMIT ISSUANCE
License Law does not apply to an owner o f property w ho builds or improve 0urcon,and
whocomracrs for such projects with a contractm(s)licenutl pursuanuo Ne Contractor's
License Law. ALTER-DIFAIN&VENT- APII(EA) .' S FEESUMMARY
❑ 1 um exempt under Sec. ,B&P C for this rtuon BACK FLOW CT.D CE SANITARYUTY DE `
Owner Dan. RECEIPT.
DRAINSFL R, F, R A.GOND.
WORKMAN COMPENSATION DE CLARATION SCHOOL TAX Y V
I hereby affirm toot lhmra or acedrofconunnreof(Smuu,m Labcertificate.) hich _ RECEIPI'a
.Vorken'Compenumion Insurance or acrrtifiedcopy thereof(Sm.3801.Lab C.7 which FIX# P PARK FEE Y V
covers all employees under this permit. GAS-EA.SYS -I ' U ETS IPI'N
Policy# BUI N (VISION FEES
Company GAS-EA.S EM-OVER ( ) 'PLANCHECK
❑ Certified copy is hereby famished. 6
❑ CeniliedcopyisfledwiNt cciryims dondivisim. GREAS YDO WAS CEPTOR GRADING _
CERTIFICATE OF EXEMPTION FROM WORKERS' S P SOILS �N
COMPENSATION INSURANCE
(This section need not becompleled if the Permit is forensic humboddedllars(SIM) SEW ARY-STORM EA.200FT. 7PAID
GY FE'
or less.) KJ
I cetify that in the pmfomance of the work for which this permit u issued,l shall W TER HEA WIVENT/ELECfR
not employ any person in any m w u to become subject to the Workers'
Z Cumpeumionlawsof California. Date WATER SYSTEMRREATING Dau ?cipto
Apphcanl
Z O NOTICE TO APPLICA`TI':IL after making this Certificate of Exemption.you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL:
ZI bcmme subject to the Worker's Compmudon govisions of the Labor Code.you must
Y � fordwllh comply with such provisions or(his permit shall be deemed«v.kcd, BUILDING FEE �y
CONSTRUCTION LENDING AGENCY SEISMIC FEE
Z I hereby affirm that there is a construction lending agency for Nc performance of p ELECTRIC FEE
J O (he work for which this permit is issued(Sec.3091.Civ.CJ rt V15
2 Lender's Name - C-s_-i.; . .
F Landers Address .MECHANICALPERMrr `FEE PLUMBING FEE
QTY. rye t,;i
CL 1 certify That I have real this city
and cou aed site raw Ju above information mining is "•� .
a conecm, la to comply •, MECHANICAL FEE
agree pywimh all city antl county ordinances end ira¢lawa trialing to PERMIT ISSUANCE
•_ to building construction,and hereby authorize reprommoves of thisciry m ern upon the CONSTRUCTION TAX
Lj Z abovamemmordprnpeny for imism1 o,timoses. ALTER OR ADD TO MECH.
.ave,indemnify and keep humlms the City of Cupertino.gains
abiliiio.judgmen¢. asua dexpenxsw 'hmayinany way seems agnins uiJCiry AIR HANDLING UNIT LTO 1.0110 CFM)
ons que cofd grand gof is perms
AIR HANDLING UNIT(OVER 20.000 CFM(
Signmurcm ,p,i.mA7rm unto Date EXHAUST HOOD(W/DUCD
PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100.1%X1 BTU) Date Rem","
Will the applicant or ltoure huilding occupant sore or handle hazardous material HEATING UNIT(OVER 100,000 BTU) AI
as defneJ by the Cupenie.Municipal Cede.Cbapmer 9.12,analthe Health and Safety
Calc,Scainn`3511.1'.'
C1 Yrx 11 No VENTILATION FAN(SINGLE RESID)
Will thea licanmrfumrcbuilJin yuipmen BOILER-COMP UHP OR IW,tX10 BTU)
ISSUANCE DATE
pp goy the ay muality Management �A
.,,.taus air comaminan(s u Jufned by the Bay Area Air Quality Muragcmcm BOILER COMP(OVER IN1.01(i BTU) I 4' A t
hmdct' [
❑Yes ❑No NEW RESIDENTIAL MECH. SQ.IT. OCT
1 have read hhe huur -ielms mrcquirtmcros under Chapter 6.95 of he
Culifomia Health&Safety Code Sections 25505.25533 and 255Yi. 1 umiemmnd that `U/94
if rbc building does notcurrently have a lemon,that it is my msrymsibiliry to notify hbe
'cugmn of the requirements whi,h must hr met prior issuance of a Cenificme of ...
Un'ugancy.
Owner nr amhmieed.gem Dae —
• ., ISSUED BY:
OFFICE