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27317r. APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO BUII'DRTC-BLE QTR BUILDING DIVISION APPLICATION/PERMIT PING FROG CTIVIRANIFIC BUILDING PRO.IKL'1'IDRMI'IN'ICATRIN PERMITNO. 27317 BUILDING ADDRESS: SANITARY NO, APPLICATION SUBMITTAL DATE lw�.. Zo3�� S.I lu'.stI' UNIT p LO'I'N O NERS NAMR: PHONE: ..�� (700ACTOR'S NAME: LIC NO: 1 I NIC ❑ CONTROL# ARCIIITECf/ENGINEER:LIC NO: G0 C© �Z ADDAYSo ` 555 -Lo J 1 CONTACT: PHONE: �jII'' I,Z e�� ^' A i i Q'fY. a°` ,`116,CTRIC+PERh11T: .hTE 4!Y ¢.- �' asd :+�. N.R*:Be, BUILDING PERMIT INFO PERMIT ISSUANCE NC LICENSED CONTRACTOR'S DECLARATION ndefovisionsofarrider9 (commencing with I hereby tiff nn that I am licensed t pr APPLIANCES - RESIDENTIAL LOB DESCRIPTION ppryp-g Section ofect. 0n 3 of the Business and Professions Code, and my liursu is in full foe llhar a mad effect. Clas License CWss Liap UPTO200AMPS Data Contractor 201. 1000 AMPS ARCHITECTS DECLARATION I understand my plans shall ba used as public records. OVER 1000 AMPS SQ. 11f. FLOOR AREA $/SQ. Tell SIGNS ELECTRICAL Licensed Professional OWNER -BUILDER DECLARATION SPECIAL CIRCUIT/MISC. 1 hereby affirm that 1 am exempt from the Contractor's License Isar for she TEMP. METER OR POLE ]NST. followhich reclaing maxim. o und Professions Code: Any city ucoumy aparneinn co3L5,Baaltess which requires n (wrmit m construe, ober, improve, demolish, ,improve, repair any strucore fi permittoLicerle.egned etalemem POWER DEVICES of the Co that host licensed u turn to the provisions pursuant 9(comisncing with Suomno")of ivisinf theContractorsLice nu Law (Chapter 9 (commencing with Section 9000)Division 3 of the Business and voce Code) SWIMMING POOL ELECTRIC VALUATION he exempt therefrom and the basis for the alleged . ouny or that Section 703 plit On. Any violation of Section subjems the applicant to ecivil pewity of /�� VV 7 IkO� ETS-SWITCHES-FDf1'l1RES /� doll rs(far$50nnit (more than five hunJrcd dollars (E50f). than five hundred n❑ c0mpBusinen. wrk.an / NEWRFSIDEMf1ALELECTR S .FT. —SQ,FT. 'TYPE CONSTRUCTION will do the thesamny,ormyempinded or ofwagesaselt,(sole oche h is not oan Business and Professions Code:'Ige Cor dos not appl(Sey t Coe 'I mactorinlende se Law License Law dux not apply lf an owner of vespoe on. progenywhobui provided improvestheuon,and whadleacntsamssuchwork himseoroff mdA o re. If, own employees, providedthat such improvementsarenot Intendedoroffered forsale. OCC. GROUP �� however, the buil r- is sold within one yemofcomplm theown«- the burden builder will have the burden of proving that he did not build nr improve for purposeof for QfY. '. PLUMBING PERMIT FEE sale.). ❑ I,mawnerofthepmpeny,amexclusivelycoattwtingwithlicensedcontremomtu Fl.000 ZONE EA±IN construct the project (Sec. 7014, Business and Professions Code) 'The Contractor's License Lowdoes not apply to an ownerofprnpecty who builds or improves thereon, and PERMIT ISSUANCE whocommes for such projects with aramnactor(s) licensed pursuant it) the Contractor's License Law. ALTER-DRAIN&VP.NT- - 1rw FEE SUMMARY ❑ 1 mo exempt under Sec. , B & P C for Nis reasonOUTSID BACK FLOW PRO , .DEVICE N. :1 :.. SANITARY YN RECEIPT# Owner Data DRAINS- OOR, ROOP,ARFA, CONI. WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y ❑ I hereby affirm that l have acenifcate ofconenmo self -insure, oraceaifcamof Wnrkero'Grmlwnvatinn lnsumnoeornewJliod copy thereof (S«.3g(xl, Lnb C.)which FIXT ES - PER TRAP RECIi1PT PARK PE.R Y N -B SA. SYSTEM.] INC. 4 OUTLETS covers all employeepermit, :, undenhis peit Policy k RP.CIi N BUILDING DI SIGN FEES Company GAS - EA. SYSTIiM-OVER 4( ) te� PLANCHECK FEE ❑ Certified copy is hereby famished. _1(copy is filed widr the city inspection division. GREASFJINDUSTRL W.RCE GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKGRS' COMPENSATION INSURANCE GREASETRAP Soil< FEE SEWER - NI R SI'O L ENE -Ay FRE (This action need not fecempletW ifthe penno is for0ne hundred dollars ($10 or less.) WATE AW/VE L I certify that in the performance ofthe work for which Nis paanit isissued,l sh 11 not employ any person in any marmer an ss to become subj«t to the Works P D Compenxmion Lawsof California. Date Applicant WATER SYS ° BEATING Du Receipt NOTICE TO APPI.ICANT:If, after makingnbis Certificate of Exemption, you should become sublect o the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. NEW RESIDENTIAL PLMB. SQ, FT. TOTAL: BUILDING I'I? 2 gra CONSTRUCTION LENDING AGENCY SEISMIC FF. Q 1 hereby affirm that there is a comuueion lending agency for the perfomunce of the work for whicJt glia pennia is issued(Sec. 3097, Civ. C.) Lenders Name IV 9ail�- TOTAL: ELECTRIC FEF: Lender's Address QTY. . ? eCHANICAL PERMITNEE PLUMBING FE certify that I have read this application and note then the above information is meet. l agree m comply with all city and county ordinances and stale laws calmingm huilding construction, and hereby initiation repmsenofves ofthis city roamer upomhe above-mentioned progeny for inspection purposes. PERMIT ISSUAN MECHANICAL - ALTER OR ADD TO MC CONSTRUCTION % (We) age reto save, indemnify and keep harmN less e City of Cupcnin0 agvnsn liabilities, judgments costs and expenses which may in my way accrue against said City AIR HANDLING UNrr(To Io, CFM) in co aquae of h 8trading of this permit. 1 AIR HANDLING UNIT (O• VER to." M) Signature of Applicn onnactor, Dan EXHAUST HOOD(W/DUCT) PAID I]BATING UNIT (TO 100,000 BTU) ALARDGO MATERIALS DISCLOSURE Data ecciptIf Will the applicant or future building occep rd, store or handle hazardous material a, defined by the Collection Municipal Code, Chapter 9.12, and the Health and Safety IIGTING UNIT (OVER 100,001h ITU) T Code. Section 25532(e)1 ❑ Yes MrNo t VENTILATION 17AN (SINGLE RESID) , Will rain co morinrail nvs as defined Mumernremit hazardous air mnmmioamx as define) by the Bey Area Air Quality Mwagement d by the Area Air DLcMct9 ❑ Yes �No 1 have mad the hawdous materials requirements under Chapter 6.95 of the BOILER- COMPLIIIP OR 100,BW B' 1' Ip I ISSUANCE D E r A I D ��� 1994 g01LF.R-CUMPIOVER IW,000 BTU) NEW RESIDENTIAL MECIL SQ. FT. I understand that California Ing do & Safety ur Code. Sechave a to 25505,25533 it is and 25 responsibility if the building Ann not currently w ich...I that it is my,amacc ioila Cernfica the weapon f rhe require nts which must Nabo at prior m issuance of a Cenifcmc of CITYu Lt, - `rI ` , Uf' t,uiEN _ i ISSUED BY:7yXV Owner or aunhoneed4ge am T 10MUSIA