22014 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Protect Identification PIRMIT NO.
=745 54 e ve -,s Creek F31 vd , c w o CA 22014
TYWvera acus: . . ane: - ' /
�;(� A /�. q'j3'1 CITY OF CUPERTINO�BUILDING DIVISION / F ,/
Co IALIJAIL
traeor'a Name: - Lk.No: / G
` APPLICATION / PERMIT
BINC M H-MCAT$ CATEGORY CONTROL M .
f ArthitM/Ener, (h(/ Lk.N.
an eu1LmN�ELECTBIC PERMIT t I i i �FEE'S I t li-',{jjBUILDING•PERMIT•INFO
L. „�,f
Address &"'BE aS n PFRhITISSUANCE •CIS
LICENSED CONTRACTOR'S DEC TION _
I hereby affirm that l am licensed under provisions of Chapter 9(comment, APPUANCESRESIDENTIAL JOB DESCRIPTION
ingwith Senion7000)of DtWsion3ofthe BuslnemandProfessionsCAde,and my '
license is Infulhon«anddied. PANELS C3Gd(UUrn GLG�1�IOn
License Class Lica
Date Contractor ]117-1000 AMPS
ARCHITECT'S DECLARATION
PQ?Ore O I understand my plans shall be used as public records. OVER 1000 AMPS SO.FT.FLOOR AREA f/SQ.PT.
E Lt.nua Pmfeskrul SIGNSELECTRICAL -
«<<•�- OWNER-BUILDER DECLARATION �f a./ e'L
In a SPECIAL CIRCUIT/MLSC �,1 /f f 41'Y.
ORowing yafRmnttual Sectioonexempt 731.5,Bfromthe Contractor's License law fart he `�1
ORFfollowing reason.(Section 7N1.5,Business and Profesions Code:Any city or
O y I.. TEMP.METER OR POLE INST.county ,
h lretapermit
ocorofrpmolhh,orrepair
anystmdmportehwancaorequimtheahantftto
file a signed statement That he islicensed pursuant to the provisions of the
POWER DEVICES
3w Contractors License Law(Chapter9(commencing with Section 7000)of Divi- V UA
SWNfMING POOL ELECTRIC
�0� sic basis fo the alleged
d exemption. Any vioiled lation f exempnherefromand
< the bash for the alleged exemption. Any violation of Section not co by any I OUTLETsSWITC1gPSEXTUAIS S� U
O five hundred apermlt mbjMelheapplkanitoa dull pcmltyana come than ♦ / � ' �
$ flF11,as owner of ars
pr). NEW RLSIDENHALELECTR SQ.I'f. STORIES 'IYPECON5IRUCTION
❑I,as owner of the property,or my employes with wages as their sok
7n mmpaee.7044,wBimens. weak and thes Codurehnotlntendedo License
ed for
Law
O sle(See.
tap4y to ano sandf property
Code:The or Improves
l.Iceme law >�t
$ does not loan owner ofproughhis o nem orlmpmvsled con,that and
whodossuch work himself orfbytgh hisawnemployees,provided that such — OCC.GROUP RFS.UNITS
improvements are not intended oroffered forse �ls.If,however,thebuilding or TOTAL: !37D
r
mcofs It withinoneyearofcompletiogtheOwner-buUderwllil ve .nofpmvinglhat hedidnot bulla or improve for purpose of ask.). QTY. , •PLUMBINGPERMIT FEE FLOOD 7ANE APN
awns of the property,am exclusively centrarting with Icemed PP' ' , , SNANCE
s to costmd the project(Sec.7044,Business and Profesions Code:ractors License Law does not apply fo an owner ed property whoALTER-DRAIN kVENT-WATER(EA)improves therron,and who contracts for such p(ojene with a di
cCr5EE SUMMARY' `
qq�B((factor(s)licensed pursuant to the Contractors License Law. BACK FLOW PROTECT.DEVICE 1 '
1 am exempt under Sec ctoB k P C for this reason
IDPFI I'S
DRAINSF600R ROO$AREA,COND. SANITARY Y N
Owner - Date RECF=#
WORRMAN COMPENSATION DECLARATION FIXNRES PER TRAP SCHOOL TAX Y N
[:]I hereby affirm that I have a certl0ate of consent to self-inmre,or a RECEIPT X
adiflateofWorkem'Compewtionlmumnceoramdifiadmpythereof&c. GAS EA.SYSTFAI-i 1N 40 J PARK FEE Y N
3800,Lb Cd
Policy N
Com any G O RGCDI'TX
I Certifed copy Is herebythhBUILDING DIVISION FEES
ed. G C E IN U PLANCHE FEE
'
F-1 Certified copy Is filed withh the city inspection division. � -
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP
COMPENSATION INSURANCE PAID
�YJ•5�
(Hesseetionned not becompleted lithe permit hforom hundreddollars SEWEQAiT1 - Date ReC i t#
($100)ImAifered WATER HEATER W/VENT/E.EC1R ENERGY FEE Y N
Icertiless.) In the pedomunceafthe work forwhich this permit is Issued, - -
Ishall nm employ any person In any manner eo a to become subject to the WATER SYSTEM/TREATINGv/d 2 n aar�O
Workers'Compensation Laws of C Ifomh.Date PAID � "/ O
0 Z Applicant NEW RESIDENTIAL PLMB. SQFF. Date Recei t#
Z NOUCETO APPLICANT.If,after makinglhisCertlflate of Exemption,you
should become subject to the Workers Compensation provisions ofthe Labor %' TOTAL: 9,51
W Code,you=at forthwith comply withsuch provisions or this permit shall bi,
LU j
, I
ADDITIONAL PERMIT FEES
BUILDING PROJECT IDENTIFICATION VALUATION 1 1 j�is
i UILOI
ADDRE c
o[IxEE4
mer �i7P 131.
`T 7 OwxEP'S � �•E y` '
NAMEM, FEE SUM
MARY
ONE
t
CONTRACTORS
NAME '''''••(�^ a BUILDING -
r•OY !T � .. Y4. 1 '.� oWly vY`•
LIC
O.
PLAN CHECK
CONTRACTOR I
ADDRESS I FEE
vxorvE SEISMIC FEE 1 '
_ fI CITY. ELECTRIC PERMIT' FEE
I UTLETS-SWITCHES-RECEP ELECTRIC �
LIGHTING FIXTURES �yq
PLUMBING
PPLIANCES-RESIDENTIAL -
�. .
PANELS MECHANICAL -
r~ SIGNS
f_,
• TOTAL SIGNS TRANS.
fI
SPECIAL CIRCUIT '
EMP.METER OR POLE INS. vexMlr vauoanoN
MOTORS SEE FEE SCH. -
SERVICE CHANGE
Z z
H O TOTAL
C N ISSUANCE DATE
LU > OTY. PLUMBING PERMIT FEE BLOC. ELECT. vlc. MECH, \
o_ o
' 1 z ALTER-DRAIN&VENT-WATER(EA.) E
C.7 O BACK FLOW PROTECT.DEVICE - - -
OU DRAINS-FLOOR,ROOF,AREACOND.
} y FIXTURES-PER TRAPI-
? GAS-EA.SYSTEM-1 INC.40UTLETS
V GAS-EA.SYSTEM-OVER 4(EA.) c ('
' INDUSTRIAL WASTE INTER.
i
1 LAWN SPRINKLERS-I INC 5 V.B.
LAWN SPRINKLERS-OVER 5IEA.)
• SEWER-SANITARY-STORM EA.ZOOIE/
WATER HEATER W/VENT
i WATER SYSTEM
WATER TREATING EQUIP.
TOTAL
OTY. MECHANICAL PERMIT FEE
• ' 1,., i ALTER OR ADD TO MECH. ♦
CC. APPLIANCE L•
I 1, AIR HANDLING UNIT ITO 10=C.F,M,) '
AIR HANDLING UNIT(OVER IO)DOOC.F.M.) O�((yy)
' "•� EXHAUST HOOD(WITH DUCT) ETL/I -
-YY .
HEATING UNIT TO 100,000 B.T.U.) '` _ -
yE/'_
• HEATING UNIT(OVER 100,000 B.T.U.)
rVENTILATION FAN (SINGLE)
BOILER-COMPIO H.P.OE 100,000H.T.U.) t
BOILER-COMP IDwv IOD,Baa BTUISEEFEESCH. - 1
,
- ` • TOTAL