22035 vAPPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
-BuildingProject Identification FERMI NO.
BWlding Add 22'75'7 5XV0 ck�x ai,vo GvPsnnA10 - 22035
lure ante:• p�?��n�pA d�� ne77 A
Aynq Pl1'•TCI�n)J'fM/'t' Sc�i CITY OF CUPERTINO-BUILDING DIVISION fL—l•�� �
1 Contra 'a Name: Lk.No: �l.
k /) PERMIT
v t�L BUIIAINC.ELECTRICAIPLUMBINGMECHANICAL CATEGORY I CONTCIp If
rtdtett/Engiruer. Lie No:
PERM_.;IN ;
f 1Q1Y rise{[TI
J \\ Add.: r PERMRISSUANCE 2 (� ❑
LICENSED CONTRACTOR'S DECLARATION IV
I hereb affiant ofDtvi:emsedhe Bu r and PmfC i erg(commme APPLIANCFSRFSIDENIIAL
y p pt ]OB DESCRIPTION
Inge.i.i tlor7000)af Dlvffect, (the Budnnaand ProlexloneCade,wd my
4 limn.is In fud(arcs and effect. PANELS J+
License Clax
Date ConCor
tractor
ARCHITECTS DECLARATION 201-1000AMPS
reit O I understand my plane shall be used as public records. OVER IDDO AMPS SQ.FT.FLOOR
AREA $/SQ.FI.
0 Licensed Professional SIGNSELECTRICAL („•�C) rl 7
6 OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC \ 'w
I hereby affirm tout lam exempt from the Contractors Lkees,law forthe
po J following reason.(Section 70315,Business and Professions Code:My city or TEMP.METER ORPOLE INST.
;hep
county which requires waarceconwuinestn Wpmvant Wsuch,.rrepJr
any atsucturtpriortent that he Is Bernard
pursuant
tto the lorauN protect t e POWER DEVICES
a� file a signed ahtement that he h darted pursuant ro the provision a( the
Contractor's License law 3 (Cha 9(commencingwith Section 7000)of Divi. SWI),MNGPOOL VALUATION 30 vion3 of the Business and Profession Code)orthatt he is exempt there0rt
cand E4ANG VOL FLECRC
the Webfortheallegedexemption. Anyvlolatl.nof Section7015byany OUTLEISSWIT'CtESFDaURES
applicant furs permit subjecta the applicant toa ct perufty d not nnrtthan
h v
rave nares dolhn(SM.
I. •owners(the pm",or my employees wkh waga u thetr wle NEW RESIDENTIAL F.LECTR SQ.Fr WOTation,wBldothework wdthestructure b not Wended or offered for h Cue.7064,B..Weas and Profmion,Code:The Contract.?.Lice.Law onnot apply to an owner of property who builds or improve,thereon,and who don such work himself a through Na own employees,provided that suchImprovements arm nm Intended proffered forsale.IL howavec the building orWpw mentis.no(proving thathedW wtbuBdor Mprove for purposeofeale.). QTy-�_t' ,.-PLUM ; ER7 ' ^ ' 'er of the Property,am..I.Wely mntncOng with Ikensed PERWI MANCEntown,tact the pmjed(Sec 7044,Business and Profeaibea Code:71u C clod License Law don nos apply to an owner of property whobuilds or impsovn thereon and sob corutacts for such p{ojesss with a ALTER-DRAIN k VENT•WATER TEN �s1
�sctons)drensxi pursuant to the Contncte.Llan Law. %FEETSUMMARY i�•, `�
L-1 I am exempt under Sac B k P C for this reason RACK FLOW PROTECT DEVICE
Owner Data DRAINS FLOOR ROOF,AREA.COND. SANITARY Y "" N_.
^ EIPT B
WORINTAN COMPENSATION DECLARATION
R1I. 1.hereby affirm that I have a a tifiata of consent to self-Kure,or FDCrU ES PFR TRAP - - - SCFTODL TAX.,,'RECpRrI1
WI at<.fWorken'ComperwHonlmurarta as artlfled copythertof bee. GAS EA.SYSI7M-11NG40VE.EfS PARKFEEa ,Y n. N
PolIn N ^
GAS EA.SYS EM.O :.'�
VER 4(EA) '••-'
Com any - :BUILDING DIVISION FEES
Certified copy h hereby furnished.
In
copy b filed with the city hapectton dr.Won. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECK FEE.;:.,
" t -� "'•
- CERTIFICATE OF IXEMPITON FROM WORKERS GREASE TRAP - PAID�� " - rr
COMPENSATIONTO
INSURANCE SEWER-SANITARY-SRM EA 20BFT. . Dat .e �V•ReR'f �D O
(M.ardlon need not b completed r I,
9 the pesrNt a forma hundred dollars
t# •I
(S100)hrlees3 WATER HEATER W/VENT/ELEM ENERGY FEE'.'Y .".N
Iartifythat Ire the performance o(the wakfor wMrh this permit Is blued, — . 1
I shag not employ any person any manner an as ca
to become subject to the WAl7R5YSIFd//77REA71NG ` c• •
Wwkan'Comperwtbn laws ofGWombPAID.Date - � • ' .f
ZZ Applicant NEW RESIDENTIAL PLMB. SOFT. Date Recei t#
Z O NOTICE TO APPLICANT:If,after making this Certificate ofFaempdnn,You TOTAL'•
should become subject to the Woskn
e 'Compensation provisions of the Labor -
N Code,yourrust(onhwlth comply wlthuchproWbnorthb permit shallW BUILDING '22f`a; "r—. QO
> domed revoked. a
CONSTRUCTION-LENDING AGENCY SEISMIC L
d G Iherebyaffirm that there h a construction lendingagency forthe perform SAL ELECTRIC FEE Ze
Z area of the work for which this permit h issued(See-3097,CIv.C.) _
O O lerdeh Namer PLUMBINGFEE '
IL I- Lender.Ada cox QrY:3MECHANI LPHRMfI' FE MECHANICAL FEE .is "-
WI nertlfythal l haven.cithisapplicationand statathattheabovelnformatlm hemmer lagreeto tomplywithallchyandcounty=1et remand state law, PFRMR 65UANCE .[aha FEES PAID: ,
y a eatingtobulldngconetsuctionandherebyauthorizerepresentativeso(this -��ll
}.. U) city to enter upon theabovementlooed properly for inspection purposes. ALTERORADDTOMECH. s W Date - Recel t#
(We)agree saw,Indemnify an d keep hmrrnlm the City of Cu pertfoo
V
against lleblWla,Ndgmenta,cost,and expenses which may In any way accrue AIR HANDLING UNIT(TO 10,000 CFM) " SUBTOTAL:
sgalrot old City In consequence f the Starting of ted,permit.
6 AIR HANDLING UNIT(OVER Ioo)ocFhD CONSTRUCTION TAXSIC 1 -
ignlmre of AppilcantOCoinarborD.f.1 DDIAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS 01S 1.0S E
Wllltheappucant or future budding occupant store or handle hazardous HEATING UNIT CTO 100,000 BTU) Date ReCel t#
material as de0md by the Cupertino MumdpaI Code,Chapter 9.12•and the
Health and Safety Cadea-Sectlon 25572 W7 HEATING UNIT(OVER 100,000 BTU) TOTAL.
nYn I—I No
VENTILATION FAN REBID)
111the applkant ar tore building oaupantsax equipment or devices ISSUANCE DATE
which emit lonnious all contamburas as defined by the Bay Area Air
Quality Management District? BOILER-COMP OHPOR 100,000 BTU) r� .-
4 Yn ❑No �y•
Wve read the hazardous matedah requ lremenis under Chapter 6.95 of BOILER-COMP(OVER 10,000 BTU) I'At
�heCrilfurnlaHeadh&Safety Code,Sectba75505,755]3and255]4.1 .M!{ t r�
u."trstand that if the building don not currently have a tenant,that It is my NEW RESIDENTIAL MECR FI.
responibWty to notify the occupant of the requirements which=at be reset C r
prior to iss....of a Certificate of Occupancy, Y`
Owncror authorized agent Date TOTAL: ISSUED
OFFICE COPY