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B 0610 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERM)I NO A 03 BUILDING DIVISION APPLICATI0N/PERNIIT PLUMBING-MECHANICAL, BUILDING PROJECT IreNnFIC.TION ao 8�jtj(a if Q BUILDING ADDRESS � SAN(I'AItV NO API'LICATI(lN?URp111'IAL UAIIi UWNf""uc�,^r"�NIE t PI ONE: CONTRAC'I'Ok'$jfA LIC NO { /'� G` �/i..a f' I /kV ,� L^ �• N/C CON'I'RULb 'T(CII 'L+LT/ENGINI{ER' l l'u // 1 ADDRESS — - 3 �J ACC L V� 1'tl NE: L BUILDING PERMIT INFO/ i " � JS F+ �y�'�'�j� Consultant fees Paid by Applicant(Initial) I BrI�A�IG ELECT PLUMB MIiCH / I LJCJ •� 0� LICENSED CONTRACT'OR'S IIEC.u,tit CON QTY ELECTRIC PERM fF FEE .I nerebr mbiili mat I aiii hreii,rd miler pmvi,ion,of chapte.9 aomtn.,telnls rI JOB DESCRIPTION W8ZO with Section]000)ol Uisnsion 3'If the Business and Preffessaon,Cedc,rnd mylaeme is PERMIT ISSUANCE Y •�© RESIDENTIAL' �IyF In full force and effect C,.�SFDWI. C KITCHEN REMODEL NUa [),to Class LICho (APPLIANCES-RESIDENTIAL DDI'1'ION ❑PLUMBING HE-PIPE. F W Umu Cnmmcto• FF ARCHITECTS DECLARATION PANELS CMULTI-UNIT ❑STRUCTURAL ZOyg Iunderstand my plana,hpll benad as public records MODIFICATION OZ� UP'1O200AMIIS ___ _ _ CIN HiRIOR ❑CHIMNEY REPAIR E-�F"W Lieciecd Prolessiuml 2111-IIMNIAMPS IMPROVEMENT CSWIMMING POOLS Y2,' OWNER-BUILDER DECLARATION OVER IfXX]ANtI'S yy X W Q 1 hereby aBimt that I ran exempt from the Contraeor',License Law for the C BATH REMODEDREPAIR C DEMOLITION X 3 OL U lollowing reason ISection 70315,Business and Professions Code Any city or county SIGNS ELECTRICAL C OTHER I k YY17 W{y which squires a penu n to ennwucl.alien improve,demolish,or repair any slrac Ore t QAI � prior to its issuance,also regmms the applicant for such permnto file.alledmammemI SPECIALCIRCUITMISC $�y the he is licensed pursuant to lire proviaons of the Cuntrautor's Lactic Low lChapter9 ylCCO (commenemgwith Section 7000)of Division aoflhe Brsme„and Podc,orns Cale)in TEM P METH If OR POLEINST. COMMERCIAL 6 tYx e C that he is exempt therefrom and the basic for the alleged exemption.Any vioimiom of C NEW BLDG/AUDITION C DEMOLITION 0,7�'y Secuon]IH LS by any applicam 4nepennrc sublcUS the upplicdnuo ucivd penalty of POWER DEVICES [I TENANT ❑FOOD SERVICE F.ZY tmorc thus fve hundred dollars($5010). IMPROVEMENT f=aO El Las mia o of the propenb nnry ettiployees with wages nc melr,olc cnmprnxaoon. S IN 11 '1 OL oil do the wmk,and the atiueure isnotimendedmrnifemd lm,Ae(Ife.7Wi.Hu,meca I--rC If�2 6 �iY'{� O COTHER as a^eeo and Professions Code:The Contractor's Licence Law does not apply n)an owner of ��5�!� -i1X9URES eX property who bold,m tinprovm thereon,and who dues such work hinl,clf or through his own employee,,provided that such improvements are not mmn tat ur offered fur l"BT 5!1! 8�I�,jf 1 A tJ SQ FT sale.if.however the M1UilJing onmpmvcomem i,sold wnhuone year of completion,the �- SO FT FLOOR AREA b/SQ FE owaser-huddler will have the burden of proving Pan he did rim Indoor improve tar put- . )L 1#j��,49,`/�1 rye 1 aalem) d-ba ^�L w er of the property,am escln,nely comranmg with licensed contmrmrs to % i I istrun the project(Sec 7031,Business and Professions Codc.)Tluc Convector's Lt- se law dice not apply to an owner of property who builds or improves thereon,and QTY. ., PLUMBINGPERMIT FEE / who contracts for such Farmers with a contrratons)licensed pumforat to the Connector', L¢ene,Law. PERMIT ISSUANCE ,� III/ .a I nue Lamnpt uudcr Sec B @ I'C In tiro reason Jut 1 `iOwm G"—� `� �Uatc AL91iN-DRAIN&VENT-H'ATIiR(EA1 / II 10 �40RKF.R:S�NiPI?NSAT�DF.CLARATION BACK FLOW PROTECT.DEVICE 'By l f\ Ihercby allinn under penalty ul pcpury one of the inllnwing dedmahmie �_` ( (.J I have and will momain a Cenificale of Consent self-mcure for Worker's Canapes- I DRAINS-FLOOR,ROOF.AREA,COND. / T '1;CONSTRUCTION aatun,as provided for by Section 3700 of the Labor Code,for the forb mtance of the work for which thj,permit s nsurd. FIXTURES-PERTRAP )� I have it will niam..Worker's Compemin"a Insurance,ac natural by Section 370(lafthe Labor Cale,for the perfomtan<e of the work for whrehthn permnarimed I (GAS-EA SYS"IENL-ZINC YOUTLE . OCC GROUP N1y Worker's Compotaemn lnmretoo aafinefand Policy nuniher are Career: Pu1my N^ GpS-EA.SYS'I EM-OVER YWA) L� CERTIFICATE OF EXEMPTION MOM WORKERS' COMPENSATION INSURANCE I GRBASF/INUUSTRL WASTE Poll ERCEPD)R I BUILDING DIVISION FEES -(Hoc-sectiorncoluat M1ecompleled dthepernat isfai unehunded dollar,(911x111 GREASE TRAP mlesa l PLAN 2 -1•C O Loy any person I.the performance of the s to ho, ou,mic, ,,the Wort,meJ,lsha- SEWER-SANITARY-STORM CA 2001-11 � l L -��jj permit not empiny my alikom any Domanncr,n:n to bcennm subjrotmthe Wnders'Cnmpcn- ENh:RGI'FP 2`' CI) a 'COI O Z A,plmlrl of CelJOrma Duo- 1 WA'1 ER 1{EATER WIV ENT/ELISCI R Z Q Apphunt l GRAD�Ijl C7 NOorra,a O APPLICANT IL after making Nn Cemfase of Exemption,on,you air I.,, Wp'IER SVS'I'ENI?BEATING ai t' nnsmeh comma tic Walh pro Com)cnr this pmakonc ul❑e Labor Ccdc,yon muss SOI F li forthwith comply with such prevision,nr this pemtit shall he JeemeJ revoked I WA'1 ER SERVICE 1 aZ CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB SO Cr. VA[ Ir U O l hereby union that there is aconswemn lending agencyro due pefomiance of 1 Date ai9i the work Tor which this pemm t,issued(Sec 3.097,Cut C) QU :-odes Name Yr0'I'AL / O WIInderspddlm,a I 'rDTp,. f/, iv/.Iy 1 artily that I have rcai Thu apphcamm and slate Thal the above mfommbn is BUILDING PEG a(A tonal.l agree to comply with all city and county ordinances and cum laws miming to QTY,' MECHANICAL PERMIT FEE "� �• p'0 holding commotion,and hereby authorize reprenentatne,of this city ni mitcrupnn he ISIi15MICi$E �w j�inireny tar m,pecuon purpiwes' PERMIT ISSUANCE eft(We)agree bs rove,indemnify and keep harmless the City of Cupertino agamat ELECTRIC FEE / �..3.0 Iubdum,,judgmentacosts and cxFentt,which may in any way accme against said City ALI ER OR ADD TO MECH �PLINIBING FEEM .JO iu e,,a,e9rrnce of the 6ummn,of thin lwi t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI.NON POINT 1 pIR fIANULING UNIi'ITO IUlxxICPNU I M 30 SOURCE REGULA'I IONS. AIR HANDLING ON[I'(OVER IILIXp CFM) Cl1NSTRUCrION'I'A a SRmum rif& 1manVConquou, / Due EXHAUST HOOD(W/DUCT) ( EE HAZARDOUS MATH /LS DISCLOSURE HOUSING MITIGATIO Will the applicant rl umm building icenpum store of handle hnrnorms materal HEATING UNIT(To Intact,if I'UI as defined by the Cupeamo Municipal Code,Chapter 9 12,and the Health and Sally Code,Section 25532(,)? HEATING UNIT(OVER IW.W(I]'TO) pYea Dife 1'Alll .- VENTILATION FAN ISINGLERISID) Date Reu•Ipt it I Will the ialr mans nr boom building mcupant me equip mem or Jevue,which ROIL ER OBI'OR 1IX1,IxN]BTU) in hazardous air comearmams as defined by the Bay Area A Quality Management 'IOTA : all, [ BOI I.ER-COMP(OVER 100,000 If'I'U1 [D YO, ( ❑Nn , I have mad'he hazardous materials recomment under Chapter 695 of WC Cdr- AIR CONUI'I'IONER I ISSUANCE DATE ludo IIealthRSedy Crate,.forml'that,o urry and 25flY,i 1.mar,ththetime NEW RESIIJIiN"ITAI.MECH tiQ Pr �. moos lgdoa,&Safety n0y hoc a tenWit.the .2513 recponsfhibty m nor t n icecupam of the"uaements which most h met prior m kmam a of Cmuit m of parry I „j5 I / _\T° (.-�Jp � /p. TOT II Si t �n Ownen?reiµM1Or{IaJ agent// // liy _ I ISSUED NY:VVV,1 - bb OFFICE