31248 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE SAL_L POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT'N°' -312 4 8
/
BUILDING DDISION APPLICATION/PERMIT PLUMB ING-MECHANICAL � ' '
BIJL GAD RESS - s - BUILDING PROJEUVIDENTIk'ICA'1'ION I SAN("1'ARY NO. APPLICATION SUBAII'ITALUAL
$,N ���� /j� PHOJyI _� Y01 CO�1'I;pC I'JI>.'S �W —)2IW)� -. N/C CONTROL#
ARClIITECT/ENGINEER /.� LIC NO /� _ A6 .,5///!I/1 /. �L'f/�� - ❑
CONTACT. PHONE:
! I BUILDING PERMIT INFO
M,41-2j, �/-/�..� �I1/.❑ Consultant Fees Paid by Applicant(Initial) B_ UlG ELECT' PLUMB ,MUCH
/ LICEtISF-D CONTRACTOR'S DECLARATION g I QTY( ELECTRIC PERMIT FEE
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing __ JOB I)ESCRIFTION '
{Q{yy 00 wit],SectionTXHUofDtvis00 ofthe Business and Ynde-oat Cade.andmyhanseis RESIDENTIAL'
FMS in full force and effect. PERMIT ISSUANCE
�UzU 4ceme Class 1.¢ p - OSPOWL OKITCHEN BE ICEDEL
�6U Data C:mMMur APPLIANCES-RESIDI?N'HAl.
[]ADDITION C1 PLUMBING NE-PIPE.
I ARCHITECTS DECLARATION PANEfS
Fnz ChfULTI-UNIT CSTRUCNRAI.
Z p r�Z I understand my plans>hall he wed as public records I „ MODIFICATION
oz-- IJ11 PO NO AMPS
H.~W Lcamed Piums,ond ❑INTERIOR ❑CHIMNEY REPAIR
peg 'T� OWNE&BUILDER DECLARATION 2111-IIXXJAMPS IMPROVEMENT y "• I hereby affirm that l am exempt fmm the Commalm's License Lew lo,do, OVER I I1)0AMPS 0 BATH REMODEURIEPAIR 0 DEMOLITION
K�LU following Mason (Seniun]n315.Business and Pmfeseans Cal,Any city or county l' SIGNS ELECTRICAL DOME;R
to O which requires a permit to cnwlma,aheq bapmve,debmhsh,nr repdu any structure r�J^
FC N prim maviswance.alsoregairn the apphcam inr malt permdm lilcii,,mad mhnnenl SI'GCIAI.CIRCUIT'/NISC
y2' } that he is licensed pursuant u the pmvrsmns of the Contractors License Law(Chapter 9
T�1 00 (Innumencmg lah Section]IXI(IlafDU'wmn3nithe Bnriaersaml Profesvnns Cn]a)., r TEMP.METER OR POLT:INS T. (_'OMMERCIAI'
that hers exempt therefrom and the halls for the allege)esenquour Any vtalmion of 0 DEMOLITION
^H Sedmn ID3LS by vny apphcam fnrapctmil subJecrs the epphunuoncnil penally oft POWER DEVICES , ONP-W BLDG/ADDITION
�M} liar mnro then rive hundred eoll.irs 1851X# CTENANT ' El FOOD SERVICE
o I,as owner of the prnpeny,or my employeeswM xeges as lticir tale cnmpcnuuon, SWIMMING POOL ELECTRIC IMPROVEMENT
F xilldathework,andthe structure is not inmededoroflered forsale(Sm.]UW,Bushes., OTHER
3 and Pndesaons Coda:The Contmmors 1-tecinc Lew rams nth apply to:m owner at OUTLETS-SWITCHES-FIXTURES
Property who builds or nutritive,thereon,and who due,such work himself or 0m6gh
his own employees,provided that such improvements one not intended or offered for NEW RESIDENTIAL ELF-CIR SQ FE
sale 1[however.thehnJdmgurtmpnrvcmem nnalJ xilhmoneyearalcnntplchon,the > ORARF,A
r rider will have the burden of provmg that he did not build or improve for par- IGI- -
I:as owner of the Sea lbul"Y.bam racer said counni
b,omg with license)ummumIs a TOTAL:
cnnstmn the proJat(Sea ]BW,Business and Prnfessians Cadea The Conoaclnr's Lo I ''
allow law don not apply to an owner of property who builds or mproves thereon,and (QTY. PLUMBING PERMIT FEE ��
who contracts for such[moves wlth a attar eler(s)huaseJ punumn m the Cora actors
Lreeme Law. - PERMIT ISSUANCE
1 am exempt under Sec ,B&P C for this reason �- " ^e
'Owner
Dad- ALTER-DRAIN&VENT-WATER(PA) VALUATION
+ Iherehy vfft rh underr pen It,afper)ur .tbc I hetoll wing dedarmmns HACK FLOW PROTECT DEVICE
J I hive and wil mmmm
I O�6
e p DRAINS-FWR,ROpIARIA,
CONE) STORIES* ^TYP CONSTRUCTION
WI Coon, ,provided for ai Section JRN]of be Lalan Cale,for the perfnnnance of R_
xork laeandt this pentaras orker I FIXTURES-PER TRAP
0 1 have and will maintain Workers Compensation work h;h required by Svcuco,
l]INlmk1Latnnnaboubnheperfonnancer and PolicA Tarwhtch this permvotwned , GAS-EA.SVS'fEhl-I INC�4OUTLETS 1 OCCC O APN
My WorAer'.Cnmpem:mon Inwrnnee comer and Policy numher
Canter oabcy NO.: I GAS-EA SYSTEM-OVER 4(EA)
C[RTIPICCOMPENSATIONIINN FROM WORKERS'
' COMPENSATION INSURANCE GI(EASIJINDIJS'I'RL WASTE INTERCI?('TOR 1111 "
(Thusemm neednot becomplamdiftbeperms,Imme humbeddollars(SIM) ILDING DIVISION Fr'
or less.) OREASP.TRAP PLANC Flil?
I rerofy lhaunih,perfnmtence, me aokfor hmis pe nn is issued,I shall I Sf;WER-SANITARY-STORM L'A.2(p FT.
urn employ any on m any m �en hi 1 Workers'Campers- ENERGY F E
0 C) sauon Laws o a¢ (WATER I HAT'BI(WAIENI'/EI-ECTR '
Z Applicant / ) _- GRADING F E -
ti NO iC O ANT'If.alter n 1 s eFi lute dKe peon,you shoal) WATER SYSTEMnREATING
f'1 bee, c su 0.to the Worker's Cnmp nation pnrvrsmns of the Lnhnr Cnde,you atom I SOILS FEE
0. Q funhwith comply with such pmvismbs or thispRmn shall be,Jenpad resided. WATER SERVICE -
CONSTI(UCTION LENDING AGENCY NEWRIESIDEN'IIALPLWB. SQ Fr. ,' (PAID
U 0 l hereby shine that hem is a construction lending agency for performance of Date ^ Receipt#
fL (✓ the work for which this perms w Issued(Sec.3097,Civ,C)
0 U Lender'isi 1" TOTAL:
rLcndcrs AdJr^•-
W TOTAL:
(„1 p, 1 cemfy that I have mail this apphcaaon and state that the above nrfnrmmmn rs 1 BUILDING FEE
(n correct l agree to comply wit h all city and County ordinances and Stara luwsrel:ningto Ty. MECHANICAL PERMIT FEE
V z laaldingconswcuon.and hereby amhonae repremnta0vec ofthn city menieruptm me SEISMIC FEE
above(We)a agree top tol fmi mouty at]keep s' 1117RMIT ISSUANCE
I We7 agree m sate,mdelnnify and keep harmless the City of Cupentnn against I ELECTRIC HE
Itabdniea,Judgmentr,costs and expenses which may in any wu)metal against said City ALTER OR ADD TO MECH.
mi
in
consequence of the granting of this pert. PLUMBING HE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(T010.000 CFM)
SOURCE REGULATIONS I MECHANICAL PER
AIR HANDLING UNIT(OVER 10.030 CM) IONSTRIICTION TAX "
Sgiumre of ApphcanUContacmr Date (EXHAUST HOOD(W/DUCq (
HAZARDOUS MATERIALS DISCLOSVRE HOUSING MITIGATION FEE
i
Will thenpphcam m future bailmngneeapantthre or handle hamidow material I HEAT INC,UNITI'TO 100.0XIU BTU) '
as defined by the C.N.M.Municipal Code.Chapter 9.13,and the Health and Safety
Cade,SDYes N 25532m)?^ C _ HEATINGIINIT(OVF-R•JUM,0011TU)
_ VENTILATION FAN(SINGLE RBSID) PAID Dvle Recaps p�rauddm at,conta nr fntnre buJmg by the Bay Aequipmentordevreeswhich OOILER-COMP(3HP OR 100,1X10 RTI11 iiavalloro tar conmmmants as def lied by the Bay Area Au Quality h1anagemem `T=CYea CNo ' BOILER-COMP(OVER 100,0(X)BTU) C
L
NR CONDITIONER ISSUANCE DATE
I have read me hazardous matenah icquireiiten¢under Chaprer h 95 of the Calry -
fomla,dre,&Safety Code,Scebons25505.2,royand355Ja.I understand thet Jihe NIiN'RESIDENT IALMI?CH. SQ PI'.
builJingdms not,unrnntlyhweamnanL.lhaulumy mspmnbllny to nosily the rccnpam l •' I - /r 1�� 7
of NC regmremems wbmh Cowl be at
pnonniasuantt nfv Cemfium of(kcupancy !/ /�
Owneroraaltrumd agent Dale TOTAL (ISSUED BY:
x', OFFICE