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APPLICANT -TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO
BUILDING DIVISION
APPLICATION/PERMIT
BUILDING. - ELECTRICAL -
RI.OMRING- MICHANIFIC
E BUILDING.PROJECT IDF.NTIIICA'fIDN,
PFI ITNO.
2083
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-
SANITA I2Y NO.
APPLICATION 9UNMITTAI. DATE
BUILDING ADD ESS:
Sig
Li- y
'
D 50!
LICENSED CONTRACTOR DLCLARAT ION
1 h ny R pull licensed I p I I pt 9( g
widS'i 9000) fD 3lthc BU dP fss'o:Ct de,adny lie Ise',
11 ce.rd Bet
d, 27 -cv&
O N
R'S NAME:
PHONE:
f ,' "TOOIL'S AM4" - LIC NO
V C{l1/••'f/ S
NIC
CONIROLA
- . .
,o n T111.no.
It( I Nil I
ADDRESS: e A _I 1 ,
❑
ARCH1TECTSDECLA 'I' )N
I undersand any plans shall be used as pub) cods
I!'ON'1'ACT'. PHONE:
-
❑ Consultant Fees Paid by Applicant (Initial)
B[DDC ELECT PLUMIy NECCH
Z /
J
LICENSED CONTRACTOR DLCLARAT ION
1 h ny R pull licensed I p I I pt 9( g
widS'i 9000) fD 3lthc BU dP fss'o:Ct de,adny lie Ise',
11 ce.rd Bet
QTY
M1
. ELECTRIC' PERMIT..
'- PEP ,•
JOB DESCRIPTION
RESIDENTIAL'
❑SFDWL ❑ KITCHEN REMODI:1.
PERMIT ISSUANCE
r
APPLIANCES RCSIDIiNT1AC
Lic lay wdp LC #
Del NI h.1 Cn I ,liar
El ADDITION El PLUMBING RF, PIPE
❑ MULTI -UNIT El STRUCTURAL
- MODIFICAI ION
❑IN'EFR10R El CHIMNEY REPAIR
IMPROVEMENT (] SWIMMING POOLS
ARCH1TECTSDECLA 'I' )N
I undersand any plans shall be used as pub) cods
PANELS
UPT0200 AMPS
Licensed Pole,siorld
201- 10GAMPS
OWNBR.HUILDER DECLARA'T'ION
I henry a(rnn'bat I am e,.mpt Eon the Cnnnaclot, License Law fur I"
fidlowiog Tabun. (Sort i�n ]0315, Hadlie,s.nd Professions Code Any lily or counly
❑BATH RF.MODELIREPAIR ❑[)FMOLEHON
❑ If HER
OVER I000AMPS
SIGNS ELECTRICAL
which rc lu'res a permit to construct, altep ilFijlrove. demolish, or repair ally slNcwre
pn a l s curance, also requires the apliberrat for h perour to filir a signed sairensent
than he is fireceird Puo ffind to the jusivisn 'r: flu Coninart., I [,a, (Cbepterl
(co g lnScct 7000) fD ki Par t H ` s dl f.. .Cale),,
the on k cxcupt Iherefm n and she bus for the alleged Ae npa or, An, .blutlo n of
SPECIAL CIRUU1T1MISC.
TEMP MI'TI:R OI21'OLF INST.
COMMERCIAL:
❑ NEW BLDGIADDITION ❑ DEMO[.] 'TION
Section 9031.5 by any alid,erm for a pennilsub,c, the npplicant evilpcnulty,f
POWER DEVICES
NT El FOOD SERVICE
... more tb.. five hundred dollars ( &san
❑1,asovn'iof [he proprdy.,rmy ennpfuters wish wages as their sale eomPCnnal
wul an the work, and the suuaua'e Is nod intended or offered fo bile(See 9(144, Business
1 R MENT
❑ OTI I ,
SWIMMING POOL ELECTRIC
OUTLETS - SWI'TCIHIS- PIXTGRP,S
and Professions Code The Convector's License Low does not apply m an owner of
NEW RESIDENTIAL ELECTS SQ HE
,,ray h Wild: or ar,loser, pension, and avul d oes .,Is nuk ti If - through
bi, sillin suctloyce, pro,ithed dat, : h murpre,eurroll .1c ins intended or oliturd for
alre. ll husilevic, the hilt g ., al,purvannot '. Id wifinnonu y' f pl r'or the
Q.IjQ OORAREA
$ISQ.IT
htilduw'Il bavethe burden alp, ngthutbcdid not build ninprove Partin'
7
-
posa of tele ).
❑ I, as nwrmr of the progeny, am cucluslv'1y contrrern8 all licensed eontmemls In
o .t t (he P J, (See 7044 Business told Prid,,sitin, Cildic, I as Conustron, L
cause lawdoesr,l apply) rofp pen)whonulld 'npvse then and
whoe,nmtas Bulrush p Jet, with actuators, Of lice„ed pur,unnl to ode Cm;vador's
t s li I
_QT 'Y. PLUMBIN6, PERMIT, ��
of
t,IrFEP,�
PERMIT ISSUANCE
License Low.
❑ Ianlcventptander, Sec. ,B &PCfor little as in
Own,, Date
ALTER - DRAW & VENT - WATER (EA)
VALIDATION
WORKER'S COMPENSATION DECLARATION
BACK FLOW PROTECT. DEVICE
I hereby of fin, rude, pe crui,idper,aryone of the following declamtiona:
Ihavc and will maintnin a Cenifcaa of Cnnsen toself -inure fur Worker's Compen-
Eon, ns provided for by Section 39011 or the Labor Poor, for the perfnmmnca of the
will for wbicb this permit is issued.
DRAINS - Flaom ROOF, AREA. COND.
STORIES
'TYPE CONSTRUC'T'ION
FIXTURES- PER TRAP
❑ 1 have and will mainmin Wn sets Compensation Insurance, its required by Smli,n
3700 nDbc Labor Code both'"" lance of the tun, bo,whlebthn,,W i,'rowed.
GAS -EA, SYSTEM -I INC. 40U'rl.B'I:ti
OCC, GROUT'
APN
My Wnr fip' sm larra n can d Policy -Qu
Collie, ( �eP,licy NO /V
GAS - RA. SYSTEM OVHI24(HA)
C19Rf1IBCATE01r iXEMITION FROM WORKERS'
COMPENSATION INSURANCE
GRHASFANDIISTRL WASTE INTERCEPTOR
BY1IL[i1NGDIVISION FERS
TTlni, scaion need not beennplemd iflbcpermit is fur one hundred donors ($100)
or leap)
GREASE TRAP
PLANCfIECK PEE
I certify lhal it tlae penbrm.nce,f thevvin urwhich lhinpennilkiwuad,Ilihed
NN rr,ploy any pers any manse t ,.u',; u. de Wuk,a C,tapan-
n.
SEWER- SANITARY -STORM EA. 200 PH
ENERGY FHH
WATER HEACERWNIiN'OBLECTIi
GRADING PEE
xatlinn Luw.,fC in )rd I I
Applic:ml
NOTIGE'0 APPI T: I1, afar cooking Ibis CeniGeam of Exemption, you should
Iwcomc subrO to a Wrrkcr's Campeneminn pov s of the Lnhnr Crxlc, yru muxt
WATER SYS'TFM/fREATING
-
SOILS PEB
WATER SERVICE
Iii dawllb comply with xrich pinvisiuns or this net it drill h'deennel revoked-
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CONSTRUCTION LENDING AGENCY
1 haehy affirm lhnt there is a.onsvuaion lending agency f,rtheperfamanmef
NEW RESIDENTIAL PLMR. SQ. HE
PAID
Reeefpt B
the work fo, wh ell this permit ix Issued (Sens 3097, Cie C)
Leall Name
-
'TOTAL
TOTAL
Laurier', Add....
-
BUILDING E E
I orally that I have read tbi, applicallnn and ,am )hill the rhos' Informalion Is
rest. I agree mwrdy th II 'ty l ty 1 .- d Tt latingm
Adldngeonstmeton ' nd hereby u.um'n en.tive,onh'a clyl rnmrrpon One
„ - t
QTY - MECIIANICALEERMIT
:bEP -� (:
SEISMIC P6
PHILMI'I' ISSUANCE
ELECTRIC EEG
shove- u....1 .1 pro perty far in, "ctlon purposes-
,We, ,gore to serve Indeonlfy .nd keep crodex 0c City of Crpenino agonam
ALTER OR ADD TO MECH.
-
PLUMBING PEE k.
Ilaahilitie,,judganonds, eostx unJ expand, which may in any wlYneloe ugain,taid City
A ousequence of the grading of lu, penlll
AIR HANDLING UNIT TO I11,000 CFM)
MECHANICAL FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOU ',REGULATIONS. r1
AIRHANDLINGUNH(OVFRIO,OWCPM)
CONSTRUCTION TAX
)
./A Z]IID— ja^iTe
w oIApplAe dd /Conlrucloe .
FXHAUS'P 11001) WMIJCT)
HOUSING MITIGATION FEE.
HAZARDOUS MATERIALS DISCLOSURE
H17ATING ON IT (TO 100,000 BTU)
-
Willthenpplieant or furore builr>Ango....sat sure or handle haeadnismeterial
aas defined by uu Cupenino Municipal Code, Chapter 9.12, and the Health and Safety
Cndc, Seclion 25532(.)]
HEATING UNIT (OVER 100,0011 RTC)
- )
VENT LATION FAN (SINGLE RESID)
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❑Yes �Nn -
PAID
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Dvlo Rrccipt#
WAIT ahe applicant or future building occupant use tgnipnlcnt or devices which
ttahocanlousairconwminantsisdefinedb (noBa Arca Air Qualiay Management
y y
BOILER- COMP(7HI'OR 1(10,000 RT'U)
TAL
BOILER - COM 11 (OVER I OQfgO BTU)
El Yes KIN.
AIR CONDITIONER
I have read the install lustelialsredriremenl, under Chapter 695 of the Cali_
fom'a I leul & Si fey Gad., Sections 25505, 25533 and 25534. 1 understand t n if the
ISSUANCE. ATP
NQAN RESIIJENTIAL MECH., SQ. IG'.
IF trendybase. tenant,tb., itlsmyresPOnsilahtylonuld , fl,9 ra try'nt
ofthcr slichamN bemGnvfr, ol.uInee rfa Crnlficarenf�Wupuyy y/„
,
_
OFFICE /