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29399
APPLICANTTO FILL IN INFORMATION WITHIN'RED-LINES.-USE'BALL POINT PEN ONLY CITY OF CUPERTINO : - BUILDING-ELECTRICAL : PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 29399 BUILDING PROJECT IDENTIFICATION t " BUILDING ADDRESS: - SANITARY•NO. APPLICATION SUBMITTAL DATE v2 — 9-96 OWNER'S NAMEI: HONE�•� - 3 CO CLUBS NAME: LIC NO: ILoo1AIiNetN/ S V `R NIC CONTROL# RCHI I dC](ENGINEER: LICNU: ADD 1S$ 70 El " CONTACT. • pf{oNe: ,f+`r BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG - ELECT PLUMB, MECH ❑ P ❑ ❑ .. LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT ` FEF. - 11 1 n by mrm drI I licensed n d p f chapter 9 permit Ing JOB DESCRIPTION woo'with5 t' -0000)nfD' 'slot3of'he Busln end Nodesslorts GrJgntd try license is PERMIT ISSUANCE RFSIDENTIAL, ' F(y in fall farce nail coed. _ �Uzr, License Cla, �• - Lich �� ❑SFDWL' '[I KITCHEN REMODEL PZ0 Date Gmarawr fl 5 i' a APPLIANCES-RESIDENTIAL ❑ADDITION r' ❑PLUMBING RE-PIPE" ARCHITECT'S DECLARATIONPgNELS - ❑MULTI-UNIT ❑STRUCTURAL Oc! K I understand my plans shall be used as public recoNs :77 J UPTO 200 AMPS, gym' MODIFICATION Licensed Padeamind p.INTERIOR. ❑CHIMNEY REPAIR 2n1-1000 AMPS IMPROVEMENT ' OWNER-BUILDER DECLARATION 0 U thereby attire than 1 am exempt from the Contractor's License Law far the OVER 1000AMPS ❑BATH REMODE /REPAIR ❑DEMOFITION (?�5 0. fallowing reason(Semon 90315,Business and Unde rdons Code:Any any or county SIGNS eLP,CTRICAL ❑ THER WO v¢F'� which requires a permit to ann,tmet,alter,improve,demolish,or repair any structure ' m.i prom I issuance, Ise qui thef r.suchpermit t Wesignedsmtumenl SPECIAL CIRCU IT/MISC. _ y [bath licensed I e p suae, thep ons f theC t m,I L c (Chapter 9 W <� (ammareardirg withSector 7000).fDrtiaimn341hBramassmadP f ons Cs,de)Ur TEMR METER OR POLE INST. COMMERCIAL, Pi p,o a that he is exempt tborefrom and the 62919 In,Ne alleged exemption.Any violation of , .. a, Semina 7031.5 by any applicant for a Permit subjects the applicant ter a civil penalty of POWER DEVICES El NEW BLDG/ADDITION El DEMOLITION L„ y ant me'ban live hundred dollars 1$50% ,: : El TENANT El FOOD SERVICE pd� 0I,os own.of lheproperty,.r my employoee wlN wages as their Sole wmpensn'Ion, SWIMMING POOL ELECTRIC' IMPROVEMENT,, ©+J will do the work.and the swcture is not Intended or offered forsele(Sec.7044,Business ❑OTHER 0.3 and Professions Code:The Contractors License Law at not apply to an owner of OUTLETS-SWITCHES-FIXTURES pmpary win builds or improves thereon,and who does Such work himself or through his own employees,provided that such improvements ere not intended or offend for NEW RESIDENTIAL ELECTR SQ FP sale.IL however,the building or improvement is andwithin oneycarofcumpletion,the SQ.FTFLOORAREA $/SQ.IT. mviner-builder will have the burden of proving(bathe did not build e,improve for Fur- pmaefsalw). - - - El 1,as owner,af the Formerly,am exclusively contracting with licensed contractors to - an,V.cI the porma t(Sea 70414,Business and Proaaaons Cartel The Contractor's Li- cause Law does net apply to an owner Ufproperty who builds or improves lhallorma.d QTY, PLUMBING PERMIT FEE r' who d+ndnets forsuch projects with a co pemgs)licensed pursuant o the Connector's " 'License Law. PERMIT ISSUANCE' ❑ 1 ore exempt under Sec B'&P C fonhis reason OwnerALTER-DRAIN&VENT-WATER(PLA) Date , VALUATION 'WORKER'SCOMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE Ihueby attire under Penalty ofperjury one of fallowing declarations: Vf have and will maintain a Certificate of Cansendn 10 Firearm for Worker's Compen. DRAINS-FLOOR,ROOF.AR PA,GOND. ation,as provided fur by'Section 3900 of the Laher Code,for the performance of the STORIES TYPE CONSTkUCTION week far which this p Tai( : aned. FIXTURES PER TRAP have will maintain Worker's ensation Insurance,as required by Section — 3900 of theLab Cash,f theperformance of the work fm which the permit is issued GAS EA SYSTEM-I INC.4 OUTLETS ' My W k C p s'i n: carrier and Policy '. - OCC GROUP APN tinier: Policy No.: jj��'�QQ GAS-EA.SYSTEM-OVER 4(EA) t CERTIFI ATE 11EXEc1PTION FROM WO RE S ' COMPENSATION INSURANCE II GREASFJINDUSTRL WASTE INTERCEPTOR' . (Tb_is sec(inn read mA bewmple'ed if the peorm is for arm hundred JUll irs($I W), s BUILDING DIVISION FLES or le") ' GREASE TRAP PLANCHECK PEE I really that in the perfurmance ofine work for whichdr,permit is issued,f shall SP.WF.k-SANITARY-STORM EA.21H1 FT. mtempley any personinany mannersna beepne�up3ecintheW..keriCompen- Z salmon Laws of Cali m ff7 ENF,RGY FEE - � Q :.L (L� WATER HEATER WNENT/eLECTR Applicant � dL GRADING FF.P. V] NOTICE TO APPLICAN'E If,after makmg this Coo ific us of Exempram.you should WATER SYSTEMOREATING (~5 become subject no the Worker's Compensation provisions of the Laber'Code,you must SOILS FEE rr forthwith comply with such previsions or this permit shall be deemed revoked. Q WATER SERVICE CONSTRUCTION LENDING AGENCY Zi t NEW RESIDENTIAL PUSH ' SQ.FT PAID Ih by affirm that iso I tion renting agency for the performance of - _ Date - Receipt of O Beware f which this Permit is Issued(Sec.3097,Civ.C.) Lender's Name _ U - .DOTAL: W Ixvdci's Address TOTAL: - y,a I certify In.I have rend this applicmimi had slate thtt the above infnummibn is BUILDING FEE tD wnect.I agree to comply whhad city and county ordinances and Imre laws misting 0 QTg MECHANICAL PERMIT FEE U building construction,and hereby amhorire representatives oflhis city In eiaerupon the 'i SEISMIC FEE above-mentioned property far Inspection purposes. PERMIT ISSUANCE We)agree to save,indemnify and keep hornless the City of Capetian against - ELECTRIC FEE -i or Is,en9le expenses which may in anywaysecen a,ocre, add City t gran of this permitALTER OR AUD TO MF.CII. p1,UMBING FEHRST DS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM)ION .MECHANICAL FEEAIR HANDLING UNIT([)VF,R 10,(I(10CFM) CONSTRUCTION TAX m/Contractor Date EXHAUST HOOD(W/bUCU HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGAI ION FEE plicant orfuture building carillon store or handle hazardous material HEATING UNIT TIO 101000 BTU) as defined by the Canaria Municipal Cade,chapter 9.12,and the Health and Safety - - Cadv,Sectio.25532bd? ,. HEATING UNIT(OVER 100,0 TU) - Elves Who r." ;" VENTILATION FAN(SINGLE RESID) /` PAID Will thea applicant orfumre building p emulation or device,which Date Receipt# pp gnesseamuseo ul BOILER-COMP(3HPOR 100,000 BTI)) mi(hazanioux air commninan(s as rtefined by Ihe,day Area Air Quality M2nagement Ditrict? - TOTAL: L� o Yesa ' BOILER-COMP(OVER IIMl,000BTU) ve read the bar Noas materials requirements ander Chapter 6s ofthe Cali- AIR CONDITIONER th&Safety Cada,Sections 25505,25533 and 25534.1 understand that If the ISSUANCE DATEsnotcurrentyhaveatenant,thin itis my responsibiliq to notify the occnpaot NEW RESIDF,NTIAL MECH. SQ.FT.rements which mus(be met pnor m issuance of a Certifiable of Occupancy.omnrr.ad agent Dale I. ISSUED BY OFFICE'