99120068 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-RLECTRICAL IT o.
BUILDING DIVISION APPLICATIONIPF.RMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION dim
al
BUILDING ADDRESS. 'ANITARY NO. APPLICATION SUIIMITTAL.DATE
WLIVC
OWNER'S NAME: �! PHONE: CONTRACT'OR'S NAME: LIC NO:
JID& n2q NIC CON'IH(ILM
'• ARCHITRCAINGI EER: LIC NO: ADD sf! L s ❑
CONTACT PHONE: WW BUILDING PERNII'f INFO
❑ Co...Brad Fees Paid by Applicant(Initial) PLUMB MECH
6 _ Cllp�l_' ❑ ❑
LICENSED CON]RACTOR'S DF,CL.AR I(INQTY_ ELECTRIC PERMIT ' FEE
I hereby allirm that I um licensed under movision,al'Chapter 9(commencing _. JOB DESCRIPTION
QaZIhlse,r 9Wo)of Dlvision3ofrhe Businesaind Profession,Cole,mainly license is RESIDENTIAL
WOO w' PERM IT ISSUANCE
CecN in full force and cave. CSFDWL C KITCHEN REMODEL
QUU
License Class Lic.p APPLIANCES-RESMENIAL ❑ADDITION C PLUMBING RE PIPE
FZW Dae Com.let
ARCHITF.CPSDECLA ATION ❑MULTI-UNIT CS'PkUCI'URAL
HDh PANELS - MODIFICATION
Z O m Z 1 understand my plans shall be,used as public records
OZ Z,-0 UPTO200AMPS ❑INTERIOR ❑CHIMNEY REPAIR
E 4t:kef Licensed Prefexainnml 201.1000AMPS IMPROVEMENT E]SWIMMING TOOLS
�ad2d OWNER-BUILDER DECLARATION OVER 1000 AMT'S El BATH REM F P�S 1.11 ION
C W Q 1 hereby affirm that I am exempt from the Comrvanr's License Law,for the
aqqaS5 O y U following reason.Nenina]031.5,Business and I'mfcsaions Code:Any city or enuntY SIGNS ELECTRICAL TIER
w'}+W y which ro a my a permit to conswet,alter,impreve.demolish or repair any swcmre
O�nn "iarmit,i"mmugalau retmires the applicant for such permit o File o signed statement SPECIAECIIRCIJI'VMISC.
�y Ilam he is lwenaed position m thepmvisionsuf the Comrucon,License Law(Chaptm9
(mntmencing with Section 9000)of Division 3 ofthe nosiness and Poflbroons Code)in TEMP MI3'1'13R OR POLE INSIK COMMERCIAL'
d 6 p Ihnt he Is exempt thcmlierm and the basin for Thu alleged exemption.Any violation of ❑NEW BLDG/ADDITION C HEMOI.I'I'ION
XI Seedon7031.5 by any applicant Ern permitauhJects the npplinmt to it civil penalty of POWER DEVICES THNANT ❑FOODSERVICE
man than five hundred del lam(8500).
^ } IMPROVEMENT
�SdQ nhasowner fthe
uldwarly,or,my employees
tend,dwith wages holds,
ot s,(Sol. 044.H Holmes, SWIMMING IH301,IiLECfRIC
F andis Professions
wons Code:
The wre ision's Laine Lmv dev, et apply to an Business OTHER
Y�I�m and Professions Gale:The Commcmr's License Law data net apply to an owner of OUTLETS-SWITCHES-FIXTURES
property who huilds or improves Nereoq and who does ouch work himself or drought
his awn employees,provided not such Improvements am not intended or offered for NEW RESIDENT[At.ELEC.R SQ FF.
sale.IL however,the building or improvement is sold within one yew ofetmpletion,me SQ.FT FLOOR AREA E/SQ,Fr..
..xam,fa klm will have the burden of proving that he did not build or improve for poi,
pone of sole.).
1,as owner of the property,am exclusively contracting with licensed continuous to TOTAL:
me
conswe the project(Sec.]UM,Business and Prefessions Code:)The Contractor's Li-
scLow does not apply toanowner of Propy who builds or improves therean
on. d QTY. PLUMB GPERMIT FEF.
wl ertcontracts for such projects with o contractors)lieemed pursuant it)the Contraem's
License Law. PER MIT ISSUANCE:
❑ um exempt under Sec. ,B&P C for Ihis reason
Owner no, ALTER-DRAIN&VL T- ER( A) VAI.BAI'ION
WORKER'S p COM PBNSATION DB OLARATI(3N RACK PLOW I'ROI'IiCT.DEVICB ���
ve and w alMn under penalty of of Con eno of elf-am rat ingW Worker's
Ca
� Ihove andwillfor
maintain erre37M of the Labto or
Code.for the performance
of the
DRAINS-FLOOR.ROOP,ARF.A, ND, STORIES TYPE CONS'IRUCFION
work I xs provided fm by Seaton 3]00 of the Lahr Gde,for the pcdnnmance of the
work have
and will
this maintain
issued. FIXTURE S_PER T'HAP Axel
Ihave andwillmaimon Workers Compensationrkfor which
it Section �/('/ Ad?
Myof the lahorC now for rfirisMo no' Oil for which this permit is issued. GAS-GA.SYSTEM-11NC.40UTLETS OC GROUP , AI'yi�
My N'ar G nm Insu JPnli t r d GASB-EA.SYSTIiMOVERi(F.A) LIO Y
Carrie, cwne Policy 2-'Z—
' -
CE KATE OF EXEMPTION FROM WORKERS' GREASIVINDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(rhi,,vOmanced nor becompmed iffle,non i..fnronehundreddnllunplIW7 GRGASETRAP
or less.) PLANCHRCK ME
I eertify that..the performance of kfnrwhich Ihis permit i+issued,lshall SliWlilt-SANI'IARV-S'T'ORM EA.200 FT.
not employ any person in may mann �'}' yqf, hie t the Worker,'Corepen- ENERGY FEC
'Z. cation Lnw I'Cfl" xu WATBIt 11EAl'EIt WIVIiNT/EL.ECfIt
OQ Applieml / �r—L GRADING FEE
'Z.~Ns NOFICII TO APPI.ICA T.Ih alter making Ihis ertilicme of Exemption,you should WATER SYS'I'IiM/I'RHATING
a tea..ar-iracua the Workm's Gen
psatian.......ionsofthe Labour Code yon must SOILS FEE
fnnhwith comply with such provisions or this permit shall he deemed revoked. WATER SERVICE
Q Q
CONSTRUCTION LENDING AGENCY NEW RESIDENT[At.PLMB. SQ.I'1'. PAID
r7 Z Dace Receipt p
V Q khereby which
that issued((Site
lending agency fnmhe performance of
the work for which Ihis permit is issued(Sec.J(19],Civ.Cl
I2., FOTAI.:
Lender's Name
>a l.<nde/I AJdre s TOTAL BUILDING FEE
I certify That 1 have read this application and state Lha the above information is
V0.1 rnam.l agree ,,cumply with all city and county ordinances undstale laws relwingm QTY, MECI0ANICAL PERMIT FEE
U Z building construction,and hereby amherile teprescoorty".1ar"by to enter upon the SEISMIC FF.F."
uhovomenlinned unitedly for inspection purposes. PERMI'FISSUANCIih:1.P. IC FEE
A- 1_-
(We)agree to save,indemnify and keep harmless The City of Curtain against �^
Iiuhilitics,judgments,costs and expernseawhich may inany way accrue against said City ALTER OR ADD TO MECH. ���"tf lT'l�
mgm
.Nuenec of the nfn,c this permit PLllM TNG FEE
AI'fLICANT U IiRS' AND WILL COMPLY Wli Al..NON-POINT AUR HANDLING UNIT('L'O IRPFT Cl:M MIICII NICAL PEE
SOUK .ATI 5. .o
AIR HANDLING L1N1'I'(OVHR In 000 CONSUMIONTAX
Sig turc MAppliallonsContoctor f Date EXHAUST DECO IW/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOS R pJ
Will the applicant or future building necupamsmear handle havuduus material HEATING UNIT(To lft(g1)RTUI'y_
as defiaW by the Cupertino Municipal Code.Chapter 9.12,and the Health sod Safety
Cale,Section 25532(x)? IIIiM ING ON]'1'(OVER Fail BTU)
e
C] s o VENTILATION RAN(SINGLF:RESID) PAID Dole Rc<eiptp
Will the applicant m inure building w.cup m use cyuipmerlt or devices which
emit hamrdnus air comaminwas as defined by the Ray Arca Air Quality Ma...emed BOILER-COMP UUP OR 100,111)RTU)
T'O'TAL:
District? BOILER-COMP(OVIiR 100,000 BTU)
Yes
I have muddle horned smaerI reyuiremenl.under Chapter(.95 of the Culi- AIR C(3NU1'1'IONER ISSUANC17 LATE
l ornialle:th&S boy Flat 'whom 5,25.93 and 25534.1 anderatndllifthe NEW RESIIIEN'I'IALMECH. SQ.FI'. 2--
1 - 7, Zd;. ��
builAin en0 veate thvt it is my rcnpmrsihillly In nn'ylh w C� G-
nflw.t pnorl 's nevot"Cerl-
ah nerd em Date TOTAL: ISSUED BY:
OFFICE