S 2720 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 1
7 S
CITY OF CUPI:RTINO BUILDING-ELECTRICAL PHIRMI'I'No,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING MECHANICALI. -/ O
BUILDING PROJECT IDENTIFICATION l/ L 1
yO1LDINC ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATIi
0 NE S NAM& PHONE CON)RACIORS NAME: LIC NO:Aft
O NIC CONTROL#
CIIII'ECI'/HNGI EER: LCNO: ADDRESS: 0
C^ON'TACl': PHONE Ii IJ II,UING PIiRMIT INFO
l �.Tri ktFr ^C5 '141463
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Consultant Fcce Paid by Applicant(Initial) BLD DTr- PLUMB MB❑f
,�/ Yom^LICENSED CONTRACTORS DI!C•LCARRAAI'ION 17 CITY. ELECTRIC PERMIT, FEC IJ Eo
or-
hereby alarm that 1 am licensed ender provision.of chapter 9(commencing _ JOB DRSCRIPTION
DMZ with Section 70001ofDlvisto3ot\he Businexsand professions Code.and my lioen.e i. RESIDENTIAL:
W O 1'ERMO'ISSUANCE.
X(y. in full force and effect. p / ❑SFDWL JKKITCHEN REMODEL.
QUU Licence Claa B I.ic'x APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
p,ZW Ilam Contrucm
w Q L ARCHITECTS Up(.ARA ION ❑MULTI-UNIT ❑STRUC URAL
F.,❑w PANELS MODIFICATION
Z O.Z I undemmni my Plans shall he used as public records
O Z,-- UP TO 201 AMPS El INTERIOR ❑CHIMNF.Y,REPAIR
p.4F•y( Liecu,ml Profte,innal 2111-1000AMPS IMPROVEMENT' E]SWIMMING POOLS
OWNER-BUILDER DECLARATION OVERIIXN1AMP5 El BATH REMODEUBEPAIR ❑DEMOLITION
C Q 1 hereby indoor tern Iain exempt from the Cmnmaonh L(cense Law far the
following 1'etlsnn(Section 70315,Business and 11mlcwaiors Coal,Any city or count, SIGNS ELIFC'I'H ICA], ❑OTHER
W 3 W y wlaiee regttiren a unit to m solo",alte,improve denud ide,or mp d,any orator,
L"pJO< Prior l tale q- .th ppli tf Iu
I1II it Ixleame SP1'CIALcIRCBI Estio . -
'� load Ipuxu a,,,heproo,imsel 11 Contructor s I' n. Law(Chapter 9
00 (ennancmm,with Scens,7000)of Di vislnn Sol 0m lits unsocial Pnacs,,,Cedap,r ('EMI',MEII!H OR P01.91NST. COMMERCIAL:
d q o tG
'hat he isexempt therefrom and the iasis for the alleged txemptinn.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
W^w Section lip LS by any applicant for apemnit subjects theappllcont to a civil Penalty mf TOWER DEVICES ❑TENANT [_1 1700D SERVICE
m mon:than live hundred dollars($500).
N Z Y rCoe IMPROVEMI:N'1'
_< n Las owner of the progeny,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC
will Jo the work,and the structure is not inteadNorolfered for sale(See.7614.Business ❑OTHER
Wm and Pospeoinns Code The Contractor's License law does not apply to an owner of OUT LITS-SWITCHES-FIXTURES
a 3^ prelied,who huilac or improves them..,and who does with.,,,it himself or Ihmugh it
his own employees.provident that such improvements am not intended(ir offered for NI!W RI?SIUEN'TIAL FLECTR SQ Em
sale,If.however.the building or improvermna is sold within one year of completion.the SQ.FI'.FLOOR AREA $/SQ.FT.
owner builder will have the burden of proving tea he did not build or improve for pur-
,ow of-le.)
❑ I of the jamped,,am exclusively contracting with liccusedcontractur,to
t 't he project(S70,14N :, nllr l ..- C I )TIeC 1 lore(. -
Lays'lov, 1 pplrl 1111,11ty b '1C a' o,cOmeremo,cod QTY PLUMBING PERMIT FEE?
who c....(,acts Emmah pmicch,with.conanm R)Ic„cl moinanu ❑he C ami (/
Utmost,Low. PI!RMI'IISSUANCE 3 '�
I] Iaaexempttrader Sec. .B&PCfor(htorcumn
Owner Doe I ACfI!R-DRAIN&VENT-WATER(EA) VN.UA'rION
WORKER'S COMPENSATION DECLARAI[ON BACK FLOW PR(Yr9CT.DEVICE Nyam•//////L, /
I hereby affirm under Penalty of perjury,one nit the following d«Iandinm: (� 5?' s
I have and rill maintain a Certificate or Consent omlf-insure for Workers Compere DRAINS-FLOOIL ROOF.AREA,COND. STORIES 11 1'YPECONSTRUCUON
waimn,as pmviJed for by Section 37W of the labra Cale,for the perfnmlanee nine
work for which this permit i,o.awd. FIXTURES-PER TRAP
❑ 1 have and will maintain Workers Compcnsolion Insurance,as required by Section v
3700 ofthe labor Code,forthe pmrfmmance iddiework forwhich(hispermit isisseed. GAS-HA.SYSTEM-I INC.4 OUTLETS OCC.GROUP APN
My Worker's Compensation Insurance carrier and Policy number are Q'1
Carrier: Pitt icy Nod GAS-I!A.SYSTEM OVER 4(EA) sl
CHRI'I FICATE OP EXEMPTION FROM WORKERS' _
COMPENSATION INSURANCI? GI EA SEANUUS"1'RL WASTE IN'TERCIT I OR
'I'
Ho-ecli ic,cnx be completed if(ine,er i11x koonceundrcddollan(SI0(p GBUILDING DIVISION IR!BS
P I ItEAST: ItAI'
nr leen,) PLANCHECK PhI?
I tcrifythal.ahepetforremetif(hewok lin,shich thi.vpemmi(I...sucIII,Island SEWUR-SANITARY-STORM I.A.200 FT.
noI employ any pe ymnm
ar wits(I m
Ay�y yy uhicn the Work...'Cumper- ENERGY FEE
OZ main.].nwsul'C: am S /9/Y7 WATI!R HEATER WNENT/ELECTR GRADING PIAT
z � Applicant—�4
= NOTICIiIO APVI.( after ma mg this Ccnitir m of Exempmon,you dearld WAT17R SYSTENU TREATING
become euhject to the Worke s Compensation previsions of the LaMar Code,you must SOILS
forthwith comply with such provisions.,,his feminsh.11 hedeemed revoked. WATER SERVICE
7 z CONSTRUCTION LENDING AGENCY NEW R15111T:NTIAL PLMB. SQ.PI', PAID
L)Q Ihcreby orientation hot sw
isaconninn lending agenm
cy far performance of Date RoceiplN
the wok for white thipermit I,periv ismW(Site.3097,Civ,CJ
LL h Icnder'v Name TOTAL:
G Lender's Address T(.
>' a I certify thin I have rued this applluNon and sole shat den above I.ronnation is U D G FI!H
1F. h comm.Ingres m comply with aE c l"oul l mn(y mdionalel and stem laws relating or QTY. MSCI IANICAL PERMIT' FEE
U hnllding umerutlinn,and herchy xuthorir,o,PrmmdaIvv,or this ebym Doter upon the SEIS ICFEE
above-mentioned property for inspection pvrposcv. i'IiHMI'I'ISSUANCE
(We)agree m,save,indemnify and keep harmless he City of Colvin.against EL .TkIC FEE
Iiabili(ie,jid, rau,cost,and ex,ma,x hichnoty in city way«cmce,enetsaid City AI TI!R(/ ,••,•.'•..r,r.,re'me�ii- PLUO
in nvequence of the grunting of this permit. M NG FEE
APPLICANT UND RSTANDS AND WH L COMPLY WITH AL1.NON-POINTAIR IIA G UNI I CF I
h1ECHAN1 ALICE
SOURC' ATIONS.
-jr�Jpr (�j/�/ AIR IIA I G UNIT(OVER 10..xfXp CFM) CONSTRUCTION]AS
.gw.ra, 6,/?a nuacmr lla1e� IiXHAII, lOD '��Cf �J 99 HWSING MI'1lGAl'ION U!li
HAZARDOUS MATERIALS DISCLOSURIi
Will the applicant or future bmIdm,u,,apam dorcmr handle hazardousmammal IMAI'IN NIT(TOUCTOORTU)
as dc1innd by the Cep,rh Municipal Code,Clarifier 9,12•and the Health and Safety
Code,Section 25532(x)? iI IIIiATIN "(OVER 100(XX)B'Till
LlY e YI!N'T11. TITAPFICIV ... .. PAID Ilam Itrcc"a#
will the applicant or future building necapanl ave cgnlpntenl or devices which
ht,adoes air conwlnivants as defined by the Buy Arca Air Quality Manegemenl ]BILLS-COMP(3HP OR I0E,000 RTU)
1(Y 75
❑Yet MLN. [301LER-COM P(OVER I BLOW BTU)
myuirelnut p AIRCONDITIONER
(have read the hvardnm materials ntrader Chapter Cali- �- ISSUANCE DATE
,,.thio Health ne Safety Cn,de,Sections 25505.255)3 and 255)4.1 to nolimna(hal if the NEW HESIDEMI'IAh MECH. SQ.FI'. -2
buiWingJ«s no«urtcyytdly haveamn s,M1ai(is my responsibility(o ratify the«cups(( Y ),
nfaIt hichmu b xi in issuance of.Cenificacce'( y
rig >aBY.
. .. T01'A L: ISSUED BY�TOI'A L: ISSUED BY.
OFFICE
APPROVED #
IN ACCORDANCE WITH THE CITY 01
CUPERTINO CODES AND ORDINANCES
GATE 2 7
SIGNEDsz vz
This set—=--c ver ;nJ :p . ::aoc s
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be kept on the jeb , a, _nes an it IS�H 1 �i z 96 129 via
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® KA ®'n•../l-) - 233 1"
Q BLDG.INSPECTIO DEPARTiNENT
® �t.i5c' �Wt�(.h5 CIN OF CU ERTINO
KRAFT KITCHENS
PETER KRAFT
OFFICE COPY 6374 ACM. c�P-ri;�,cA
0w9rzie
HOWARD 8 GAIL JENSEC, PLA RES.
Svze 0. Number Rem
A KITCHEN ELEC PLAN
❑ace sneer or
MOX 24. 1999 1 1