S 1978 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY _ -
CITY OF CUPERTINO BUILDING-ELECTRICAL, PESIT NO..1978
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION,
BUILDING ADDRESS: SANITARY NO. APPLICATION SUHMITI'AL DATE
711y0 R�NNa L. C-0-98
OWNER'S NAME. �e•' y 11OO�NB' CONTRAC-101 NAME- . LI NO: (/
Lowce FIe eG� 0 ,_0,0 ( /Y7 7 ��Vj✓I l/ O� NIC CON'1'kOLq
ARCHITECDP,NGINEER: LIC NO: A DRE ': ❑
. 0 .&Y CF- Sa")
CONTACT PHONE: - BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
❑ ❑ ® ❑
LICENSED CONTRACTORS DECLARATION QTY. .ELECTRICPERMIT' FEC
II by f na tl fen. 1 I p _ fChpte 9Bonnatena .LOB DESCRIPTION
EOOv,imS,h 7mRF fD I thelmsma,mindProm,don/J dmylctser PERMIT ISSUANCE RESIDENTIAL'
[IF in p
U [).to Glass --g r coal 8�1.3 ❑SFDWL , El KITCHEN RE-PIPE
E-PIP I.
-a Dme�-�'��� Cnmreu APPLIANCES-RESIDP.NTIAI. ❑pDDIT1ON ❑PLUMBING RE-PIPE
1,q ARCHITECT'S DE RATI N PANELS El MULTI-UNIT ❑STRUCTURAL.
y p y 7a 1 understand my plans,hull be used a,public m,ad,, MODIFICATION
OIZ^0 UPTO200AMPS El INTERIOR - El CHIMNEY REPAIR
¢I Licensed Professional 201-1000AMPS IMPROVEMENT El SWIMMING POOLS
.g
OWNER-BUILDER R DH CLAkATaON OVER IOUT AMPS El BATH REMODEL/REPAIR [I DEMOLITION
09 1 harnby vRimt that I um exempt from the Contractor's License Low for the
O y U elEv ing nucha.(Section 7031.5.Hitor,ts and Pmfexsiona Code Any city or poorly SIGNS BLPAI'k ICAL ❑OTHER
W W 2 y wM1ich requires a pwmit m Cnngmm,alter,improve,damellsh,or repair any Amain
'
prior m'Jsissuance,also requires the applicant for such penniuo rile a signed stammnnt SPECIALCIRCUIT/MISC.
'j that ha ie licencnl mursunnuntha Pmvisihns o[thc Conaucmr9 License Lnw(Chapter9
t¢d� 00 Ouradmncingwuh Section 9000)of I1,idmd3 ofthe Business and Profes.ions Codger TEMP L:
METER OR POLE INST. - COMMERCIAL,
p y o test he is excmpe therefrom ad the basis for besieged exemption.Any vielarion of ❑NEW BLDG/ADDITION ❑DEMOLITION
m Section903LI by any applicant for a pcnnitsuhjaen the applicant to a civil penalty of POWER DEVICES
FRY not ore thin five hundred dollar, ❑TENANT El FOOD SERVICE
m
d D 1,as owner of the property,ormycmployees with wages as their sole pompensodnn. SWIMMING POOL"ELELTk ❑IMPROVEMENT
M�q+ w11 do the work,and the structure is not intended eref1.4
fered for sale(Sec.9 ,Hhsineae OTHER
5m and Pmfessions Cude:'fhe Contractor's License Law does not apply to an owner of OUTLETS-SWITCHES-PIX I
i properly'he builds or improve,Happen,and who does such work blmeclf or in a,h -
his own employees,provided that such improvements ate not'armaded or offered for NEW RESIDENTIAL ELECTR S
sale.If,however,the building or Improvement is sold within one year ofeiandetioq the SQ.FTPLOORAREA $/SQ.FE
nerFailder will have the human of proving that he did not build or Improve for pur-
Poae of sola.).
❑ 1,oc owner ohne pmmedY.stn exolusively cnmrveting who lixcnsed emm�mmrs m 'DOTAL:
enn,wclthe pC jest(Seo.9044,Business and Pmfessions Code)pro Conations 4- . .
ase Lnwdnesnotopplymanuwnerofpropenywhobuild,crimprovesibereim,;md QTY PLUMBING PERMIT ' PEF
who commcw forsuch projects with v wnaacmr(s)licensed murrowrm m the Conor eters
License Law. PERMIT ISSUANCE
❑ tom exempt under Sec. ,B&P C fur this revshn
Own -
ALTER-DRAIN&VENT-WAGER DA) VALUATION
WORKERS COMPENS AI ION DECLARATION 13ACK PLOW PROTECT.DEVICE
'
Owner Dere l hereby fi ifm ander menulty of,and y one critic dldwing dielectrics,
I have and will maintains Cerffearte of Consent to self-insure for Workur's Gorman- DRAINS-FLOOR,ROOF,ARRA.COND. S'rORIHS 'I'YPH CONSTRUCTION
valinn,its provided for by Section 3900 of the Labor Code,for the performance of the
work for which this peracids issued. - FIXTURES-PER TRAP
❑1 have and will maintain Worker's Crmptmsation Insurance,vs required by Section
3900 of Labor Code,for the prificutunea of the sank for which thi,Carmine Issued, GAS-EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP MIN
My Worker,C��t��11!!�� tion loauy�n carrier and Policy number an
Cnciel.*7 /� ce Pnlirysm L ( :V GAS-EA.SYSTEM OVER 4(EA) `
qt
E OFF.XEMPTION FROM WORKERS'
COMPENSATION INSURANCE' GRF.ASEANDUS'I RL WASTE INTERCEPTOR
prak,an'tlouneednht bee mono¢if(hopermiH,boom,hundradddlan(SIM) _ gyp*'I * 'BUILDyN0 D1S)ISRON OFFS",
or loss.) GREASE TRAP
pLANCHACK FEC
Loy any that in(lieperformance
a,,anceo fe a,inherk for which this perthe it Weser,ed,Cr IshaO SEWER-SANITARY-STORM EA.200 Ff.
not Employ any Cason many manner so us to baeunte auhjed m the Workers'Cornlwn- ENERGY FEE
� ,Z sauhrrLaws ofCalifomia.DateApPWATER HEATERW/VENVELECTR GRADING FEE NOTICE - _
NOTICE TO APPLICANT':If,after making this provisions
n s of of Exemption,you should WATER SYSTEM/1'REATING
H bauble subject y the Worker,pro Compensation pmv siens of tho Labor Coke,you moat SOILS FEE
!� fnrthwilh comply with such provlaions nr this mermit shall be named revoked. WA'CER SERVICE
W Q
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMH. Q.FI' PAID
L) 0 I hommafftrm that them is a construction lending agency for the performance of - Date Reccip
{L the work for which this permit is is.sued(Sce.3099,Civ,OJan
Lenders Name - 'IT 'TOTAL
Lenders Add.... TOTA
d1 toul,tbut Im im Cpl' f d orm but the have-formation is
1NBUILDINGFEF PEEy po�t I g t mlv rn n ty e p l.t t 1 r fag m QTY . MECHANICAL PERMIT {�-Z building ntrua'on,and hereby urbanism a settatves eftl s city chanter open the EE.above-mentioned property for inspection purposes,(We)agramsavq indemnify and keep harmlss the Citycf Caloric.against PHRMIT'ISSUANCP, PEEIlvbilitles,judgments,costa and expenses which may in nay wayaccom spinst said City ALTER OR ADD TO MECEL -in nsequenee of the groutir,of this permit. PEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINTPIR HANDLING.UNIT(C)IB,WH CPM) 'SOURCE REGULATIONS. �I CAL PEE. .AIR HANDLING UNIT(OVER I r0n CPM) CTION TAX reef plieendCommeror Date EXHAUST HOOD(W/DUCTSMITIGATION PF,H
HAZARDOUS MATERIALS DISCLOSURE
Will theapplicont hr femre hoilding heampmn c momlhandle Irritations;material HEATING UNIT(TO I00,N)"IT]U) -
4s defined by the Cupertino Munidpal tide,Chapter 9.12,and the Health and Safety
Code.Section 25532(a)9 HEATING UNI'C(OVER 100.000 It I U)
❑Yes ❑Nc I -
VEIN'fILA'C[ON FAN USI NGLERESID) V/ V%
L, PAID
Date ,Receipt#
Will the apPonta on mhrrc defining occupant use equipment or Maras which
milt hazardous air contaminants as donned by the Puy Arca Air Quality Mamtgentent BOILER-COMP(3HP O1210(I,fM10 BTU) 1
District? TOTAL:
❑Yes No BOILER-COMP(OVP.R 100,0000'#) -
I hemposal the tr m ate �I Alk CONDITIONER
q es J Ch pt fi.95 flee Cal'- ISSUANCE DATE
fomia Health lth&Safety C d Section,25505 25533 d 25534 1 Ie T d thin Hue NEW RESIDENTIAL MPAI1. SQ.FT.
building l t Oyh tenant,ett mane responsibility to IfOrc occupant
none gJrenem,which tatromet pdhrl lana hracerlr t IOc pang - A
Owner or outhonzed agent Date TOTAL: ISSUED BY:
OFFICE