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S 0313 TTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY ,PUPERTINO BUILDING-ELECTRICAL PERMIT NO. ING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL S 0313 BUILDING PROJECT IDENTIFICATION ,$)INGADDRESS: .SANITARY NO. APPLICATION SUBMITTAL DATE OWN!ENSED r ONE: _ CONT AM LIC NO: frl .ZS -I 3 s� a NIC CON ROLtt RCHEER: LICNO: ADDRESSONTPHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applieanf(Initial) LD ELECT PLUMB MECH CONTRACTOR'S DECLARATION QTY, ELECTRIC PERMIT FEE El E - 1 hereby affnn that 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION "Z with Section 7000)of Division 3 ofthe Business and Professions Code,and my license is --'— RESIDENTIAL: E+.Z in full force and effect PERMIT ISSUANCE ❑STOWE ❑KITCHEN REMODEL PZad Data—License Class LLCM APPLIANCES-RESIDENTIAL. ❑ADDITION (_1 PLUMBING REPIPE yQL - Gmtructor _ ARCHITECTS DECLARATION I [I MULTI-UNIT ❑STRUCTURAL C y Z 1 understand mnsy plashall be used as Public records PANELS Z MODIFICATION OZ4O UPTO 200 AMPS El INTERIOR [I CHIMNEY REPAIR Licensed Professional 201-I"AMPS IMPROVEMENT []SWIMMING POOLS I OWNER-BUILDER DECLARATION OVER 1000AMPS ❑BATH REMODEUREPAIR El DEMOLITION a I hereby infirm that 1 am exempt from the Contractor's License Law for the iq5 O y U following reams.(Section]031 5,Business and Professions Cade:Any city nr cnumY SIGNS ELECTRICAL W 31c E' which requires a permit to consumer,alter improve,demolish,or repair any structure E-;,�f0fnn pit.,.its asoancn,also requires theapplicant for such permiuo flea signed statement SPECIAL CIRCUIT/MLSC. ' y that be is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 00 (commencing with Section 7000)of Division 3 of the Business and Professions Com)or TEMP.METER OR POLE INST. COMMERCIAL: 6 p,M e' that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION Ll DEMOLITION u1"w Section 7031.5 by any applicant for a permit subject the applicant to a civil penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE not more than five hundred dollars($501). F >' IMPROVEMENT QUI,as owner ofthe property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC will do the work,and the structure is not intended or offered for sale(See.7044.Business ❑OTHER' F' and Notessions Code:The Contractor's License Law dues not apply In an owner of OUTLETS-SWITCHES-FIXTURES property who builds or improves thereon,and who does such work himself or through — PAID his awn employees,provided that such improvement are not intended or offered for NEW RESIDENTIAL ELECTR SQ FT sale.If,however the building or improvement is sold within one year of completion,the SQFLOOR AREA S/SQ.FT owner-hailder will have the burden of proving that he did not build or improve for par- 'JUL)i�IIIA � ,so f,.Ic.). - pP�l(T>• ❑ 1,as owner of the property,am exclusively contracting with licensed contractors to TOTAL: T'5/ ,gyp s construct Ne project(See,]044,Business and Professions Code)The Contractors Li- I1 U90j INU cense Law aces not apply to an owner of property who builds or improves thereon,and QTY. PLUMBING PERMIT FEE Y� who contracts for such project with a contractors)licensed pursuant to the Contractors License Law. PERMIT ISSUANC ❑ lam excurNmder c. - ,B&P C forthis reasone if off _ ALTER-DRAIN F ATER(EA) yALUATION Owner Date / / i DECLARATION BACK FLOW PROTECT.DF.VI - -'f Ih hT�mrvntler�petmlty-of per}orinnc oP[he following declarmions: BZ (have and will mainmina Cenifcam of Conserv to self-insure for Worker's Grmpeo- DRAINS-FLOOR RO ,AR ,CO ,STORIES TYPE CONSTRUCTION ddon,os provided for by Secdor 3]lNl o[the Lobar Code,for the performance of the work for which this permit is issued. - FI%TURES-PER TRAP ' 1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. GAS-EA.SYSTEM-1 INC.4 OUTLE OCC.GROUP APN My Workers Compensaion Insurance carrier and Policy numberam: - - - Cartier: Policy N., GAS-EA.SYSTEM OVER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASFANDUSTRL WASTE INTERCEPTOR (Thissectimmeed not be completed Him permit is furore hundred dollars($100) BU 1 D ISI NFE orlessJ I GREASETRAP PLANCIIECK FF I certify that in the pedormanceofthe work for which this Nmalis issued,Ishull SEWER-SANITARY-STORM F.A.200 FT. not employ any Person in any manner so as to become subject to the Workers Cnmpen- ENERGY FEE _ zZ. satin.Laws of Califomla.Date WATER HEATER WNENT/ELECTR O Applicant GRADING w•t % NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SYSTEM/I'REATING (••' become subject to the Worker's Compensation provisions of the Labor Code,you must SOILS FE r forthwith comply with such provisions or this permil shall be deemed revoked. WATER SERVICE aQ CONSTRUCTION LENDING AGENCY NEW RES-IDENTIAL PLMB'. SQ.FT. PAID V I for rwhich tmthat sfrand i issued Scetion len ding agency for the perionnmce.f Dme ReceiptN fA the work for which this permit is issued(Sec.31N],Civ.CJ Q Lender's Name TOTAL Lenders Address TOTAL: 1 certify that 1 have mad this application and mom that the above information is BUILDING FEE / an correct.1 agree to comply with all city and county ordinances and smm laws relating to QTY. MECHANICAL PERMIT FEE V building construction.and hereby monei,arepresentatives of this city to enter upon the• SEISMIC FEE is above-mentioned prupeny for inspection purposes. PERMIT ISSUANCE - (We)agree to save,indemnify and keep harmless to City of Cupertino against ELECTRIC FP liabilities,judgments,costs and expenses which may in any way accrue against said City ALTER OR ADDTO MECH. in asequence of the starting of this permit. PLUMBING rE APPLICANT UNDERSTANDS AND�MPLY WITH ALL NON- I AIR HANDLING UNIT(TO IQ000 CFM) MECHANICA FEE SOURCEREGULATIO i AIR HANDLING UNIT(OVER IB,q)O CFM) CONSTRUCTIO X o A li nt - EXHAUST HOOD(W/DUCT} DOUS MATERIALS DISCLOSURE HOUSING MITIGATION F W' eapplieam or tutu.mildingocc...at more or handle bawrdous material HEATING UNIT 170 100,00 BTU). ;�dga efin by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety e,Section 25532(a)7 HEATING UNIT(OVER 100,003 BTU)❑Yes ❑No VENTILATION FAN(SINGLE RESID) PAID Date Receipt0Will the applicant or future building occupant use equipmmn or devices which t hazardous iiform..i...is as defined by the Bay Area Air Quality Management BOILER-COMP(3HP OR 100,000 BTU) TOTAL:trlm7❑Yes El No BOILER-COMP(OVER IOf"BTU) I have read the mourdous extends requirements under Chapter fi 95 of Ne Cali- AIR CONDITIONER ISSUANCE DATE fomia Health&Safety Code,Sections 2550.5,25533 and 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.ET. building does not currently have a tenant,that it is my responsibility.notify the occupant of the requirements which mum he met prior to issuance of a Cernficam of Occupancy. • Owner or antumaed a ger. Date TOTAL: ISSUED BY: OFFICE. u, FE!i mac . C�r�, G) 3.5 r' J f •� � 607 1 E I �! I y f � I PLOT PLAMS} DATE_ 7 17 q r /'2 D „�� lz f/ 0 PLA1VNllV D BCOG /NSP 17199 DATE l C/;r OF -10 CFPg9T OFFICE COPY BLDG. DbpT• FATINO MFNT � w2 o � o [[ rzo�tns Rr�zw °z Es m rw °eS4'+8 rC x^ �P C' ~ a vx� gnaxv cs E:5-6 SON ? pn:e6 � c6 r= rm�O�s s°Yz� i eZv.c nx A I I •—•�� T `oi ww"'F Es"C:R '°o.R`� •'E . g � 6^ acN6" ns6^6 sn�.6 as .n .1'F F vwoml°r ES' cv y i s4 • °mc6 X F 5mE nw ' RCRF� �`v SoCnP _6 2 nE �i�no n uz EEvnw o wv�R E6�: C. Scz Fe'e•nrn,l..wa •r'--°'nrnwr..uns n ��wn.". iRw" wrn«Pti _ ? _�/JTV FLVl �•rI[•gt. uov n �E"gR !`^C .IM"nn tlT1uBFrS e 6 6 s 6s 6 m p 1 I z (n �r D � r $➢ A � c m C • r•n�. 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