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99090010 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN CITY OF CUPERTINO BUILDING-ELECTRICAL RMITN . BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL it'.-t'1'BUILDING PROJECT"IDENTIFICATION',.,.Pr(t;`ut" BUILDING ADDRESS: SANITARY NO. APPLICATIONS] ITTAL DATE 1 h 2-'? -q g OWNER'S NAME: PHONE: CONTRACTOR'S NAME: LIC NO: i I 'r——` 2 Z CAY — NIC (?6 /6 CONTROL# CHITECT/ENGIN ER'. r✓li LIC NO: l ADDRESS S} / ❑ 7 © Q ii CONTACT: PHONE: '.r t, 'f, IJUILDING'PHRMIT INFO, ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH G '�2so +� N. ❑ ❑ LIC NSED CONTIIAC TOk 'DFCI AItAT ION QTY. ELE TRICPERMIT't111-1tt t' i(111-1111 *,Mki I nereny arfirtn m r I r s a p I chnptmr 9(nomme s 4 ,, / „:, a „"rs :� s `"� - JOB DESCRIPTION Woo with Sneuon 9000)ofD" n3ofthe Boaf :.and Ir fsdonv Cade and mylice sec O O (��j � PERMIT ISSUANCE RESIDENTIAL: Fz� in full farcevtdl ef/ r ,z ❑ADWL D PLUMBING LUMBIINREMODEL �UU License Class Lie.# — APPLIANCES—RESIDENTIAL [I ADDITION DKITCHEN REMODEL y et cW Date Comm ARCHITECT'S DECLARATION ❑MULTI-UNIT D STRUCTURAL Z'pa, m z 1 understand my plans shall be used as public records PANELS MODIFICATION OZ�'+� UP TO xn0AMP5 [I INTERIOR ❑CHIMNEY REPAIR rr„`Zd❑zE'W Licensed Professional 201-IOMAMPS IMPROVEMENT �Se --ttj OWNE&BUILDER DECLARATION SWIMMING POOLS W d 1 hereby affirm that I am exempt from the Contractor's License Law for the OVER 1010 AMPS D BATH REM Dfi{✓JiEPAIg ❑D'MOLITION 304 U following reason.(Section 7111.5,Business and Professions Code:Any city or county SIGNS ELECTRICAL. D OTHER > 4 vHi which requires a permit to eonatmo6 alterimprove,demolish,or repair any structure G prior to its issuance,also requires the applicant forsuch permit to filea,ignedsmtemcm SPECIAL CIRCUIT/MISC. �y G , that he is licenced pursuant to the provisions ofthe Cormadoes License Law(Chapter 9 ' 00 (commencing with Section 7000)ofDiv,s,on 3 of the Business and Professions Code)or TEMP.METER OR POLL INST. COMMERCIAL: 4 cr m rL f.,he is exempt tl¢refmm middle orhe basis fthe alleged exemption.Any violation Of [I NEW BLDG/ADDITION El DEMOLITION W.rte Section 9031,5 by any applicant fora permit subjects the applicant macivil penalty of POWER DEVICES F Z N act more than five hundred dollars($500). ❑77?NANT El FOOD SERVICE ❑ 1,as owner oftheproperty,or my employees with wageses their sole compensation, SWIMMING POOL ELECTRI IMPROVEMENT Lr� wilt do the work,and the structure is not lmtandedoroffemd Forsook(Sec.1044,Business DOTHER and Professions Code:The Cornmems License Law does not apply man owner Of OUTLETS-SWITCHES- 4 PI UR' n h builds or ire raves thereon,and who does such work himself or bring.. property who p g his own employeese provided that such impres sold are not Intended or pOfferedlvpom far NEW RESIDF.N'1'lAL ELECTR sale.B,howeveq the have the burdding en n of playing is he within onebuild or improve the 01 SQ.FT FLOOR AREA E/SQ.PT. u-builder will have Ne hurler of proving that he did not build or improve far poo pose f.al ). D I of the property, exclusively contracting withld t t t TO fAL. ,urrame,dre p J t(Sce.7644 B ...and Pr fe Cook:)BCmanicarrami,L - t , cense) d t apply to owner Iproperty h boldsImprovesthere d QTY: i PUIMBINGPERMIT` a - FBE;rrS whe contracts for_vuch projectswithv contmctioro licensed pustnt to the Contractor a ts ' is License Low. PERMIT ISSUANCE D I am exmapt under Site ,B&P C for thi,aw,cn Owner DALTER—DRAIN&VENT—WATER(EA) VALUATION IO WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE I hereby alumunder penalty mperjuryoneofthefollowing Worker aCo: Ihwe and will forbyinection 3cateol ConcernsCode,for for Worker Compact- DRAINS—NI-OOR,ROOF,AREA,COND. STORIES TYPE CONSTRUCTION salon,as provided far um Section 3100of the Lahor Code,for the pedmmunce of the work for which ill maintain Workers FIXTURES-PER TRAP 1 have and will maintain Workers Compenvation Insurance,as required by Section 3900ofthe Lobar Code,fortheparformyyyace nftheworkfivol ve hthispennit is Issued. GAS—EA.SYSTEM-]INC.4 OUTLETS OCC.GROUP APyX Came, hot t erandPolicy etllytR+l=wK� / YY Cartier. ss Policy No.: GAS—EA.SYSTEM-OVER 4(EA) _ Zw CERTIFI ATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASFANDUSTRL WASTE INTERCEPTORie2 5 R UIL 1 �IVI$IOMFGE6'rt R`or n is fl� (ThisswtjOnneed not be completed ffthninfor tfs(oven hundred dollars($100) CREASE TRAP or less.) PLANCHECK PEE # Icenify that in the performm coft eco rkfor hich this permit is issued,I shall 9EWP.R—SANIg'pRY.�9TORM EA'"OO PT not nm to an Y 6 ject to the Wmi eri Compw- R ENERGY FEE Z cation Laws of p- t alma e- ^ O O Applicant - WA MHEAT'ER /VBN /ELECTR 7 Pp I t GRADINGFEE G h NOTICE T P 11 A If,after making this Cenifcme of Exemption,you should WAT' (y'ySTEM/TREATING C-t become subject m the Worker's Compensation conforms of the Labor Code,you must SOILS FEE forhwithcomply with each pr,,iO,osm this permit shall be dee.W revoked. OVAL SERV C QTIVE t CONSTRUCTION LENDING AGENCY NEW 'IDENTIAL PLMB. SQ.FT. PAID V O Ihemby ulRnn that lhereisaconswedon lending agency for the performance of Date Receipt# 4L H the work for which this permit is issued(Sec,3097,Co.C.) �_ O U Lender,Name TOTAL: ❑.l Lend Address TOTAL: d Tnadify that 1 ha ed this ppl hon and state that the above informationr i;. .t , .n BUILDING FEE h correct.)agree to comply with all city and county ONnancesand state laws reloi 1 { PERMIT'; g t QTY._ {MECHANICAL PEP U ,7. builJng construction,at tlh reby umhor'ze representat vas of tti act,toemer upon tiro 1 . R. 't.' SEISMIC FE abate-meMoned proper,for inspectimt proposes. PERMIT ISSUANCE (We)agree m save,indemnify and keep harmless the City of Cupertino against ELECTRIC E 10 linbitities,judgments,Oosis and expenses hich maym anyway aocmemmindwid City ALTER OR ADD TO MECH. VFN one onmquence of the granting of his mil PLUMBIN APPLIC T STA A W COMPLY WITH ALL N INT AIR HANDLING]NIT(TO 10,000 CPM) SO Jac ON, MECHANICAL FEE Alli HANDLING UNIT(OVER 10,00OCFM) CONSTRUCTION TAX Sin re of ppman, nmrenor Dat EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSU WdIthe a..Hernamfor¢e bnddomtocupentetareorhandlemomilous neonatal HEATING UNIT(TO IM000 BTU) as dafined by the Calen aro Municipal Cede,Cookie,9,12,and the Do ahh and Safe,, Cele.Section 25532(np HEATING UNIT(OVER 100,000 BTU) ❑Yee F1 No VENTILATION FAN(SINGLE RESID) PAID Will thea applicant of future building Date Receipt# pp ga fire Bay Area Air usury Management BOILER—COMP(THE OR 100,000 BTU mit hazardous air contaminants ns defined by the Bay Aren Air Quality Management ( ) ❑istrict? TOTAL: ❑Vas CNo BOILER—COMP(OVER 100,000 BI U) Ih fie road ¢hazeAIR CONDITIONER v1101'aZ5513d,.25 neder Chapter fi.95 of the alt- IS$UAN AT 9 fomin th fery C id534.I undztstw th if the NEW RESIDENTIAL MECH. SQ.PI'. 'Tbuil d _ m' .14.1 to drate LOf rrc h may. authun agent D* TOTAL: ISSUED BY: OFFICE