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S 3380
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDS NG-El ECTRICAL PE IT NO. BUILDING DIVISION APPLICATIONAXERMIT PLUMPING MECHANICAL 8 O BUILDING PROI IDEN'TIFIC'ATION BUII, �NG'\ADDRESS: I A SANITARY NO. APPLICATIONSUPMG7ALDAI£ OWNERS NAME: PIIf1NF::� c CONTRACTOR'SNAME: C� 9 LIC©: �_�� C�� NIC CONTRDLX 'HITECDENGINF.ER: LIC NO: ADDRESS: - ❑ CONTACT: �QO lyprv—. Z3�O BUIL GPERMIT INFO L ) + ❑ Consullanl Fees Paid by Applicant(Initial) BLDG A-ECT PLUMB MECII V stir l ❑ ❑ ❑ EACH SEDCONTRACT( DECLARA'T'ION QTY ELECTRIC PERMIT FEE 1 hereby affirm Nal l am licensed muter n emons of Clamour 9(cnrmmencing JOB DESCRIPTION OZZ with Section]1100)of Division 3 oflhe Business and Pmlessfons Gale,onJ my license is RESIDENTIAL: Foo ' full force and effect. 1201-1 MIT ISSUANCE ❑SFDWL ❑KITCHEN REMODEL. a U License Class Lic.p Q V LIANCES-RESIDENTIAL OADDITION ❑PLUMBING REPIPE. F-Z,W Datc Cmm�ctor an't, ❑MULTI-UNIT ❑STRUCTURAL F D W ARCHITECTS DECLARATION ELS ✓+Z lundenclnd myplanishuh himself aspublic records MODIIgCAfION zOZ^y0 O 2PRAMPS [I INTERIOR 11 CHIMNEY REPAIR W Licensed Professional OWNER-BUILDER DECLARATION (000AMPS IMPROVEMENT SWIMMING POOLS following ria.itmuralima jual,Buimesrand Professions Cs License Lnw far NoR KOEAMPS ❑BATH REMODEUREPAIR ❑DEMOLITION I hitch (firm thin am exem t from Nc C.ntracmr56ODB,ciU ode:Any ciryor candyNS ELECTRICAL Cl OTHER .hill requires a permit to construct,mbcr,improve,demolish,or repair tiny structure Q prior h,it issuance,also requires the applicant forsuch pencil m File a signedslatimarm SPECIAL CIRCUIDMISC. thin he is licensed twomanno the provisions of the Contractor's license law(Cantle'9 Hog (commencing with Section IIKKRofDivision 3 of the Business and Professions Cale)or TEMP.METER OR POLE INST. COMMERCIAL, 6 c Iha,he is exempt,herefrom add the basis for Ne alleged exemption.Any violation of ❑NEW LDGIADDETION El DEMOLITION �N Section 7031.5 by any applicant for a pcmrilsubjems the applicant to a civil penalty of POWER DEVICES ANT ❑FOOD SERVICE! not mre athan five hundred dollars(8500). VVVIMPROVEMENT '�Q1❑ ,as owneroltis'the property,or my employees with wages theirsole compeneatinn, SWIMMING IE.F.CfRIC y= will do the work,and the structure is not intended omffemd for sale(See JMusi 4,Business OTHER yl and Professions Coda.The Contractor's License Law Anes not apply to an owner of OUTLETS-SWITCHES-171VI'GRES property who employees, Pr Providedimproves thereon,and who does such work himself or Through his awn employees,Provided dam,inch impmm veems are nm mudded nr nll'ercJ for NEW RESIDENTIAL ELECIR SQ FT. sale.IL however. he building.,improvement back]withinone yeam ufma pleliothe SQFT.FLOOR AREA pSQ.l4. . ter-builder will have the burden of proving thin he did and build.r Improve for pm- ofsalc.). TAL / 'L at owner of the property,.,it exclusively convecting with lwraord onmm recrs la �O a wet the project(Sec.70,14,Business and Profitai.ne Cadep no Ci m uchas U- se law does not apply to m owner of property who builds or improves thacen.and QTY, PLUMBING PERMIT FEE who contract far such Projects with a contractor(s)licensed pursuant o the Conwmars License Law. PERMIT ISSUANCE! lam exempt made Sec. .B&P C for this mason ALTER-ISRAIN&VENT- TE (I VALUATION Das. RT/: DI ECLARATION BACK FLOW 1'ROITCT. / f4 Z) s 11 ebyoffinna rppenahy(If perjury one ofthc following dalarmods. C/ I haveand will maintain aCasfGcaeof Consenttovelf-insum for Worker's Compem DRAINS-FLOOR,ROI III ST, IES TYPE CONSTRUM ION saint,as provided far by Section 37110 of the Labra Gude,for the perfomutnce of the work for which this permit is issued. FIXTURES-PER TRAP I have and will maintain Wallace.,Compedsaim,Imuranee,ms required by Section 3700 ofthc Labor Cale,for the serfmmamic offle walk far which this Pencil is issued GAS-EA.SYSTEM-]INC.4 OUTLET S OCC.GROUT' APN My Workers Compensation Insurance carrier and Policy number are: C.I Policy Nn: GAS-EA.SYSTEM-OVER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS' GREASFIINDUSTRI.WASTE INTERCEPTOR COMPENSATION INSURANCE BUILDING DIVISION FEES (Tbisscetionnc nolbecompletWifthcpermit d onanehundnddnllao(SIM) GREASETRAI' PLANCHECK IPE or less) I lordly that in the icdomwm of the work for which this scroll is issued,I shall SEWER-SANITARY-STORM BA.200 FT. not Iany person in tiny manner xo es m became contact m the Workei, Carrier' ENERGY FEC Z cation Laws of Cafffomia.Date WATER HEATER WNENT/ELECI'R GRADING PER Z O Applicant ` ' NOTICE TO APPLICANT:1(after making this Certified,of Exemption.you should WATER SYSTEMfTRRATING f'+ become subject 1.the Worker's Compensation provisions of the Labor Calc,you must SOILS PEG bet ti forthwith comply with such provisions or this permitshall he deemed revoked. VIWI£R SERVICE DJ O Receipt CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FI'. PATI 5z I hereconstructiondi byafOrauhere iso construction lenngagency for the porfonamerof a U C) the work for which this permit is issued(Sol.3097,Cil C.) O TOTAL: tenders Name {U11 Lenders Address TOTAL: ;b, 1 cenify that I have cad this application and nffe,hal the above infemsmion is It.D FFEE0. t�-tN coned l agree m comply with all city and county oldieaneesnnd slate laws relating 1. QTY. MECHANICAL PERMIT FEE S1, 'FEE U.z-t half.,emouniction,ondherebyaahonu repmsenm,ivxs ofthiscitymemerupon the aboic mentioned properly for inspection purposes. PERMIT ISSUANCE RIC PEG (We)agree m save,indemnify anlf keep harmless Nc Cfly of Cupertino ngnina labflities,jultinara,castanJ expenses whirl try i n any wily accrue against said City ACI'ER OR ADD TO MUCH. pLU PING FLG inconsequence f,he g2N,o'-�ANI is APPLE 1NI' .NDERCQNIPLV WITH AhL NONPOINT AIR IIANDLING UNIT(T0111,( )CPMI Mli HANICAI,FEE SOU £ 'U�AT / ? ISafety AIR HANDLING ONI'1'(OVF;R 111,(0(1 CFM) CO UCf10N TAX gf w lie C mnemr 1 EXHAUST I IOOD(WIDUCI') HOUSING IGATION FEE HAZARDOUS MATERIALS DISCLOSURE Willtheapplicmm.,fmax building oecupart sore or handle hamichI I EATING UNIT(10100,000 BT Of as defined by the Cdplumm,Municipal Code,Chapter 9.12,and the HealtCade.Section 25532(x)'7 I IEA'TI NG UNIT(OVER 100. 51)B'T ) ❑Yes ❑No V EMILA'1'ION PAN(SINGLE RESIDE PAIDDam Receinl x Will the applicant ser Tatum building occupant use equipment or dEOILIiR-CONI'(3HP OR Ifp,lxp BTU) i,h ttaNnns air contaminants as defined by the Bay Area Air Quality Management T f District? BOILER-COMP(OVER 100,000 BTU) ❑Yes ❑No I have.,,it the haemdoweraennls roaterenmms under Chapter 6.95 of be Calf- AIR CONDITIONER ISSUANCE DATE forma Eiealth&Safety Cale,Sections]55(15,25533 am!25534.1 understand That if the NEW RESIDENTIAL MECIL SQ.FC building does a.(currently hive amnant,thatdis my responsibility to rally'he«capard of the mquimmerm which must be mel pia It,issuance of a Cenfficae of Oreffe roY T Owner or emhodael agent Date 1OTAUI ISSUED BY: OFFICE ,tPCLARA CSO FIRE DEPARTMENT rM CONTROL NUMBER m '.e SANTA CLARA COUNTY • 14700 Winchester Blvd., Los Gatos, CA 95030-1818 PERMIT NUMBERSRS 3490 (408) 378-4010(phone) • (408) 378-9342 (fax) PLAN CHECK No. PLAN REVIEW COMMENTS CODEISEC. SHEET NO. ECIST/UC: F/f2e SPS'/A,lrtCR S'57"1*'H SNAtt 8Q "OD/F/a'p AS NEcsa-S6,,p,A,y To AelonoP.I1'E New �^�gT�7ucr�ea, L/f@NEED FI/te PROTC-OTeoN con7,jZ4cTo/Z SHAcI $HBn �T To F/RE DE/�A�T/YEUT 3 $erS mF SNoF DRAwr�J65t A eo++BteTcb ?e2�/r APPdIc�T/°� T"O ,4A)7 FSS FOR 2&!lr t. w2102 ?C/tFORH/MG //✓!'/R i.J°R/( JJUURIS PLANS SPECS NEW REMODEL AS CONST.DESCRIP. BY DATE— Q PAGE Cj) X EJ L] JL ❑ W t3t�y !��!'+� VS]�OL 42hs —j—OF SECJFLOOR OCC OCC.LOAD AREA ARCH,ENGICONTRAC70R,OWNER NAME OF FACILITY LOCATION �^ �N E NTE kNT10NAL qE 1 Z-3 I 8448,6 `J^J A California Fire Protection District serving Santa Clara County and the communities of Campbell, Cupertino,Los Altos, Los Altos Hills, Los Gatos, Monte Sereno, Morgan Hill, and Saratoga Gr r PER.TIIVO, CA APPROVED re ° IN rcr)RDANCE WITH THE CITY OY S o d u t TING CODES AND ORDINANCE` °x JE� Z L2 is set ,a p; c. . ,tions mus, 'sept on „ss and it is urs ° s ; s;,erati, t ,i? t",•„5o n:cion Yr;,c o Lao. s.ar,;•.n do,iticariunt � .LL IVUT Ge ,ir r t 1 : , r t.) ho provision• ❑ ❑ dv .u.1lu e or Stall N ° v ° Al a .• Al ❑ ° P v , ° Ab Q w o.�o is N ° ° ° 55o O i Q1 0 ° 61 64- o a o C7 CG 0 cl c2 v I � N 6i p O E6 D9 DG a I S 4' o IIS—fI 0 4B I�j P m r DG r E1 v O E4 r + d a n Q K OZ ° O 46 C as T U U G7 a p D'v a ce E3 EG Pi o LE.G 7 v 4b