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S 3135 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO I BUILDING-ELECTRICAL Pli IT NO. BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL 3135 BUILDING PROJECIADENOF'ICATION BUILDING ADDRESS: SANITARY NO. AI'PLICAHON SUBMITTAL.DA'Z'E /vL /3u /+10 A' -/2- Q$ OWNERS NAME: PHONE: CO R LTOR'S NA E: LIC NO NIC ^ CON'L'HOL# ARCHITfiCDENGINEER: LICNO: A )RISS: F-1 CONTACT: 'G-p ,r p ��P1fyNG G BUILDING PERMIT INFO 6 7 CAJ -x / ❑ Consultant Fees Paid by Applicant(Initial) BI'DoG ELECT PLUMB MErECCH LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT F17E I herehy affirm the,1 am licensed under grovisime.of Chapter,9(cmmm,ming JOB DESCRIPTION O egZ with Section 7000)al Dlalsion 3 orae Buxinn<:mm Processions coda andm liccnu is (1 RESIDENTIAL FOO in full force and effect. y PERMI'TISSDANCE n Ca U— /� � `I ❑SI'DWL ❑KITCfiEN REMODEL JVt License class .C2_LICN �1/ � s APPLIANCES-BESIDES UAL ❑ADDITION ❑PLUMBING RE-PIPE I-<W Dete r -!;t ='Sit—Contractor F,Om 'A If CC irIF.CTS DECLARATION A e..� PANELS C1 MULTI-UNIT 0STRUCTURAL O 2 1 underswnJ my plans shall he used as puM1lic records �`�S x"�• ], MODIFICATION UPT0200AMPS (J INTERIOR ❑CHIMNEY REPAIR F-4F'W licensed Pmfen.ionul 2111-I(Xp AMPS IMPROVEMENT SWIMMING POOLS �g5; OWNER-BUILDER DECLARATION OVER I0AMPSPS ❑BATH REMODEL/REPAIR ❑DEMOLITION 6 1 hereby M.that I am exempt been the Contractor's License[.me for the x2x06 U following reason.(Section 7031.5,Business anal Professions Cade:Any city or county SIGNS ELECTRICAL ❑OTHER a134 y which requires u permit rte construct,alter,improve,demolish,or repair any ewcturc F'u'06 prior 1.ini.ssuance.also requires the applicant(nrsuch scruninn file a signed statement SI'I;CIAL 1IRLl11T/MISC. that he is licensed pursuant o the provisions of the Contractor's License Law(Chapter 9 1i1 p0 (commencing with Section 7000)of Division J of the Business and Professions Core)or TEMP.METER OR POLE IN COMMERCIAL, d q CL that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION iLLC7 4• Section 7031.5 by any applicant far a permit subjects the applicant)a civil penady of POWER DEVICESTENANT Fool)SERVICE Zy not more than five hundred Jollurs S500), {'IMPROVEMENT =60 71...... SWIMMING POOL ELECTRIC []OTHER add do the work,and the structure is not intended uns0cted for sale(Sec.7044,Business m and Professions Gale:The Contractor's License Law does not apply m an owner of OUTLETS-SWITCHES-FIXTURES property who builds or Impnrvcs therem.and no docs such work himself or Through his own,mpleycea,provided that such impmeemems are not imendW or oRereJ for NEW RESIDIi!"HAL ELEC!'R SQ FT. sale.If.he.,,,,the building or improvement is.mldwlfldm one year of completion.the SQ.FT.FLOOR AREA S/SQ.17. ownerbuilder will have Ne burden of proving that he did nod build or improve for pur- pose cl'sale.). Tq `A L as owner of 0e property.am exclusively contracting with licensed contractors onmmct the projcm ISa.7044,Business trod Pmlcssions CWc)'Ihe Cnn....no,Li- / �O ave law does not apply to an owner of property who builds or improves thereon,and QTY. PLUMBING PERMIT FEE who contracts for such projects with a conducnm(s)licensed pursuant onhe Contractor's © ,O Licenm law. PERMIT ISSUANCE / C]I am exempt under Sec. ,B&P C for this Toason Owner UALTER-DRAIN&VENT-WATER(EA) VALUATION ^ WORKER'S COMPENSATION DECLARATION N IIACK FLOW PNtTI'ECL DEVICE I herehy allinn under penalty of pcTjury one of the following Jwlamtinns: Ihave andwill for Section he La ,Care.for the Worker'sce of the DRAINS-FLOOR.HOOF,ARBA.CONK STORIES TYPE CONSTRUCTION cation, r provided for by Section J71g)ml she labor Cale,hn the performance of the work avearuh this maintain issued. FI%TURES-PER TRAP r3/7 1.. tmJ will maintain Worter, ....coxme w Insurance, h require)by Station J�nf the Labor Code,for the performance of she work for which this OCC.GROUP APN perrtdl id issued GAS INC.40N'I,EI'S My Wmkcrs tion JBSgrance sorties and Policy n hpr e: Cnr Wo N;: e 1�__1�_ iw Policy Nn.: "d GAS-EA.SYS'IEM-OVER4(IiAI CF.RTIFICA9£OF EXEMPTION FRO WORKERS' ) GREASEANDUSTRL WASTE INTERCEPTOR ✓ (/`V COMPENSATION INSURANCE / BUILDING DIVISION PEL_S_ ___ _ (This section need not be completed ifthe permit is Bron,hundred notion,SIN)) GREASETRAP or less.) PLANCHECK FEE O I cendythm inure pefformanccofthe work forwhichthis SEWER-SANITARY-STORM ISA.21017. O not empa,oary persom m o ny manner, setts b lot e Wo 'Como ENERGY FEIi D Z mind Laws of Cal l m.,Date WATER HEATH WNENT/ELECfR z� Applicant - GRADINCITV111 11 NOTICE TO APPLICANT:IL after m d6 this Cer ifeme of Exemption,yen sh 1 WATER SYSTIEAG BEATING SOILS hli C•" ; become subject to the Worker's Coope.,no.provisions of it IS4yyWFF#�..ppII GQ fonhwith comply wird such provisions onhid permJ9l�In I 's#u s WATER SERVICE CONSTRUCTION LENDINJGkAGENCY NEW ICES IDENT1AL PLMB. SQ. •. ID /^ V Ihenby allinn shat there is acorn residentlendinyagcncy for the performance of Dam kecci l/ f•s the work for which this permit is Issued 1 ec 3(y)7,Civ.C) 'is TOTAL: O ULender's Name _ A Leaders Address BUILDING 1117\1 I certify to comply 1 have read thirty and county dune ces the shove information is Uh buildingcone,mco,and wideall ynumornd tom,ryhmaenmsand sedystate tenterlmin the QTY' MF:CHANICAI.PERMIT FEE U � building construction,and hereby amhnriss repmumatives of Nis citywenmr upon the SEISMIC HE above-mentioned pmperty for inspection Impose, PERMIT ISSUANCE (We)agree Rs dove,indemnify and keep harmless the Cin,of Cupertino alums' ELHCTR e liodelinies,judgmems,costs and expensed which may in anyway aceto,against said City ALTER OR ADDTO MICH. in consequence of the ranting of this permit. ) PLUMBI e APPLICAN UN MANUS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IBg10 CF SOURCE Gl .ATII S. � MECHA FEE AIR HANDLING UNIT(OVER 10.0110 CFMI CONSTRU NTAX S' azure of ApplarralContentor Delco EXHAUST HOOD(W/DUCI) O HOUSING MIJ'IG 'ION FEE HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hamrdous mutcnd HFATI NO UNIT CFO 100,000 BTU) ' ss defined by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety Code,Section 255320)7 HEATING UNIT(OVER I BUMS)B'I'U) ❑Yes u / VENTIa(SING('LEGLE RESID) 4(0 !ISSUED DateWill die applicant infurore buildingoceapam use cul inated nrdevices whichrunt h tomdous air cmntndane. s vydcfired by the Bay Arca Air Quality Management BOILEk IBd.f(If RTU) �1��Q/ T 'AI.: District? BOILE100,NNI B'ru) E)YesI have read, hmnrdove m. ria rements under Chaster 6.95 of the Cali. AIRCOISS ANCEDATEfmmia Health&Safely C e,SoniV.,255 5533 and 255]4.1 und,rsutnJ Ihm it Ne NEW RECII.Jbuilding dresnmcurret base t v,dyn,fm ibifin'tonolfylhcoecuganlr / Q ermcdoquircmere namobete idsonc d nificare f ed w/ �/C� Owncror archon m Dac : • — 2,_9" OFFICE