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S 3314 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING.KLRC1'RICA), I'F:�91T NO BUILDING DIVISION APPLICATION/PERMIT PLUMBING MECHANICAL J 3314 BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS SANITAARY NO. APPLICATION SURNI TIAL DATE /035/ rr,,o ,Ave ve, 2- I-4 OWN ITS NAME: PHONE: CONTRACTOR'S NAME: LIC NO: N/C CONTROL,, OPs% Ner : G�2Nv1 C2Ciol LIC 2'6,�4hSQS f'rewroxt Of D a (o_ CON'IAC'r, PHONE: BUILDING PERNIF'INFO &leh n CR l ORO) 1523-789,6 ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB SUPER ifr LICENSED CON'TRACTOR'S DECLARATION QTY EL1iCT'RIC PERMIT .FEIi LJ Gl I hereby affirm mal I am licensed under pmvi.vions of Chapter 9 Rommencing JOB DESCRIPTION 0 d'z with Section]000)of Division 3 of Business and Professions Code.and my license is p in full force and eRect. PIikMIT ISSUANCE �t RFMENT1 L aUV License Class Lia.p :FDWL ❑KITCI IEN REMODEL rFaa DataCOmracbx APPLIANCES-RESIDENTIAL []ADDITION ❑PLUMBING RE-PIPE ARCHITECTS DECLARATION ❑MUCfI-UNIT ❑SI'RUCI'URAL z O W 7J I understand my plans shall he used as public records PANELS MODIFICATION Oz^0 IIP T02f1(mAMPS El INTERIOR F1 CHIMNEY REPAIR F,WkOWNER-BUILDER Licem'cJ I'rnrasinnaf 201-10)OAMPS IMPROVEMENT dam! '-1 IIUILDEI(UIiCLARA99ON ❑SWIMMING'POOLS I hereby mifm,that 1 um exempt frau,the Cnnlmcmr's License Lew findOVER I"AMPS ❑BAT IB MODEL( 12-`1' W following reason.(Section 7031.5,Bwincss and Professions Cade:Any city or amply SIGNS ELECTRIC 1;1 LLl M which recurs,a Penni,m construct a11Cr,inmate,demolish,or repair any droulurc fJ�C) prior to its issuance,also requires the applicant for such permit to file a signal statement SPECIAL CI IT/MISE. E } that heed licensed pursuant o me provisions of ilia Contractors License Law(Chapter 9 W 2500 (commencing wise Section 7")of Division Sof the Business and Professions Coddor TEMP.METER .:IN. R 1 1�9� d 6 oY mat he is exempt Beacham and,he buts for the alleged exemption.Any violn,inn of ❑NE LDG/ADDITION DEMO TTI W^N Section 70315 by any applicant for a PCnnlLxLbjects the applicant a civil Penalty of POWER DEVICPS ❑TE ANT ❑FOOD SER more than five hundred dollars($500). WSp ❑1,as owner of the property,or my employees with wages as their sole compenxainn, SWIMMING POO IiL1:C C IM k , '"ENT will do the work,and the structure is no,intended Or ofTcrcd for sale(Sec.IIW4,Bmincxs ❑OT W rad Professions Cala Tha Commetor'x License Law docs not apply,o an owner of OU9'LP.'1'S-SVG IC11 '-F XTIIRFS fi properly who hands or improves secrete,and who docs such work hlmvclr Fir through his Own employers,pmwided that such impmvamenls arc NO,intended,r oRLre1 in NEW RESIDENT Al,Ii1.11CI R SQ PT sale.ll;hnwmar,the building or improvement is sold within one yar of mmplminn,the SQ.Fr.FLOOR AREA $/SQ.PT. builder will have me burden of proving that he did nn,build Or improve fur par- t 9, fu'w vma (� atheIofthe property,amexdusi and Contracting wi,M1licensed maracda's i- 2 /des, 2/797- ds m.amd the Dmjecf l5ec.],194.Rosiness and Profession,Galea The C,n,rannrs Li- came Law does not i-camelawdoesnot apply to an owner of propeny who builds or improves Alarcon,and QTY. PLUMBING PERMIT I>EE whocom uc,s 6arsuch pmjecrs with a contrectorl licensed pursuanuothe Contractor% ✓" License Law. PERMIT ISSUANCE 0 C3 fume xw B&P C for this reason ALTER-DRAIN&VENT-WNIER(EA) Owner am VALUATION l� RICER COMPI! , ON RATION BACK FLOW PROI I7CL DEVICEl I hce rkiri,mmerpemalty of perlury one s,rollowing deolanninns: 7 I have and willmeincid.Cenifamol Cnnsun nnclf.insure for Worker's Cnmpcn- DRAINS-FLOOR,ROOF.A It I IA,CON 1l. S'fOkIHS 'I'YI'I?C(1NSTRUCTION action,us prnvideJ for by Section 3]1X1 n1'Be Labor Gxlc,for the Performance OF the work for which his pomata e,issued. FIXTURES-PFR I RAI' ❑ 1 have and will maintain Workers COnmensation Insurance,as required by Section 3701 of labor Code,for me performance of the work for which mix pari,iv Swed GAS-EA.SYSTEM-1 INC.4 OUTLETS OCC GROUP -3�� APN My Worker's Compemw,inn Insurance carrierand Policy Familiar are: —/ Carrier: Policy No.: GAS-EA.SYSTEM-OVER4(RA) ©2� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSA'T'ION INSURANCE ORGSENINDUSTRL WASTE INTERCEPTOR BUILDING DIVISION EELS Oris section need no,be completed if the permit is for one hundred dollan(S 11101 OR TRAP or less.) PLANCHECK FEE 12 ( O 1 employ any,Perin me performance,(the work for which Bis pari,is a s'ad,Co[,hall not cm In any 55WF.R-SANITARY-$9YIRM HA.200 Pf. ' P s fCmn min any manner en as to twconac subject me Workers'Cnmpcn- IiN1iNCY FEE s ,� cation Luwx OI California.Data L O Applicant ' WATER HEATER W/VIiN'I'/lil.l?C'I'k 2GRADING FEE h NOTICE'I'G APPLICANT:IF,after nwki ng this CON i flat,of Exemption,you shnuld WATER SYSTEMG REAUNG a7fact)me subject to the Worker's Compansu,ion pownums Of me Labor Code,you ams, SOILS PU3 Lkl r fonhwiB ennaply with such Dnrvisionsnnhi.lmnit,shut l hedeemedrevoked. WATER SERVICE i7. z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL I'LA111. SQ.Fr. PA >' G 0 IlmrcM1y affirm,hanhere is aConstmetinn lending agency fonhe perfnmmntt of Dam Receip,N ,he work for which this permit is issued(Sec.3097.Ci,C.) Q U Landers Name TO�i L: r J CS Lender's Address ZTO d I ceniry Ihx,[have read this application and state that the above information is HUILIIING E fn cored l agree to comply with all City and county ordinances and state laws mlmingm QTY. MECHANICAL PERMIT FEL? ,� bully n:au, .addh by ,1 ize rcp . „msofmi city, nR D the SEISMIC 5 ^0 above mentioned property for inspection pu p aePERMIT ISSUANCE I1(W) b to my indemnify and keep less fCpt ya cr EE r 2 Inbilfineas.judgments,cotand Osper,c.swh y is any way accme nyinst and City unwalmo0snf the granting of this permit AL'T'ER OR ADD TO MI?CII. PLU FBP, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Alk HANDLING UNI'I'CH)III,IaIMm CPM) SOURCE! ' AGONS. ME. AL FEE AIR HANDLING UNIT(OVER 10.(0()CFM) CONST CTIONTAX i o Apphcaa✓ n,recmraDate EXHAUST HOOD(W/DUCT) IIOUSI GAIITIGAI'ION PEE HAZARDOUS MA'I ERIAIS O$URE Will theisnAicint mforme building¢cupamsmram handle havallous material HEATING UNIT(TO 100.000 RTU) as defined by the Cupertino Municipal Code,Chapter 9.12,and Be Health and Safe,, Coda Saedoo 25532(n? HEATING UNIT(OVER 1000)(1 BTU) ❑Yes L]NO VENTILATION FAN(SINGLERESID) PAID Will the rpplian,or tutors building nl use equipment mdevices which Data R caipt W erns,harunlnm air cuvtuminamv as dclinnby tile hy,hc Ruy Area Air Quality Mrnugi•Im,nt BOILER-COMP IMP OR IaP,(X)E BTU) Dintrictp TOTAL: ❑Yes No BOILER-COMP(OVER I00,I01113'1U) Zz0 I have read the hazardous materials plocoll under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DA'I'li forma Health&Safety Coda,Section 25505,25533 and 25534.1 understand that if,he NEW RESIDENTIAL.MECH. SQ.IT. builds yllurufpfc`nently have a annanuhm it tam nsibilitym Firmly me rxaryam �/ ^ /N of 0i0 oon tN tl wti est lK me,pro Cerf -Occupancy. 7 FbxnxrF,rAtdamnzcc1 agent DamISSUED BY: T L OFFICE