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S 1918 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL. PE1\W IT NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL �J 1918 BUILDING PROJECT IDEN'TIF'ICATION � SANITARY NO. APPLICATION SUBMITTAL DATE BUILDING ADDRESS: Qat. G YlAJO OWNER'S NAME: PHONE - CONT'RACTOR'S NAME: LIC NO'. •,CU TWD Wwai-�iir Q,tc. as3- � 1uo (�_pNL �1(" -74" NIC corvruol.a ARCI ITECTMNGINFrR: LIC NO: ADDRESS ❑ CONTACT: PHONE: BUILDING PERMIT INFO [—AVE 7�"3—Cq0oxt` ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT _ PLUMB MOH LICENSEDCONTRACfOR'S DECLARATION / QTY. ELECTRIC PERMIT FEE JOB©DEESSCRIPTION 1 hereby a1Brn that 1 mm licensed under provisions of Chapter 9(commencing WOO 'th Section70,hof Division 3.faim Busin,caand Pmfe,siuns Coda,and my license is RESIDENTIAL WOO in ERMIT ISSUANCE N full force anJ,Rat. ❑SFDWL ❑KITCHEN REMODEL �VU License Clens Lica� J - APPLIANCES—RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE E..Z UW Datc Contractor 'nQy ❑MULTI-UNIT ❑STRUCTURAL p.,a v ARCHTfECTS DECLARATION PANELS w Z 1 understand my plans shell be maid nx public record. MODIFICATION OZ4p GPT0200AMPS ❑INTERIOR ❑CHIMNEY REPAIR h•.ntW Licensed Professional 201-101(OAMPS IMPROVEMENT E]SWIMMING POOLS �.j S,'j OWNER-BUILDER DECLARATION OVER I"AMPS ❑BATH REMODEUREPAIR ❑DEMOLITION OC W Q 1 hereby i1Erm that I am exempt from the Contractors License Law far the yx a U following reason.(Section 7031.5,Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER 41�+4.y which requires a permit m construct,alter,improve,demolish,or repair any,acture ��� prior to its issuance,also rcyoires the.pplicam lar such permino flcnsigncJ smtemc^d SPECIAI.CIRCUIT/MISC. 6� Ilml he is licmval pau,mml to the pmvisiaas of the Contractors Liwnse Law(Chapter9 GC (commencing will Section 7(k0)ofDlvlslonlot'the Business unit l'rotcssiom Code)or TEMP.METER OR POLE INST R L y m K that he is exempt Therefrom tend the basis far the alleged exemption.Any violation of ❑NEW BLUGIADDI 10 EMO.ITION 4X1 p• S¢tion]OI LS by any applicam fora permit suM1jects the npPlicam Tnocivil penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE E. not more than five hundred dollars($500). IMPROVEMENT =Q1]1.as owner of the property,or my employees with wages ms theirsmle compensation. SWIMMING POOL ELECTRIC ❑OTHER will do the work.and the structure is not intended moRered for sale(Nov.7044,Business and Pmfesskms Cale:The Contractor's License Law docs not apply nut an owner of OUTLETS-SWITCHES-FIXTURFS a' property who but his or Improves Thereat),mad who does such work hina,df tar through his awn employee,,providW that such impmvemma ere not intended ter ofle ed for NEW RESIDENTIAL FLECTR SO IT. role.If.however the building or improvement is sold within one year ofcompletion,the SO.FT.FLOOR AREA USE.ET. ownerbuilder will have the burden of proving that he did not build nr improve for pur- pose of sale.). El 1.as owner of the Property,am exclusively contmatra crng with licensed cmctors to TOTAL: construct he project(Sec.7044,Business and Professions Code:)Me Contractors Li- m Law does not apply to an owner of properly who builds or improves thereon,and QTY. LUMBING PERMIT FEE who rmore,s for such pmjeals with u comraator(,)I Icensed pursuant nut 0a Comadur'n Liocco,Low. pP.RMIT ISSI E I mm exempt under See. .B&P C for this reason ALTER-DRAIN& -WATER(121) VALUATION Owner Dare I WORKER'S COMPENSATION DECLARATION BACK FT0*V(qJICT.DEVICE A O I hereby affirm under penally of Perjury one of the following decimations: lit F1Ihave and will maintain Certificate of Cnnsenuo self-insure for Workers Compen- DRAINS-FLOOR.R .AECOND. S OBI S TYPE CONSTRUCTION cation,as provided tar by Section 3700 of the Labor Code,for the perform.....of the work for which thin Permit to,issued. FIXTURES-PER'I'RAP ❑ 1 have and will maintain Worker's Cnmpenxati m Insuanco,as aeyulrod by Section 37M of the Latin Code,for the performance of the work for which this permit is issued GAS-EA.SYS'IT?M-I INC.4 OUTLETS OCC.GROOil APN My Workds Com nsaaio Insummerti Carter and Policy num r Cmrdee CC/�!P c'al ti Policy No.: J7 GAS-EA.SYSTEM OVER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS' GREASFIINDUSTRL WASTE INTERCEPTOR COMPENSATION INSURANCE BUILDING DIVISION IMES or less.) (Thissectionncednat be completed ifthe permit is forma,hundred dollars($100) GREASETRAP � PLANCft[CK Flili I certify dint in the perfmrmmace of eche work for which this permit,,Kwed,Ishall SEWER-SANITARY-STORM EA.21NI1T not employ any person in any manner so us,,become subjano the Workcrk Compete ENERGY PEIi rodeo laws of Calif now.Date WATER HEATER WN1IMLECfR Z Q Applicant GRAZI 'Zr rA NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should WATER SYSTEM/IREATING f' become subject to The Workers Compensanion provisions of the LUNO QMe,you must SOIL [ala u forthwith comply with such provisions or this permit shall be deemed revoked. WATER SERVLCF. Q ps CONhem,,U TIONuLEN DING AGE NCY NEW RESIUF.N'1'IAI.I'LMB. SO.FC PAID ()am I herehy nllirm that there is a,nnswedinn Inding agency for the performance of U E the work for which This permit is issued(Sec.3197,Cie C.) LL E" Lenders Name U Lenders Address TOTAL: C I certify thin 1 have read this application and stare that The above tri mnrl.limn is UIFE -2 F N7 comet.l agree to comply with all city and county ordinances and sone laws relafingto QTY. MECHANICAL PERMIT FEE S SU Gbuildingcouruction.and hereby aathoriae representatives Of This city nut enter upon the - alsoc-mentioned property for inspecditin purposes. PERIOD ISSUANCE ELEits (We)rya,to,mve,Indemnify incl keep harmless the City nl'Cuperdino agmalt liobiliums,judgmem,c.... and expert,ez which nay in any way accrue ugninnt said City ALTER ORADDTOMECH. f,l I r I -PI�IBINGiPBEVI� in asequence Of the granting of this Proud. APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1.NON-POINT AIR HANDLING UNIT(TO 10,OO(i CFM) MECHANICAL IEE SOURCE REGULAVS. U �a7 AIR HANDLING UNIT(OVER IO.OBIICI M) CONSTRUCTION TAX Signature of Appiican ontacmr Dade EXHAUST IIOOD(W,DUCf) HOUSING MI'fIGATIUN FEE HAZARDOUS MA'1'IiR LS DISCLOSURII Willtheuppllcant or future builJlnyucxupamstom tar handle hm.nrdeus materinl HEATING UNI'I'(101O,0(10 BTU) .. as defined by the Cupertino Municipal Code,Chapter 9.12,and the Ihaldh and Safety HEATING UNIT(OVER 1(O,OW BTU) Cole,Section 25532(a)7 ❑Yes ❑No VENTILATION FAN(SINGLE RESID) PAID Date Receipt a Will The applicant or future building occupant use equipment or devices which BOILER-COME OHI'OR 100.00 IF OD .'emit hazardous air contaminants v definN by The Bay Arca Air Quality Management (yf & District? BOILER-COME(OVER IWA1013'PU) ❑Ven 0 N I have mai the hous materials aquiaments under Chapter 6.95 of the Cali- AIR CONDITIONERI^¢I I Nt DA] ' maN from;.Health&Safety Code.Sections 25505,25533 and 25534.1 understand that if The NEW RESIDENTIAL MECH. SQ.FT. ramason, � ' �yN/ building docs net comically have a mm,that it is my responsibility it)Unify the occupard R/']'.`A of the requireaocnu which must be met prion ua issuance of a Cenificam of thcupancy. ///�� 'Tor) Owner or amthorimdagent Date TOTAL' ISSUED BY: "` J OFFICE