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S 0136 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL. Pl!r'`7 MITNO. O BUILDING DIVISION APPLICATION)PERMIT PLUMBING-MECHANICAL, BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: 136 . SANITARY NO. APPLICATION SII({MITTAI,DATE bs77 C1 I, Ff•-,d billCL.fpdI.-I11ne (A. °11561 4 G AT/3..q � t OWNS 'S EN PHONE: C9N'(RA OR'$NOpME: w.M Llrvr.107-5 N/C CONTROL It ARCHITECT/ENGINEER: LIC NO: 'Wif�I5f5:PPAC.LIC� , / /N_ ❑ 3GG S,ra� C1wz. IYdx .CONTACT: PHONE: BUILDING PERM IT INFO ❑ Consultant Fees Paid 6y Applicant(initial) BLDG ELECT PLUMB MEC( LICENSED CONTRACPOR:S DECLARATION QTY ELECTRIC PERMIT FEE imQ/ 1 hereby aB1rm that 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION �aZ with Section 7N)T.fDivision 3oOhe Business and Profession,Cottonton my license is r W in full force and effect I e Z e� PERMIT ISSUANCETIAL LAN Qd.Uz License Cl' _Lie.# 5 DWL ❑KITCHEN REMODEL. NQa Data dtTl3 Contractor APPLIANCES-RESIDENTIAL ADDITION ❑PLUMBING RF.-PIPE 'Doo ARCHITECT'S DECLARATION PANELS ❑MULTI-UNIT El STRUCTURAL Z O rn� I commandant my plans ehall he used as public records oz-- UP TO 200 AMPS MODIFICATION Rofasmnal ❑INTERIOR ❑CHIMN17Y REPAIR aY OWNER-BUILDER DECLARATION 201-1000AMPS IMPROVEMENT El SWIMMING POOLS yay O0 6 I hereby affirm that 1 am exempt from the Contractor's License Law for the OVER IINRAMPS ❑BATH REMODEUREPAIR L1 DEMOLITION X a U followingreason.(Section 7031.5.Business and Professions Cade:An it r count �Tyl tt�d1 y,F SIGNS ELECTRICAL 3�a which requires a permit m comwcL slaty,improve,demolish,or repair any structure prions its issuance,also requites the applicant for such permit to fife a signed statement SPECIAL CIRCUIT/MISC. �<f ghat be is licensed pursuan 10 the provisions 01 the Commons', 9 License Low / (commencing with Section 7000)of Di vision Sof the Business and Professions Gxlc)ar TEMP.METER OR POLE(NST. COMMERCIAL•' S a' Nat he is exempt thercfrom and the basis for the alleged exemption.Any violation of „y Section 7031.5 by any applicant fm a permit subjects the applicant to a civil petmity of POWER DEVICES ❑NEW BLDG/ADDITION❑DEMOLITION nm more than five hundred dollars($5001. ClIsJ El TENANT [_1 FOOD SERVICE =12 L]I,ns owner of the property,or my emplgoas with wages as their sole mmpcnsetion, SWIMMING POOL ELECTRIC ,, .VySS IMPROVEMENT y the wtrck.end the stmcwreis nm intended or nRered Tarsale(Sec.]044,Huxineu BOTHER a :� willdo and Professions Code:The Contractor's License Law does�nal apply to an owner of OUTLETS-SWITCHES-FIX I!KJ property who builds or improves thereon,and who does such work himself or thmugh his ason employees.provided than such improvements are oat imended or oI,d for NEW RESIDENTIAL ELEC R wib PL w sale.IL however the building or improvement ix sold within one yearofaompletion,the \ - SQ IT.FLOOR AREA $ISQ.14. wner-builder will have the huNen of proving that he did not build or improve for Aur- �$ Pete of sale.). ❑ I,as owner of the property,um exclusively contracting with licensed contractors to TOTA o..I It the project(Sec.7034 Business and Professions Coda)The Cmdommes Li- ectow Lawdoes not apply t0 an owner of property who builds or improves thereon,and QTY, PLUMBING PERMIT I FEE who contmms fur such projects with.cl)ntwtt)r(s)licensed purguanno the Contractor's License law. PERMIT ISSUANCE ❑I am exempt under Sec. ,B&P C for this mason OwnerALTER-DRAIN&VENT-WATER(EA) Date VALUATION (- munderWORKER'S COMPENSATIONderyon DECLARATION BACK FLOW PROTECT.DEVICE D I hereby effinn ander Penalty nl'pepury one of the following declarations: 7 a © - ❑I have and will courasod CenificamofComentm ulf-inmrc for Worker's Camper. DRAINS-FLOOR,ROOF,AREA,COND. ation,as provided for by Section 3700 of the Labor Code,for the performance of the STORIES TYPE CONSTRUCTION * hich this permit is issued. FIXTURES-PER TRAP f II�f bare and will maintain Worker's Compensation Insurance,u required by Sagion , 37M ofthe Lamo-Code,for the performance of the work for which this permit ix ismed, GAS-HA.SYSTEM.I INC.4 OUTLET'S OCC GROUT' APN My Wor nsyynn�g umnce carrier and Policy number�.�{��^ Cana'.. Ef..Je Policy No.:O'sitt GAS-P.A.SYSTEM OVER 4 HIA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASUINDUSTRI.WASTE INTERCEPTOR (This section road not be completed ifthe permit is forces,hundred dollars($1yq BUILDING DIVISION FEES of IexsJ GREASE.TRAP pLANCHECK ITE certify that in the perfomeace ofthe work forwhich this permit is issued.)shall SEWER-SANITARY not employ any person in any manner so as to became subject m - the Worker,Co.,.- STORM EA.200 FT. Ll sodium laws of Edifamia.DateENERGY FEE ZO Applicant 1 WATER HEATER W/VIEs DEILECTIR GRAVr�F NOTICE TO APPLICANT:If,aper making this Cenificarc of Exemption,you should WATER SYSTEMRRLATING P ;