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S 1877
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PIi IT NO. BUILDING DIVISION APPLICATION/PERMIT PLUNKING-MECHANICAL 1877 IIUILDING PROJECT IDENT'IF'ICATION BUILDING ADDRESS: ±SANSTARYO. APPLICATION SUBMITTALDATF z277 CreSCent Rea ertino 6A 25-0 � 7- Zo -9OWN R'S NAME: PHONE: CONTRACTOR'S NAME: LIC NO: CONTROL#IcLnYLAe✓1 �f0, 2553-24330 RC lTTI'CT/ENGINEER: LIC NO'. ADDRESS CONTACT: PHONE: BUILDING PERMIT INFO A lam YKetaik (65"*3- 3780 ❑ Consultant Fees Paid by Applicant(initial) BLDG/ I?LECT PLUUMMBB MFFCCH Ig` ©' . Z4 LICENSED CONTRACTOR'S DIiCLARA9'ION QTY. ELECTRIC PERM19• FEE 1 hereby ahnn mat I am licensed Oder provision,of chapter 9(commencing JOB DESCRIPTION O0Z with Sectbn700mvfD,si,ion 3.Nhe Businessand Profea,iom Cnde,and mYGcenwin RESIDENTIAL, y�00 PERMIT ISSUANCE r S.5 Fry_ ancone class elrea. ❑SFOWI, ❑KITCHEN REMODEL aVV Liccn,e Class 1.ic.n APPLIANCES-RESIDENTIAL ADDITION ❑PLUMBING RE-PIPE Fz all Dare Commctnr ln<1 MULTI-UNIT ❑S'TRUCTURAL DN ARCFlITECI-S DECLARATION PANELS F- MODIFICATION1 undersmwords a l my plans shall be,tonal as public z O-ZUP'T0 200 AMPS Oz�O ❑INTERIOR [I CHIMNEY REPAIR FSI:,Iy Licensed lhnfessional 201-1010AMPS IMPROVEMENT 0SWIMMING POOLS OWNER-BUILDER DECLARATION OVER 1010AMPS ❑BATH REMODEfJRF.PAIR [I DEMOLITION 1 hereby aflimt that I ma,exempt from me Coriander's Licenw Law for the ❑OTHER �d OO.U following ream,.(Section 7031.5,Business and Profession,Code:Any city or county SIGNS ELECTRICAL Ill a W h which requires a penult to construct,alter,impown,detndi,h,oa repalr any smmmre Iqq'�f0fnn 6, pderm its ismme...N.inqulmsthenpp]iant branch permit..fileasignedstammatt SPECIAL CIRCUIT/MISC. . 2 } mat he is licensed pursuant m the provi,mnnof the Cotaracmrk License Law(Chart"9 yCpO (commencing with Section 7000)lir Division 3 ofthe Business and Professions Code)or TEMP.METER OR POLE INST. 00"COMMERCIAL: d q a y that he is eeempt therefrom and me basis for the alleged exemption.Any violation 0f ❑NEW BLDG/ADDITION C]DEMOLITION Section 7031.5 by any applicant lin o pennitwbjects the applicant to a civil Penalty 0f POWER DEVICES 0 []TENANT ❑FOOD SERVICE rn of more than five hundred dollars($500).Fz6 Las owner oftbe n,or my employees with wines as their sole coin tion, SWIMMING POOL ELECTRIC IMPROVEMENT SO ❑ grope Y P Y 6 laud Fs will dthe work. nsCand e:The antras nota Livens Law1;dfmsale(Seepply 7B W,Boniness ❑OTHIiR 3 m and Professions Code:The Commcunk License law does nm apply to an owner of Oil'fLEI'S-SW I'rCllliS-FIXTURES 4' propenty who builds or Improves thereon,and who does such work himselfor through his awn employees,provided that such improvements are and intended or offered for NEW RHSIDF.N'TIAL ELECTR sale.If.however,thebuildingor improvement is,ald within oneyearelcompletion.theZ SQ.FT.FLOOR AREA LSQ.FT. ebuilder will have the burden of proving that he did not build or improve for per- 3 o s OG �ur-nitate.). 3 0 TOTAL: �1,an owner nl'the propuny,inn encladvely contractingg with Ilansed contractors to ,rower the Forest(Sec.7844.Bonino cad Pantheon...Cade:)TM Can.maor's Li- ems,I.w does not apply to an owner ofprogeny who builds or hnp...ve,mefe0n,and QTY. PLUMBING PERMIT FEF, who contract,facwch prnbel,with a eoclaw nrL)liven"porsuan to the Commcmr, License Law. 2q - PERM]'TISSUANCE J• ❑Iamexent doS ,H&P C far do'nason A 12 --- QQQ--- ALTER-DRAIN&VENT-WATER IEA) VALUATION Owner —Da1c ORKE C M NSATION DECLARATION 11 , BACK FLOW PROTECT.DEVICE 2 D D Q O �rJJ Ghertby ulErm underpcn I,of get)tory One of the fo110wing Jedarmi.ns: El 16aveand will naimain aCer f:neof Censentmwlf-innurefnr Worker's Compcn- DRAINS-FLOOR,ROOF AREA,COED. STORIF TYPF.CONSTRUCfIOF .tion,as provided far by Sectio 700 of me LaMn Crde,for the performance of the /• d,rk for which this q:.it is Inst FlXTURES-PIiR TRAP � / ❑1 have and will maintain Workers Compensation Gnsumum,as required by Section (/ J 3710 of me Labor Code.for me perGmnence alike work for which this permit is issued GAS-LA.SYS'rEM-I INC.4 OUTLETS OCCGROUP APN My Worker',Ceatpenwtlon Inaumnce camO and Policy nanher ere: / Carrier: Policy No: GAS-F.A.SYSTEMOVER 4 HIM � � 32V CERTIFICATE OF EXIiMM ION FROM WORKERS' GR IN " GEPI OR COMPENSX'ION INSURANCE LUING DIVISIO _v E_S _ (Thi,section need not he mmpletW lfthepermit is ronme M1u.dreJ J.Ilarn lSlfN AP rw - orlesn.) PL NHL? O f V I certlfymat in the performance.fthe work far whichmispermit is i-med,I so 'WER-SANITARY-STO ant employ any pe,,air in any manna nn as m become xat,,,,m rho Werkcrs'Comp Y FEE �/� Oz nmion laws of Califomia.Date R R 2 Appliconn SO DING PGE NOTICE 10 APPLICANT:If,after making this Cenllicate of Exemption,y,m sh Id WgTIiH$YSTIiM/I'REATI 1 h ; become subject to the Workers Compensation provisions of the labor Code.you SOIIIS FF.F. Wf.Mwim comply with such provisions or this permit shall he do revoked, , TER SERVICE 7 z CONSTRUCTION LENDING AGENCY NEW RF.SIDFN SQ,FT. V 0 IMrcby affirm that there isuconstruction lending agency for Performance of W-luDine Re,xiptp the work fur which this permit is issued(See.3097,Ci,CJ O V 1<nders Name 2 GOT O Lenders Address TOTA r L S! 115 fy unify that 1 have rend this application and sta that the chose information in BUILDING I'FE 4 tF-t h correct.l agree to comply with all city and county ordinances and state laws relating.. QTY, MECHANICAL PERMIT FEE U Z building construction,and hereby aummize representatives olmis city to enter upon the SEISMIC FEEg, 9Q ab.vomemioned property far inspection par,"", 7_7 (We)agree t.save,indemnify and keep harmless rhe City of Cupertino against PERMIT ISSUANCE . himiliries,judgramrs,costs and penwswhich may in any way acerae against said City ALTER OR ADD'TO M CCH, PLUMB mcmtsequcnccaftbe"mo g this permit. APPLIC T ON)ERS L N AND W GLt.COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.1X10 CFM) / z� Mli' NI LItF co SOU EKE:UI ¢PION. AIR HANDLING UNIT(OVER 10AX)CFM) Cffr C'HO AX ignam tu of aN rot Doc FXHAUS'r HODD IW/DUCq HO INCA '[G 10 E HAZ R US MATERIALS DISCLOSURE Wi 11 the applicant r arc building nccupant,mre or handle hazardous material HEAT]NO UNIT CFO 101000 B'TU) ns def neJ by au ca o lunicipal Cato.Chapter 9.12,and the Health and Safety Code,Section 25S1F(e)? / HEATING UNIT(OVER 100,01X1 FORD Yes L7Na VENTILATION PAN(SINGLE RES]Of PAID Data Receipt g Will the applicant ar rutm'e building:ccupent use equipment or devices which 11011-ER-CONI'(LIP OR I W,IXI(I IITU) r coat nutations air commmium s as defined by the Bay Area Air Qualily Management Drarial � BOILER-COMP(OVER 1(0,0(X)B U) ❑Ye, Bae AIR CONDITIONER I have mad the hazatdoux mar ids rcyuircments under Chapter 6,95 of the Cali- ' ISSUANCE DATE Toronto Hcalm&Safety Code.Seninn/8505,8533 aM 8574.1 utdemm�d that i(me NEW RESIDENTIAL MECH. SQ,FT. 3 4 building e[liot en0y have:�te t,mut it i,myrestram"Iility mnetify the occupant or thea pure e s uhi!tmmt Ft poor to issuance uLa Ceni6c:mof 4c p�ancy�. agcn I aT tel TOTAL:"SSUED BY: �P OFFICE