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99070060APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY q V74" OF CUPERTINO BUILDING - ELECTRICAL DIVISION APPLICATIONIPERMIT PLUMBING- MECHANICAL BUILDING PROJECT IDEN'1'D'ICATION PBRMI FBIU'ILDIN(; DING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE 7-Z7Jt'S NAMN� / PF{ONI� C RACI(IR'S yA1NF.: � ^ L alk l`-h/.Vwu1'^ig YW' V NIC ❑ CONTROL# ITECT/HNGINEER: LIC NO'\',M•�—u_T,-, ADDRESS:# Qva D� COM'pCf: PxorvE: BUILDING PERMIT INFO //rr f 4&.7 C�, p, ❑ Consultant Fces Paid by Applicant (Initial) BLLDDG/ ELECT PLUMB MECH e iL - ❑ ❑ LICENSED CONTRACTOR'S DECLARATION 1 nerenr air mol 1 am EeeneJ nodes pmviriwna „r enapmr 9 (ewmmenemg Bmi.xand P...l'ucm ioCode, and my license is th Senior WXXuof ion3ofthc ne fmccandclie ' y�5 f'j'� 1i<e is I tic # �P ,�•`-'L�J Uare Contras 0I4a01 ELECTRIC F QTY PEEE y0 Z YU�.full QUv _QL 7th jyZ Z— �F-'(Cif U .J C 6 'Ca U a y whicM1 �ef y}`I C0� a c LL N E=C F Wl ,� se L JOB DESCRIPTION RESIDENTIAL' ❑SFDWL E] KITCHEN REMODEL CIAADDDITION El PLUMBING RE-PIPE LYMULTI-UNIT ❑STRUCTURAL MODIFICATION ❑INTERIOR ❑CHIMNE\'REPAIR IMPROVEMENT SWIMMING POOLS REMODEUREPAIR DEMOLITION ❑OTHER /sj PERMIT ISSUANCE APPLIANCES- RESIDENTIAL ARCHII'EC'I'S DECLARATION l understand my plansdadl he used as public records PANELS UP TO 200 AMPS Licensed Pmfcssiunal OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Conlmtor s License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county reyuims a permit m nmstmn. aper, improve. Jcmolish, or ¢pair any nmaurc prior to if, issuance, also requires the applicant for such permit to filen signed.aiterecm Nat be is licensed pursawn to the provisions of the Contractor's license Law(Chupmf9 (commencing with Section 7000)of Division 3 within Business and ProfasZ., Code)or (hal he is exempt the¢mfm and the basis for the alleged exemption. Any violation of Secdnr 9031.5 by any applicant for u permit suhNcls the applicant ext u civil Penalty of not mom than five hundred dollars ($51X1). Las owner of me pmpcny, nr my cmployces with wages as their sole compensation. will Jo the work. and the structure is not intended or offered for sale(See704, Business and Professions Code: The Contmnm's License Law does nal apply to as owner of property who mi Ids or improves memm, and who does such work himself or through hisown employees, provided mat such improvements arc not intended or offered for 201-1000AMPS OVER ["AMPSE]BATH SIGNS ELECTRICAL SP12CIAL CIRCUIT/MISC. l7 TEMP. MEIEROR POLEINST. COMMERCIA ❑ NEW BLDG/ADDIT[ON E] DEMOLITION ©TENANT ❑FOOD SERVICE IMPROVEMENT ❑OTHER IIOWI',R DEVICES SW hIMING''"s MC"fRI 0 ,BTS-SWITCHCS-FIXTUR r r as N V R�SIDEKI1AL`P.LECfRj �w FT sale. If.however. the building or improvement is sold within one year ofeempletionthe will have the burden of proving thus he did not build or improve for pur- t SQ. FT. FLOOR AREA $/SQ. FT. pusnerbuilder s of sola). ❑ 1, as owner of the propcny, am exclusively contracting with licensed contractors to td construct the project (Sec. 70b1, Business and Profeoions Coude:) The Contractors Li- nae I,aw does not applyn) an owrer of property who hueds or improves Person, and QTY. PLUMBING PERMIT FEE who contracts four such pmjcelu with a contractors) licmtsed pursubt to the Contractor's PERMIT 1 UA 'E License Law. Cl l am exempt under Sec. , B d P C for this mason ALTER- F.N'1'-WATER (EA) �ncr Date VALUATION O O O WOR nder poCOMPENSATIONn'l,mon Df;CLARXI IONlowing (hereby affirm under penalty of perjury one of me following declaration BACK PLOW PROT T. DF. CE DRAINS- Fh(IOR. ROOF, COND. Workers...mpen- I have and icaforbyineCcoi 3700 of he LabtoCore, for the for by Section 3]1X1 of Ibe Label Gdq for the pcdnrmuncc of the vvti k 1 as hick this work Ga which tills ix Lvorker STORIES TYPE CONSTRUCTION �� FIXTORES -I'ER TRAP 1 have and will maintain Worker's rairodt Insurance, required by Section 37 earlemeation ]](lo(f me lsborCMe. for n Insurancehe canner and work forwhichane, permit is issued. h My Worker's Cwmpensalinn Insurance sanies and Policy number um; GAS -FA.SYSTF.M1LI INC. 40UTLLTS OCC.GROUP Crosier: PNn; OAS-P.A.SYS'T'EM-OVER4[EA) CF;RTIFICATF, OF EXEMPTIONION FROM WORKERS' y GREASFIINDUS'fftL WASTE INTERCEPTOR z z O y �> c Q U COMPENSATION INSURANCE ❑Tis sectio need not be computedame permit is for one bundfpd"mums0$100) nr Ices,) I certif thmi lbw pert to cul thew okf�r which this [#omit is issued., shall not employ an pe m n any ran n r s s to S e subject to the N'arteri Com solar Laws. If ti Dm _I pro- A Pisano Pp BUILDING DIVISION FEES GREASE TRA(' LANCHECK FEE SEWER -SANITARY-STORM EA. 200 FT ENERGY HE WATIik HEATER WNENT/ELf:CTR GRADING FE NUPICI? TO APPhICANT: IL uRer m' this Ccoilicam of F,awoumn, you should bcrome svbjecno tM Wnrkcrs Compe on tams Binns of me Labor Code, you must forthwith comply with provisions to this permit shall be decmcd revoke], CONSereUCT... ].ENDING AGENCY I nor by agency fonhe perfnnnunee of hi lb i>aco)Scv. WATER SYSTEM/1'REATING SOILS FEE WATER SERVICE PAID l �7 Dat Be Iptp NEN' RPSIDF.NTIAI. PLMB, SQ, FT. � f-' Ill Fy 3nlenJing which emit i the work for which this pennil is issued) (Sec. J09], Civ. C.1 Lenders Name 'DOTAL: BUIL .E Lnnda''s Address TOTAL: 1 cenify that 1 have read this application and state that the above information is QTY. MECHANICAL PERMIT FEE Le, U Z correct. l agree to comply with all city and county ordinances and stain laws relining m building conatm lion. and hereby imposture representatives of this city to enter upon the SEISMIC F: shove-memioncd propmty for inspection pmposcs. (We).,or, ,, save, indemnify ..it keep carries, the City 0f Catacomb against PERMIT ISSUANCE ELECTRIC FE liabilities.judgments, costs and expenses which mayinany way acm.eagainst said City in asequence of the gramin, of this pcomit. AIXER OR ADD NMECH. PLUMBING E AIR HANDLING UNIT (10 ly0WCFM) APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT SOURCGREGULATIONS. MECHANI LFEE AIR HANDLING UNIT (OVER Io000 CFM) CONSTRUCT( TAX Signatum of AppliewboCiamemr Dale HAZARDOUS MA'I HRIALS DISCLOSURH EXHAUST HOOD(W/DULTI HOUSING MITIGA ION INE HEATING UNITCIO 100.00 BTU) Will lhe.pplieanterfuture building ucoagantaoreorhandle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety Code, Section 25532(a)9 ❑ Yes D<N,, HEATING UNIT (OVER 100,000 BTU( VENTILATION FAN (SINGLE RESID) Will the applicant mfurore building occupantyAe. Air Quordeviceswhich use basalso air containment, as defined by me Roy Area Air Quality Mabgemem PAID Receipt p � BOILER- COMP3HP OR 100.000 BTU ( ) No TOTA h: BOILER-COMP (OVER 100.000 BTU) AIR CONDITIONER materals requiremcma ouster Chapter 6.95 ofthe Cali- VEI BI 25505. 25533 and 255]4. 1 unmrsmntl that if the tuns my mPomibilityt n ufy tecupwlofe met grit 'awancc of a cea�fi m of tk panty. V Z L 06 ISSUANCE DATE NEW RESIDENTIAL MECH. SQ. FT.but ISSUEDBY: J Owner or anme"ed agent _ Dam TOTAL'. OFFICE