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S 2459
---APPLICANTTO-FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-If ECTRICAL PIiRMI'1'NO. BUILTi1NG DIVISION APPLICATION/PERMIT PDIO PROJECT IDEKOFIC .2459 BUILDINI:PROJECT IDENTIFICATION BUIIAINGADDRESS: SIyVtiR�IJO. APPL/TIOUBMIT .�TE -27 OWNERS NAME: TONE: CONTRACTOR'S NAME: LIC NO: / O NIC CONTROL# �J RCH1TECTIE GIN LIC NO. ADDRESS: ❑ CON'T'ACT: l PHONE: BUILDING PERMIT INFO CJ ❑ Consultant Fees Paid by Applicant(Initial) BLU ELECT ILII_ MECH LICENSED CONTRACTOR'S DECLARATION J QTY ELECTRIC PERMIT ITE JOB DESCRIPTION �/ 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing o00 with Section 7")of Division 3ofthc Bminessand prefcscions Code.and my license is R SE IDENTIAL' fD O p PERMIT ISSUANCE �� F�LyE in full force and eBect. #$FOWL pKRCHEN REMODEL QUU License Class Lic.x _ APPLIANCES-RESIDENTIAL []ADDITION 0PLUMBING RE-PIPE b-z W Dae Contractor w Q P. [IMULTI-UNIT ❑STRUCTURAL F y ARCHEII ECI'S DECLARATION PANELS z I understand my plans shall harmed as hlic records MODIFICATION c z- Pu UP TO 260 AMPS C:1 INTERIOR [I CHIMNEY REPAIR W Licensed 11 lc.....nal 201-1005AMPS IMPROVEMENT (]SWIMMING POOLS i iaa ' OWNER-BUILDER DECLARATION OVER 11q AMPS El RIiMODEVR1iPAIR pDHMOLHHON C ef I hereby affirm that 1 me exem th mpt froe Cwaawrwr's License Law lin Inc S U fallowing maw,.(Section 9831.5.Business and Professions Coda Any city or county SIGNS ELECTRI p OTHER li1'�+LL y which requires a permit to conswet,alien improve,demolish,or repair any,rucmrc Irme m ars ismance,also waimis the applicant for such permit m n file a signed muteent SPECIAL CIRCUITIMIS . IF '04 F Y J that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 O (commencing with Sieben 7")of Division3ofthe Business and Professions Code?or TEMP.METER OR IYILf:INST. R I Q.d y that he is exempt therefrom and the basis for the alleged exemption.Any viola......... SO BLDG/ADDITION ❑DEMOUTION XmoN Section7031.5 byanyaPPlicon.forapermitsuaisna the applicant l..a civil penally at POWER DEVICES NANT FWD SERVICE t more than five hundred dollars($51X)). IMPROVEh1ENT fxG pl,os owner of the property,armyemployers with wages as their sole compensation. SWIMMING I'OOI.ELECTRIC p. will do the work,and the sunaure is not intended or ssffered Wasale(Sec.1044,Brunde []OTHER 63 and thade,xlons Code:'rhe Cmunions Liccmc Law docs not apply ,,anownerof OUTLETS-SWUCHES-PI%TURES properly who huilds or improves thereon,and who does such work himself or through his ovin employers,provided Ihm such improvements are not(mended sir ulfered lot NEW RESIDENTIAL.HLEC!'k SQ FT. sale,lf.forever.the bindingor improvement isauld wilhlnone ycal.conaplmi..rs,tlm SQ.FT.FLOOR A`13/p x �U/SQ.FI( : nerhuilJcr will have the harden of proving that he did not build or improve for par- e�_1Cryj�% rr L ?,2_z 1.of ruled. 1.asowner ofteeproperty,amexclusively carbonate,Co licensed mmerce, m T` a,ma the project(Sec..an Business and Pmwho bud Cade:)The Cs th..ad. nd cense Law Jces sol apply to an owner of pmpeny who builds orimprovn menton.and QTY. PLUMBING PERMIT FEE who contracts for such projects with a commands)licensed pursuant to the Conttuadoes License law. PERMIT ISSUANCE. e �� #1am xm n er c. .B&IsCfrtni, a sant ALTER-DRAIN&VENT-WATER IF VALUATION Owns Date O IIECLARATIO OW ROTECL DEVICE WORKER'S COMI'f per I N BACK FL P ©� ,w,,.,I,sLerchy affirm under penalty of perjt ry one of the following dmlumtinmc. I have Jaid will maintain a Cerlin,acol Cunodd lovcll'-in sure fe WmkeT',Coin rin- DRAINS-FLOOR,ROOF(AREA,GOND. STORIES l'Yl'ECONSTRUCTION snlinn,us pnwiJeJ[ar ey SCttinn 391X1 of Ina Lobar Cuda fonhc perlormanec of the //-- 0�' ark for which this permit is issued. FIXTURES-I'ER TItAI' El I have and will maintain Worker's Cnmpensalion Insurance,a%required by Section 1700 of the Lahr Code,for the performance of the work for which this permit is issued. GAS-EA:SYSTEM-I INC.J OUTLETS OCC GROUP �/ API4S7ZY My Wmkcrs Compematiun Irro m er artier and Policy number arc: / Y f .J 1 Cartier: ]'..toy No.: GAS-EA.SYSTEM-OVER 4 BiA) CERTIFICATE OF EXEMIT10N FROM WORKERS' GREASF/INDUSTRI.WASTIi INTERCEPTOR V 1-3 COMPENSATION INSURANCE. BUILDING DIVISION FEES (This section need not be,completed ifthe Permit is Toren hundred dollars is 100) GREASETRAP PW NCHECK FEE or less.) I certify that in me performance ofthe work forwhich this permit is und.l shall SEWER-SANITARY-STORM P.A.29)Ff. not employ any Person in any manner so as in wean subject or the Workers Compun- f?NCRGY FP.E z ,mann Laws of Califamia.Dam WATER H HAIER WIVBN1'/ELEC1'B z O APplknnt GRADING FEG NOTICE TO APPLICANT.If,after making this Cedifiram of Exemption,ynu should WATER SYSTEMORHA1'INC, SOILS FEE F^ l,mmm subject to the Workers Compensmion pwvuradn of the Lidan Code,yutnnusi forthwith comply with such provisions or this Permit shallM deemed revoked. WATER SERVICE e— I' UO CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMR. SQ.FE PAID Date Receipts I hereby affirm mat mem is a construction n lending agency for the performance of D. H the work far which this Permit is issued(Sect 3091,Civ.C.) Lenders Name TOTAL: D.) lender's Address TOTAL: U tis I cenifythat 1 have read this application and mate that the alive information is ItU11.DING FEF. E-' !'n corren.l agme to comply with all city unA ttmnry ordinances and sm¢lass relining us QTY. MECHANICAL PERMIT FEE SEISMIC FEE Q Z building construction,and hereby amhor,aarepresentative%Ofm,s City rot enter uponds abuva-memicard pmpcny far inapeclnn Purpow, ' PERMIT ISSUANCE (We)agree 1.save,indmnnBy and keep harp less the City of C.'e'lino again, i' ELECTRIC PE6 linhll'nies.judgments,caste and expenses which may in any way arras against slid City ALTER ORIiCll. PLUMBING FEE me m.ea,were of the graminitof this Fermin x AP'.IC T UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HAND G N11'(11 )CFM) / MECHAMCAL FBE O SO 10' . y AIR HAND UNIT(OVER Ie, CFM) CONSTRU TION TAX Ignamreol' pplicanUCocard racmr Da EXHAUST D( HOUNNGMITIGAtiv N FEE HAZARDOUS MATE PALS DISCLOSURE Will the applicant or furore building cupam store ur M1andlehmardom mmmal . HEATING 1 IT(TO IIXLIXNI PTU( as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? , / . HEATING T(OVER 100000 BTU) C]Yes VENTILA PAID Date Receipt le Will the aplilow.,❑Imre budding occupant use equipment or Acvhxs which BOILER-COMP(.1HPOR 100,00013TU) 40 it hazarJnua air mnmminame ns JchneJ by the Bay Area Ar Qualify Munugenlcml ).,earl! ..,,..ww BOILER-COMPPOVER IIX,00011TU) p Yes Dec) Ihave read the hamdous mmerials wituiremems under Chapter 6.95 of the Cul,- AIR CONDITIONER ISSUANCE DATE f..mia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL.MECH. SQ.FT. buildir,d not currently have a tenant,that it is my wsPniflaltry to nor the mcupamnat currently have a tenant,mat it my resPniflal try.notify the occupant 1/ of the s s ich m met 'or to i.auartce of a Crabber, j c y. act or Ifullhofired agent TOTAL: b ISSUED BY: OFFICE ,o. V aaaa z t- t- A LL: Eyi Q' a. aaaaaaawmmcLa. a. aa (Lw aaaaa. wwo. aaa as N N I N N N M N Cl) M M M N N M N m N N N N Iq N (N N N M �C. 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