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31075 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL. - � PERMIT NO. 31075 1075 APPLICATION/PERMIT BUILDING DIVISION PLUMBING-MUCINNICAI. BUILDING PROJECT'IDENTIFICATION ILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATI W NAME: s PNONE: RACT(Rt�NAM woN/C KESCONTROLp ARCHITECT/ENGINEER; LIC NO: A S: \\P V D ❑ �gy CONTACT: PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG EL PLUMB M vets"� ❑ LI ENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE 1 hereby affirm Nat I um licensed under provisions Of Chapter 9(commencing JOB DESCRIPTION OM with Section700q.f Division 3ofthe Buslnessind PmfessionsCMlemid my license is Ti PERMIT ISSUANCE in full force and t. ❑SFDWL ❑KITCHEN REMODEL Lice las Lica APPLIANCES-RESIDENTIA1. - ❑ADDITION ❑PLUMBING RE-PIPE a COmmemr ARCHITECTS Oi,ddia ATION ❑MULThUNIT ❑STRUCTURAL Z O�Z I enders.. n 0 s be used as public recants PANELS MODIFICATION OZ..� - - UP TO NO AMPS ❑INTERIOR [I CHIMNEY REPAIR Y.4I Licamedlm vl 201-IOIp Ah1P5 IMPROVEMENT G C 6 OWNER-BUILDER DECLARATION OVER EKXI AMPS ❑BATH REMODEUREPAIR (:)DEMOLITION y '1 hereby trip.that I am exempt from the Convectors License Law for the u O a U following reason.(Section 7031.5,Business and Professions Code:Any city or county SIGNS ELECTRICAL (.]OTHERY7 a0 which requires a permit to conswet,al¢p improve,demolish,or repair any structure priormim issiance,also requiresthe applicant for such permittofilea signed statement SPECIAL CIRCUIT/MISC. } that he is licensed pursuant o Ne provisionsofthe Contractors license law(Chapter9 <C) (commencing with Secrion70110)o1'Division 3 ofthc Business and professions Code)or TEMP.METER OR POLE INST. COMMERCIAL' 6 q o�• that he is exempt therefrom sad the basis far the alleged vacations.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION a� Section 70315 by any applicant(a,a pante,subjuts the applicant.civil penalty of POWER DEVICES 4WmLEfNANT ❑FOOD SERVICE y�ynotmom thanrivehundred dollar,(55000 IMPROVEMENT OC31,as owner of the property,nrmyempinyees with wages as NeirsOle compensation, SWIMMING POOL ELECTRIC will do the work,and the structure is not intended o,.1fa ed for sale(Sec.7(04,Business ❑OTHER 3 and Professions Cade:The Convector's License Law does not apply in an owner of OUTLETS-SWITCHES-FIXTURES property who builds or improves thereon,and who does such work himself or through his own employees,provided thus such improvements me not intended or offered for NEW RESIDENTIAL ELECI'R sale.If,however,the building or improvement is sold within one year of a+mpktiore Ne SQ.FT. OyWI ?rb LSQ.Fri. owner-builder will have the burden of proving that he did oat build or improve fur Pur- XY y (� pose of sale.). p-/j Q I,as owner of NAR e property,am exclusively contracting with licensed contractors to TAL: 1 consumer the project(See.7044,Business and Protestant,C .)The Comr curs Li- K canse Law does not applymanownerofproper, ]a.build..,imprave,damon,vad QTY.. PLUMBING PERMIT FEE city who contracts for such projects with acontratua 7 licensedpureuanuo the Contractor's License law. PERMIT ISSUANCE ' �V�`a 1✓'�,yV - ❑IamPas exemptunderSee. ,B& Cforthisreon fyV Owner Uate ALTER-DRAIN&VENT-WATER(EA) VALUATION WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE V a 1 hereby affirm under penalty of perjury one of the following declarations: I love and will maintain a Certificate of Camentto self-insure far Worker's Compo- DRAINS-FLOOR.ROOF,AR EA,COND. SMIU& TYPE CONSTRUCTION ` station,as provided for by Section 37M of the Labor Code,for the performance of the work for which this permit is issued. FIXTURES-PER TRAP ❑ 1 have and will maintain Worker's Compenmtion Insurance,as required by Section 3700ofrhe Labor Cole for the perfomwnce ofrhe work for which this permit is issued. GAS-EA.SYSTEM-1 INC.40UTLEIS OCC.GROUP APN My WO e C Im mote tinier and Policy art's / Carrv}ltb XPolicy No.:\s)7•e w`ll GAS-EA.SVSTEM OVER 4BA) . CEkTIFICATEOF EXEMPTION FROM WORKERS' GREASPIINDUSTRL WASTE INTERCEPTOR COMPENSATION INSURANCE. BUILDING DIVE Its (Thissection ratednot becnmpletedif Na,minit is fooaehanJredd.11cosSI010 GREASETRAP or law.) PLANCHECK FEE 0� I certifytha in the perfonnanceofthe work for which this permit is issued,I shall SEWER-SANITARY-STORM EA.20111`77. a.,ma,m,any person in any manner so w to become s.bjeeno Ne Wm1mrs'Compem ENERGY ME Z ,Z' station Laws of California.Dane WATER HEATER WNENT/ELLC R O Applicant GRADING FEE tr In NOTICE TO APPLICANT:IL after making his Certificate of Exemption,you should WATER SYSTEM/TRFATING abecome sold.,to Ne Workers Compeasm cos provisions of the Labor Code,you most SOILS FEE f47 forthwith comply with such provisions or this permit shall be daemon revoked. WATER SERVICE z O CONSTRUCTION LENDING AGENCY NERESIDENTIAL PLMB. SQ.FT PAID � Receipt p I hereby.ffirm thaubere is a mmwction lending agency far rhe performance of T the work for which this permit Is Issued(Sec.3097,Civ.C.) 0 h lenders Name TOTAL : ELenders Address TOTAL: 96 1 certify chat 1 have d N ve reais application edtunt nsNot Nrm e above infoation is BUILDING FF.E - VJ coma.I agree to comply with all city and county ordinances and smte laws relating to 'QTY. MECHANICAL PERMIT FEE V?; buildingcansvucrion,and hereby undamize representatives ofthis city tocnlerupon the SEISMIC FEE above-mentioned property for inspection purposes. �Ixs Is PERMIT ISSUANCE (We)agree to save,index ntly and keep homdcss the Cityof Captain.against ELECTRIC FE �^ s,judgmentsee rants and expenses which may in any way ame against said City ALTER 0RADDTOMECH. in consequ of the granting of this permit PLUMBING APPLICANT ')ERSTANDS AND WI6L COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO I0."CFM) MECHANICALVF 5)URGE REGI' IOSI.� (' yYT\\VkVVr7t. 1•\\.aN-t AIR HANDLING UNIT(OVER 10,000 CFM7 CONSTRUCTIONT Signature eamlContmctor Data EXHAUST HOLD(W/DUCT) HOUSING MITIGATIO E HAZARDOUS MATERIALS DISCLOSURE Will the.pplicantorfuture building ucupamnareorbandle hmarmas materiel HEATING UNIT 00 IDB,O(O BTU) m defined by Ne Cupertino Municipal Code Chapter 9.12,and the Health and Safety Code,Section 25532(.)? HEATING UNIT(OVER 100,000 BTU) ❑Yes, ❑NO - VENTILATION PAN(SINGLE RESID) JPAID Ruc tX Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP GHP OR 101000 BTU) TAL: DistfiuY ❑Yes ❑Nn BOILER-COMP(OVER 100,0101 BTU) read the hicardous materialsregrommenu under Christ,6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE' Omia HcaIN' Safu CMe,Sections 25505,25533 and 25534.1 undelcound Nor if the NEW RESIDENTIAL MECH. SQ.FT. ildmR Joea not tly lav mnvnt,than it is my responsibility to notify Ne oeeupanr '�. e mluiremenu hot s prior to ofaCenif to of Occu Y. Owner nru ed agent -Date - TOTAL: ISSUED BY: )aWN OFFICE I .