30512APPLICANTTO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL PERMITNO. .30512
BUILDING DIVISION APPLICATION/PERMIT PLUMBING -MECHANICAL.
FEE
0
20-
I
RF_SIDENTIA ....o
❑SFDWL
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El KITCHEN REMODEL
❑ADDITION -
CONTACC PHONE:
❑MULTI -UNIT
- ❑ Consultant Fees Paid by Applicant (Initial) _
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT
'0000
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section0000)ofD"'on3'fine
IMPROVEMENT
Business and Professions Cede. mnf{my license is PERMIT ISSUANCE
n full force and effeq. 'J'7
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LidenseC Lick D•7
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Dam APPLIANCES -RESIDENTIAL
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ARCHITF;CTS DRCLARATION PANELS "
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1 understand my plans shall be used as public meoeds
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. UP TO 200 AMPS
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Licensed Professional 201-100(t.•,......IttI
OWNER-BUILDERComON OVER I" AMPS
6
I hereby affirm that 1 am exempt fromm thee Cor nmructor's Licence Law for the
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following moron. (Section 7031.5, Business and Professions Cade: Any city or county SIGNS ELECTRICAL '
which requires a permit to construct. alter, improve, demolish, or repair any structure50
priorto its issuance, also requires lhcupplicant forsuch permit to file a signed statement SPECIAL CIRCUITIMISC.
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that he is licensed pursuant o the provisions ofthe Conuanars License Law (Chapter 9
(commencing with Section 7")ofDivismm 3 of the Business and Professions Cole) or 'f EMP. MEIER OR POLE INST.
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that he is exempt therefrmn and the basin for the alleged exemption. Any violation of
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Section 7031.5 by any applicant for a permit subjects the applicant to e civil petmlly of POWER DEVICES
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not mart than five hundred dollars (S50tp.
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Las owner ofthe property, or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC
will Bothe work,and Nesuucmee isnot inteoadmoiffmcd for ade(See 9044. Brainxs
and Professions Code: The Contractors License Law does not apply to on owner of OUTLETS -SWITCHES -FIXTURES
..
property who builds or improves thereon, and who docs such work himself or through
his own employees. Provided that such improvements an, not intended or offered for NEW RESIDENTIAL F.LECIR SQ FT.
sale. If, however, the building or improvement is sold within one year of completion, the
owner -builder will have the burden of proving that he did not build or improve for par-
pres, of -
TOTAL:
C]11, asownerof the propeny, um exclusively contracting with licensed momentum to
commuct the project (Sm. 7044. Business and Professions Code:) The Comraetors Li-
neLaw does not apply manowner (if property who builds or inipmms thereon,and- QTY. PLUMBING PERMIT
who contmets for such projects with scohaamor(s) licensed pursuant to the Conuucmrs
License Law, PERMIT ISSUANCE
❑ 1 an, exempt under Sec. , B & P C far this reason
ALTER - DRAIN &VENT- WATER (EA)
OwnerDate
a\ WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT. DEVICE
1 hereby affirm under penalty of perjury ane of the following declamation: -
❑Iheve and will maintains Certifimm of CodecnIto self -inure far Worker's Cumpen- DRAINS- FLOOR, ROOF AREA, CON
nation, as provided for by Section 37M of the Lobar Code, for the performance of the
works for which this Permit is issued. FIXTURES - PER TRAP
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
37M of the labor Code, for the Performance of the work for which this permit is issued. GAS -EA. SYSTEM -I INC.4 OUTLETS
My Wort -ofyte�fs i Hasan yrsntrierand Policy nytNJ /Fyll� — - GAS -EA. SYSTEM -OVER 4(EA)
CCPolic
urrier: G l� y Na: �e}'T1 T _ _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASMNDUSTRL WASTE INTERCEPTOR
(This soman held at he completed lithe permit is Forane hundred dollars($ 100)
or less.) GREASE TRAP
I cenify that i n the performance of Ne work fin which this partial is issued, l shall 'SEWER -SANITARY -STORM EA. 200 PT.
not employ any Person in any manner so as to become subject m the Wurkma Compen-
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nation Laws of California. Data WATER HEATER WIVENTIELECTR
Applicant
yNOTICE
TO APPLICANT. IL Inc, making this Certificate of Exemption, you should WATER SYSTEM/TREADNG
abecome
subject to the Worker's Compensation provisions of the labor Code, you must
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foMwith comply with such provisions or this permit shall be deemed revoked. WATER SERVICE,
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMIL SQ. PT.
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(hereby union that there is a construction lending agency for perfermanceof
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the work for which this permit is issued (Sm. 3097. Civ. C.)
Lenders Nome
WLenders
Address TOTAL:
-
information
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1 modify that I have read this application and state that the above is
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correct. l agree to comply will all city and county ordinances and state law., relating to QTY, MECHANICAL PERMIT
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building conswction, and hereby authorize representatives ofthis city to enter upon the
above-mentioned propmy for inspection purposes. PERMIT ISSUANCE
(We) agree m save, indemnify and keep murder, the City of Cupertino obi int
liabilities ,judgments,cuatsandexpenses which mayin Y. 'ityuccueagainstraiCity ALTERORADDTOMECH.
in mnscqucntt of the erantin8 of this pewit.
APPLICANT 114 RST fGS AND ILL., MP WITH ALL NON -POINT AIR HANDLING UNITfTO 10,000 CFM)
SOUI�j'W}' r r -
AIR HANDLING UNIT (OVER 10,0011 CFM)
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Signanineal ApPlicandContoure 91e EXHAUST HOOD (W/DUCT)
HAZARDO 1ATHRIALS DISCLOSURE
Will the applicant or tutu wilding occupant store or handle havardous materiel HEATING UNIT( TO 100,000 BTU)
as defimad by the CulminaM icipal Code. Chapter 9.12, unit the Health and Safety
Cade, Section 25532m)? HEATING UNIT (OVER 100,000 BTU)
❑Yes E] No
VENTILATION FAN (SINGLE RFSID)
Will the applicant or furore building occupant use equipment or devices which
canttremendous air ntaminants az defined by the Bay Area Air Quality Management BOILER- COMP OHP OR 100,000 BTU)
co
District? BOILER - COMP (OVER I00,M) BTU)
❑Yes Fl No
I have read the htmrdou.c materials requirements under Chapter 6.95 of the Cali- AIR CONDITIONER
foods Health & Safety Cada Sections Z5505.25533 and 23534.1 undcrsuM that if the NEW RESIDENTIAL MECH. SQ. FT.
building does nit formally have o tenant, that it is my responsibility to unify the receptor
of the requirements which most he met prior to issuance of a Certificate of Occupancy.
FEE
0
20-
I
RF_SIDENTIA ....o
❑SFDWL
.. ..v..
El KITCHEN REMODEL
❑ADDITION -
❑PLUMBING RE -PIPE
❑MULTI -UNIT
❑STRUCTURAL
MODIFICATION
❑INTERIOR
❑CHIMNEY REPAIR
IMPROVEMENT
El BATH REMOD•
PA OIgljMOLITION
DOTHE
GCT
COMMERCIAL:
❑NEWBLDG/ADDITION ❑DEMOLITION
❑TENANT - ❑ FOOD SERVICE
IMPROVEMENT.
❑ OTHER
SQ. FT. FLOOR AREA
V 4a
I
FEE SEP 131996
BUILDING DIVISION FEES
PLANCHECK FEE
ENERGY FEE
GRADING FEE
SOILS FEE
PAID
Dole Heceipak
TOTAL:
BUILDING FEE '
FEE SEISMIC FEE
ELECTRIC HE
PLUMBING FEE
MECHANICAL FEE
CONSTRUCTION TAX
HOUSING MITIGATION FEE
OFFICE
PAID
Data Receipt
TOTAL: