B 01447 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPRRTINO BUILDING BIN .-MECHANICAL
PI7RM1 1) n
ItUIIAINC.DIVISION APPLICATION/1"ERMIT PING PROIEL7IDENXFIFIC so"
BUILDING 1'RO1P:6T IUFSI'IfICA'1'IUN
BUILDING ADDRESS: SANI'T'ARY NO. APPLICATION SUBMIITAl.HATE
104g0 � � o7AR_A C 'k)(t,,t 1
(lWN" #AMG: n C 756_152 VOTfN PHONEIt)@'S AME: LV✓✓k rJ lry�- LI-1.E(� .O
1` L rG NIC CONTROL#
1 ARCHITECfIENGINEEk: LIC NO'. ADDRESSA ❑
2C H�Ix� r Amo eFU q"�0
CONTACT. PHONE: BUILDING PERh11T INFO
❑ Consultant Fees Paid by Applicant(initial) ISLDG El FCCr PLUMB Vey
❑ ❑ ❑
LICBNSEDCONfRACTOR'S DECLARATION QTY ELECTRIC PERVHT FEE
1 hereby affirm that 1 am licensed under pnwilimml of Chapter 9(commencing JOB DFSCRIPTION
DMZ with Section 70001of Division Sof the Business an�d P1ronfes1si-on(s1.Cede.0.and my license is PIiRF11T ISSUANCE NCC Ra'1DFNTIAI
W-b- in full force and eticGN/ r I V 3(r / V FDNI, ❑KITCHEN REMODEL
aUU License Clay. (% CSS IJ<.M �/ AI'I'LIANCGS-kCSID13NT1A1. ❑ADDITION C]PLUMBING BE PIPE
i-Z w Dee Cunlmc
m Q a ❑A1UhTI-0NIT ❑STRUCTURAI.
ARCHITECTS FECIARATION
Z~O y z I unda,u n l my plwmxshall he used se public tcunds PANELS MODIFICACION
Z.4 UP'B)200AMPS
Oat, ❑INTIiRIOR CHIMNEY RI?PAIR
F=.�FW Licensed Prolec,imeil 201-1003AMPS IMPROVEMENT (]SWIMMINGPOOLS
OWNER-BUILDER DECLARATION
icd --t OVER I"AMPS BAT EMODEUREPAIR ❑DEA101ITIQN
C C Q I hereby affirm that 1 um exempt from the Concis tors License Law for the
3 LL U following renu n.(Section 7031.5.Business and Professions Cale:Any city or county SIGNS ELECTRICAL HER
14
y�0Q
h which scrams a ,.air,e m dsmah.alter,improve,demolish,or repair any structure
y..l pr In.,... I4 e r, io mf hpe a 6 Jaemenl SPECIAL CIRCUIT/MISC.
man -r d I m p nn t l r License Law Icnaper9
W, C Ieonmeneag with Sector 700(nof llvivo 3tf the Hm'ne and Not esmon,Code)or 11C I,MIs
'M OR POLE INS'il COMMe GIAL:
e.a e C that he Is exempt Iherctiom and the ba.i,Ior the alleged exemption.Any violation of ❑NEW BLDG/ADDITION El DEMOLITION
X-y Section 7031.5 by any applicant for a pmmit subjecl.v the applicant to a civil penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
n mom than five hundred dollars(55Uo). IMPROVEMENT
F-?Q ❑ Lox ox.ter of the pmpeny,or my empinyec,wilM1 wages as their uric compensation. SWIMMING POOL ELECTRIC
will do the work.and the structure is not intended m 01
offered for sale 74,Business DOTTER
13 Le and Professions Cede:'Me Contractor's License law Joe,not apply to an owner of OUTLETS-SWITCHES-I'IX'1'URFS
property who builds or improves mereon,end who does such work M1iayself nr though
his own employers,provided that such malmocincntt am not immhdnl of o0crd for NI?W RESIDENTIAL 1?hl;C'IR SQ FI'.
sale.If.M1owc,,,me hoilJing or imrynl
pnctneixsold witho
inore yurfconithetion,the SQ Il, AREA A/SV�IcI'.
er4mader will have the burden of proving that he did not build or improve for pur-
po a of sales. TOTAL: MAY 19 1999
❑1.as owner of the pmNny am exclusively contraafng with licensed contractors to
construct the proper(sec.7011.Business and Professions Calc:)The Cnntmetnrs Li
-
cenwLawdoesnotapplyu)an owner of pmpery who builds or improves dames.and QTY. PLUMBING PERMIT FEE
who contracts fm suet poseas within conwanrcx)Lceawd pmsuam m the Coarcts,
License Law. PERMIT ISSUANCE By
[-I 1 at exempl under Sec. .13&P C ha Ibis reesou
ACGiR-DRAIN&VFN'I-WA]ER(EA) VALUATION
Owner Date
. WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE
I hereby affirm under penalty of perjury one of the following declarations: U V
I have and will maintain aCcnlfcaaor Comm...self-ince he for Workers Cnmpen- DRAINS-FLOOR,ROOF.AREA.GOND. STORIES TYPE CONS'1'kUCTION
ration,as provided for by Section 3700 of Ne Labor Cede,for the perfomanec of the
work for which'his prount is ismd. Fi XTURES-PER TRAP
t>14turve and will natintain Worker's Compensation Inxnrance,as remptird by Section
3700af lbe Labor Cole,for the perfnmeewolhewlink for which lhi,vennit is acted, GAS-I:A.SYSTEM-I INC.401JTLETS OCC GROUP
My War Cninpunsalina Ins are n 1 Pulley number urn I
Cl It p,fey No.: A\1nA0U d-2�-21 GAS-HA.SYSTEM-OVER 4(EA)
CI?R'IPICA' 1 TE OI'7 E_XXEEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASEANDUSTRL WASTE INTERCEPTOR BUILDING DIVISION IiP
(This section red not M compinper
W if the mit is feature hundred dollars($I W) GREsSETRAP
nr less.) PLANCHECK EGG
I eenify that in thcperformancc of the work for which this permit is Imud,l shall 51iW I?k-SANITARY-STORM F.A-2(X1 FT.
not employ any pct 'in any mc Vjeer ,,he Work...Camper- ENERGY FEE
Zi xmlun hew Ca untturp� .Dal I1yc(7 WATER HEATER W/VHN'Id7J.CCTR
C
Applievm--�t a 2(T — GRADING PEE
NOTICE TfNSIT CANT:IL after making this Cenilica a of Exemption,you should WATT?R SYSTEMTRGATiNG
become subject the Workers Cnmpunemien provision,of the Labor Cdm
Code you el SOILS TEE
5: mw
forthwith comply isilhsuch previsions or this permit shall be deemed revoked. WATER SERVICE
aO
z Receipt#CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLNIB. SQ.ET. PAID
7 Ua
U O 1 nereny arum mm at Iteis a ean,trntian tending aseney fa he perrnm,anec of
the work for which minn x penis issued(See.3097,civ.C.)
W Lender's Nave 'IY)TAL:
U Lender,Address TOTAL:
>. 1 certify that I have rend this application and.state that the aMtve information in BUILDING PEE
tat/) correct.l agree to comply with all city and county ordinances and stale laws relating to QTY. MECHANICAL PERMIT FEE
C.7 Z building construction.and hereby authmim representatives ofthis city m enter upon the SEISMIC FEE
... above-memichd property far inspection purpmcz PERMIT ISSUANCIi
(W,agree to save.indemnify and keep barriers me City of Cupertino agaiml 36 F.LECTkIC IEE
Iiahilities,Juigmmais.costs and expenses which may in any w'ay theme agaiml said City AUILR OR ADD TO MFCI I.
mequcnce of the granting of this permit. PLUMBING FEE
tAPPLICANT I 111m.RS'rANDS )Will.COMPLY WI'TII Al,h NON-POINT AIR HANDLING UNIT'fro 10,OW CPM)
MECHANICAL FISH
SOU ?RGC LAHONS.
! � r AIR HANDLING UNIT(OVER 10,WOCH,) CONSTRUMON'1'AS
Sig o[ApplicanUCommmor D9a' EXHAUST HOOD(W/DUCT) HOUSING MITIGATION ITE
HAZARDOUS MATERIAIS DISCLOSURE
Will the applicant or future building occupant time Or handle hazardous material HEATING UNIT(TO 101.100 BTU)
as defined by the Cupcnino Municipal Code,Cbapmr,9.12,and the Hedlh and Safety
Cods,Sector 25512(.)? HFADNG UNIT(OVER 100,001 BTU)
El Vcxo
VI?N'ly OLATION PAN(SINGLE RESID) PAID Dart kcccipm#
Will the applicant or future building occupant use equipment or devices which
emit la,in ous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(3fIP OR 100.000 BTU) To vd.
District, BOILER-COMP(OVER 11X1,1100 BTU)
❑Yes XNo
I have read the h Vandoon,mmcrials ismoncmcna under Chapter 6.95 of me Cult- AIRCONDITIONER ISS DANCE DAT
litmia Health&Sammy Cale,Sections 25545,25533 and 25534.I understand that lithe NHW BESIDES TIAL MUCH. SQ.PT.
bhiliingda:xn,�humadlyh: ulmenl,Ihul it ix my esprnubilily rarity tlm weeper
,fit ego.ir xwhicht lube shekpdnrino,main,cora Cenificae of tc'I't,vwhicht sibs shelttdnnno,main,cofe Cunifieue of tc'I't,v.
)>Vf oramounted agent Da TOTAL' Q ISSUED BY:
OFFICE