B 0425 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL I'F.NNII'I'NO.
RUICiiINC.DrvISIDN APPLICATION/PERMIT PLUlIRINGMECIIANICAI. '}g
I4.....ING PREGuEcr IDENTIFICATION
• BUILDINGADDRESS'. SANITARY NO. APPLICATION SUBMITTAL.DN
ionsC-:�Gs s-Z��
OWNER'S NAME: YHONl CONTk O�NA� /�� D�(� l
9 C/ NIC CONTROLN
'BITECI'/' NEER: LIC NO: Psbgox
S
33301- 4,&,- ❑
CON'I'AC'1': PHONE: BUILDING PERMIT INFO
❑ Consultant Fecs Paid by Applicant(Initial) BLDG IiLECT PLUMB NtL'❑CH
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE LrJIO
hereby affirm that 1 am licensed under provision.of Chapter 9(commencing JOB DESCRIPTION
w0000 with Section 7")of Division 3 of the Business and Profa.ioas Code,�ilty bcense is PERMIT ISSUANCE RESIDENTIAL:
F W_ in lull force anti t. 04 �9 6 ❑SFDWL ❑KITCHEN RENIODEI
n'O F Li<cnce CI\s J O Lic.p
6 V APPLIANCES-RESIDEN'HAI. []ADDITION DPLUNIBI.N'G RE-PIPE
NQ6 Dalc Loc , m
A HITECTS DELL ATI ❑Ml1LTl-UNIT ❑STRUCTURAL.
zc.z I uwlectmd my Piens shallMusedmP erase PANELS MODIFICATION
OZ41O UP 102U)AMPS [I INTERIOR ❑CHIMNEY REPAIR
F�.F',lV Licensed Promsirand 201-1000AMPS IMPROVEMENT E]SWIMMING TOOTS
I hereby affirm th��amexempt ER DECLARATION
Contractor's License law for the OVER 1000 AMPS ❑BATH REMODEIIREPAIR ❑DEMOLITION
yx 3 LL F hallowing rcuson.(Sectimn 7031.5.Business and PrafeW...Cale:Any city or county SIGNS ELECTRICAL ❑Of HF. ^
W Ovs which require.a permit m colonial.alien,improve,demolish,lir mpmr any amemrc /l 7 �
F.. 6 prinnoia izsuana.alm meyuircs the applicant Rrt such permit In fie asigneJ smtemem SPRCIALCIRCOIT/MISC.
Fi2 y-` that he is licensed pursuant m the provisions of the Connector's License law(Chapter 9
=%'x070 (commencing with Section 70NoofDivikion 3 of the Business and Professions Coda)m TEMP.METER OR POLE INST. COMMERCIAL:
a
WHO
C Not he is exempt therefrom and the basis bar the alleged exemption.Any violation of ,W BLDG/ADDITION ❑DEA101,ITION
•_y Section 0031.5 by any applicant for v permit subjects the applicants a civil penalty of POWER DEVICES ANT DFOOD SERVICE
num Five hundred dollars($500).
F Z ot I R
S6 D1,a.s owner of the pmpert.or my employees with wages-as their.sole comperouinn, SWIMMING POOL ELECTRIC :MI:NT'
lz will do the work,and the structure is not intended or offered for sale(Sl 00.14,Business 'I HER
3 m and Professions Code:The Cmuamis License law does not apply to an owner of
property who build or improves Iheram,and who does such work himself orOUTLETS-SWITCIIFS-FlXTURIiSthrough
his nwn employee,,provided he,such imp ce,on.F bre nm intended cr offered fist NEW RESIDENTIAL PIECE R SQ IT.
sale.If.however.the building or improvement is sold within one yearof completion,the SQ.FE FLOOR AREA S/SQ.ET.
owner builder will have the burden of proving that he did not Wild or improve for pur-
prose ofsale.).
D I,as owner of the property,am exclusively contracting with licensed cnnttactots to TOTAL'.
construct the project(Sec.](N4.Business and Pmfosions Code:)The Cmmi LI-
nsLaw does not apply toair owner otpropenywho builds orimproves thereon,and QTY. PLUMBING PERMIT FEF.
whocsm.-acLfor suchpro)acts with ucunceror(s)licensed pursuanttothe Comme, is
License Law. FLESH I ISSUANCE
❑ I me excmpl under Sec. ,B&P C for this reason
Owner Dam ALTER-DRAIN&VENT-s4'AI ER(EA) VALUATION
7�17� WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE O�"
I harcby affirm under penalty of Perjury one of the following declarations: /Q Os7
"Wof
ve uad will mamano u Carrificumof Consent to set Nitrate for Worker's Cooper- DRAINS-FLOOR.ROOK AREA.COND. STORIES 'TYPE CONS'I'kUC'1'I(
as Provided for by Section 3100 of the Latin Gde,fonho performance of the
r which this lw.it i.issued. FIXTURES-PER TRAP
d'will n:aimarm WaHe..r C alsdusmm.In.....ce.as returned by Section
the Latin Cade,for the{crLsrmance ofthe work for which this per it is issued. GAS-HA.SYS'HiM-I INC.J OU'TLE'r5 (X)C.GROUP APN
rk ' a as rt a l eQaace r and Policy nu _Policy No.: GAS-['A.SYSTEM-OVER J(P,A)
CERTIFICATE OF ;XEMPI'[ON PROM WORKERS'
COMPENSATION INSURANCE GREASEIINDUSTRI,WASTE,INIE CTI'TOR
(Huns sent,,.need not be completed if thepennit is marine handled dollars(SI W) BUILDING DIVISION FEES
CREASE TRAP
or lest) PLANCHF,CK PF.E
1 rectify therm in any manner arse week for widen t to theW is issued, mr1 qty'Sr'
SEWER-SANITARY-STORM EA.2W FT.
not employ any perm in any manner m as w becnmc subject m the Worken'Compcn- ENERGY FEE
Z .mlion tawsof Cortland..Data WATER HEATER WNEFELERZ Q Applicant
GRADING 143E
Uj NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you.sheuld a'+ WATER SYSTEMfBEATING r become subject m s the Worker's Compensation provisions of the labC de.you masa SOILS FEE
G forthwilb,mo,ly with mithprovismosmlhirpermit slialiladcemed revoked. WATER SERVICE
CONSTRUCTION LENDING AGENCY NIiW RISIDEN'f1AL PLMB. SQ.FII PAID
V I for
which thi that is.
sued(Sec.30 len ding agency Brnhe perfonmance of Hum ItttciPlM
fL F. The males bar which this per it issued(Sec. Civ.C.) p� /1. U�
Q Landers Name TOTAL:
WI<neersnden,s TOrAI.: /7G.93
y 1 oafily mat 1 have mad this application and sole that the ons,information is BUILDING THE / 7•0
N anren.l agmc u.umrply wnh all oily and county anlinances nnJ su¢laws rdaing to mQTY. MECHANICAL PERMIT FEE
V Z building eonstction,and heretho
hynurisereprescitudies oflhiscay t.enter upon the SEISMIC Dili
r0,
above mentioned pol for inspection purposes PERMIT ISSUANCE
(We)rafter,to are,indemnify and keep Females,the Cityof Capital..agairq ELECTRIC FEE 'Sys
Iiahililies,judgment,,coa.andastresus which may Mary way uceme ngainsl suid City ALTER OR ADDTO NIRCH. /
in emnegoence of the grantin,of lhi.permit. PLUMBING FEE 6th
SUBI.ICAE 'UERS N LI OMPLY WI 1.bLaON-POLYP AIR HANDLING UNIT TO IQINNICIM)
SOUItC EGG �� MECHANICAL IYIi
AIR HANDLING ON]'I'(OVER 10.000CFM) CONSTRUCTION TAX
more(Itinrmrxmr Data EXHAUST HOOD IW/MUCO
HAZARDOUS MATERIALS DISCLOSURE HOUSING ME FIGATION FEE
W 1l the vpplic
I., future building onvpanl.mre lir handle h:nn.dausmvmrial HEATING UND(10100.0N)B'1'U)
as defined by the Cupertino Municipal Csde.Chapter 9.12,and the health and Safety
Code,Sedan 25532(.)^ HL'ATING UNIT(OVER E KLWII BTU)
❑
year PAID's
VENTILATION PAN(SINGER RESID) Dea Rmcipt 4
Will the applicant terloran building occupancuse y Area Air
Managerial,
BOILER-COMP(3IIP OR IN).(IW BTU) `
nit hamnlous air cnnmminnnlr as defined by the Bay Ana Air Quality Mwagemcm TOTAL: 5,0,/.2<
i.IncG /
E]Yes BOILER-COMP(OVER 100,00OBTU)
I have nvd the huusrdow muteriuls is Is uuJa Chn lar 6.95 of the C.li- AIRCONDIT10NER
,25533" p ISSUANCIi DATE
fomite Health&Safety Cn Senions 25505,25533 anA 25534.1 undcmm�J thus it IM NEW RESIDIiNT1AI.MECH. SQ.FT. /�
buildingJwe urn torte arms ,th itlsmytep,,msibilit t pair
oftncrcP aen' tell6ccupW¢ys P
Ow er naad cot Data!Y TOTAL: ISSUED eY.��` lk�7�
OFFICE
G.R. ELLIOTT CONSTRUCTION
General & Electrical Contractor
P.O. Box 33301
Los Gatos, CA 95031
I - l (408) 356-0753
CA LIC. #404390
�, 1 � tA`�j �IAY 02, 1999
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el9G• SPEGTIONDEPARTMtN[
av OF CUPERTINO
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G.R. ELLIOTT CONSTRUCTION
wGeneral & Electrical Contractor
P.O. Box 33301
R�[� pp Los Gatos, CA 95031
_ n l RIF Fn (408) 356-0753
ObA 0 IC I �:14 T �AY O CA LIC. #404390
2 1999
1USSq �. �sr>� z-s '2 .
BLDG. ITY OF CUPERTINOTMENT
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