S 3089 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUDAI NC-ELECTRICAL PIiR lI NO
BUHJANC DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL, � 3089
BUILDING PROJECT IDENTIFICATION
LI2GAI)DRIiSS: � le714 [� / P12 r SANITARY NO. AI'I'LICAIION SIIifhf l'I'IA1.UA'II
�4gA1/CC./v 14 �� (/1�/� CONI'RACI'OR'SNAME: CNO'.
NIC CONTROhM
Itr
ARCHITECT/ENGINEFR: LIC NO: ADDRESS: ❑
` w�,•HONIi: RUILDINC PER NFO
7 J/c)S/ ❑ Consultant Fees Paid by Applicant(Initial) yLpa tLEc' PLUMB MliCll
5S— OO N ❑ ❑ ❑
LICENSED CONTRACTORS DECLARnl'ION QTY ELECTRIC PERMIT FEE
1 hereby affirm that 1 am licensed under provision,of chapter 9 aotmneneing JOB DESCRIPTION
Z with Section 70010)of Division 3 offs, oCode.Husins and lhofesNons Ce.and my license is RESIDEL:
NTIA
W O_ in full lours,send effect. PERMIT ISSUANCE ❑SFDW I, El KITCHEN REMODEL,
Fesp
Q Ur, License Class Lick APPLIANCF'_S-RESIDENTIAL ❑ADDITION ❑PTUMBING RE-PIPE.
vFi Q
Q. Dara Conrmem,
ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT []STRUCTURAL
zoccz public
I understand my plansshall be used as records MODIFICATION
UPT0200AMP5
O_W (3 INTERIOR ❑SWIMMING PO I-
FNf'u] Licensed Pndessiunal 201-IWU AMPS IMPROVEMENT C]SWIMMING I'OOIS
C S4 OWNER-BUILDER DECLARATION OVER Kali AMPS ❑BAt'H ODlillltlil'AIR ❑DEMOLITION
Q I hereby afforded 1 am exempt from the Comment,Liceme Law for the
X 3 C U fdkwang reason.(Section TID I.S.Rosiness and Professions Code:Any city or county SIGNS ELECTRICAL lel+
tll ti which requires a pcnnit to constrom,alter,improve,demolish,or repair any structure 19
F�0Q prior to in issuance.also requires the applicant for such pennluo file a signed structural SPECIAL CIRCUITIM ISC.
FWy- that he is licensed pursuant o the provisions of the Comraaor'a License l.aw(Chapter 9 Id-
�CO� (commencing with Secron 7000)of Division 3 of the Business and Professions ColcOa TEMP.MEFER OR POLE INST. COMMERCIAL:
a a c C that be is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BI.DG/ADUi EON ❑DFMOIA PON
NSection 7031S by any applicant for al smut subject,the applicant to a nail penalty of POWER DEVICES
FZY
not more than Ea
rive hundred dollu ($50). ` ❑TENANT [D FOOD SERVICE
�=Q ❑ Las owner of the property,or my employees with wages as their ode compensation, SWIMMING POOL ELECTRIC \ IMPkOVEMIiN'I'
N will do the work,and the sencome is out intended orol'1'ered for sale(Sec.9014.Brim... ❑OTHER
W3 co and Professions Code:The Contractor's License Law does not apply to an onvncr of OUTLETS-SWITCHES-FIXT O
Furtively who builds or improves thereon,and who does such work himself or through
his own etaplayms,provided that ouch impmvemmuts are not iintruded or )nvrvd for NEW RESIDENTIAL .R 'Q
role.If,hevvece,the building nr intpr.wan.al—old within one Yre,of cornpletior,the 'C
own—buildcr will have the tounica of,pi-vingdidh did notM1 11 or improvefor Per-
Rose A
1 ). 6�
❑ 1,mu.nerel Ih poo,dy,.,,I elur,ively contracting withI J coldriecons to
construct c pro,ect I.o "1044 Ii : J I : C o )Ih C t t :1'- �)
I t Iplyf Ip p ty 1 b 'I I. p tM1 J QT U I ER FEE 19 8
who' t t:l ...li, dtrunl tn(.H,2'el ntlInthsCramnm NOV 05
Lx PERMSSDANCE
(] xwtiptundcr Sac. ,B&PCI
rRAIN&VENT-WATER(EA) VA I.UA PION
O:nc - _
WORKiilt'.' OA ISNSAUONOIiCI.AIIAUON
M1 AC ,)W PR(YI'EC'r.IJIiv ICli
r7I[",,bynlRrm under penalty of p,rjury on.ol'Ihe Od'owing dee ancien
Ihuv vnJwilllnninwinvC,niOcatcnf ConscnnosdGins rclisr Wnrkar's Cot RAINS-FLOOR,ROOF,AREA,COND. STORIES '1'YI•Ii CONS'IitUC'I'ION
.svtion,as provided for M1y Section 1901 of Ibc LuhnrCndc,for the If nonce n
work far which lM1is Ixrinit is iee'ucd. FIXTURES-PER TRAP
1 have and will maintain Workers Colopen.solion Insurance,as required by Section
371X1 of the l.alsn Code.lot he perliennmce al the work lot which link perint is issuul. GAS-EA.SYSTHM-1 INC.4 OUT S
My Workers Contltensation Insurance carrier and Policy Intruder sere: OCC.GROUT' AVN
Cartier: Policy Na,; GAS-EA.SYSTEM-OVER 4 ,A)
CERTI171CATI:OF EXEMITION FROM WORKERS'
COMPENSAI]ON INSURANCE GREASOINDUSTRL W EINTERCEPTOR
(Th— ce
Tion ndmn they oplmcl Hire permit I,Raise,hundred dollars($100)
BUILDING DIVISION FEIiS
or less.) GREASE TRAP
I'LANCIfIiCK FEE
(certify that
Person heperform:otceo flacas
work become subject
Perthe it Workers
Con,Nn- SEWER-SA ARY-STORMEA.2001T.
Oholl
employ any nifonia:my manner xn us et Mcnn¢whj,a.the Workers'Compen- IiN13RC•YIIHi
z. Applicant WATER of Culifnmia.Data
O WATER( ATER N'/VEM1T/F.LECfR
Z Q Applicata GRADING LIFE
y NOTICE TO APPLICANT:If,after making this Certihcam of Exemption.You Shaul) WA SYSTEMTREATING
? become whj sci to the Workers Compensation pmvisinm of the Labor Code,you must SOILS IEE
forthwith comply with such provisions or this permit shall he deemed revoked. ATF,R SERVICE
L
U Z CONSTRUCTION LIvNDING ii, mAGENCY NEW RESIDENTIAL rLMB. SQ.FT PAID
C.7 IherebYmErm lbaOMreissnd(Ser.onl,nCis.agency for the performance of Umc Rattipta
the work for whim this permit is issued(Sec.3097,civ.C.)
Lenders Name TOTAL:
IxnderI Address TOTAL:
y I certify that I have toad this application and state that information above infoatinn is BUILDING FEE
Tr, emrem.lagmcset comply with all city and count'ordinance,and ,are laws Mining ns QTY. MECHANICAL PERMIT FEF.
f>Z buildingcomtmclion.and herebyawbrree representatives ofthiscity tocaterupnn the SEISMIC FEE
above mentioned property for inspection purryues. PERMIT ISSUANCE.
(We)agree lesave,indemhomeless nify and keep haless the Cryof Cupertino again. ELECTRIC PER
li ilt .judgments,costs and expen,s which may in any way accrue against viJ City
i van ce sedan grunlir,of this 't. I ALTER OR ADD TO M ECH. PLUMBING FTE
PPL((ANT UNDE STANDS AN) LL COMP s W ITH ALL NON-POINT AIR HANDLING UNIT(TO 10,(W CFM)
OR( :IEGULATIONS. MECHANICAL.THE
AIR HANDLING UNIT(OVER 10CFh1) CONSTRUCT ION TAX
tore of ApplicanUCanlren Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION ITIi
HAZARI )US. ATERIAIS DISCLOSURE
Will the applicum ar fawn buildir,occeprnanvor handle bamnlous mmmial HEAnNG UNIT(TO KRTI1013T
as defined by the CaNnlno Municipal Calc,Chapter 9.12,and the Ilmlth and Safety
Cole,Section 25532m) HEATING UNIT(OVER Ir, 1 eTU) ��
[]Yu ❑Nn PAID'
VENTihA'1'ION FAN 1 .GEF,RHSID) Dote Receipt 0
Will the applicant or furore Building by the B use Area
Air Qcleu or devices which
mit hamnluue tar mntvnuname ns Aclincd by the Buy Arm Air Quulily Manngcnwyd BOILER-CONI'-Hp OR I W,fXXI H'N)
18 Distrin' 'I'IYIAI.:
0Yu 0 N HOLLER-94 P(OVER IW.W)RTU)
iv rmA the banndous nuneriulx ronpi mnmmx under CFuptur h95 of the Cuii- AIR C DITIONER
ISSUANC
e Ii IJA'I'li
in He hM1&Sufwy Calc.Seen i 25. 533 n l 2.5534.1 undcuamtiled if the
It dda, o u.t,r,r n11,1a,ratv.:it., t s.ry ro,,san, illy RnunilytM1ctampm0 NEW RESIDCNTIAL MECH. SQ IT.
'there ra Is which muxl he'I l 11 11accele 11nm of
O anammi,cal agate I DIIc TOTAL' Issulf)BY:
OFFICE