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99100029 IJ T:ICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY qq / coo I Y OF CUPERTINO BUILDING.-ELECTRICAL PE LI ,;.U11.DING DIVISION APPCA•PION/PERMIT PLUMBING MECHANICAL BUILDING PROJECT IDENTIFICATION . .UII.DINGADDRESS', - SANITARY NO. APPUCATI N ' BAR LOATE tCO�A�: /Yl cif `� la�PHyN': .. CONTRp(:IY14'$s NAWE: LIC NO:gigVNIC CONTROL. CND1 `IKX � 9.3 . 6LJ PHONE: W BUILDING PIiRMITINFO LJQQ•8&(0 ❑ Consultant Fees Paid by Applicant(Initial) BLDGELECT PPLLUUMB MEECCH NShb CONTRACTORS DECLARATION QTY ELECTRICPHRMIT FEE I • � - 1 homby ulfrm that I am licensed under provisions,ef chapter 9(commercial, JOB DESCRIPTION QOZ with Scclion ID00)otDivisinn3ofthe Business and Professions Code andmylimakic is RESIDENTIAL: FWD in Poil(orce and ellen. J`F`� PERMIT ISSUANCE ❑SFDWL ❑KITCHEN REMODEL �U� License Cl Lic.p APPI.IANCF.S-RESIDENTIAL ["z Q pW, Date Ctummemr ❑ADDITION [:1 PLUMBING RE-PIPE ARCHITECTS DECLARATION PANELS ❑MULTI.UNIT ❑STRUCTURAL 2O ZZ Iundenland my plana shall be once as public recoNs MODIFICATION toz--'O r,l UPT02MAMPS [I INTERIOR ❑CHIMNEY REPAIR I. W I-penud Professional 2 A .1 OWNER-BUILDER DECLARATION rfi IMPROVEMENT SWIMMING POOLS < 1 herchy uffitm Thai I;un exempt foot,the Comracmr;License W. k f IN [-]BATH REMODEUREPAIR ❑DEMOLITION O m UF ml4nving cenaon.(Section 11171.5,Business and I'rofessiotu Calc:Any cit &33 y S TOM []OTHER WWW 3 W N which cultures a permit to construct,allm improve,demolish,or repair any amtmu FLL0a Poor to its issuance,also requires the applicant for such perminn file a signed stat pF L T FISC QEduaheislicensedpursuant ar The provisions nithe Cnmmcmrs License Law(Chapotr R (commencing with Section 1000)of fe Division 3 ofthe Business and Prossions C, MP.M pR COMMERCIAL: d Qo a That he is exempt Therefrom and the basis fnr the alleged exeTnption.Any vlolxT tomf ❑NEW BI.DG/ADDITION ❑DEMOLITION Section 7031.5 by any applicant for a permit xubjmts the applicant to a civil pco�ia'II 1p IR LRI L.i ^res ❑TENANT [I FOOD SERVICE FZ not more than live hundred dollars($500).a E] 1 .s owner of the progeny,or my employees with wages as their sole in h 1 P 1 ' IMPROVEMENT �Fc will do the work,and the strtinurt ix mtinnndeJomReredfor sale(Sec. n ❑OTHER W"e9 and Powesa ud,Gate:The Commetor's License I.aw does not apply I a o r S S t R 3^' pmperry who huilds or improve,thereon,and who docs such work himself.nlnough601 PSI his own employees,provided that such improvements am am intended or offend for � NhW RESIDENTIAL RLECTR sale.If,however.the building or improvement is sold within one year ofcompletion,the SQ.FF.R.00R AREA $/SQ.FT. owner-builder will ravens:burden of proving thud he did not build or improve for To., posetfxowne 3 co 1,as owner of the pmpenm y,aexchTsively contracting with licensed coruors m TOTAL. tmwethe project(Sec 7044,Basins,and 11ufessiots Code:)Be Cmarxiors I.i t cense l.aw docs not apply to an ownerofpmperly who builds or Improves Thereon,mal QTY., PLUMBING PERMIT'. FEE SI�FJ who contracts for such projects with a contrmhods)licensed pursuanno the Contractor's License U. PERMIT ISSUANCE. ❑I am exempt under Sm. ,B&P Cfmnhun reason AT:[ER-DRAIN&VENT- . IEA) VALUATION tuner Z� WORKER'S COMPENSATION DECLARA'HON BACK FLOW PR(H'13C1'. C� _p 1 hereby eRrm ununderpcnnity of perjury Wool the following declarations: 46(��V ❑1laveand will m.intub.ConificateofConsom to self-insure for Workers Co.,.- DRAINS-FLOOR,ROOF,AREA,CON . STORIES TYPE CONSTRUCTION smion,ea Provided for by Section 7]W of the Labor Cade,for the performance of the 'ark for vo this permit is issued. 171XTURIS-PER TRAP have and will maintain Worker',Gnnpensution Imam me.u.a raptured by Section .fine Lubin Code.fnr The perfonnumceof The work for which This permit is issued. GAS-EA.SYSTEM I INC.40 6f5 OCC.GROUP AP�Nvf My Workers pcnsetingJylrarygcamc Put YNiocyt�' 8e11'r4yri GAS-EA.SYSTEM OVER 4(PAT Carries -!!YYIIJJAAIDIDJJ / �'^��' L �V CERTIFICATE OF E%EMPfIDN FROM ORKERS' COMPENSATION INSURANCE GREASEANDUS'TRI,WASTE INTENCF.PTOR 1Thi,wiaitimmed not be completed note T is fortune hundred dollars W) B1111.DING DIVISION FEES pcnni Gltl!AtiG TRAP orR .) PLANCHECK IIiE Loy any that inthe performance o the work for which this ThepermitWisissued,Ishad SEWER-SANITARY-STORM EA.200 FT. not employ any person in any manner a as to become subject To the Workers'Cumpen- ENERGY FEE Z Apron Laws of California.Date� WATER HEATER WNENT/ELECI'R O Applicnm GRADING FEE V) NOTICE TO APPLICANT:11;after making this Certificate of Cxempdion,you should WA'I'1?R SYSTEM(FREATING SOILS FEC a become subject at the Worker's Compensation pnwkions of the I.ohor Cade,you must W fonhwithctnnply with such pnn'isiu so,this pemtil shall be deemedcowilod. WATER SERVICE 0 CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. PAID VQ work for notion that issued(Sec.30lending agency for the performance of Date Recc p � T•w the work for which this pemtit is issued(Sec.709],Civ.C1 U Lenders Name TOTAL: L) Unders Address TOTAL: I eerily that 1 have read this application end unto that the choose information is BUILDING FEE V) comet.l agree to comply with all tidy and county nNirowees and state law.relmungm QTY. MECHANICAL.PERMIT FEE U z buiddmg construction,and hereby authorize representatives ofthis city Locator upon the I SEISMIC FEE above-mentioned prnperty dim itnpenim,purposes. PERMIT ISSUANCE(We)agree m save,naloc nd,and keep harmless Bte Cay of Cupertino against ELECTRIC F kabditics.judgmenn.co'sand expense sit Imay in any way uccmcagaimt said City ALTER OR ADD TO MECH. in comegpcam of the"amin$I� Ili mit. PLUMBINGF APPLICA ' N ERSTA GDS WILT 'Dist X WITH ALL NON POINT AIR HANDLING UNIT(TO 110.00OCfM) MECHANICAL 'L SOURCE ULATIONS. p/n� _ �� 1 Alli HANDLING UN1'1'(OVER 111,111x1 CFM) CONSTRUCTION TAX Signctur pplmanUCo meate IWHAU.STHOODIW/DUCT) HOUSING MITIGATION PER HA RDDUSSm TERIAL.S DISCI-OSDRG Willtheapplicanl At.,..buil ng occupant store or handle hmardous material HEATING UNIT TO 100,100 BTU) as&flood by the Cupenin unicipal 'Ne,Chapter 912,and the Health and Safety Gdc,Section 25532(x)7 HEAUNG UNIT(OVER 100,0100 BTU) ❑Yeses PAID VI!N'1'ILATION PAN SINGLE REST[)) PAID Receipts Will the applicant to future building occupant use equipment or devices which BOILERCOMP(JHP OR 100,0(10 BTU) it hazardcontaminants hazardous air as defined by the Bay Area Air Quality Managene - nl TOTAL: District? Ycs 3011.I!R-COMP(OVER 100,N)O RTI]) re ❑ ,'u��1'I I have ad the hazmdo1�/ Mocrials requirements under Chapter 6.95 of the Cali AIR CONDITIONER - ISSUANCE DATE four.health&Safety Cale,Sections 25505,25533 and 25534.I understood That if the NEW RESIDENTIAL.MECH. SQ.FL / duce f building nod camntly have a toren t. id is my respWilly cc onsibilitym lly the oupant /- ,/©— oftherequiremets;which must the met priorut issuance ofa Cenifcade of Occupancy. ((( Owner or authorized agent Dap TOTAL: ISSUED BY: OFFICE