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B 0600APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERT[NO BUILDING-ELEMR1, RQ PERMITNO. Anr BUILDING IDIVISION APPLICATION/PERMIT or n nLu n 1,I.NGFllF.C11ANICAI. S0001 FJ ©[�• v `� `� `� I - mrvrm�treTum r CIII'I'[CI'IGNGINIH!R: LIC NO: ADDRESS: ❑ COrACT. t ( (� PHONE: BUILDING PERMIT INFO CV It 7 �^ i63 -7o0 $ ❑ Consultant FeeS Paid by Applicant (Initial) DLIH ELeCf PLUMB LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE I hereby aliinn that 1 am licensed under previsions of Chapter 9 fau.ncing JCIR DE$CRI ION "WZwith Scnion7W0)ofDlvisianJ of me Bu.Nincss and PrnfcNNiona Coac, and my license i. FOO PERMIT ISSUANCI! RESIDENTIAL; In full lbrce and effect. SFIWI, O KITCHEN REMODEL �Ou License Class Lic.M Fzw Dale CommerceAPPLIANCES- R[SIDCNTIAL DITION [I PLUMBING RE -PIPE wGa MULTI.UNI'r El STRUCTURAL F O m Ar shall F.CPS DECLARATION PANELS Z O n? I understand my piens shall be used as public rt,nns MODIFICATION OZ—A UP TO 2(lAMPS ERIO E] CHIMNEY REPAIR r. W Licensed Professional 201-IIk10AMPS PRO .. ENT E] SWIMMING POOLS �Y�s? OWNER -BUILDER DECLARATION OVER 1000AMPs ORA I�DEUREPAIR El DEMOLITION 66'' �� 1 hereby affirm nn that 1 am exentpl from the Commcmrs License law for the ��' xGx O a V following mind. (Section 7031.5, Business and Profusion Code: Any city or county SIGNS IR.1! ICAI, k �� W 3 W T- which requires a permit to construct, alter, improve, demolish, or repair any stmcturt AQ prior tune iasaance.nlso requires lbe applicant rarsucb permit fileasigad statement SPECIAL CIRCUI SC. Mi�y y that he is licensed pursuant to the provisions of the Contractor's Licmme Law (Chapter 9 E (commencing with Section7000)m'Division 3ofthe nosiness and Professions Coke) or TEMR METER OR POLE. li Il p¢ that he is exempt therefrom and the basis for the illegal exemption. Any violation of ./ADDITION ODEMOLITION XyN SearM,7031.5 byaayapplicaut forapermit subjects lheapplicanno acivilpenaltyof POWER DEVICES [1 TEN ❑ FOOD SERVICE WFZY not mom than five hundred dollars (1500). IMPR VL ❑p dQ i]I, as owner of the proPcry,ormymn,d,ris with wngesos their sola contpensmion. SWIMMINGPOOL ELECTRIC ztCs�. willdnthcwork,endlhe ntrucmrearol intendedoroffemd for.... t....]IIM14, Husines> OTHER W 3 m and Nor ..in., Cole: The Control License Law does not apply m an owner of 01 TLE'1S -SWITCHES - FIXTURPS property who builds or improves tWo mn, and who Jas such work himself or through his own employees, provided that such improvements are not intended or offered for NEW RESIDENTIAI. HLECfR FT. ,are If, however, the miiliin, orimpnrvemem i.asMd within one yamofcormlefal,the FLOOR ARTA $ISQ. FT n cr-midder will have The burden of proving that be did not build or Improve far par- of Fnh.). r of the cc. 70,1 am exclusively moaning Cur] licensedcontmrmm - TA anstrvcl theeproject (Sec. o an Business and Professions ds or Tan arra srtr.cmFN Li - 1, i whse law a«a not arrlrwwowna of property who hauda or imtimv,N mereon,and Qty, PLUMBING PERMIT � FEE o cnntrocn for such mnjecu with a unntmcmr(s) licensed pursuant m the Gmwctorx License Law. PERMIT ISSUANCE ❑ I am xcmpT under Sec. , B ffi P C fur this reason . ALTER - D IN&VENT-WATER TEA) VAI. ION mer Date ORKE 'S COMPS TION DECLARATION BACK FLOW P OrECT. DEVICE ) py the aby affirm under penalty of Perjury nn, of the following declarations: �Ihpvc and will mannan a Cendleme of Consent to sell' -insure for Worker's Compen- DRAINS XULY, ROOF,AREA, CONI). S,ORIE TYPEC S3 UT'I( ._.:Iration. as Provided for by Section 3700 of the Ia so Cuba. for the performance of the sol, for which this permit is issued. FIXTURES -PER ❑ Phos and will maintain Worker's Compensation Insurance, as required by Section 37(Mlol'the Larso Code. forlhe performance ofthe work forwhich this tiered, is issued. GAS-EA.SYS'1'EM-I . O LHIS OCG.GROUP My Worker's Compensation ]asumncc carrier and Policy number art: Carrier. Policy Na: GAS -PA. SYSTEM -OVER 4(EAT CERTIFICATE OF EXEMPTION FROM WORKERS' GREASEANDUSTRI. WASTE INTERCEPTOR 7 COMPENSATION INSURANCE BUILDING Ill S N FEES flhis section need not ro completed lithe permit is forma, hundred dollamI$ Karl GREASETRAP or last.)PLANCfIGCK PGH f I certify that in the parfo..nacof the work for which this pertainsissued,I shall SEWER -SANITARY -STORM EA. 200 CO. not employ any person in any ms rner.so as to become subject to 0e Workers' Compere ENERGY FEE O z lou on laws of CaGfomia. Data WATIiR HEATER WNENDELECfR GRADING FHE T. O Applicant q y NOTICE TO APPLICANT If, arm, mulamg this Certificate of Exemption, you should WATIiR SYSTEMO REAPING a hecnesubjecl to the Worker's Compensation provisions of the Labor Code, you muss SOILS PEI: m forthwith comply with such provisions or This permit shall be deemed revoked. WATER SERVICE 0 �z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB SQ PT PAID construction Rcc t L% a I hereby anion that there is a consction lending agency for the tierfndrarce of ILFhe work lie whichthis permil is ke,rd(Sea 1097, Civ. C.) T 1. Lentos Name Linters Address ICTAL:BUILDING IEE eF^' 1 crafty that 1 have read this application said state that the prove information is h central. l.,mr to comply wire all city and county entrances andstam laws,.].nogm QTY. MECHANICAL PERMIT FEE V z building construction. and trembly authorize repres,mmives.fdr, city Incineration the SEISMIC FEF. H rhose-«nnoned prpeny forinspeelien Pnrpmes. (We) ag.c dm see, indemnify and keep handless the City of Cupemo against PERIOD ISSUANCE BLHCTRIC ;ii Iiabiblics,judgreenls. costs and expenses which may in any way same agmad said City ALTER OR ADD TO MECH. PLUMBING FEE in APPLICANT oftheginning of tANpermit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINI AIR HANDLING UNI-I'(TO 10,000 CFM) MECHANICAL 'E $ SOURC' GULATIONS ^I 5 N AIR I IANDLING UNI 'I'(OVER I(0y) CFM) CON$TRG )N'FAX Signature oIAppliru.mCo.'—t r Dee EXHAUST HOOD (W/DUCI') HOUSINC.IITIGATION TIE IIA%ARDOUS IERIAI S DISCLOSURE Will the applicant or future building«cupamsuncor handle Turnabout ..,coal HEATING UNIT (TO 100,000 BTU) as delined by the Cupertino Municipal Cade, Chapter 9.12,mal The Health and Safety Cade. Seale. 25532(.)" BEATING UNIT (OVER I II(laill [it ❑Yes []No VENTILATION FAN (SINGLE RESID) PAID Will the applicant or future building occupant use equipment or devices which nthhmanlues air nnn.minonds es Achncd by the Huy Ama Air Qaulhy Management BOILER-COMP((IIP OR IT70,(XO BTU] 91nRin'7 BOILER -COMP (OVER 100,fU) \ ❑Yes ONo I base read The hmardons materials mr,uhcmcnts antler Chapter fi 95 of and Cali- AIR CONDITIONER Him I 1 U A Turner health & Safety Core, Sections 25505, 25533 and 25534. 1 understand that if the NEW RESIDENTIAL MECH. SQ. 19'. ' building One, not tonically have. Teruo, that it k my respnsi nbllity m notify Ibc« oupmn of the mends, i mnstbemcTPfiormissmnceuf.Cv of Oar P c Owner ora onizeda m ode TOTAL: Y OFFICE