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S0006 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL ") Ill cilia BUILDING PROJECT IDEN'I'IYIC'ATIUN BUILDINGADDRISS: SANITARY NO. APPLICATION SUBMITTAL DATI 'S Lot q� OWNER'S -7 f90 ^. FJ70 C ACTORS Ary _ � I.IC NIC CONTROLM ARCHRECT/ENGINEER: LIC NO: S 7 ADDRESS: /M7/r'�Y�L ❑ CONTACT" PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) I3L CCS ELECT PLUMB MECH L1� r ❑ ❑ LICENSED CONTandordr DECLARATION QTY 'ELECTRIC PERMIT FEE I hereby aRrm Lha I am licemed under previsions of Chapter 9(coenmeceming JOB DESCRIPTION �U2, with 5cction]IxMllnc Busincaa and x' dmylicenae is RESIDENTIAL: F O in fullfierce and eyes PERMITISSUANCE �� ❑SIq)WL ❑KITCIiEN REMODEL U U Liccme Lic.p QL Dam t Cammctor APPLIANCES-RESIDENTIAL ❑ADDITION E)PLUMBING RE-PIPE Dm ARCHITECTS DEC RATION PANELS ❑MULTI-UNIT ❑STRucTURAL Zz l underared my plane shall he used as public records MODIFICATION OZ C UPTO2WAMPS �/' F-Nf'm Licensed Prefc,sionA '6NNTERIOR ❑CHIMNEY RHPAIR HFI-IBBBAMPS 1�IMPROVEMENT WI 11NG POOLS ctl" 4 OWNER-BUILDER DECLARATION ❑' C C Q I hereby afro that 1 am exempt from the Contractor's License Law for the OVER 1000 AMPS ❑RATH RE -LJ ❑ .ITION X 34 F following reason.(Section 7831.5,Business and Professions Cede:Any city or county SIGNS ELIi01'RICAL ❑O� YI u.y which requires a Permit to construct,alter,intprme,demolish,or mplia any structure F�'Oa Puerto its komac.al.wrequirea Neappliconl forsuchpanni lofileosignt,il acream SPECIAL CIRCUITNISC. SE"' Baal he is homestead pursuant the Provisions ofthe Contractor's License Law(Chapter 9 gty0_q (commencing with Section 701))of Division 3 tithe Business and Professions Code) TEMP.METIiR R EINST COMMERCIAL: L C W Bhat he is exempt therefrom and the hasis for the alleged exemption.Any violation of ElNEW BLDG/ADDITION [I DEMOLITION m Section 7031.5 by any applicant fur a permit suhjeas the applicant is civil penalty of POWER DEV. ' F Z�• ail more than five hundred dollars($500). ❑TENANT ❑FOOD SERVICE C ❑I.as owner of the property,or my employees with wages as their sole compenmtion. SWIMMING LELE IMPROVEMENT will do the work,and the statement,is not intended or offered Our sale(Sec.](K4,Rosiness ❑OTHER Sand Professions Cimt The Continent's License Law docs not apply to an owner of OUTLETS-SW FS FIX property who builds or improves thereon,and who does such work himself or through his own employees,Invented that such improvements am nm intended or offered for NEW RESIDEN- R 1?. sale.IL hosannVr.the building or improvement issold within one year ofcompletion,the SQ.Ff.ROORA12yA $/SQ,FI'. err-builder will have the burden of proving that he did not build or improve for pun A ' poses eeleJ. ❑1,as owner of the property,am exclusively contracting with licensed contractors to �� construct fee project(Sm.704,11,Business and Professions Code)The Conuacnr.c Li- Y cense Low does not apply to an owner of property who builds or improves thereon,and QTY. PLUMBING PERMIT FEE ` j /IBpI� who commets for such projects with a contrecmr(s)licensed pursuant the Commctur's b s 6(' Liesuse 01 am exempt under See ,B&P C for this mason w. PERMIT ISSUANCE �IlY�fj- LurL tu oil) Owner hate N M211-DRAIN&VENT-WATER(EA) VALUATION J WORKER'S COMPENSATION DECLARATION HACK FLOW PROTECT.UIiVICE SF/M I hereby affirm under penalty of perjury one of the following decimations:kersCounted. .rfiLV ❑Laws pinvidl marry eCcrti3caw7W of Con sent self-Code,for the sce of the URAINS-tLIXIR,ROOF,AREA.COND. tion,este provided for by Section J]W of the Veer Code,for the perfnnnance of me STORIES TYI'li CONSTRUCTION as for which this permit is issued 171X'I'URES-PER TRAP ve and will maintain Worker's Compensation Insurance,as required by Section 700of the labor Code,for the pedon:Iance of the wmkfor which thisp Bis issuM. GAS-EA.SYSTEb1-I INC.4011TLLT5 OCC GROUP ANN M Work m t,y�y.u� tie rand Pudic ala that(���z^^^ Cli nerd in " IJcarrie Policy No.: -��(/ ,J— GAS-EA.SYSTHM-OVER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE OREASEBNDUSTRL WASTE INTERCEPTOR (This section need Brat becumpleted if the pemul is for onehundmd duffers($100) BUILDING DIVISION FEES m less.) GREASE TRAP PLANCHECK FEE I certify that this,meed is issued,i shall 517 W ER-SANITARY-STORM EA. 17. not employ any perum in any manner so as to become subject to the Workers'Compen- ENERGY FEE 0 Z within Laws of Date WATER HEATER WNENT/ELF,CTR Z Applicant GRADING FEE h NOTICIi TOILAPPLICANT: after making this Certificate of Exemption,you should WAITER SYST EM/TREA'I'ING a ; become subject to the Worker's Cmer,acaum Provisions of the Labor Cude,yue..,at SOILS FEE foMwith comply with such provisions or thio permit shall M deemed revoked. WATER SERVICE CONSTRUCTION ONLENDINGAGENCY NGW RESIDENTIAL PLMB. SQ.FT. PAID V 0 l fare which foe that ski isacedSce.30 len ding agency for the performancc of D eceiptN tr the work far which this pcmul is issued(Sec.J(19].Civ.C.) 0 fs Letter's Name TOTAL: Lendcr' AJdress TOTAL: I' Z) certify o c I have read this application and stem tam the arm information dining is RUILUIN r Z coered.lagree toaemply withallordinances insmlatingm QTY. MECHANICAL PERMIT FEE V Z building nmawclion.and hereby emhoeiss rephsematives n(this city to enter upon the SEISMIC above-mentional xmparty for inspection purposes. PERMIT ISSUANCE (We)agree to wive,imlemnily,and keep harmless the City of Cupertino agaiml ELECTRIC FEE fiabildice.judgmem,custsand expenses which ren y way attmeaguimlaaid City ALTER OR ADDTO MECH. me onsequence of the grenting of this permit anPLUMBING FEE APPLICANT ON �)iRST/yVDS WICALL NON-POIMI' AIR HANDLING UNIT(TO IU,0100 CPM) SOURCE RE 'I 55 MECHANICAL iG AIR HANDLING UNIT(OVER 10.10x)CFM) CONSTRUCTI TAX Signa hof A,pIaamA` B ate EXIIAUST HOOD(WMUCO HAZAR .'MATERIALS DISCLOSU HOUSING MIT FEE Willmeapplicvm orN m building occupant stertor handle hicadous material H17ATING UNI'1'(TOIW.(NX)BTU7 as defined by the Cupcnin unicipol Code,Chapter 9.12,and the Health and Safety Code,Station 25532m)? H17ATING UNIT(OVER 110.000 BTU) ❑Yes ❑Nn PAID VENtILATION FAN(SINGLI3 RESID) Dam RcccipBp Wtionsll the applicamcrfuture defined occupby Buyse Area AirQntotyiManage ichant, BOILER-COMP(3HP OR 1(X1,(01)BTUI mit hazardous sir comaninants as defined by the Buy Areu Air Quality Management, Dianct] TOTAL: ❑Yes LJ No BOILER-COMP(OVER 110.W0 RTU) I have read the hnzardons materials mgnimmems under Cheerier 695 of the Cali- AIR CONDITIONER ISSUANCE DATE fomite Health&Safety Code,Sections 25505,M533 ort 25534.1 understand cut if the NEW RESIDENTIAL MECH. SQ.FT. building does not currently have a moan tit it is my responsibility mainly the occupant of dee mquihmana which most be,mel prior m issuance Ufa Certificam of Occupancy. Owner at authorized agent Dae TOTAL: ISSUED BY: OFFICE APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL ") Ill cilia BUILDING PROJECT IDEN'I'IYIC'ATIUN BUILDINGADDRISS: SANITARY NO. APPLICATION SUBMITTAL DATI 'S Lot q� OWNER'S -7 f90 ^. FJ70 C ACTORS Ary _ � I.IC NIC CONTROLM ARCHRECT/ENGINEER: LIC NO: S 7 ADDRESS: /M7/r'�Y�L ❑ CONTACT" PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) I3L CCS ELECT PLUMB MECH L1� r ❑ ❑ LICENSED CONTandordr DECLARATION QTY 'ELECTRIC PERMIT FEE I hereby aRrm Lha I am licemed under previsions of Chapter 9(coenmeceming JOB DESCRIPTION �U2, with 5cction]IxMllnc Busincaa and x' dmylicenae is RESIDENTIAL: F O in fullfierce and eyes PERMITISSUANCE �� ❑SIq)WL ❑KITCIiEN REMODEL U U Liccme Lic.p QL Dam t Cammctor APPLIANCES-RESIDENTIAL ❑ADDITION E)PLUMBING RE-PIPE Dm ARCHITECTS DEC RATION PANELS ❑MULTI-UNIT ❑STRucTURAL Zz l underared my plane shall he used as public records MODIFICATION OZ C UPTO2WAMPS �/' F-Nf'm Licensed Prefc,sionA '6NNTERIOR ❑CHIMNEY RHPAIR HFI-IBBBAMPS 1�IMPROVEMENT WI 11NG POOLS ctl" 4 OWNER-BUILDER DECLARATION ❑' C C Q I hereby afro that 1 am exempt from the Contractor's License Law for the OVER 1000 AMPS ❑RATH RE -LJ ❑ .ITION X 34 F following reason.(Section 7831.5,Business and Professions Cede:Any city or county SIGNS ELIi01'RICAL ❑O� YI u.y which requires a Permit to construct,alter,intprme,demolish,or mplia any structure F�'Oa Puerto its komac.al.wrequirea Neappliconl forsuchpanni lofileosignt,il acream SPECIAL CIRCUITNISC. SE"' Baal he is homestead pursuant the Provisions ofthe Contractor's License Law(Chapter 9 gty0_q (commencing with Section 701))of Division 3 tithe Business and Professions Code) TEMP.METIiR R EINST COMMERCIAL: L C W Bhat he is exempt therefrom and the hasis for the alleged exemption.Any violation of ElNEW BLDG/ADDITION [I DEMOLITION m Section 7031.5 by any applicant fur a permit suhjeas the applicant is civil penalty of POWER DEV. ' F Z�• ail more than five hundred dollars($500). ❑TENANT ❑FOOD SERVICE C ❑I.as owner of the property,or my employees with wages as their sole compenmtion. SWIMMING LELE IMPROVEMENT will do the work,and the statement,is not intended or offered Our sale(Sec.](K4,Rosiness ❑OTHER Sand Professions Cimt The Continent's License Law docs not apply to an owner of OUTLETS-SW FS FIX property who builds or improves thereon,and who does such work himself or through his own employees,Invented that such improvements am nm intended or offered for NEW RESIDEN- R 1?. sale.IL hosannVr.the building or improvement issold within one year ofcompletion,the SQ.Ff.ROORA12yA $/SQ,FI'. err-builder will have the burden of proving that he did not build or improve for pun A ' poses eeleJ. ❑1,as owner of the property,am exclusively contracting with licensed contractors to �� construct fee project(Sm.704,11,Business and Professions Code)The Conuacnr.c Li- Y cense Low does not apply to an owner of property who builds or improves thereon,and QTY. PLUMBING PERMIT FEE ` j /IBpI� who commets for such projects with a contrecmr(s)licensed pursuant the Commctur's b s 6(' Liesuse 01 am exempt under See ,B&P C for this mason w. PERMIT ISSUANCE �IlY�fj- LurL tu oil) Owner hate N M211-DRAIN&VENT-WATER(EA) VALUATION J WORKER'S COMPENSATION DECLARATION HACK FLOW PROTECT.UIiVICE SF/M I hereby affirm under penalty of perjury one of the following decimations:kersCounted. .rfiLV ❑Laws pinvidl marry eCcrti3caw7W of Con sent self-Code,for the sce of the URAINS-tLIXIR,ROOF,AREA.COND. tion,este provided for by Section J]W of the Veer Code,for the perfnnnance of me STORIES TYI'li CONSTRUCTION as for which this permit is issued 171X'I'URES-PER TRAP ve and will maintain Worker's Compensation Insurance,as required by Section 700of the labor Code,for the pedon:Iance of the wmkfor which thisp Bis issuM. GAS-EA.SYSTEb1-I INC.4011TLLT5 OCC GROUP ANN M Work m t,y�y.u� tie rand Pudic ala that(���z^^^ Cli nerd in " IJcarrie Policy No.: -��(/ ,J— GAS-EA.SYSTHM-OVER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE OREASEBNDUSTRL WASTE INTERCEPTOR (This section need Brat becumpleted if the pemul is for onehundmd duffers($100) BUILDING DIVISION FEES m less.) GREASE TRAP PLANCHECK FEE I certify that this,meed is issued,i shall 517 W ER-SANITARY-STORM EA. 17. not employ any perum in any manner so as to become subject to the Workers'Compen- ENERGY FEE 0 Z within Laws of Date WATER HEATER WNENT/ELF,CTR Z Applicant GRADING FEE h NOTICIi TOILAPPLICANT: after making this Certificate of Exemption,you should WAITER SYST EM/TREA'I'ING a ; become subject to the Worker's Cmer,acaum Provisions of the Labor Cude,yue..,at SOILS FEE foMwith comply with such provisions or thio permit shall M deemed revoked. WATER SERVICE CONSTRUCTION ONLENDINGAGENCY NGW RESIDENTIAL PLMB. SQ.FT. PAID V 0 l fare which foe that ski isacedSce.30 len ding agency for the performancc of D eceiptN tr the work far which this pcmul is issued(Sec.J(19].Civ.C.) 0 fs Letter's Name TOTAL: Lendcr' AJdress TOTAL: I' Z) certify o c I have read this application and stem tam the arm information dining is RUILUIN r Z coered.lagree toaemply withallordinances insmlatingm QTY. MECHANICAL PERMIT FEE V Z building nmawclion.and hereby emhoeiss rephsematives n(this city to enter upon the SEISMIC above-mentional xmparty for inspection purposes. PERMIT ISSUANCE (We)agree to wive,imlemnily,and keep harmless the City of Cupertino agaiml ELECTRIC FEE fiabildice.judgmem,custsand expenses which ren y way attmeaguimlaaid City ALTER OR ADDTO MECH. me onsequence of the grenting of this permit anPLUMBING FEE APPLICANT ON �)iRST/yVDS WICALL NON-POIMI' AIR HANDLING UNIT(TO IU,0100 CPM) SOURCE RE 'I 55 MECHANICAL iG AIR HANDLING UNIT(OVER 10.10x)CFM) CONSTRUCTI TAX Signa hof A,pIaamA` B ate EXIIAUST HOOD(WMUCO HAZAR .'MATERIALS DISCLOSU HOUSING MIT FEE Willmeapplicvm orN m building occupant stertor handle hicadous material H17ATING UNI'1'(TOIW.(NX)BTU7 as defined by the Cupcnin unicipol Code,Chapter 9.12,and the Health and Safety Code,Station 25532m)? H17ATING UNIT(OVER 110.000 BTU) ❑Yes ❑Nn PAID VENtILATION FAN(SINGLI3 RESID) Dam RcccipBp Wtionsll the applicamcrfuture defined occupby Buyse Area AirQntotyiManage ichant, BOILER-COMP(3HP OR 1(X1,(01)BTUI mit hazardous sir comaninants as defined by the Buy Areu Air Quality Management, Dianct] TOTAL: ❑Yes LJ No BOILER-COMP(OVER 110.W0 RTU) I have read the hnzardons materials mgnimmems under Cheerier 695 of the Cali- AIR CONDITIONER ISSUANCE DATE fomite Health&Safety Code,Sections 25505,M533 ort 25534.1 understand cut if the NEW RESIDENTIAL MECH. SQ.FT. building does not currently have a moan tit it is my responsibility mainly the occupant of dee mquihmana which most be,mel prior m issuance Ufa Certificam of Occupancy. Owner at authorized agent Dae TOTAL: ISSUED BY: OFFICE