29353 rasa Puxi I IV FILL IN INFUHMATION WITHIN RED LINES-USE BALL POINT PEN ONLY '
CITY OF CUPERTINO BUILDING-ELECFRICAI. PERMIT NO. 29353
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BNLDING DIVISION APPLICATION/PERMTT PLUMBING-MECHANICAL / 9 K '1'3
BUILDING PROJECT'IDENTIFICATION L..J V VVV
BUILDING ADDRESS: SANITARYNO. APPLICATION SUBMITTAL DATE
7536 ffo(/anderry P/aee�Cupery%'no ReiP,o�e!(l �6
OWNER'S NA E: PypONE: F CONTRACTOR'S NAME: LIC NO:
kk Q .1. (Q s "Wo1N b —3333 N/C. CONTROL«
RCHITE NGINEER: LIC NO: ADDRESS: 0+ -
CONTACT. PHONE: BUILDING PERMIT INFO
c t o S Kwok ¢f S R 67-333 0 Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MF,CH
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT P X );�_ ❑
I hereby altirm that I am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
CCZ with Section lOW)of DivisionJofthe Business amlProfexsions Cade,end my license is RESIDENTIAL:
�O" full Tatar end effect. PERMIT'ISSUANCE
W ❑SFDWL ❑KITCHEN REMODEL
NU firL]] License Class Lia N
�til Dase _ Contractor APPLIANCES-RESIDENTIAL []ADDITION [I PLUMBING RE-PIPE
p.p,nLy ARCHITECTS DECLARATION PANELS ❑MULTI-UNR ❑STRUCTURAL
yb! IundemtanJ my plans shall be used as public amads MODIFICATION
0 Y. UPT0200AMPS
�� {Q�I License)Profasionul INTERIOR ❑CHIMNEYREPAIR-
OWNER- 201-1000AMPS ROVEMENT
Y .J BUILDER DECLARATION OVER I(XpAMPS - OBATHR D' PAI ❑UEMOI. ON
y�0 W 6 1 hereby affirm that 1 am exempt from the Contractor's License Low for the
SY 3 S U following reason.(Section 7031.5,Business and Professions Code:Any city m county SIGNS ELECTRICAL ❑OTHER
Ly
til R.('� sthich rtquires a permit to construct,ulmr,improve,demolish,or repair any swewre
��y prior to its issuance,also requites the applicant for such permit o file a signed statement SPECIAL ttinCIRCUITIVj
g y that he is licensed pursuant the Provisions ofthe Conctoes License Lew SkM
(commencing with Section 7")of Division 3oftheBusiness and ProfessiamCosta)or TEMP.METER OR ST commERcTA
IN Y that he is exempt therefrom and the basis for one alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
{°• Section 7031.9 by any applicant taro permit subjects the applicmfIn is civil penalty of POWER DEVICES
w ❑TENANT ❑FOOD SERVICE
t mom than five hundred dollars(1500)..
p O ❑I,as owner of the property,or my employees with wages as their sole compensation, SWIMMING PULL ELECTRIC IMPROVEMENT
YW will do the work.and the swcwre is not intendedora!feral for=to(Sm.704,L Business ❑OTHER
6 w$ and Professions Code:no Contractors License low Jews not apply to IX
un owner of OUTLETS
pmpeny who builds or improves thereon, it who does such work himself oT through -
his own employees,provided that such improvemems arc notintended or moral for NEW RESIDENTIAL ELECTR SQ ET.
sole.If,however,the building or improvement is sold within one year of completion,the SQ.PT.FLOOR AREA SJSQ.FT.
er-builder will have the burden of proving that he did not bond or improve for pur-
Kowoe f sola). (000
as owner of the property,am exclusively contracting with licensed contractors m
cons ct the project(Sec.7044,Business and Professions Code:)The Cornmctor's Li-
cause Law does not apply to an owner of property who builds or improves thermn,and Ql'Y. PLUMBING PERMIT FEE
who..,.is for such projects an.contractors)licensed fora uant to the Contractor's }I'�
License Law. PERMIT ISSUANCE �
❑ lam exempt un rsec. ,B&P C for this rcas.a _
ALTER-DRAIN&VENT-WATER(E.A) VALUATION
caner Dom
WORKER' OMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE O/!kA
I hereby affirm under ally of perjury one of the following declarations: (,,//(��
❑ Ihaveandwillmemmin a CeniricateofConxnttoxlf-inmmfor Workers Compen- DRAINS-FLOOR,ROOF,AREA,COND.. STORIES TYPE CONSTRUCTION
Nation,as Provided for by Section 37M of the Labor Code,for the performance of the ,
work for which this permit is issued. FIXTURES-PER TRAP
1 have and will maintain Workers Compensation Insurance,us required by Section
3700 ofthe Labor Code,for the performance of the work for which this Permit is issued. GAS-EA.SYSTEM.I INC.4 OUTLETS OCG GROUP APN
My Workers Compensation Insurance comer and Policy number am:
Cmner: Policy No.: GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASE4NDUSTRL WASTE INTERCEPTOR
BUILDING DIVISI N
('This snefionncdnm IN,completed ifampermit is fmone hundauddoliars(5100) GREASE TRAP
or lees.) PLANCHECK FEE
I comfy Nat in the perfift.Mthe work for which this permit is issue,Ishall SEWER-SANITARY-STORM EA.20(1 FT.
not employ any person in any manner so as u,become subject the Workers'Compen- - ENERGY FEE
Z Sado.laws of Coliforms.Data WATER HEATER WNF.NT/ELECfR
Q Applicant - GRADING FEE
i NOTICE TO APPLICANT.If.after making this Cemificam of Exemption,you should WATER SYSTEM,TEHATING
a -N become subject to the Workers Compensation provisions of the Labor Code,you must SOILS ME
forthwith comply with such provisions or this permit shill be deemed revoked. WATER SERVICE
Q
CONSONLENDING AGENCY NEW RESIDENTIAL PCMB. SQ.FT. PAID
Q Ihertby affirm that thereem isisaconstruction lending agency for the performance of D Receipt#
t+ the work for which this permit is issued(Sao 3097,Civ,C.) TOTAI.
0 V Lenders Name
Lender's Address -
1 certify that 1 have read this application and nam that Ne above information is BUILDING FEE
f..l fA corer.I.,.a,.comply with al)city and county m inancesand state laws relating to QTY, MECHANICAL PERMIT FEE
V Z building contraction,and hereby authnnm representatives of this city to enter upon the SEISMIC FEE
above-mentioned property for inspection purlmses. ELECTRIC FEE
em
1 (we)a,.a to nava.indnify and keep attitudes,the City of Cupertino against PERMIT ISSUANCE
s liabilities,judgments.costs and expenses which may in any way.cane against said City ALTER OR ADD TO MECH.
in consequence of the Starting of this permit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFM) MECHANICAL E
SOURCE REGULATIONS.
AIR HANDLING UNIT(OVER 10.000CFM) CONSTRUCIO X
SignatuadApplicam/Conttactor Data EXHAUST HOOD OYMU(T) HOUSING MITIGATI FEE
HAZARDOUS MATERIALS DISCLOSURE.
Will the applicant in from building occupunt.t.or handle h.rnrdaus mamnal HEATING UNIT(TO 100,QM)BTU)
as defined by the Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety
Code,Section 2553200? HEATING UNIT(OVER IOt"BTU)
❑Yes F1 No - PAID
VENTILATION FAN(SINGLE RESID)
Data Rec rpt g
Will the applicant ar furore building use equipment or devices which A
emit haasi
concontaminantsous air contaminants as defined by by am the Bay A.Air Quality Management BOILER-COMP(3HP OR 100,IXI0 BTIO -� G P� TAL:
,
DislnctY " BOILER-COMP()VER 100,000 RTU)
' ❑Yes FIN.
i
PR
AIR CONDITIONER -
Ihavemadthehock,Sextions 55requirements 2553Chapmr6.95ofthe Cali- Yxt'. IS ATE
(untie Health&Safety Cede,Sections 255at i 25537 255)4.I understand than if the NEW RESIDENTIAL MECfi. SQ,FT. W Y UJ_does not is which
have a mtmm.that o is ua impossibilityofaiim notify the occupant GP
of the requirements which must he ran pdmmismantt nfa Certificate of(kcupuncy.
Owilai-m mhoneedagent Dam TOTAL: ISSUED BY:
OFFICE
r,�odel�ih Project_ �o� d
15 3 C"Pert mo , CA 95
I . Coh Ver o«M to a bath y-ool+.,
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PER MFR. REQ'MENT 3dsig( kIGHT BY
OK�EFFEE. W< ICBD 03710
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1/2' GYP BD TYPE 'Xf TEXT 4 PAINTED