S 0758 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY ON CUPERTINO BUILDING-ELECTRICAL PERMIT rvo.
RUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL 0 0758
BUILDING PROJECT IDENTIFICATION V
1ARLDINGADDRESS: SANITARY N(J. A''I.ICATION SUBMI'ITALDAH
SS licWe SFisnJ R� C0PfiLTr!�0 2lann
l OWN 'S Ni M^ PHONE: mNTRA Ir 01^ pM J /r` 154949 NIC CONTROL.
�ARCHITEECCTO&C•IENGGINEER: LIC NO: ADDRESS lIA/1 ❑ ��
' 1IDDE 6¢ Sr L� gvool
CONTACD 17i6 PHONE: BUILDING °ERMIT INFO
3ohJ P4 -ro,J 64-9'-7412-
LICENSED
S9'_�L 2 ❑ Consullanl Ftts Paid by Applicant(Initial) BLDG uMN MECu
7 6 0 ❑ ❑
I,ICIiNNIiDCONnsed under prevision,
of CON QTY ELECTRIC PERMIT FEE
1 hereby afrrm Inas I am❑«dates under nm��i:inn..arcbapmr 9¢ommenang JOB DESCRIPTION
OdeZ with Section 7000)of Division 3uf do Business and Profession.Code,sed my lirense is RESIDENTIAL:
WOO PERMIT ISSUANCE
F in full force and clfect. C SFDW L C KITCHEN REMODEL
z V F- License Class Lic.p
Q U APPLIANCES-RESIDENTIAL LJ ADDITION ❑PLUMPING BETTS
NQW Dom Contractor
FOy ARCHITECTS DECLARATION PANELS [IMULI FENCE [I STRUCTURAL
ZOtnZ I mocomnd my plans.hall be used as publicrccmds MODIFICATION
OZ�p�o UlIT02MAMPS [I INTERIOR [I CHIMNEY REPAIR
t•+„E]W Licensed Professional 101-100LAMPS IMPROVEMENT ❑SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER 1000AMPS ` C BATH REMODEUREPAI ❑DEMOLITION
Q I hereby affirm that 1 am exempt from the Contractor's License Law for the d
X
cal
d ❑OTH17rRS
O following reason.(Section 7031.5,Business and Professions Code:Any city or,m u, SIGNS ELECTRICAL
W a y which Icraims a permit to construct,alter,improve,demolish,m repair any stmaure
0Prion.itslssmmce.alsorcywres the applicant for such permit 4t file a signed nutemmnt SPECIAL CIRCUIT/MISC.
f y that he is licensed pursaenuo the previsions of the Contractors License Law(Chapter 9
aOQ (emmuamcingwitb Section7(XXh of Division 3 oftha,lousiness and Poo1exs my Ctxlc)ur TEMP METER OR POLE INSL COMMERCIAL:
d 6 c C that he is exempt therefrom and the basis for the alleged exemption.Any violation of C NEBLDG/ADDH ION ❑DE OLITION
X on Section 7031.5 by any applicant for a Permit subjects the applicantto a civil penally of POWER DEVICES ❑TENANT CFOOOD SERVICE
LL7 not marc than five hundred dollan(b50)T
IMPROVE?MENT
$$Q ❑ Las owner of the pmpcay.or my employees wish wages as their role compcnout inn. SWIMMING FOOL EL[CTRIC
[..0 will dolhework,und tit^,immure is at mended nrnRered far so In Nes.pIH4,Ilusinas CDTIIE:R
and Prdfasions Cale:The Contractors License law docs not apply to nn owner of OUTLETS RXTLRE.S
pmpcay who builds nr impmvcs Ihuoo,and who does such wod loar”. tar IM1rougM1
his own employees,Provided that such impmvemems are not amended or oRemd far NEW RESIDENTHAL ELEt711t SQ FT
sale.11.however.the building or improvement is sold w hhin one year of completion,the / ( RARE VSQ.FF.
owner builder will have the burden of proving that he did not build or improve for put- /
[11, !sole.). TOTAL: L/ z
c. I,as owner of the pmpcay,,B excessively contracting with licensed cnno-naors i- /
crud,L l the es not (Sec.nano Business and Professions Cale:)The Contractor's Li- q
selawdnefors apply rejects with
itha of Pr.P.ns who sedJsorintpro the thereon.and QTY. PLUMBING PERMIT FEE
who asntracu for such projects with a contractions)licensed punuum m the Contmanrs
License Law, PERMIT ISSUANCE
❑ 1 am exemfu under Sec. .B&P C for this reason
Owner ' Date AIIPER-GRAIN&VENT-WATER HEA) VALUATION,C'
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE 2.�� �S.
I hereby aRnm under pet of perjuryone of the following dcclureomr,
Cl I have and will maintain.Certificate of Comenl to self-insure for Worker's Comped- DRAINS-FLUOR,ROOF.AREA,COND. STORIES TYPE CONS'IRUC I'101
mtinn,us Provided far by Suction.1700 of the Labor Code,for the pcffonnance of the
work far which this permit is issued. FIXTURES-PER TRAP
C I hove mi will maintain Works,,Companallon Insurance,us ro,aned by Section
MyOftheCut -. fo t rnce curcc of the work for whidttt thl (�'I is t�ssu GAS-EA SYSTEM-I INC.iO1JT1.BIS OCC.GROUP APN
My worke s Cotn I anter d Poli ^d b„1/ /
Carrier atr c P.Ii,,N GAS-EA.SYSTEM-OVP,R a(EA)
CE "CA E SATTONIONFRANC
4
C PIr EXEMPTION
ON RO, . GREASIJINUUSTRL WASTE INTERCEPTOR
(His section need not hecompleted ifthe Permit is f hM
ureddollao 5100) Bul G (VISION FEES
or less.) GREASE TRAP PLANCHECK F
I certify that in the performvnre ofthe work for which this Permit is koied.I shall SEWER-SANITARY-STORM EA.910 ITT
not employ any person in any insurer so as m become subject to the Workers'Compen- ENERGY ITE A�
ZZ salt..Eaws.f Culif.mia.Dae WAI'Elf I IEAT ER WNIiNT/I!LECFR
2 Applicant t GRADING FTE
.. NOTICE TO APPLICANT:IL after making this Cenificme of Exemption,you should WATER SYS"SENITREA'FING
a ' become subject to the W.rkers Comp dvalion provieiam of the LOW,CNB,you most NOELS PEE
forthwith comply with such provisions of lh is Permit shall be decried resokca. WAFER S17RVICE
0
z
CONSTRUCTION LENDINGlend AGENCY NEW RESIOiiNT1AL PCMB. SQ.Ff. PAID
U 0 Iherehy.[firm that lM1um is conswaron lending.gency�nhe perfnrman¢o( Dom meipta
U. .. thework ILrwhich this pconit is issued(See 3D97.Cie C.)
O U Lenders Name TOTAL:
T Le^Jcrs Address TOTAL:
I certify that I have read this application and state that the above information is BUILDING FEE �
.. V) macro.l agree mcomply wall all cityand county ordinances and stare laws relating to QTY, MECHANICAL PERMIT FEF,
LJZ building construction,and hereby u^thorite representatives ofduicuy to enterupon the SEISMIC FEE 0
above-mentioned pmpcay for baseman purposes.
b y and p y o per s PERMIT ISSUANCE
1 WcJ agree m save,indmmlf d kw hmnnluxs 0c Ctl [Cu lino a miml / ELECT FEE
liahilities,judgmems,mau and expenses which may in any way accrue against sail City ALTBB OR ADD 10 MECH.
mcyuenec of the starling of this permit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Alk HANDLING UNI I'(f0 bots oCPM)
S( EGULATIO�NS.. - MECHANICAL,FEE
S't; AIR HANDLING UNIT(OVER 10,(MJCFM) CONSTRUCTIONTAX
Sign:nureof Appltcani/Contfactor �T Loan HXHAUS'1'HOODIW/DUC'I') HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the upplicam nr fwum building rwcupum sore ar handle h...Nousmmcrial HEAPING UNIT(TO 1!1(,003(PTU)
as defined by the Cupenin.Municipal Code,Chapter 9.12,and the Health and Safety
Cafe.Section 25532(.)7 FLAT ING UNIT(OVER 100,00)8U)
F7 yes CNo VENTILATION FAN(SINGLE RESID) PAID TO
Will the applicam nr future building mccmem,use eyuipmcm nr dcviceu which Duro Recoil N
ab.dous air comamionalsa,defined by the Bay Area Air Quality Management BOILER-COMP CUP OR 100.0110 BTU)
Di,m,17 TOI'
❑ KK11P
Yes CNo BOILER-COMPIOVEk Ia1,ITU)
I have read the hasardnusmatcrou,farm. reyuitcmcn to under Chaser 69 of the Cali- AIR CONDITIONER Z�$ ANCE DA p �'
fou Health&Sal'cty title.Natinds 25505.25533 sed 25503.1 understand thio if Inc NEW RESIDENTIAL MIiCH, SQ.FT,
nwlain site.nm emrmnay navealemmt.that tt i.mrre.prnsinirty to rout,mm',attparl
,if, remenN which t he all prior to issuance of a Certificate of ecu /^
tJwne}or auth�on'uJ ascm Date TOTAL'' ISSUED RY. P
OFFICE