99100040 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 000
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO,.
APPWCATION/PERMIT PLUMB ING-Mf.CHANICAL O
BUILDING DIVISION BUILDING PROJECT IDENTIF'ICA'TION `10001
BUILDING ADDRESS: / SANITARY NO. AI'P'LICATI NSU MITTAI.DATE
700 IRS NA E: I'110NC: CO RACT(1t' NA i LIC N(T.
N/C (ION-1 R x
I' i /ENGINEF: ^ I 1 N AI I])RI;.'ti; t/1 ❑
CONTAC"I': C•_ PHONE: L�J4/ BUILIJINC P(hR(M IpT INFO'
❑ Consultant Fees Paid by Applicant(Initial) BLDG - HLECIPLUMB M
El
LICENSED CONTRAC ONS DECLARATION QTY. hl-ECTRIC PERMIT I°IiF- TTT
1 heam,affirm that I am IiceroW oder provisioms of Claque,ue,9(commencing JOB DESCRIPTION
WOO with Section]fl(Itry of Division3 of the tuts nexs unJ lrnfesxians Code.and mylicense is RESIDENTIAL
x10 0 FERMIT ISSUANCC
F-win full force and effect. ❑SFWL I(Iff,${;�',$F.�.TODEL
FaVU License Closes to., pl'PLIANCGS-RISIUF.NTIAL ❑ DD ION gP�.UA1R N(i RE-PIPE
Nab Dam omrmtor
S DRCLARATION ❑ 1-UNI SRU AL
g.Om PANELS M DIFI TI N
N Z
or
n as public records 11
OZ=q UPTO 200 AMPS ❑1 IOR C N X AIR
F4-w rREcrislall• iun 201-1000AMPS I VI!M6ENT 7 MM I OLS
s OWNS - EIDER DECLARATION OVIiR IINNIAMPS ❑ IIREMlS�II�IJRITA1R DEWOLII
hereby affirm that 1 a exempt from the Cmaracmr's Limine Law for the
U following reason.(Scedon]031.5,Business and Prote,A...s Cndc:Any city or county SIGNS ELECTRICAL' ❑ LER
47 W y
WO F which require,.permit in comwet,alter,imp ce,Jetnolkh, a repair any structure .
111g!...y.... priorm it issuance,ulsorcquiresthe upylicantImsuchpenning file usigncd strement SPECIN.CIRCUIT/MISC.
that he is licensed pursuant o the provisions of the C onencmfs License Law(Chapter 9
W CO (mmnmmcing withScotian0(NI0)of Division 3ofthe Bminesswd Profcs.unns Cale)nr TIiMI'.h11fl'ER OH POLF.1 ST COMMERCIAL:
6 eC nom he is exempt Iherefrnm and Ne hmis for Inc alleged exnnption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
^y
Section 7031.5 by any applicant for apconain subjects the applicant to a civil penalty of POWER DEVICES NANT ❑FOODSERVICE
t more Than five hundred dollars(3500).
F Z} Ih1PROVEM1iNT
ESp ❑1,nuwner of We progeny.or my employees with wmges vs nheirznle compensation, SWIMMING POOL:ELECTRIC ❑OTHER
C� will do the work,wddieamcmte is amermadedoroffered firms,(See 7GO,Business
W 2it Professions Cale:The Contm mfr License law does not apply toe not no,of OUTLETS-SWITCHES-FIXTURES
6 w^ progeny who huilds or improves theman,and who does such work himself or through
his own employees,provided that such improvements arc not intended or offered for NEW RESIDENTIAL ELECTR SQ FT:
sale.If,however,the building or improvement is sold within one yearofeompletiorathe - SQ.IT.IR.00R AREA $/SQ.FT.
owner-builder will have the burden of proving that he did not buifloat mprove for put.
pose f vie)
❑ 1,ro,owner of the progeny,am exclusively commulin,with n.odtintruchic,ol TOIAI_
cinimmul theproject(Sec,]mi Bubnesea P Code:)TI Contractor s Lt-
cell 1 d n pplymun owner ofproperty wt.t h ill. 1 there a.and Q'fY PLUMBING PERM] FF.F. ti.Yr
who onatracts for such project with a eo nramor(s)licensed pt rem nus the Contnmmrs
License Law. PL'RMI'I'ISSUANCE
1-1.1 sun exempt under Sm. .11&P C for Nis reason
ALTER-DRAIN&VENT-WATER(EbO f VALUATION
her Dem �Ta(
WORKER'S COMPENSATION IofCe folie [ONvin, BACK FLOW PROTECT DEVICE
1 hereby ill mo under peachy to Perjury one ofthe fallowing dedoretions:
In, a and will forty Section 37M of ConsentLabor sod i,for the Workdsce of the
DRAINS-MOOR.RODE AREA,COND, STORIES TYPECONSTRUCfION
cation,r provided far by Section 3]00 of Ne Labrt Calc,for the performance of the
work Bnwhich nhistan issued. PIX'ILRES-PF.H TRAP
❑ I have mad will maintain Workers Compensation Insurance,fwhich
required by Section I
P(Xl nfthe[.shot n
xM1or Code,fobe perfonv<enof the workrk for whichh Nis permit is issued GAS-HA,SYS'TEM-I INC.1 'LFITS OCC GHOUL' APN
My Workels Contgeasadon lnsurommiclenmd policy nunhcrarel
Currier: F Policy NaGAS-I!A.EY$TBM-G 4(EA)
:
CERTIFICATE OF EXEMPTION PROM WORKERS' - NtI:ASHIINpt15 WASTE INTI?RCBPIDIt COMPCNSATION INSURANCE BUILDING DIVISION PEES
('I'nisscedan need not bemmplmed it.'I hcpmntil is for atm hundral 11,11).IS 1 O GREASE P '
or less.) PLANCHF,CK PIiIi
I certify that in the ge,barm nce.rimumakmavvi i,h lois permit is issued,lshall SIPN -SANITARY-S'I ORM EA.NNI IT.
not employ any pmam in my manner se us to become subject to the workers'Compcn- ENERGY FEE
z ,'2' eah"Laws of California.Date Al1iR I[EATER WNEN'1'/ELECTR
A(rplicant t T: GRADING FEE
tr� NOHCE TO APPLICANIL after making this Cefificom of Bsemptica.you should WA S YS 50115 FF.I
F > became subject to the Workecs Compensation provisions of the Labe Code,you must i
Wti forthwith comply with such provisions or this permailmil be deemed revoked. WATER SERVICE
Q
U0• CONSem is a0N LENDING AGENCY
agency NIiW RISIUENTIAI.PCMB. so 11L PAID Date Receipt#
I hereby affmm the there is a contraction 3 lending7. e.agency for the performance of
(~-I the work for which this permit is issued(See.J1Nl],Civ.C.)
O U Lcndcr, T
's Name 'OTAL:
IT-1 Lebens AJAtuss O'TA L: p
ly codify that I have read this application ani aline thul the above information is BUILDING
H.I y comer.]agree to comply with all city wd county onhirraces and slam laws relatingm qry, +MECIIANICAL PERMIT PPE
U Z Noldingeonswction.and hereby authorize represmardives oflhis city toemer upon the SEISMIC ITB
uhove-niummined lar as y for inspection Purpe.es. PEiRMI'f ISSUANCE
(We)agree m save,indemnify.sad keep harmless the City of Cu,nima against BLECfR EIi
liabilaiex.judgmcots,costs and pcnseswhabomyinony Wuyoccme iguana said City ALUM OR AUDIO MECH. PLUMB] 1FEE
in consequence of the ancon/ fty' permit.
API'LICAD 'N :B TA/ (A ID WILT.COMI'1.1'WITH ALL NON 'DINT AIR IIANDLING UNIT ITO 10.(X10 CPM) MF.CHANI AL FEE
SOU ' Al T rN.
„� ' 'Q AIR HANDLING UNIT(OVER.10,000 CFM) CONSTRU 'ION TAX
Sig mu of 1 lican Commnor D o "IIAUS'1'1 OODDV/DUCD HOUSING MITIGATION FEE.
f1AZAR9OU fAl'ERIALS DISCLOSURI(
W Ithc ugplieem or floor ullJing occupum store nr hello huaardous material 1117AI ING UNIT(10 I all"B-TU)
as defined by the Cnpenino Municipal Code,Chapter 9.12.:md 0e llmlb and Safety
Cecle,Section 25532(a)7 HEATING UNI'I'(OVER 1fNl,Bg1 BTU)
❑Yue a PAID
V13N'I ILAI'ION PAN(SINGLE RESID) Oatc Rmclpt p
Will Ire applicamt o afar,building mcupanl axe equipment sur devices which 13011 IeR-COMP(3HP OR I(1(I,IMNI DTII)
mit haivrJous err mnmminant m defined by the Buy Area Air Quality Managemad TOT b
District! BOILER-COMP(OVER 100,000 BTU)
❑Yu
- - - AIH CONDITIONER
Am
s rryuircmems under Chaper fi.95 of oculi- - ISSUANCIi DATE
f5115.25533 mall 25531�Ry
atifthe NEW RESIDENTIAL MECH. SQ.I.T.
What it is my respnnxinilityt si 7- 91
nmissuanm ara
own, m f and, agent [(/ TOTAL: ISSUED BY: /
OFFICE