S 0399 s. APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-LSE BALL POINT PEN ONLY
CITY OF CUPERTINO BUDAING-FILECI RICA], P17RMIT No
BUILDING DIVISION ' APPLICATION/PERMIT PLUMBING-MECHANICAL S 0399
BUILDING PROJECT IDENTIFICATION'
B UILDINO ADDRESS: 1 1 SANITARY NO. - AITI./ICAI'IOJS/SUT .DAIT
V o V I
pill Opkm NON i I IC NO: _
V1111 NIC COMROLM
t• ARCTB'ITCT/ENGINEER: LIC NO: 1 RE /1 c ❑
'ONTACC ,J PHONE% FliA>` BUILDING PERMIT INFO -
�x ,L' b-2514_ 0(�� ❑ Consultant Fees Paid by Applicant(initial) HL ELECT PLUME MECH
,µ]II /'0.D�]1 6.,,\J 1-1 ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FET:
I hereby affirm tom L am licensed Under provisions of chapter o(amnmeming JOB DESCRIPTION
�pa.1O Dam commct0 Y nPl'1.1A IU
UZ in L ilull force and eller Lich SFDWL ❑KITCHEN REMODEL
Divisinn3nf ihn Business and PmRssi...Cale tundra Imenseis
fatf
IAO P17RMIT ISSUANCE
ENTIALF
zU NCES-RESIDENTIAL. �ADDITIGN , El PLUMBING RIYI'll'li
NGS' ARC]II'1'P,C'S DECLARATION El MULTI-UNIT ❑S'FRIICIURAl.
(.,p>m tRESIDE�DA
S' MODIFICATION
Z q I andencend my plans shallh used m public records
OZ G 200AMPS El INTERIOR OCHIMNEY REPAIR
F.[4„fC'u] Lummel Professional � 00AMPS IMPROVEMENT 0SWIMMING POOLS
�Y2•,.1 OWNER-BUILDER DECLARATION IWOAMPS ❑BATH REMODEUREPAIR ❑DEMOLI'I WN
C S 6 1 hereby inion that I am exempt from the Contractor's License Law for the
SU following mason lSeetion 7031.5.Business and Professions Cade:Any city or county ELECTRICAL ❑`OTH�R
RI LLp y which requires a permit m contacts,niter,improve,demolish,or repair any snamurc
prior mils issuance,also requires the applicant forsuch pennia to file a signal lmmmesL CIRCUFUMISC.
f } that he is licensed pursuant the provi.sionsofahe Comracmrs Limma Law(Chapher9
1 0 (commencing with Section 70)(Rof Division 3 ofthe Businessand Professions Cak COMMERCIAL
)car METER OR PiLLEINST.
a y m IY that he is nempa thetefrmn and the basis for the alleged exemption Any violation of ❑NEW BLDG/ADDITION ❑DEM0LI HON
W:2 o, Section 7031.5 by any applicant for a permit subj¢ts the applicant a civil Penalty ofR DEVICES []TENANT ❑FOOD SERVICE
FZ� nm mnrethan five hundred dollars(3500), IMPROVEMENT
SQLas owner 0f the pmpcny,car my employees wim wages as their sole aampcnsminn, MING POOL ELECTRIC
will da the work,and the nctcwm is not intendedoroRertd Totals(Sec.](1W,Business DOTTER
m and Professions Code:The Contmemis License Law does not apply in an owner ofETS-SWITCHES-FIXTURES
pmpeny who milds ser Impmvex thereon,and who does such work himself or through
his non employees provided that such improvements are not intended or offered forESIDENTIAL ELECTµ SQ Ff.
sale.If,however,ihehuilding or improvement is sold within oneyedrnf completion.the SQ.FT�Fl-(I01bAgRA $/SQ.IT.
mer-builder will have the burden of Proving Nut he did not huild or impmve for put. AA Ee MM
p..cn of sate.),
0 I,at owner ol'the pmpeny,ten exclusively contracting with liunsed contractors u, TO JAIL:
instruct the project(Sec.71144,Business and Professions CaleJ'fhe Contruchsrls Li- - ���
nc Law dour not apply to on owner of property who builds or improves memon,and QTY. 'PLUMBING PERMIT F17E AUG,-nV
who camnwts for such profess with ti malmemod licensed.......(m the Comimsm's
License].it. PERMIT ISSUANCECl11 Ty
6f Ul LtiI INU
❑ Iter exempt under Sm. .B&P C holds reason
ALTER-DRAIN&VENT-WATER IFA) VALUATION
Owner Ilam
• WORKER'S COMPENSATION DECLARATION BACK FLAW PROTECT.DEVICE �� al
I hereby affirm under Penalty of perjury,one of me following declinations: 7
❑ I haveand will moimanaCeriGcam mCmtsent to self-i...mor Winker,Compdn- DRAINS-FLOOR,ROOF,AREA,COND' STORIES I TYPEONSTR=;ION
anion,as provided for by Section 37IXI of the Labor Cade,for the peRnrriance of the
which this pcnnia is itxued. FIXTURES-PER TRAP
or ^ave anJ will maintain Workers Compensation Insurance,as acquired by Sectio M11I(�,•)
J ft he Labor Cada fur the 10rnanee of",poork for ishichdo,permit is issued. GAS'-EA.SYSTEM INCA OLfILEI'S - OCC.GROUP PN
My War' n rel eerierand Policy"A reiNa 1'--' co
Cartier. Pulley No.: 1�-1'1o1b1 —11 GAS-EA.SYSTEM OVERJ(F.A)
CERTIFICATF.O XEMMON FROM WORKERS' GµFASFJINDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE. BUILDING DIVISION 1717 is
(This section need not bo completed lithe Permit is for one hundred dollars 1$IW) GREASETRAP
or
lest.) PLANCHECK FEE
I unity that in the performance ofine work fbrwhlch this permit is ismad.l shall SEWER-SANITARY-STORM HA.200 IT
not employ any person in any mannersu as to become subject subjecn the Workms Cumpen- ENERGY HE
O O sad0n taws.1 Caldimlia Dam WAFER IWATER W NOTICH TO APPLICANT.If,after making this Certificate of Hocianirn,you should WATEATINGI7R SYSTEMIfµA $CTR
TING CRAVING PEE
az SOR.S FEF
; become sublsi to the Workers Compeor this emat itel of the Labor Code,you most -
� forthwith cnnNly with such pmvisi0nt or this permit shall be Deemed ranked. WATER SERVICE
0. Q
� z
CONSTRUCTION 1.ENDINGAG agency NEW RESIDPMIALPLMIi, SQ,IT. PAID - Dam Receipt
UpI hercbyich thi muuberc is..W IS .30 leading agency far the Performance of
f+ the work for which this permit is ismW(Sec.31X],Civ.CJ
0 Lenders Name OT
,r [Uil Isnders Address TOTAL:
fy 1 certify that I have read this application and site that the above information is BUILDING/EE xf
V1 monst.I.,am m comply with all city and county ordinanew and state laws relating is QTY, MECHANICAL PERMIT' FEE
U building constctsion.and he, manure rtpremomivesofthis citym enterurym the SEISMIC E
nMve-meni ny rims{•ctionp Hoses. PERMIT ISSUANCE
I agrte t aid
yen cep hmmiess the City of Canenim against ELECTRIC FE
tlitie cros,u is nus Ibh may in any way accrue against said City ALTER OR ADD TO MECH.
onscyucntt from
theg mi Of is pc PLUMBING FEE
AP NT UNDER TAN ND 1 L COMPLY WITH ALL NON-POINT p1µHANDLING UNIT(TO 10,M)CFM)
MECHANICAL FEF.
SOURCIIR.
� AIR HANDLING UNIT IQVIIR IB INNI GI'M)
CONSTRUCTIONTAX
namrenf AppliwmlComonctnr Date EXHAUST 11001)(W/DUCT) HOUSING'MITIGATION F
IIAZARIX)US MATERIALS DISCLOSURE _
r rilicuni ser fttlu'-6 m,912,enndle moul sold mMhal IRATINHEATING 11N1TfTO.I1NI,INN111'PUJ
g ocenpan
C defined by the Intapa do,CMtpter HJ2,:uW the Ilvulth amA$limy "
Collo,Section 25532(a).l (OVER IINI,INN)13U)
❑Yes ,. V ENT LAT ION FAN(SINGLE RES]DI PAID Rmcma
Will the applicant or farm building occupant use equipment or devices which
•curia lamntall air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP(Jf{p OR IINI,(XN)BTU) 'TOTAL:
DinricB BOILER-COMP(OVER 100,000 HTID
❑Ycs ON. -
'
I have reslthe hvnNons rmtedds mquiumen.under Cmirm,695 of Om Cali- AIR CONDITIONER - ISSUANCE DATE
forma Health&Safety Cale,Sections 25505,25533 and 255M.1 understand that if the NEW RESIDENTIAL MECH. SQ.PT.
of
re dues nm currency have a tenant,p that o is my responsibility m notify abs pen y.
of the requirements curnmwhich have
M ma prim ro issuance,re pof aon Cenifcnte notify
Occupancy.
Owner or aathorind.gear Date TOTAL ISSUED BY:
OFFICE