130616 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
BUILDING-ELEITfRICAL PERMIT'No.
CITY OF CUPERTINO UM
PLBING-ME
APPLICATIONA'RRMIT CHANICAL 0910 /
BUILDING DIVISION BUILD5000 1
ING PBOJECp IDENnIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMI'I'IAI"[)Atli
O O ' NSA n9 \V% Cu of IS_'Z� 7 ,9
OWNER'S NAME: I'HON+' CONTRACIOR:S NAME: LIC NO:
(( fL NIC fAINfROLp
l I ARC'fit]
' i 7VENGINI dR: `QtS_,,LIC O D A)DRESS: ❑ Q 3 7
CONTACT,�O WIA V�j,g,I yg�9'77, ($(jr - ❑ Consultant Fees Paid by Applicant(Initial) BLD BIJILLLL T PERMIT MSCI
v� LICENSED CONTRACTOR S DECLARATION QTY. ELECTRIC PERMiT FEE
I hcrchy affirm that I am licensed under provisions or Chapter 9(commencing JOB DESCRIPTION
CEaZ with Section 91100)of Division 3 ofahe Business and Podesslons Code,and my license is
8-00 w+ PERMIT ISSUANCE •
Fty in fun foraand effect. I - ,I'DWL . ❑KHCHFNRF ODEL
�UU Licenac Clens Lic.M APPLIANCES-RESIDEN'I']AL ❑ADDITION [D PLUMBING RI?-Pll'E '
F Z W
F oe Dc Cmnr
trun—
.<c.
❑MULTI-UNIT ❑STRUCTURAL
ARCHITECTS DECLARATION PANES
MODIFICATION
1 undcrsund my plans shall be used as public awardsO Z. � IJPT02W AMP5 ❑INTERIOR ❑CIIIMNEY REPAIR
OF Liccmal 11 mist onal 201_10(OAMPS IMPROVEMENT E]SWIMMING POOLS
OWNER-BUILDPR DECLARATION OVER IIXNIAMPS E3 PATH REMODEUREPAIR ❑DEMOLI'I ION
6' < 1 hereby affirm that I am exempt from the Coal rucmr's License Law for the
XOaU followingmaza..(Section 7031.5.Business and Professions Cde:Any city or county SIGNS ELECTRICAL ❑OTHER
3 e.1-� which requires a permit m construct.alter,improve,demolish,or repair any structure
pFpA�0 prior it,its issuance,alto requires the applicant for such peon tto file a signed statement SPECIAL CIRCUIT/MISC. e
C CS that fork liven.edpursuumwthepmvloanxot'theCcuumauorsLicenseLaw(Chvpla9
IaC�1 (commcnoing wird Section 9(NNl)of Olvlsion3 of the Buslnca anJ Pmfcsainns Codyor ,TEMP.MI3'IER OR POLEINST
a L o Y0Y that he is exempt therefrom and the basis for the alleged exemption.Any violation of — DG/ADDITION ❑DEMOLITION,
, N
Section 7011,11,any applivemfor a permit subjects theopplicint to a civil gen try of POWER DEVICES TEND ❑FOOD SFRVICE
not mom than five hundred dollars($500). IMPROVEMENT
Q ❑I,ax nwnernfthe prnleny,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC
will do 0 a
+e work,and the stclum is net intended oruRercd tbrsale(See.9044,Business ❑OTHER
and Professions Cede:The Contracmr'e License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES
property who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvements am not intended or offered for NEW RFSIDElJTIAL F.LECIR SQ FT.
sale.If,however,the building or improvement is sold within one ykarofcomplaim,the SQ.FT.IL.00R AREA $/SQ.LT.
owner-huildm will have the burden of proving that he did out build or improve for Dur-
Poseol'sde). TOTALyCy J l
[31,as owner athe propcny.u exclusively contracting with licensed contractors m ' :
consumer the pre at(Sec.9044.Business and Professions CMS:)The.....Our,Li- s�I
nee Law does not apply to an owner ofproperty who builds or improves thereon,and QTY PLUMBING PERMIT FEE
who contracts for such projects with a mmtroemr(a)licensed moment o the Commemev -
I,iccnsc I.ew. PERMIT ISSUANCE
1 not xe pt ander St .B&P C for this reason -
ALTIiR-DRAIN&VENT-WATER O:A) LUATION
Owncr Datc _///)//
WORKER'S COMPENS TION DECLARATION BACK FLAW PROTECp.DEV E / O O T
I hereby of rm tinder penalty of perjury one of the foaming decimations: ( V
❑ I co mod will muimmina CcoRirmeofCmrsaue scll'Inmrofor Wnrkcr's Compen. DRAINS-I7LOOR. f.AIREA.CONO' STORIL'S TYPE CONS'I'RUC'IION
smith+,as provided far by Section 3710 of the Ulwr Code,for the perl'nnnance of the
work for which this permit is issued. t I9X'IURE4-P RAI'
❑1 have and will maintain Worker's Compensation Insum for as examined by bye of the V
37W mf the Luber Cid,for the performance ofthe work for which this pcnnd is issued. GAS-EA.SYSTEM-1 INC. "EI'. OCG GROUP APN
My W..re.,Compensation lummocc cameo and Policy number tire: - _
Cutout: - Policy Nod GAS-IiA.SVSTEM1I-0 <4m 75—:36-009
CERTIFICATE OP EXEMPTION FROM WORKERS' GREASEANDUSTRL WAST NN HiR OR
COMPENSATION INSURANCE IIIILDING DIVISION FEES
(D+iseation need am be,completed ifthePermit is for one hundred dollars($IN)) GREASF:1
nrlgsJ I'IANCH "I'iE , 3 Q
I cervi fy that in the performance of the work far which this permit is issued,l crill SEWHR-SANITARY-S'IORMEA.2 )IT '
not employ any person in any myna i)as it)become culled to the WorkersCompen- IiN13N V pP.
0 Z sdion Laws of California.Date WATER HEATER WNENT/ELEM OWE Ii
Z O Applicant
(n NMCI7 TO APPLICANT:IL after making this Cea ficate of Exemption,you should WATER SYS'I EM17RF"ATING
a ^ herome suam,it,the Weker'c Cmrpen.amion provisions of the Labor Cale,you all SOILS EE
I�+y+ fonhwi0 comply with such pmvisinnx nr tl+in permit shall lw Jcemed revakcd. WAIERSERVICE
DZ CONSTRUCTION LENDING AGENCY NEWRIESIDENI1ALP1,10I3. SQ.FT. I'All
V C) I hereby afiim+that there is a connmQ le dingtigency for the perfonnanceof Dvm Receipt
{✓ti r.
he work for which Dss aro itis issued IScd 3097/Givl
Q Lender's N:nne aJ! I LJL. 3 Y19L' O
L$) oder.AAJrex 'I'OI'AL: IJ
y I eerily that 1 have read this application and sate that the above Inlinmation is BUILDING FEE c)V) cared.I agreemucandy with all city and county ordinances and state laws relining to Q'ry. MECHANICAL PERMIT FEE Q
U Z building ttmswninn,and hereby amhome rcpresenmtives mf this city men¢r upon the ^ SE1ShIIC FTiE 0
nMve-mcmioned pm,ay for inspection purposes. PERMI I'ISSUANCE J17117171 BIC
(We)agree to sour,indemnify and keep harmless the Gly of CuPcneno against b ' V
1'mhilities,judgments,casts trod expenses which may in any way merroe almost wed City ALI IiR OR ADD TO MUCH,
nsequc cc I egmntmganmspernal 1'I. RING .�
PLICA UNDERSTANDS AND WILL COMPLY III ALL NON-POINT AIR HANDLING UNIT(IT)10,(X0 CFM) G
SO(RCE R IULATIONS. MECHANIC 1
AIR HANDLING UNIT(OVHR 10,00CFh 1999, O AS
Sig Phe Cunate I Rn • EXUAUSI'HOOD W/DUC'1) HOUSINGM TION PER
` HA2ARDOUS MATI:RIAIBDISCL.OSURE
Wll the applicant nr fmure huilJing oecupam store orhandle hazaNnuunaterial HEATING UNUTO IW,INOBTU)
as defined by the Cuperino Municipal Cole,Chapler rIA2,and the Health and Safety
Code Section 2553260'! _ HEATING UNIT(OVER 100.000 BTU) 39��
Yes
VENTILATION FAN(SINGLE RESID) I'AIU Date accept# -"
Will the applicam or(alum)net"ing accupm use equipment or devices"'n, BOILER-COMP(3HPOR 100.000 B'N)
emit hazardous air Ommmonana as de ed by the Bay Arca Air QualityManagement TOTAL: /ys f./�
District? BOILER-COMP(OVER 10,000 BTI[)
Yaa
I hens red one hmallous mammals arinoments under Chapter o1 the Cali- AIR CON DI'I'IONER ISSUANCE DATE
firma Health&Safety C de,SecOom 25505,8533 and 255:4.I uokmmnd But Bose NEW RESIDENTIAL MECH. SQ.FT.
building does net currently have a tenant,that it is my respnnsihility to notify the rocupm
of luiremenls which nwst plum for m issutincc or i0cam of Occupenv. --/�
eraatharizedtisem Dene TOTAL: .6ISSUED BY:Is rk/7- k.I,cG
OFFICE