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CITY OF CUPERTINO BUILDING. HERE I'RICAL
NUILDING DIVISION A PPIACATION/PERMIT PLUMBING - MECHANICAh
' - BUILDING PNfI.IPCI' IDENTIFICATION
II�Nc
S000I 0421
BUILDINGADDRESS:
SANITARY NII.
APPLICAIIjINSUlip1II LIJATE
0
6G/�gP ef
O NER'S AM is PHONE:
CORIRACIOR'S NAME: LIC NO:
WC
CONTROLM
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ARCHITECTiENGIN:Nt: LIC O:
AIIIIRiSS: O&U awww❑
14
CONTACE PHONE:
NUILUINO PIiRMIT INFO
❑ CansWlant Fees Paid by Applicant (Initial)
BLDG ELECT PLrrU�yM,r B MF.CH
;4n 16,1.
E] 1:1Id ❑
LICE•NS iD CONTRAQON'S DECLARATION
I herchy affirm that I an limned wider prnvi,mos of Chapter 9 (commencing
Q'PY ELECTRIC PERMIT FEE
TOR DESCRIPTION
PERMI"I ISSUANCE
with Section 7") of Division Sof the Business and Professions Cade, and my license is
in full farce vnJ
RESIDENTIAL
0 SFDWL ❑ KITCHEN REMODEL
APPLIANCIiS-RESIDENTIAL
Liven. Clas LicClw"a�'�t'
I
nate E
C1 ADDITION ❑PLUMBING RE -PIPE
❑MULT'hUNI't El STRUCTURAL
CHIMNEY
El INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT 0SWIMMING POOLS
TS DELL
ARCHITECTS DECLARATION
I understand my plans shill he ns<J as public records
PANELS
UPT02(XIAMI'S
Licensed Profecdonel -
20Id000AMPS
OWNER.BUILDER DECLARATIONGVHR
1 hcrem moonlit nlmu thin I ucmpt floor the Commoul License Law for the
t rnllowing reason. (Section 7031.5, Business and Professions Cale: Any city or county
[I BATH NHMOI EVNI?VAIN II EMOI,ITION
fTIII sR C,--
1
IIThIIAMT'S
- SIGNS EL13C'ritICAL
mquiree a Imrmit tar ema, nr repair any tmcwru
iduar,pplim improve, eenrail
Sf'IiCIAI. CINCIJiT/MIFC
(he t
� prinn)ib ismunce,nbo requirevlM1e utplicam for such permino Ble aligned stawmenT
pli,a
Ihm he is licensed pursuant n the provisions of rho Courts', License Law (Chapter 9
COMMERCIAL:
(commencing with Section 7000) of Division 3 offho Business and Professions Cure)nr
th.T he is excn... Ihomfnsm .,,,line half, for the alleged exemption. Any violation of
TEM RMEI'HRORVOIXINST. -
❑ NEW BLDG/ADDITION ❑ DEMOLITION
Section 7031.5 by any applicant for u permit subjects the applicant too civil penalty of
not more than Eve hundred dollars ($500).
❑I,mnwner of the prnpeny, or myemployees with wages as heirxnlecompensmion,
will do the work, and the structure is net intended mattered for sate (Sec. 704/, Business
POWER DEVICES
❑TENANT FOOD SERVICE
OTHER IMPROVEMENT
1-1 OTHER
L
SWIMMING I'OOELECTRIC
mid limitations Code: The Comm ear's License Law does net apply to an owner of
OUTLETS -SWITCHIS- PIX] 'OHM
NEW RESIDENTIAL ELECTS S A
4
proper who builds or improves thereon, wad who Jae, such work himself or Through
his own employees, provided that such impmverm ms ate not intended or offered for
sale. If. however, the building or improvement is sold within one yearof completion, the
.FT. Ft RAREA
$/SQ. FT.
owner-huilder will have the burden of proving that he did not build or improve for put-
'
[_ TO'T'AL:
posewrafle.),
owner of the amexclusivelysineand commcional with licensed comrac i-
7
sum Sm. 70,1 es
Business and property butnal Code:) The as them en. Li -
(Sly it) an who hemm,and
music roar whensed aorimt
music La the es not apply
QTY. PLUMBING PERMIT FEE
with aofprecony
coawdaesnmapply
tothe
who nmwcrs for such pmjcns with u conwnorts) liccnsmi pursuant to the Cantmcmrs
PIiRMI'1'ISSUANCE
License Law.
C] [am exempt under Sec. ,B&PCfonhis reason
ALTER - DRAIN as VENT- WATER HLA)
-
BACK FLOW PR(YI'ECT. GCVICE
Owner Date
WORKERS COMPENSATION DECLARATION
VALUATION
�'
'lI hereby afTrm under penalty of perjury one of the following declarations:
huve:mA will rnnimvinaCcnilic:rte of Cnnsem ¢r selGinsnre fir Worker's Cnmpen-
audan, as provided for by Section 3710 of the Labor Code, for the performance of The
wo k fin which this permit is issued.
.
DRAINS-P1.00R. ROOF. ANSA. CONO.
STORIES
O'YPH CONSTRUCTION
- -
PI X'1'URCS - PER TRAP
- I have unit .,11 .i all l W.. kce,, Compensation Insurance, as required by Section
Onl'tbu l.nboyr�Cynyolygp lir tba Pctliarnunm.[Bra work fir whish thin permit is issued
OAS -lib SYS'IT:M-I INCAOII'ILIi IS
-
-
OCCGRGUP
APN
My Wrrky�. Cr rp tiny Ipa run�q urrrcr and Policy 9y''j� ry
Currie L MJtGyU��Z_or alis No:o+cIC QOMId Ig
OAS -IIA. SYti'I'EM OVIiRJ(EA)
OItEA$I%INDHS'I'It I. WASTE INTERCEPTOR
CENT'IIBCKI'1; OP E%IiMPI'ION FROM WORKERS'
COMPENSATION INSURANCE
IHALDING DIVISION ITES
('llik, mionmced nm becnmpleled if the permit is fo tale hundmd call ars($IW)
or less)
GRVASET'RAP
PLANCHECK IIJC
SILVER -SANITARY -STORM FA. 200IT.
ENERGY Piil?
I malty That in the perfwoulaceof the work fnrwhmh this permil is issued, Isbell
not employ any person many .,anner.n as m bc�pme uo Ne Workers' Camper -
WR'I'ER HEATER W/VCNT/ELECfR I —
GRADING ITE
come Laws „rrul'nm'a')mce D - 95M-
{Sp �
j NOTICE -OAP 11CARE If, after making this Cenificam of Exemption, you should
become subject I. The Workds Compensation Transitions of The Labor Code, you must
WATER SYSIHMURl!ATING
SOILS FEE
forthwith comply with such ptiesmwelor This Aman shall be deemed revoked.
WATER SERVICE
CONSTRUCTION LENDING AGENCY
I hereby eltirm the There is ocnnnmmion lending agency for the perfnrmmce of
NEW RESIDENTIAL PLMB. SQ, FT.
PAID
Ilme Receipt Is
TOME:
The work for which his perma is issued (Sec. 30W, civ. CJ
Lendee. Name
TOTA S• Q
Lender's Address
is
BUILDING Plili
1 comity that I have Txad this application and two That The above mrormum.
nen. lagmemcomply with all city and county ordinances and state lawsrelatingm
construction, and hereby aothod¢representatives of this city to ewer upon the
construction,
-
QTY MECHANICAI. PERMIT FEE
SEISMIC
FEEbuilding
PER MI I' ISSUANCE.
ELECTRIC I'lili
above "mentioned ErapenY for irespect ile, Toulouse,
(We) agree ur mvc 'nde rify and keep harmless the City of Catania. againsT
PLUMBING PCC
lishilbles,jmdgments,ar.rme espenms which may in any way memo against said City
Inminsequonamoflhu antic as per
APPLICANT IINI .115" D A Wil .CO LY WITH ALL NON -POINT
ALTER OR A DU'r0 M EC11.
AIR IIANOLINO UNI 'I'(To 10,000 CENT)
MECHANICAL VII:
SOURCP 'GI AI'I
AIR HANDLING UNII'(flVl?R 0,000CFM)
CONS'IRUC,'I'ION 'TAX
_ _
Srgnu •nf Applicum/Cont Dula
EXHAUST HO0D(W/DUC'G
HOUSING MI'I IGATION IEE
HAZARDOUS MATERIALS DISCLOSURE
IMAGING UNIT GO 00.000 BTU)
Will the applicant orfulum htildingoccupvnt store or handle hazardous material
THIN] INC, INC, UNIT(OVER 101.00 BTU)
as defined by the Caperton Mmricipal Code, Chapter 9.12, and the Nowa. and Safely
Code, Section 25532007
❑ Yes $(No '
I D
VENTIIA'1'ION BAN (SINGLE RESID)
Date ....
Smeft lg
HOILIiR-COMI'(JHP ON.Ifi(LIXX)BTL)
Will Ice vpimenm or furore building accupanl Bu egaiplo nl or devices which
mil hnznrdou, air comaminams as Jefimcd by the Buy Area Air Quality Management
JUN 8 9�I.
Districll
❑Yes (�Na
BOILER-C(lhfl'IOVER If%LIXNI RTU)JU
AIR CONDITIONER
havNous lw¢,is), requiremenK under Chapter 6.95 of the Cid.
ISSUANCE DATE
By
NEN' RESIDENTIAL. MECH. SQ, F E
4,-�ae"' and'SS3J.1 understand that if rhe
huillycatrnamonsibilitY Ta notify the occupant
forma r�1 Sections �5)0.
orThh VI dloofa Ce/nifcam fOccu wLBpy.
OOMngent DaZr—
TOTAL
D
OFFICE