B 0291 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT,PEN ONLY
r CITY OFCUPF.RTINO BUILDING-ELECTRICAL PERMITNO12,0291
BUILDING DIVISION APPIACATION/PERMIT PLurv1u1NG.MECHANICAL •, S0001 ••
BUILDING PROJECT IDENT'IF'ICATION
BUILDING ADDRESS: SANITARY NO. APPLICA'I NSU Tp1AI,UA'I'f
3 Arc sBVay P2 AC,6, CVPElZT A/d C 7�Q 9�
G NC SNAMii: 7 Gf�fONE: CONTRACTOR'S NAME: - 't LIC NO:
!�, K NIC CONTROL
RC "/ENGINE- : GIN
od ADDRESS: ❑ ��
co
- TACO //JJJJ PHONE: - - BUILDINGPERRRMIT INFO -
❑ Consultant Feiss Paid by Applicant(Initial) BLD EV PLUMB MEED
7r1aRK fill SZC2pA' 7.30-72b5 MY
LICENSED CONTRACTOR'S DECLARATION - ( "
QTY. ELECTRIC PCRMiT FEE
I hereby affirm Chet I am licensed muter provisions of Chapter 9(commencing _ -_ � JOB DESCRIPTION�
Picowith Section 7000)of Division 3 of0c Business and Professions Cade,and my license is �{^ O RESIDENTIAL'
8100 . PERMIT ISSUANCE I. 1
I. force and ellen. t El STORE, ❑KITCHEN REMODEL
aUU License Class Lice APPLIANCES-RESIDENTIAL El ADDITION El PLUMBING RE-PIPE
F W Ume Colman,
ARCHITECT'S DECLARATION - - ❑MULTLUNIT ❑STRUCTURAL
Z O=catIn PANELS MODIFICATION
undecstund my plans shall be used as public records
OZ—.q I', UPT0200AMPS . El INTERIOR ❑CHIMNEY REPAIR
LicensedPmfexsional 01-1000AMP5 IMPROVEMENT SWIMMING POOLS
� $� OWNER-BUILDER DECLARATION OVELIS - ❑RA'I'N RF.MOD V PAIR ❑DEMO[IT] N
BC7 6 1 hereby affirm that 1 am exempt from the Coolmcom's License Law I.,Ne
O W U following reason.(Section 7031.5,Business and Professions Cade:Any city or county SIGNS ELECTRICAL OTHER Imo'1��`I
a y when its i io o perms re cuneate,alts,improve,demolish,nr repair n d sateen ' V lJl 1
so
'poor hat he sliced ed pursuant
to tea lhovisio so for Commsuch rminofleasigned statement SPECIAL CI A11.
y�B11y"e that he is licensed aM pSteel to ilia provisions of the Convaemrls licence Low(Chapte9
pt d00 (commencing with Sect ion 110%1).1Division 3 oftha Buainessand Potassiums Code)nr TBMP.MEI'ER OR POLE IN'T COMMERCIAL,
d y M y Oat he is exempt therefrom and the basis for the alleged exemption.Any violation of - ❑NEW BLDG/ADDITION ❑DEMOLITION
LLX1 n' Settinn]W LS by any applicant fore permit subjemslM1e applicammecivil penalty of POWERDEV
m ❑TENANT ❑FOOD SERVICE
� Qnot more than five hundred dollars($500).
I,aeownerofthe rt,orm em In eas with wages as their sale compensation, SWIMMING POOL ELECTRIC IMPROVEMENT
O ❑ prose Y Y P Y g F
"$y�! 11 do the work,and e:Thit cture isContra hots License Unit red does of apply to an Bnsines., C1 OTHER
��m anJ Pndessions Code:The Commemr's License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES
Property who builds or improves thereon,and who does each work himself at,through
his we employers,provided mm sucli improvements manor intended or offered for NEW-RESIDENIFIAL ELECTR SQ PT.
aale.If,innovate,the biilldim,or improvement!.,.,old withiromYear of completion,the SQ.FT.FLOOR AN EA $/SQ.FF.
owner-hailder will have the burden of proving that he did not build or improve far put- _
- pose le.). ✓✓✓G
rod ct(Secperty am exdus and eofessi ns wits licen'calculate
sd canaers to
construct the project(Sea 7004,Business and Professions CndmJ TTe Convaear's Li�
ase Law does not apply town owner of property who builds or improves thereon.and QTY, ' 'PLUMBING PERMIT`s FEE
who contracts for such projects with a contrucmr(s)licensed pursuant to the Commemrs -
'J Lic a TISSUr
�Yd� f
exempt under Sea _ P this
B& C
-DRAIN& -W l' RTEA - VALUATION
Dana—
wron 1'r147 r7w WORKER'S I'ENSATION DECLARATION KP DEVICE S f
Y.. l nerebyelirm under penaltyef,rjuryaneafthe fol lawingdcdamtinns -
[I I have and will maintain a Camficate of Consent to self-insure lar Worker.,Compen- RAINS-FLOOR RO N STORIES 'fVPE CONSTRUCTION
moon,as provided for by Section 3700 of the Labor Code,for the performance of the - -
work far whichthis pemail isissued. �fiUR ES-PER TRAP Z
❑I have trod will maintain Workers Compensalion Insumncr as required by Section -
37IMI of the Labor Code,for the perfnrmarne of the work Full this permit is issued G - J INC 40UTLETS OCG GROUP APE
{ -
My Worker's Compensation Insurance carrier and Policy oumM1ervrs,
o Carrie: Policy sem: GAS-EA.SYSTEM EVER 4(B ,
CERTIFICAI E OF EXEMPTION FROM WORKERS' r COMPENSATION INSURANCE UI GRP.ASBIINDUtiTRh WASTE INTERCEPTOR
) GDIV(SION FEES
(Thmoaian need not be completedfth
ie permit is future hundred dollars($100) GREASE TRAP . - -
arlesa) PLANCHE �.�
I certify that in the perforrombe of the work for which anisbannerisi uaucd,Ls TORM F.A.200 FT.
not employ any cenun in any manner m on,to necume xubjen to the ENERGY '
Z cation Laws of Caf tia.Da WATERIIEATERW/VENT/F.LECTR
Applicant GRADIN EE hrx
NOTICE TO P LI T.IL a nakin Ce00eam of Exanptioq you should p' ,R. BATING
h 4 necome subject m the Worker's Compensation provisions of the Labor Cala you..It
- SOILS FE
Wforthwith comply with such provisions or this permit shall No deemed revoked WATERSERVICE
Q
CONSTRUCTION LENDING AGENCY .i'I.MB. SQ.Ff. PAID
CT
U 0 I hereby affimuhanhere is a concoction lending agency for the perfonnanwpf Dnl � Rsceiptp
F der work for which this partur k issued(Sec.3097,Civ.CJ 01
O ULender's Name • - TOTAL:
Lendm.,Address IAI.
y 1 certify that 1 broomad this ppl f al late that the above infornialain is I o BUILDIsomi
m correct,1 agree ba comply with all city and county lardinamesmal fare law.,aflatin,to QTY, MECHANICAL PERMIT FEE-
building construction d lanalry authorize representativesofthsriyt enter upon the - SEISMI F
above nenhoned pmp,ay for irspeCton purposes PERMIT 1551fANCR `2-
(We)agree no save,indemnify and keep hvnnless the City of Cupertino against 1 O ELECT FEE
liabilities,judgment,mac and expener which may in any way acerae ammo said City �' AITERORADDTOMECU .d
nnwyuence of the gentiug of this permit �" PWMBIN'PEE
tAPPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1.NON-POINT AIR HANDLING UNIT(TO III,OIIO CFM)
SOURCE REGULATIONS, MliCilAN1C PEE
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Signature mApplicarr Conbador Data EXHAUST HOOD(W/DUCT) HOUSING MI'HGATION FEE
HAZARDOUS MATERIALS DISCLOSURE - -
Willthcapplicamm future building occupantst a or handle hazardous material f HEATING UNITGro 100,000BTU) O t
as defend by the Cupertino Munie/i�y Castle,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)'! L HEATING UNIT(OVER INOW FIT or
PAID
No VENTILATION FAN(SINGL.L RESID) - Dam �'N�Receiptp "N
Will the applicvnt or lLwre building occupant use equipment of devices which BOILER-COMP(3HP OR 100,000 BTU)
emit harridan,air cnntmninaned by the Bay Area Air Quality Management STA w
District? -
El Yes Na BOILER-COMP(OVER 100,0001ITU)
AIR CONHA HONER,
- 1h dtheh hazardous req t t: d Chpr 6.95ofth Cali- ISSUA CEy,(ggTE
font a H Ith&S fety CM "S i .25505 25533 d 25534 I ode tend Oat itthe NEW RESIDENTIAL.MUCH. SQ.FT.
bn'l i mefA"radearrom ee Te Lihm hrtm l'ty!7 (a�{
[t hen issuance eta Ceml Cama .r�9
Or authorized g l�� IOTA ISSUED BY: 111111
OFFICE
t