The URL can be used to link to this page

31211 ' . APPLICANTTO FILL IN INFORMATION WITHIN RED�LINES--USE�BAL'L POINT PEN�ONLY J • � � � ' CITYOFCUPERTINO ' ' ' � BUILDING-ELECTRICAL � PERMITNO. q � 'Bv[LDING DIVISION � APPLICATION/PERMIT ' rcumnwc�mecxnrv�ca�. � . . , , . , 3 1 2 11� , � � BUILIIINGPRWF.CTIDF,NTIFICATION ' OUILDINGAUDREtiS: ' � � � , SANITARYNO. AP�LICATIONSUBMITTALDATE 8sb �� A�- c� ..��,. � �s-a��., = , S q'� . , � OWNER'SN N: � � PHONE: CONTRACTOR'SNAME: ' - � LICNO�. e� ' .. 2-SS'/Y7 R w � �.wc . , , . •. coivrao�a . ' 1RCHITECf/ENGINEtR: .. LICNO: .A��REsg�� /� S' A /�„� gU,� ❑ � ��YN UG/ �r (�1! . . corvTnCT:� ' Pnorve: - . � BUILDINGPERMTTINFO '7 ' ❑ ConsultentFeesPaidbyApplicantpNNap HLDG ELECT PL� MgCH, I � ' � ❑ .' yu\ LIC�uSED CONTRACTok'S DCC�nanTioN � QTY ELECTRIC PERMIT FEE � �hu�by aYfiem mm��m��en:oB ooau prows�ons ut ehopmr 9�w�r.��os ' JOB DBSCRIPTION �{��'Z ih5ec�ion]OOf))ofDivision3of�heBosincssenJPmPossiunsCade,nndmylicenseie RESIDENTIAL: F�� n'full force and effm�. PERMIT ISSUANCE , � �U V Licensc Class L � � I,iu N- � � . .O SFDWL ❑KITCHEN REMODEL F�W �am ' '�Commcmr /+PPLIANCPS—R&SIDBNTIAL ❑ADDITION '' ❑PLUMBINGRE�PIPE y[..`�.lN - ARCHITECT'SDOCLARATION pqNEI.S " ❑MOLTFUNITI , � ❑STRUCTURAL OO I unders�and my plare shull h uud us public recoMs � • MODIFICATION G�0 UPTO 2W AMPS ' ❑INTERIOR ' ',, ^ ❑CHIMNEY REPAIR ��; LlcensW ProRssional 2061000AMPS „ IMPROV2M6NT {@ J,�pg�4p � OWNER-Bl1ILDERDECLARATION OVERIOOpAMPS ❑BATHREMSy;Iw�'�YI�-S,I'— yc� / y f�] � I hereFy effrm tha 1 am exempt from�he Comracmh License Law Yor ihe �'�� x a L F (opowing re¢wa(Su�ion]031.5.Busines,e und RoPoesione Code:Any ciiy or coumy SIGNS P.I.F.CTRICAL � •OOTHER t �L(. `"�� u� � whicM1 rcquircs u pcFmil lo consWcl,ol¢q impmve,Jemnlixh,nr repvir eny swcwre " �� pnnr4�i6ismancqelsoreqW�estheappliwntforsuchpeemino�lceeignodemtemwl SP6CIALCIRCUIT/A1ISC. pr �M1i�helsliansc�pursonmmrhaprovislonsopheGmtmcmr's1.IeenseLaw(Chap�u9 00 �°omm<ncinywith5wtion]000)of�ivieian3ofiheBo.cinessnndPmPo,vsionsCode)or TEMP.M6TF.RORPOLEINST. ' COMMERCIAL: ` ' I S m y� �hal he is exempi therefrom and�he basie for Ne alleged enemptiun.Any viola�ion of ❑NEW BLDG/ADDITION ❑�EMOLITION'� �,,,�L 5<ciion'l03LSbyenynpplicamforepemiitFohjwts�heapplicem�oacivilpeml�yof POWFRDEVICES � � � - - ' � ' m .�TfNANT ❑FOOU SERVICE not more�han fve hunNea dollurs(E500). - .IMPROVEMENT ��O �I.es owner of�he pmperty,or my employces wiih wages os�heir sole compensvtion, S W IMMING POOL LLGCTRIC - , , . , wJl do�ha work,end ihe swnureis no�imm�de�oroRered for sule(Su.9044,Busioess ❑OTHHR a� and Pmfessions Code:The Conuacmrs License Lew d«s m�upply�o an owner of OUTLETS-SWITCHES-FIXTURGS � property who builas or improves thereun,un�who doca such work himself or�hrough - ';J-, � � his awn employees,provided ihe�soch impmvemen�e are mt imrnded nr otTered for NLW RLSI�GNTIAL ELECfR - SQ FT. sale.lChoweveq�heboildingorimpmvementissuldwiihinoneyeorofcompletioq�he . . , SQ.Ff.F100I�REA 5/SQ.FT. ownervFuilAer will have I�e burden of proving thul he did mt build or improvc for put- � G � V poscofsaleJ. ' , . P�� •. �� ❑ 1,as owner of�he propeny,em exdusively convoc�ing wi�h licensed con�racmrs�o � ' " . 9OTAL: �n ons�me�iNeproJeel(Sea9044,9usinesrundProfassiousCotleJTheConuaemrsLb � e Q Ii[(�p cense Law does na npply m en owner of propeny who builds nr improves ihereon,nnd Q7'Y. ING PERMIT FEE ,(U{� O �Y�+ ' whowntrec�sPoreuchprojecswi�haronvecmds)Iicensedpursuem�oiheCan�memle Ip7� License Law. �a P2RMIT ISSUANCE µ��V• ❑I um exempt under Scc. ,H&P C for�his reason Ur �jV(�t Owner - � Wre ALTER-DRAIN&VEIJT- R(EA) " VALUATION ' � WOR%ER'SCOMPGNSATIONDECLARATION BACKFLOWPR CT VIC " ' �� 1 hueby afFrm onder pwalty of ppeJury one of�he(nllowing dulem�ions: � � ❑IhavenndwillmaimnineCertifcamofConsentmsdGinsurefnrWorkersCampem DRAINS-FLOOR. � A. ONU. " ' STORIES TYPECONSTRlICC10N � ee�lon,us pmvi�W fnr tiy Section J]OU af�ha Lvbov Cade,for iM1e perta�munce of ihe . workforwhicM1�Fispermiiisiswed. � FlX'fURPS-PERTRAP � - � ' ❑I heva en�wlll mulnmin Wurku's Compensetion Insurenee,vs required hy Sxrion .. � � � JOO�oftheLaborCode,fonhepedormanaofthewnrkforwhichNispermi�isissued. � GAS-EA.SYS'fEM-IINC.40UTL OCC.GROUP APN, � My Woher's Compensu[inn Insurance caener unJ Policy nombcr are: ' , � , Camee PolicyNo,: GAS-EA.SVST2M-OVERA(2A) • � ' ' CERTIPICATEOFEXEMPfIONFROMWORKERS' � ' ' � COMPLNSATION INSURANCE � � GRF.ASPIINDUSTRL WASTE INTERCEPTOR ' BUI[:DING 4IVISION FE&S � '� (ThlsebcdonneedmthecomplemdifihepermitisfomnchundreJdollars(EI00) GREASETRAP ' oAessJ ` ' � PLANCH0CKF00 � ' Ittrtify�hutinihepedormenceof�heworkforwhichihispermiiisissued,lshnll ,� SEWER-SANITARY-STORMEA.2WFT. ' � - '� nut employ uny persun in eny man�er so as m beron�e subjec��n the Workers'Compen- � ' ENLRGY FEE �, - z 'eatian Lews of Califomie.Date ' zO APP�.,a � , � � �,. WATERHEATERW/VENT/ELECTR GRAOINGP06 q NOTICB TOAPPUCANT:If,aRer making this Cenifcore of Exemptiun,yuu ehould WqTF.R SYSTEMITREATING. - ' 1 ' ['", '„^ become subjec�m the Wnrker's Compensmion pmvisions of�he Labor Code,you mus� SOII.S FEE � Wti fonhwiihcomplywilhsuchprovisinnsnrNispertniishallbedeeme�rcvokud. WpTERSERVICE , � z � � � �CONSTRIJCTIONLENOINGAGENCV NLWRESIDLM'IALPLMR. SQ.FT. � PA�� ' • U � Iherebyaffrm�hauhercisacnnswctionlenJing�genryfnnheperfortnanttnf , � . D� ReceiptN' . the wovk for which�his pemi ia�suad(Sac.31N],Civ.CJ u" �"� LendersName �I� NL TOTAL: ! �.V LendersAddrea�' .. . . � � �� 'roTAI.: � y1 certify�het I hwc reud�hi's applica�ion and s�am ihe��he above informaion is � BU IN Iq crtec�.lagreemcomplywi�hallci�ya�dcoontyominaneesandsmmlawsrela�inS�o QTY MECHANICALPERMIT FEE . C.) � Auildingconswati�n,nndherebyeuthorimrepresenm�ivesa[�M1ischymenmrupon�M10 Se �' }, ' abave-memionedprnpertyfnrinspectionp�rposes. ' ' . pF.RMITI55UANC6 � - ' ' (We)agree m enve,indemnify nnd keep harmless�ha Ci�y of Copenino agaiost HLECfRIC 8 Iiabilities,judgmrnts,cns�undexpenuswhichmayinanywayaccmeagains�snidCiry� ' qLTERORA��TOMECH. � imm�sequenccof�he6��ngnf�hispem�it. ' PLUMBIN FEE ' � APPLICANTUNOGR57AN-5'ANDWILLCOMPLYWiTH'ALLNON-POINT p�RHANDLINGUNIT(TOIO,lN10CFM) " MECHAN ALFEE � SOURC EGllLATIONS. / , w/�� f^�0.�4� � AIRHANDLINGUNIT(OVBR'IO.00OCFM)" CONSTA CTIONTAX J / , � SignumreofApplicw✓Cammanr . * Dare� E}(HAUSTHOOD(W/DUCf) HOUSIN MITIGATIONFEE � HAZARDOUS MATF,RIALS UISCLOSORG ' Wlltheapplicantorfo�orebuildingoccupamslorcorhaneleM1azardousmaenal HPATINGUNIT(TOIIIq00UBTO) � , � . az definea by�he Cupenino Municipel Codq Gnp¢r 9.12,and Ne HcnhM1 uutl Snle�y ' Coda,Sec�ion25532(a)P HNATIN011NIT(OVERIOO,�OOATII) F , . � ❑Yes' � �}'IVo ,. . � ' , . �PAIO . � VONTILATIONPAN(SINGLORPSID) . Will the e licnnt or fumre buildin ' �use c mem ov devices whlch , Da�e' Rweipt X pp gucwpan quip BOILL'R-COMP(3HPORIOO,IIOOBTIn emi�hazsrdous eir conmminams ae dcfnetl by Ihe Bny AmaAir Quality Mane6emen� �� ' TOTAL: DismicB ' _ _� BOILCN-COMP(OV9HIOO,OOOBTU7 ❑Ves. �� Oj:o ' . " ' - . . "� . . �� AIR CONDITIONER 1 huve reoJ�he hazvdous mamnala requir<men[s under Chapmr 69S of Ne Coli- � ` � ' ISSUANCE DATE , � � fomie Heatrh&Safmy CeMe,S¢�ions 25505,25533 nnJ 255J4.I uMers�and Na�if the ' NEW RLSIDENTIAL MECH. � �SQ.FT. � � . buOdingdce�noicunw�lyhoveatcnun4�hu�i�ismyrexponslb0i�ymnodfy�heoccupunt ' � of�heayuiremehtswhiehmus�beme�prlovmissumwofaCertificomiifOccupanry. - ' ' . , • OwneroramM1orissJagem Dae - � TOTAL: ISSUEDBN I : ' ' , OFFICE , .' .