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29405 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL - " PERMITNO. ' BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICALS 29405 BUILDING PROJECT IDENTIFICATION I BUILDING ADDRESS: - - - SANITARY NO. APPLICATION SUBMITTAL DAT! OWNER' AME: - PHONE: _ CONTRACTOR'S NAME: LIC NO: ��' © ``�S - -�0�� NIC CONTROL# ARCHIT CT 1 EER: - LIC NIA s ADDRESS �[Y e �. CONTACT: - - PHONE: - BUILDING PERMIT INFO �., _ t ��/� ,❑ Consultant Fees Paid by Applicant(Initial) B ELECT PLu B' MEcx I Q Im fast I CONTRACTOR DECLARATION' QTY. ELECTRIC PERMIT FEE 1 hereby affirm Nat I am licensee under and Pro Inns ofs Coder 9(commencing� � JOB DESCRIPTION �O C'z with Seniea0(XIU)of Division of the Business and Profession Code,and my license .00 y PERMIT ISSUANCE RESIDENTIAL' �W in full farce and ef�Fc., r"ti ,.fT(� ❑SFDWL ❑KITCHEN REMODEL V� License Class `- ��r.ic.# � � � -%' {.2 APPLIANCES—REMDENTIAI. ViG Date�Contrecmr�l!_-la_!_p):. ❑ADDITION ❑PLUMBING RE-PIPE A MITI Container DECLARATION PANELS - p.p m MULTI-UNIT MODIFICATION z pr�4 1 underhand my plans shall be used as public records • OZ'[•.+� UP TO 200 AMPS EJ INTERIOR - ❑CHIMNEY REPAIR Licensed Prefessioral - 201-1000AMPS2 IMPROVEMENT OWNER-BUILDER DECLARATION WW GG I hereby affirm that 1 am exempt fmm the Contractor's License Law foi the OVER 10(1!1 AMPS ATH REMODE!/REPAIR 0 DEMOLITION '3 F following reason.(Section 7031.5,Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OTHER which requires a permit to construct,alter,improve,demolish,or repair any structure E.I'JOr3 Prior to its issuance,slso reItemstheit,licann for such permit m Glee.signed statement N,3arm SPECIAL CIRCUIT/MISC. i+ Not he is wait pursuion700o of Division 3 the Conwness andLice Law(Chapter9 (commencing with Section'I0W)of Division3nf the Business and Professions Cade)or TEMP.METER OR POLE!NST, - COMMERCIAL: 6 ps tL that he is exempt therefrom and the basis for the alleged exemption.Any violation of t ❑NEW BLDG/ADDITION ❑DEMOLITION W"m Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of POWERDEVICES ❑TENANT ❑FOODSERVICE SWIMMING POOL ELECTRIC 06 y not mon than five.handr'oldollars($500). IMPROVEMENT ❑1,as owner of the property,ur my employees with wages es their eolecompensation, will do the work,and the structure is not intended oroHered hassle(See.7044,Business []OTHER + and Professions Code:The Commerce',License Law does non apply m m owner of t OUTLETS—SWITCHES—FIXTURES 6'3 property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECTR SQ FI'. sale.If,however Ne building or improvement is,sold within one year of completion,the SQ.FT FLOOR AREA WSQ.FT. owner-builder,will have the burden of proving that he did not build or improve for poo p pre of sale.). - D 0 I,as owner of the property,am exclusively contracting with licensed contractors to cnntrue[the project(gee.7044,Business sad Foreswore Cede)The Convectors LapenLi- ,YIflR 15 . Li- cense w does not apply to an owner of prdy who builds or improves thereon,and QTY. PLUMBING PERMIT FEE 1996 who contracts for such projmts with a contmcums)licensed pursuant m the Convacmr's License Law. i " 1 am exempt under Sec. - ,B&P C for this reason PERMIT ISSUANCE ch r Owner Date - - ALTER—DRAIN&VENT—WATER(8A) VALUATION WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE //hereby affirm under penalty of pe jury one of the following declarations [d9heveand will maintain a Certificate of Consent o self-insure for Worker's Compen- DRAINS—FLOOR ROOF,AREA,COND. - STORIES TYPE CONSTRUCTION ea 34 wosation,as provided for by Section 37W of the Labor Code,for tie performance of the �k for which this permit is issued r FIXTURES—PER TRAP I have and will maintain Waders Compensation Insurance,h required by Section J' - ofme kw'xeCWatwnfiws2formancla1wd work forwhich this permit is issued GAS—F?A.SYSTEM-1 INC.4'OUTLETSM,WwOCC.GROUP APN4 Crier: 's rq�n'Flns rp{far{ and Policynu�Lpt��'G�q f r GAS—EA.SYSTEM-OVER 4(EA) _ f/ FIR IA licy No.: .G4 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASEANDUSTRL WASTE INTERCEPTOR - BUILDING DNISION PEES (This snnewncednot he completed if the permit is fomeahuodreddollars(S Fill GREASETRAP or less) PLANCHECK FEE Ioy any Natlnthe perforanymmanceof the work for subjectch to thepermitWrkesuCompeall SEWER—SANITARY—STORM EA.200 FT. neniorT Towns any perforin any manner sonmbecome subject to Werkers'Cnmpem _ ENERGY FEE ,7s senior Laws of California.Dane ' Q WATER HEATER W/VENT/ELECTR Q E GRADING FEE NOT! y NOTICE TO APPLICANT.r' attorranking this Certificate of Exemption,you should WATER SYSTEMiLREATING become subject y the Worker's Compensation provisions of the Labor Code,you must SOLSTICE, 'forthwith comply with such provisions nrthis permit xhnllMdeemed revoked. , WATER SERVICE Q CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMR. SQ.Pf.' PAID W�6 ,l herebyich thi Norton issue (See u)97,Cie.agency for the performance of � � � Data Receipt# Le wars for which this permit is issued(Soc.3119"I,Civ.CJ TOTAL: ' U Lender's Name - ' "' W� !sneers Address` Iy 'I certify That 1 have read this application and stone That the above information is � BUILDING FEE o-r 0 reran.I agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE building construction.and hereby authorize representatives of this city m enter upon the SEISMIC FEE above-mentioned property for inspection prepeces. PERMIT ISSUANCE (We)eg va to save,Indemnify and keep hamless the City of Ceramic.against ELECTRIC PEE Iiahilities,judgments,costs and expenses which may in any way same against said City ALTMORADDTOMECH. inconsequence of the griming of this permit. PLUMBING FEE �• APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,"CFM) SOURCE REGULATIONS: MECHANICAL FEE AIR HANDLING UNIT(OVER 1Q000 CFM) CONSTRUCTION TAX Signature efApplicardCoalracmr Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant snore or handle hazardous material HEATING UNIT(TO 100,01M BTU) as defined by the Capetian Municipal Cade,Chapter 9.12,and the Health and Safety Code,Section 2 532hq? HEATING UNIT(OVER 100,000 BTU) _ ❑Yes VENTILATION CAN(SINGLE RESID) PAID '^ Will the applicant or future building occupant use equipment or devices which Data Receipt# emit hazardous air contaminants as defined by the Bay Area Air Quality Management BOILER—COMP OFF OR 100,001)BTU) TOTAL: El Yes WN District? .`o BOILER—COST(OVER 100,10)BTU) •� i have read the Intenders`mutenuhomitcments order Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE forma Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the" NEW RESIDENTIAL MECH. SQ.FT. building doesnotcomentlyhm<utenant,Nm it is myt ponsibility m notify the oecupent /vJ of the req ' is 'c m�yttt�nor to mss ce ofa Cetifiewcof� Owner ranthodzed g ( Dare TOTAL: ISSUED BY: OFFICE