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29583 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO � BUII.IIING-MECIIRICAI, PERMIT NO. - BUILDING DIVISION APPIACATION/PERNIIT .29583 rl,umnlNr.�su:cnnNlcnl. 131111,111INGPItOJECT IDENTIFICATION BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE Q o e S q nq,+64 Z) ,.,-, /�J k 22 NER'SNA E: F� PHONE: CONTRACTOR'SN E: LIC NO: NIC CONTROLx 4154 v• 3 1 ECT/EN GINEER: ^ u NO:� ADDR17SS: S ❑ ONTACT. IV_ PHONE: BUILDING PERMIT INFO „baF� ao�-za5- Will. e ✓t"S� ❑ Consultant Fees Paid by Applicant(Initial) iiLDO,,ps EL PLUMBME Q LICENSED CONTRACTOR'S DIiCLARAq'(ON QTY. ELECTRIC PERM IT FEE 1 hereby airmn mal 1 mat licensed ander previsinma of chapter 9(cmmmem0ag JOB DESCRIPTION Qa'Z with Stt,iun]rOr)of Division3 of the Businmsand Professions Code.oM mylicense isC TIAL' W O PERMIT ISSUANCE F,WO in full internal effect. DEN WL OKRCHF.N REMODEL aU� License Class Lic.p QF U APPLIANCES-RESIDENTIAL AUDITION 01'LUMIIING RE-PIPE; NZ Dam Comracmr MULTI-UNIT ❑STRUCTURAL ARCHITECTS DECLARATION F m Z 1 understand m I shall be used a% abbe records PANELS MODIFICATION Z O4—a my P UP rO 2fM)AMPS O'L—� [I INTERIOR [I CHIMNEY REPAIR F-.~u1Littnsed Professional 2014000AMPS IMPROVEMENT W -1 S_t OWNER-BUILDER DECLARATION OVER 1000 AMPS 0 BATH REMODEUREPAIR O DEMOLITION C Q 1 hereby afrrm that 1 ant exempt from the Contacwrs License Law for the ig506 U following mason(Section 703 1.5.Business and Professions Code:Any city or county SIGNS ELECTRICAL, 0OTHER W 3 a h which ra,am,a permit to conmact,alar.improve,demolish,or repair any xtrucmrc Fp.00 prior m its issuance.also requires the applicant forsuch Permit rile a signed statement SPECIAL Cl RCUIT/MISC. y y that he is licensed pamount the pnwisinm'n1,M1c Contractors U,im,Law(Chapter 9 - �ty�� (cummencing win Sec,inn]Wtq of Division lof the Business and l'n0essions Ctde)-I 'TEMP METIER OR POLE INS'1'. COMMERCIAL: a txy c ty that he is exempt Ihere.fmm and the basis for the alleged exemption.Any violation of 0 NEW BLDG/ADDITION 0 DEMOLITION W Zvi Section 7031.5 by any applicant for a Permit%objects the applicant to a civil omily of POWER DEVICES ❑TENANT 0FOOD SERVICE. =Q not marc than rive hundred dollars($500) IMPROVEMENT Las owner of Ne progeny.or my empl.yees win wages a%Ihcirwle campensaion, SWIMMING POOL ELECTRIC F. will d.me work,and theswcare is not intended.,offered for sae(See,70,W,Business ❑OTHER L 3 m and Professions Code:The Conuacmrs License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES pntpeny who builds or improves thereon.and who dries such work hinvcell nr Through his own employees.Provided that such improvcmem.v arc not intended ur oficred for NIiW RESIDENTIAL IiLEC'IR SQ FT. wle.If,however.the building or improvement is sold wimin one yo..f..plminn.the SQ.1'[FLOOR AREA &SQ.t1'. r-builder will have the burden ofpraving that he did not build forpur- �� �{.. /�2 ewne '�-1j•`•` V pow as sown. I.ss owner of the progeny,.B exclusively nd emceeing with licca.d c.nrncmrs m 'TOTAL: cons"'the project(Sec.]044,Business and Professions Co1e0 The Comment,%Li- tx�'•f�r��� 1 cmc Law does no,apply to an ownerofpmpeny who builds or improves thereon,and QTY, PLUMBING PERMIT FEE whocommes forsuch pmjeaswith acontrector(s)licensed pursuant o the Co taxers, License Law. PERMIT ISSUANCE 1 am exempt under Sec. ,B&P C for this Mason ALTER-DRAIN&VENT- A VALUATION Coves" Data WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT. IC .` • Ihereby affirm under Penally of perjury one afthe fallowing declarations: ` �+ Ihavc and wi111nuinminnCcnirca,a est Cunsenunsd Ginwre lit Worker's Cnmpero DRAINS-FhOOR,R(I(3P.AR. NIn STORIES TYPE CONSTRUCTION satin,as Provided for by garden 37W of the latter Cole,for the performance of the weak for which On permit is issued. FIXTURES-PER TRAP ❑1 have and will maintain Worker's Compensation Insurance,as required by Section T 1100,411u lab.Cale.for mepedonaraceof the work for which this Iscoan is issued, GAS-EA.SYSTE'M-1 INCA OUTLETS OCC.GROUP APN My wakcr's Compensation Insurance carrier it Policy number arc: GAS-EA.SYSTEM-OVER 4(EA) / Caner: Policy No.: dol R CERTIFICATE OP EXEMPTION FROM WORKERS' ORFBSFJINDUSTRI.WAST INTERCEPTOR COMPFNSAIION INSURANCE si� n, RUILDINQDIVI'ION FEES (This section need nor becompleted Bible permit is for one handled dollars(SIM) GRGSE'I'RAP vUC or less.) PLANCHECK FEE/ I cenify that in the perfonnnn"of Nc work for which this permit is issued,I shall not employ any person in anymanmeranas to becon.e ahjacr,,,,hc Workers'Compete SEWER-SANITARY-StONM F.A.200 PE ENERGY PEE `7�I/P/1 Z scion Laws of Cnlifomia.Data WATER HIiATER WNENT/ELECTR zO Applicant GRADING FEF, NOTICE'IO APPLICANT:If.after making,hly Canircum of Encmp,mn,you should WATER S STE Ma R RATING. SOILS FEE F ^ become subject,.the Worker's Compensation pmviouns of,he labor Code,you mus, WBunwimcumply with such pmvislans lir this permit,hat be deemed resulted. WATER SERVICE 0. CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. PALO V O I hereby affmuhatthem is a cam,moiun lending agency for the Performance at Uma Recciptp {L me work far whish this parted is ixmal(Sec.3097,Civ.CJ U Looe,Name TOTAL: f<adel's Address TOTAL: 6. 1 cenify,ha,I have real Nis application and mate mal the above information is BUILDING PGE E-" N correct.l ugac to comply with all city and county ordinances and sate laws renting u, QTY. MECHANICAL PERMIT FEE ww U ,Z, building conamction.and hereby aahorizcrepresentatives uf,hiscity toenter upon the ELECTRSEISMICIC) `c)40 abovennrntioned prop my Ro ar,pe nim purposes. RMIT ISSUANCIiAu.11ri (We)agree m save,indemnify and keep htemless the City of Cupertino again%, ELECTRIC ITE liabilities.judgments,costs and expenses which may in anyway accrue agains,sual City ALTER ORADDTO MELD. PLUMBING FEE in soryence of the granting of this permit. APPLICANT of AND WILL COMPLY WITH ALL N N AIR HANDLING UNIT(TO 10,001 CFM) MECHANICALFEE S CE REGUI ATIONS. ZAIR HANDLING UNIT(OVER 10,0(10 CPM) CONSTRUCTIONTAX name r Applican Comracnt ]a HXHAUS'I HOODIW/UUCP] HOUSING MITIGATION FEE I \Z R. MATF,RIAIS DISCLOSUR Will mork"hcant nr future building a<cupma nmre ar handle harardom material HEATING UNIT(TO 100.00)BTU) m chnira d by the Capeninn Municipal Cala,Chapter 9,12,and Ne Ileahh and Safety Cole,Section 25532(.)^ 1IISATI NO UNIT(OV I?R IMOMl BTU) ❑Yes ON. VENTILATION FAN(SINGLE RESID) PAID Date Rccciptp Will the u,ferin ,,I'amre baddingoccupun,use eyuipnmm mAcvicas which BOILLN-COMP(3HP OR IIYJ IYdO BTU) ami,ham,dous air containment,as defined by the Bay Area Air Quality Management 'TOTAL: Disuse] BOILER-COMP(OVER I(.,000 BTU) E]Yes ❑No I have read the havadous materials"uiamen,s under Chapter 6.95 of the Cali AI R CONDI1'IONER ISSUANCE DATE fomia Health&Safety Code,Sections 25505.2353]and 25534.I undersand Nat if the NEW RESIDENTIAL MECIL SQ.PIT building docs nat cumently have.mumu,that d is my aslamslbillty to omify the occapant of the requirements which must he met prior to issuance rf a Can ficus of occupancy. owner or amhnrircil agent Data TOTAL-1 ISSUED BY: OFFICE q S 2 - Z6, - ) | /M c 7 : ! ) � ) / § m 0 / - § ) § / ; ` ] - \ ; $ 7 , \ \ / \` § ` ` \ ) ) mz\ , \ � \ \ \ � � � k / / A K )\) }\} i; ` : \ } \ 7 | § " R 02, \\ � \�� _ _ \ | ( / \ / � ° { , | | . , m . _ \ § \ � � � | ; B \ � � \\\ > n e , U m `!; \ i { 9 § ; ! % � ! ; � ! 7 ' ; )/; 2 /\ (Cf) , , , ` k 2 }\k - m CL ` _ ' ` ` / ° 2 / � °>: " ` E 4 k , _ !|! W | . . . n , - n \,! . , m s m � - ea` _ § § \ ' | [ 7 \ . f; _ 2m I § � | © :3 ) : $ . . � ; . . g 2 m\ Ln � Ch , 4