S 0594r W D,IcnoMATlnN INITH!M RED 1 INFS _ I ICF HALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING. - ELECTRICAL,
BUILDING DIVISION APPLICATIONFPERMIT PLIJMRING-MECINNIC'AL
BUILDING PROJF,CTIDENTIFICATION
Pl: Br NO.
0594
BUILDING ADDRESS:
/01/05 / 4Aa PrivG
SANI'1'ARV NO.
AI'I'1"ICA'TION Slll{ AI, DATE
OWNIiR'. ;DMF PHONE:
t! O &eAk. Lvtiiske 1i'
CIIN I RACTON:SN ME LIC NO
C��[ �� DSI
NIC
❑
CONTROL It
ARCHI I ECDENGINELR: 1, 'NO'.
AUURE'S:
CONTACT: PHONE:
❑ Consultant Fees Paid by Applicant (Initial)
BUILDING PE ETINFO
HLDG ELECPLUM f MECII
QTY ELECTRIC PERMIT -FEE
LICENSED CONTIR 70WS DECLARATION
1 hereby affimt that I am licensed under pmvisions of Chapter 9 (commencing
with Section 7") of Division 3 oDM1e Huviness and Prnlit Code, and my license in
in full litmcimd ell'cal.
License Class Lk.4
' JOB D SCRIPTION
R I 1
'DWI, ❑KIT'CIIIiN REMODEL
❑A NTION ❑PLUMBINGRE-PIPE
L,
PERMIT' ISSUANCE .✓
APPLIANCES —RCSIDUN'1'IAL
Dutc Comousum
ARCHITECTS DECLARATION
PANELS
❑MULTI -UNIT MODRICAT10N
1 understand my plans shall he used as public records
UP TO 210 AMPS
C1 INTERIOR ❑CHIMNIiY REPAIR
IMPROVEMFN'P []SWIMMING POOLS
[I BATH REMODEUREPAIR EMO J.1'I'ION
❑ OTHER
Licensed Vm[cssiony
OWNER -BUILDER DECLARAI ION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
201-1001 AMPS
OVER 1000 AMPS
following remon. (Section ]031"5. Business and Psofessiuns Code: Any city or county
which requires a pe olio u' construct alter, improve, demolish, or repair any structure
prior In lis issuance, also requires the applicant for such permit In file a signed statamc"t
That he iv lien M Taciurn, tom. pootwons"f the Cmmnmwr'I License [.use (Chapter 9
(commencing with Section ]WOof Division 3 of the Husines and Professions CodOor
and the basis for o alleged exemption. Any violation of
that he is exempt dumfrom t
permit objects the applies. a civil penalty of
Section ](131.5 by any applican' for a permo.
not more than five hundred dollars (SSW),
El [.;is Owner of the pr"peny. or my cmployces will' wugex to, their sole cmnperexti"n,
will do the work, and the.urucore is not intended maimed Ia unssisale (See. ]IW. Bit
i and profession. Code: The Contractor'.. License Law docs not apply ,t an miner of
propery who builds or improves thereon, and who does such work himself or through
his own employees, provided that such improvements art not intended or offered for
sale. If, however, the building or improvement is Sold within one year (1fmmpletion,the
avant,builder will have the burden of proving that he did net huild or inmrove for par-
unpest of,de.).
,,e
Cl I. a. Owner of the property tom exclusively concocting wit licensed come nos m
construct the project (Sec. ]014, Business and professions Cale:) The Contractor s Li-
eocLswdcesnotapplyit) an owner of property who builds or improves therein,and
who umtmms for Tach prajcmv with n weipursuant r rn"(s) licensed pursuano the Contractor's
License Law.
a execs �& :C=or an, reason
SIGNS ELECTRICAL.
/
SPDC I AL Cl RCUI"I oNUSC.
TEMP METER OR POLE I.
M I 1.
NEW RLDG/s\DDITIf C]DIiMOLITION
❑TENANT ❑FOODSERVICE
IMPROVEMENT
❑ OTHlili
POWER DEVICES
SWIMMING PO( .ELECTRIC
OUTLETS— ITC IXTURES
SQ. F. FL R L
CIN OF �HTI
SiSQ. I'
NEN' . IDENDUAL R SQ FT.
j
QTY. PLUMBING T FEE
PERMIT' ISSUANCE
ALTIiR - DRAIN & VINT- WATER (EA)
VA [.OAT
Owner
)RKF"R'S COMPENSATION DIiCI. RATION
BACK FLOW PROTECT. DEVICE
1 hereby snout under penally of perjury one [lie hollowing declarations.
E] IhaveandwillmalntainaCeaificalcof ConscnU"w1f-insumfnr Workces ComNn-
cation. a. provided far by Section J]W of IM1e Lahr Csalc. (or the perpmnance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700of the LaborG.Il, for the pedo...nncofthe work fur which this fiction is ismed.
DRAINS -FLOOR, ROOF, AREA. GOND'STORIES
OCC.GROUP
TYI'I?CONSTRUCTION
APN
FIXTURES -PER TRAP
GAS - EA. SYSTEM -I INC. 4 OUTLET
GAS -I'A"SYSTEM"OVER 4(•
My Workers Compensation hcunmcecarlerand Policy number art:
Cameo Policy Nn.:
CIiRI'IFICATP OF EXEMYI'ION FROM WORKERS'
COMPENSATION INSURANCE
GRIiAtiI. NDUSTHhW-INIT:NCIi{'roR
BUILDING DIVISION THES
GREASE TRAP
PLANCIIECK PTE
(Ttisoctlnnn,ud nothecomplatul ifthepenuil is forom hundred dollars (510(0
or Icxs.)
whkhtI. the W rker,' Conued. I taaillin.
not employ any Canon in any manner as sex Ise become object to the wnrken' Compete
Loy any tannin Performance (if Us to
ration of California. Date
SIiWER - S ITANY - STORM EA. HX)IT'
IiNERCY ITiIi
WAl ' HEATER wN1iNT/EL[CI'R
GRADING ITE
ers
Applicant `
APPLICANT: r atom making this Ccri...S of of Exemption, you should
heannc xuhjeet y the Workers r'n C.'tt.. I,, t i, vermis hal mf the Ia'M1mr Calc, You nim'
become subject
forthwith comply with such provisions or this Cennil shallMdeumed revoked.
A'TEk SVSTEMlTR1iATING
SOILS hili
WATER SERVICE
Ietc
CONSTRUCTION LENDING AGENCY
herc is lending agency for the performance of
� Ihercaffirmby unn thaumaru
the work Iia which this permit is I ... rd (See NP7. Civ. C.)
PAID
RmeiplX
NEW RESIDENTIAL. PLMB. SQ. FL
'IGIAL
jUnder', Namc
lender's Addoc,
TOTAL:
BUILDING FEE
L 1 comfy that 1 have read this application and ams that the alone information is
n incorrect. n, m I Neocomply wit all city and county ordinances and seam laws relating to
building consauction, and hereby autoriec reprex,nlmivex of tis city inciter mum the
QTY. MECHANICAL PERMIT FEE
SEISMIC THE
abmvanmmimnctl property for inspection purposes.
(We) spree In save, indemnify and keep humJesu the City of Cupe Lino aeainxt
RNI iIHies.judgmente emu and expcnsss which may in any way aceme againsis4d City
in consequence of to granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
PERMIT ISSUANCE IS
17LFCI RIC FEE
PLUMBING HE
MECHANICAL FEE
ALTER OR ADD' TO MECH.
AIH HANDLING UNIT LTO I0,00 CFM)
SOURCEREG IONS,
AIR IIANULING UNI 'I'(OVER IILIXN) CIM)
CONS IAl1C1'[ON TAX
EXHAUST HOOD(W/DUC)
HOUSING MITIGATION FEE
ienawrt APPlicam/COnnecto Dao
14AIARI�US MATERIALS DISCLOSURE
Will the applicant fusers building '.scups"t.tom or handle haeardoux material
as JdinN by the Cupertino Mmicipul Ctde. Clutter 9.12, nnJ'he liwhh end Salny
Coils. Section 25532(0)2
ElYv, L] No
HEATING UNIT (101 fly" BTU)
IIFRI'INC, UNIT' (()VIl 1m).(XH) DI'LH
PAID
Da ceipt p
VENT ILATION PAN (SINGLE RESID)
Will the applicant or future building occupant use equipment or devices which
mit loeardous air civmamiramx ax defined by the Huy Area Air Quality Management
BOILER—COMP (311P OR 100,000 BTU)
TOTAL: is s/
I OHXR—COMP(OVER IW,ols)1{'TU)
District?
E] Vie, E] NO
AIR CONDITIONER
ISSUANCE DATE
I have rtml the h under Charter of the Coli
NIiW RTSIUENTIAI. MECH. SQ, fT.
ode, Se tionunits 2 5 5. 2553 an mi.r
Immix Health & Safety Axle Sections 25505.2553) and 25534 1 undenwnd that if the
huilAing Jacs nal currcnily haveotrn:un, tat it is my .lamxihilily Ntmmil$ the oavpum
nl't yjXR/snix wbicb semito int ixx cal" rlfieas 1'(7k'cupan,y.
-
TOTA
�"
ISSUEDBY:
O cr or iment agent Ume
r W D,IcnoMATlnN INITH!M RED 1 INFS _ I ICF HALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING. - ELECTRICAL,
BUILDING DIVISION APPLICATIONFPERMIT PLIJMRING-MECINNIC'AL
BUILDING PROJF,CTIDENTIFICATION
Pl: Br NO.
0594
BUILDING ADDRESS:
/01/05 / 4Aa PrivG
SANI'1'ARV NO.
AI'I'1"ICA'TION Slll{ AI, DATE
OWNIiR'. ;DMF PHONE:
t! O &eAk. Lvtiiske 1i'
CIIN I RACTON:SN ME LIC NO
C��[ �� DSI
NIC
❑
CONTROL It
ARCHI I ECDENGINELR: 1, 'NO'.
AUURE'S:
CONTACT: PHONE:
❑ Consultant Fees Paid by Applicant (Initial)
BUILDING PE ETINFO
HLDG ELECPLUM f MECII
QTY ELECTRIC PERMIT -FEE
LICENSED CONTIR 70WS DECLARATION
1 hereby affimt that I am licensed under pmvisions of Chapter 9 (commencing
with Section 7") of Division 3 oDM1e Huviness and Prnlit Code, and my license in
in full litmcimd ell'cal.
License Class Lk.4
' JOB D SCRIPTION
R I 1
'DWI, ❑KIT'CIIIiN REMODEL
❑A NTION ❑PLUMBINGRE-PIPE
L,
PERMIT' ISSUANCE .✓
APPLIANCES —RCSIDUN'1'IAL
Dutc Comousum
ARCHITECTS DECLARATION
PANELS
❑MULTI -UNIT MODRICAT10N
1 understand my plans shall he used as public records
UP TO 210 AMPS
C1 INTERIOR ❑CHIMNIiY REPAIR
IMPROVEMFN'P []SWIMMING POOLS
[I BATH REMODEUREPAIR EMO J.1'I'ION
❑ OTHER
Licensed Vm[cssiony
OWNER -BUILDER DECLARAI ION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
201-1001 AMPS
OVER 1000 AMPS
following remon. (Section ]031"5. Business and Psofessiuns Code: Any city or county
which requires a pe olio u' construct alter, improve, demolish, or repair any structure
prior In lis issuance, also requires the applicant for such permit In file a signed statamc"t
That he iv lien M Taciurn, tom. pootwons"f the Cmmnmwr'I License [.use (Chapter 9
(commencing with Section ]WOof Division 3 of the Husines and Professions CodOor
and the basis for o alleged exemption. Any violation of
that he is exempt dumfrom t
permit objects the applies. a civil penalty of
Section ](131.5 by any applican' for a permo.
not more than five hundred dollars (SSW),
El [.;is Owner of the pr"peny. or my cmployces will' wugex to, their sole cmnperexti"n,
will do the work, and the.urucore is not intended maimed Ia unssisale (See. ]IW. Bit
i and profession. Code: The Contractor'.. License Law docs not apply ,t an miner of
propery who builds or improves thereon, and who does such work himself or through
his own employees, provided that such improvements art not intended or offered for
sale. If, however, the building or improvement is Sold within one year (1fmmpletion,the
avant,builder will have the burden of proving that he did net huild or inmrove for par-
unpest of,de.).
,,e
Cl I. a. Owner of the property tom exclusively concocting wit licensed come nos m
construct the project (Sec. ]014, Business and professions Cale:) The Contractor s Li-
eocLswdcesnotapplyit) an owner of property who builds or improves therein,and
who umtmms for Tach prajcmv with n weipursuant r rn"(s) licensed pursuano the Contractor's
License Law.
a execs �& :C=or an, reason
SIGNS ELECTRICAL.
/
SPDC I AL Cl RCUI"I oNUSC.
TEMP METER OR POLE I.
M I 1.
NEW RLDG/s\DDITIf C]DIiMOLITION
❑TENANT ❑FOODSERVICE
IMPROVEMENT
❑ OTHlili
POWER DEVICES
SWIMMING PO( .ELECTRIC
OUTLETS— ITC IXTURES
SQ. F. FL R L
CIN OF �HTI
SiSQ. I'
NEN' . IDENDUAL R SQ FT.
j
QTY. PLUMBING T FEE
PERMIT' ISSUANCE
ALTIiR - DRAIN & VINT- WATER (EA)
VA [.OAT
Owner
)RKF"R'S COMPENSATION DIiCI. RATION
BACK FLOW PROTECT. DEVICE
1 hereby snout under penally of perjury one [lie hollowing declarations.
E] IhaveandwillmalntainaCeaificalcof ConscnU"w1f-insumfnr Workces ComNn-
cation. a. provided far by Section J]W of IM1e Lahr Csalc. (or the perpmnance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700of the LaborG.Il, for the pedo...nncofthe work fur which this fiction is ismed.
DRAINS -FLOOR, ROOF, AREA. GOND'STORIES
OCC.GROUP
TYI'I?CONSTRUCTION
APN
FIXTURES -PER TRAP
GAS - EA. SYSTEM -I INC. 4 OUTLET
GAS -I'A"SYSTEM"OVER 4(•
My Workers Compensation hcunmcecarlerand Policy number art:
Cameo Policy Nn.:
CIiRI'IFICATP OF EXEMYI'ION FROM WORKERS'
COMPENSATION INSURANCE
GRIiAtiI. NDUSTHhW-INIT:NCIi{'roR
BUILDING DIVISION THES
GREASE TRAP
PLANCIIECK PTE
(Ttisoctlnnn,ud nothecomplatul ifthepenuil is forom hundred dollars (510(0
or Icxs.)
whkhtI. the W rker,' Conued. I taaillin.
not employ any Canon in any manner as sex Ise become object to the wnrken' Compete
Loy any tannin Performance (if Us to
ration of California. Date
SIiWER - S ITANY - STORM EA. HX)IT'
IiNERCY ITiIi
WAl ' HEATER wN1iNT/EL[CI'R
GRADING ITE
ers
Applicant `
APPLICANT: r atom making this Ccri...S of of Exemption, you should
heannc xuhjeet y the Workers r'n C.'tt.. I,, t i, vermis hal mf the Ia'M1mr Calc, You nim'
become subject
forthwith comply with such provisions or this Cennil shallMdeumed revoked.
A'TEk SVSTEMlTR1iATING
SOILS hili
WATER SERVICE
Ietc
CONSTRUCTION LENDING AGENCY
herc is lending agency for the performance of
� Ihercaffirmby unn thaumaru
the work Iia which this permit is I ... rd (See NP7. Civ. C.)
PAID
RmeiplX
NEW RESIDENTIAL. PLMB. SQ. FL
'IGIAL
jUnder', Namc
lender's Addoc,
TOTAL:
BUILDING FEE
L 1 comfy that 1 have read this application and ams that the alone information is
n incorrect. n, m I Neocomply wit all city and county ordinances and seam laws relating to
building consauction, and hereby autoriec reprex,nlmivex of tis city inciter mum the
QTY. MECHANICAL PERMIT FEE
SEISMIC THE
abmvanmmimnctl property for inspection purposes.
(We) spree In save, indemnify and keep humJesu the City of Cupe Lino aeainxt
RNI iIHies.judgmente emu and expcnsss which may in any way aceme againsis4d City
in consequence of to granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
PERMIT ISSUANCE IS
17LFCI RIC FEE
PLUMBING HE
MECHANICAL FEE
ALTER OR ADD' TO MECH.
AIH HANDLING UNIT LTO I0,00 CFM)
SOURCEREG IONS,
AIR IIANULING UNI 'I'(OVER IILIXN) CIM)
CONS IAl1C1'[ON TAX
EXHAUST HOOD(W/DUC)
HOUSING MITIGATION FEE
ienawrt APPlicam/COnnecto Dao
14AIARI�US MATERIALS DISCLOSURE
Will the applicant fusers building '.scups"t.tom or handle haeardoux material
as JdinN by the Cupertino Mmicipul Ctde. Clutter 9.12, nnJ'he liwhh end Salny
Coils. Section 25532(0)2
ElYv, L] No
HEATING UNIT (101 fly" BTU)
IIFRI'INC, UNIT' (()VIl 1m).(XH) DI'LH
PAID
Da ceipt p
VENT ILATION PAN (SINGLE RESID)
Will the applicant or future building occupant use equipment or devices which
mit loeardous air civmamiramx ax defined by the Huy Area Air Quality Management
BOILER—COMP (311P OR 100,000 BTU)
TOTAL: is s/
I OHXR—COMP(OVER IW,ols)1{'TU)
District?
E] Vie, E] NO
AIR CONDITIONER
ISSUANCE DATE
I have rtml the h under Charter of the Coli
NIiW RTSIUENTIAI. MECH. SQ, fT.
ode, Se tionunits 2 5 5. 2553 an mi.r
Immix Health & Safety Axle Sections 25505.2553) and 25534 1 undenwnd that if the
huilAing Jacs nal currcnily haveotrn:un, tat it is my .lamxihilily Ntmmil$ the oavpum
nl't yjXR/snix wbicb semito int ixx cal" rlfieas 1'(7k'cupan,y.
-
TOTA
�"
ISSUEDBY:
O cr or iment agent Ume