29947APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL r.v PERMIT NO.
BIJILDINO DIVISION APPLICATION/PERMIT PLUM IIING-MECHANICAL.
idrtrm Ihm 1 at licensed under pct sm.... of chapter 9 (cors
shot Division 3 of the Business andfrofnsions ColIt. and my
o/ C3 G-Cn -3
-Je 3�)
❑ Consultant Fees Paid by Applicant (Initial)
)TY.1 ELECTRIC PERMIT
PERMIT ISSUANCE
APPLIANCES -RESIDENTIAL
Z I undersanJ my plans .hull he used as public meads
Licensed Pro essirml
OWNER-HUILDER DECLARATION
1 hereby option that 1 um cscrap, from thc Contractor's License Law far the
U following reason. (.Section 7031.5. Business and Professions Codc: Any city or county
ywhich requires a pemdt to comment. alter. improve, demolish, or repair any structure
prior to its issuance, also requires the applicant ror such permit to file a signed statement
Thar he is licensed p ... and m the mvision, of 'he Cammnnr's License Use (Chapter9
O (commencing with Section 7000) of Division 3 of the Business and Pmfnssions Code)or
that he is exempt thtrefiom and the basis for the alleged exemption. Any violation of
m Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollen ($500).
G❑ I,mownernfthepnmeny,orrny employee<with wages us theiranle compensation,
mwill do the work, and do, structure is not mtendednroli'cred for sale (Sec. 7044, llusiness
_ and Professions Code: The Contractors License law does not apply to an owner of
property who builds or improves Incisor, and who does such work himself or through
his own employees. provided that such improvements are not intended or offered for
,cote. If, however, the building or inter Aminal is sold within one year of completion, the
owncolmilder will have the burden of proving thin he did not build or improve for per-
pme of ease).
0 1. as Owner of the property, am exclusively contracting with licensed contractors Ir
construct the pmjmt (Sec. 1W4. Business and Professions Code:) The Commucors LI-
reno, Law does not apply to an owner of property who builds or improves thereon. and QTY.
who commars for such projects wills a comotc o i licensed pm,mm m the Conwcwrs
License Law.
0 l ore exempt Me, Sec .B& P C for this mason
Owner Date
. WORKER'S COMPENSATION DECLARATION -
1 hereby affimI under perally of perjury one of the following dedication.:
0 I nave aro will maintain eCcri37te of the Labor
for Workefs ce of the
mbmn, as provided for by Section moo of me Labor ewe, for the perrrrmantt nr cot
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance as required by Section
3700 of the Labor Code. fee he perooremse of the work for which this peroshii, issues.
My ti m carrierand Policygmty4jkrypV40
ne'7!!1')!
; Policy Nn //(C'Z
CIiR'rl ; CA ; Op EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE
(This swoon need sol hcompleled if the Pettit is for one M1undred Jollarx (Slip)
or lev.)
1 cer ify that in the performance of the work for which this permit is issued, l shall
not employ any person in any ntanoer.so as to hecome subject to the Workers Compen-
z ..tilaws of California. Date
Zon 2 Applicant
NOTICE TO APPLICANT: If, after making this Cenificaf of Exemption, you should
became mbjtcl,, the Worker'. Compensation provisions of he Labor Code, you mull
HForthwith comply wifli such provision, or this penial shall be deemed revoked
z CONSTRUCTION LENDING AGENCY
V C) Ihereby affirm thatthem is a constructionlending agency ford¢Performance of
P. f•' the work for which this permit in issued (Sec. 3097. Civ. C.)
QLender's Name
U
Lender's Address
I cenify that I have read this application and sate that the above information is
E' V) come,. I again, to comply with all city add county constants and state laws flaming to
V Z building construction. and heebyawmarim representatives of this city m enter upon the
.above-owntioned prapeny for inspection purpose..
(We) agree to save, indemnify and keep Harmless the City of Celtic.. against
liabilitics.judgmans, costs and expenses which may in any way accrue against said City
in vancriumee of��gpe standing of Iy1y'sft�p��it.
APPI iMPNCI IIERSTAND9diAN6'WILL COMPLY WITH ALL NQN-POINT
J6TYRDOUS MATERIALS DISCLOSURE
Will the applicant or fumra building occupum sore or handle hazardous metemill
as defined by the Cupcnim Municipal Code. Chapter 9.12, and the Health and Safety
Code. Section 25532(a)7
❑Yes FNo
Will the Tpheant ar mom hadding occupant use cyulrynem or devices which
mit hazardous air centaminams as defined by the Bay Area Air Quality Management
District!
(D Yes No
I have rend the hmorado., material, rNo mincots under Chapter A95 of the Cali.
fomia Health & Safvly Cwe. Sections 25505, 25533 send 25534. 1 understand thin if the
building does not cunendy have a tenant, that it is my respmsibilhy to notify the occupant
ofthe rNiirements which mus, be mer prior o isaance 1' a Cinificas of 0s,,mney.
PANELS
UP TO 200 AMPS
SIGNS ELECTRICAL.
❑ -P' ❑
SPECIAL CIRCUITIMISC.
raz
TEMR METER OR POLE INST.
GRAVING FEE
POWER DEVICES
SOILS FEE
SWIMMING POOL ELECTRIC
PAID
Rweiplp
OU1LE'I S - SWITCHES - FIXTURES
NEW RESIDENTIAL F.LECTR
SQ FT.
PLUMBING PERMIT
PERMIT ISSUANCE -
ALTER - DRAIN & VENT- WAT13X (EA)
BACK PLOW PROI'EC'E DEVICE
DRAINS- FLOOR. ROOP. AREA, CON
FIXTURES - PER TRAP
GAS - EA, SYSTEM -I INC. 4 OUTLETS
GAS - EA. SYSTEM -OVER 4 (EA)
GREASHIINDUSI'It], WASTE IN1 ERCEPPOR
GREASETRAP
SEWER - SANITARY - STORM EA. 210 FT.
WATER HEATER W/VENT/ELEC'I'R
WATER SYSTEM?REATING
WATER S17RVICE
NEW RESIDENTIAL. PI.MB. SQ, FI'.
TO AL
QTY. MECHANICAL PERMIT
PERMITISSUANCH
ALTER OR ADD TO MECH.
AIR HANDLING UNIT ITO 10.0011 CFM)
AIR HANDLING UNIT (OVER 10.000 CFM)
EXHAUST HOOD ON/DUCT)
HEATING UNIT (TO 100,000 BTU)
HEATING UNIT (OVER 1)0,000 BiV)
VENTILATION FAN (SINGLE RESID)
BOILER - COMP (3111' OR I Might BTU)
BOILER - COMP (OVER 100.000 BTU)
I AIR CONDITIONER
OFFICE
SQ. F-1'.
C
SQ -Fr. FLOOR -AREA
u (`1 I
FEE MAY 28 1996
ILII VI, VNf Llllll%u
❑ -P' ❑
FEE
JOB DESCRIPTION
RESIDENTIAL
O SFDWL O KITCHEN REMODEL
❑ADDITION OPLUMBING RE -PIPE.
O MULTI -UNIT ❑STRUCTURAL
- MODIFICATION
❑ INTERIOR 0 CHIMNEY REPAIR
IMPROVEMENT
0 BATH REMREP IN 0 DEMOLITION
[]OTHER
GRAVING FEE
SOILS FEE
PAID
Rweiplp
TOTAL:
COMMERCIAL:
El NEW BLDG/ADDITION ❑DEMOLITION
[]TENANT FOOD SERVICE
IMPROVEMENT
0OtHER
EE:.FEEAL
SQ -Fr. FLOOR -AREA
u (`1 I
FEE MAY 28 1996
ILII VI, VNf Llllll%u
PLANCHECK PEE
ENERGY FEF.
GRAVING FEE
SOILS FEE
PAID
Rweiplp
TOTAL:
EE:.FEEAL
M- C� CTION'AXITIG
M
ION FEE
Dae Receipt#
TOTAL: