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31321APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPF RTINO BUILDING. ELECTRICAL PERMITNO. 3 1 3 2 1 BUILDING DIVISION APPLICATION/PERMIT PLUMBING - MECHANICAL J ❑ Consultant Fees Paid by Applicant (Initial) L FEE ❑c BUILDING PERMIT INFO 1 fl1.UG ELECT PLUMfl/ ME❑CIi 11 ID❑�-'I/ JOB DESCRIPTION LICENSED CON'TRACTOR'S DECLARATION QTY. ELECTRIC PERMIT Z pOp _EO U U I hereby afford Inas I an licensed under provisions of Chapter 9 (commencing with Section ]1X%11 ofDivisionJot Business and Pmfc"iom GMc Jmylicenan in full farce I Licca. Lic.I Ilam Convuenrt ❑MUL'1'1-UNIT PERM I ISS UANCH APPLIANCES RESIDENTIAL DNCHIT ZI ECr:S DECLARATION understand my plans shall be used a, public recoNs PANIi1S IMPROVEMENT UPTO 209 AMPS :F"Ygc1 r,-,4 W 6 Dp {UF L O N (j a Z Oo K N jSpnot Licensed Professional OWNER-BUILDFR DECLARATION 1 hereby flion Ihnl 1 all, exempt from the Coulli r'e License Law f.. the following masen.(Section 7031.5, Business and Professions Codc: Any city or county which mluires a permit In construct. alter, improve, demolish, or repair any structure prior to itsissuance, also requires the applicant for such permit to file a signed sediment Ihot he is licensed pursuant or the pmvisiam of the Contractors License Law (Cla ter9 (va.norrainy with Sectilm7001) of Division Solthe But noel and Professions Gyle) or that he is eaempt therefrom and the basis far the alleged exemption. Any violation of Section 7031.5 by any applicant for it Permit subjects the applicant to a civil penally of more then Sive hundmd dollars ($500). ❑I, as ownerof the pmpeny. or myemPloyees with sages as lhcirsole compenmtion. 201-1000AMPS OVER 10(X1 AMPS SIGNS ELECTRICAL SPECIAL Cl RCUIT/MISC. 'TEMP. METER OR POL 1T. POWER DEVICES SWIMMINGP OL LLECI'RIC F. y3 m will do the work, and the structure is not intended or offered for sale (See. o_ Du.xiness and Professions Codas The Commaor's Licemx law does not apply bt an owner of who builds or improves thereon, and alto does such work himself or through OUTLIR —SWITCIIES—hIXTURIS Property his own employees, provided he, mch imprnventems urs oat intended or oflcred for NEW RESIDENTIAL F.LECTR SQ FI. sole, If, however, the building or improvement is sold within one year, of complmiao. She uilder will have the burden of proving that he did not build or improve for par- pssur4 of sale.)' I, as owner of the property, am exclusively contracting with licensed contractors to 'DOTAL common the project (Sec. 70J4. Business and Pndesslons Cadeq The Contractor's Li- ismseEa. does not apply toair owner ofpropeny who hands or hnproves Merron,and QTY. PLUMBING PERMIT who contract for such projects with a cantmnor(s) licensed pursuant o the Contractor's PERMIT ISSUANCE. License Law. 01 an exempt under Sec. , B& P C for 'his reason ALTER— DRAIN & VENT— WATER (EA) Owner [)are WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT. DEVICE I hereby affirm under Penalty of perjury one of the following declarations: ❑ I have and will maintain a Canifcateol' Coneenl mself-in sure fill Worker's Cwnpem DRAINS— FLOOR, ROOF, AREA, COND. ami... as provided for by Seninn 37M of the Lahr Code, for the performance of the work for which this permit is issued, FIXTURES — PER TRAP 0 1 have and will maintain Worker's Compenwtion Insurance, as respired by Section 3700ofthc CMe.f apeafggqqmtane, of newask far which this permit is i ... ad, GAS — EA. SYSTEM -I INC.4 OUTLETS My Works sui n nxur. a cgrrier and Volicy m,+pr . Cartier. �l Pohcy No.: LGCt� GAS—EA.SYSTEM-OVI3R4(EA) r,wn CATE OF EXEMPTION FRW WORKE S' COMPENSAS '[ON INSURANCE. GREASMNDUSTRL WASTE INTERCEPTOR GREASETRAP (This section need aalbe completed ifthc Permit i% intone hundrtddollvn(SIW) or less.) SEWER—SANITARY— S'IORM HA. 201 FI'. I certify lhmor the partionume,ol Sic work for which this permit is i .... d, Ishan not employ any Person in any mamor.so as to become subject o the WorkersCompel. WATER HHATER WNENT/ELECR ZZ xntion Laws of Califnmia Date Applicant 0 CX {A 0. Q V z lks F F' N U NOTICE TO APPLICANT: If, afmm making this Cenificam of Esemption, you should become subject to the Worker's Compcnmtion provisions of the Lnhsa Code, you must reked. fordwith comply with such provisions or this permit shall be deemedvo CONST RUCTION LENDING AGENCY I hereby affirm that them is a construction lending agency for the performance of the work till whichthin permil n issued See. 3097, Civ. C.) lender's Name WATER SYSTEM/TREATING p ! WATER SERVICE NEW RESIDIESPIAL PL,NIL SQ. Fr. TOTAL: Landers AddSess 1 canary that I have read this applicminn and state that the above information is causer.) egmamamn,ly with .11 city and county mdomme, ani sWa lows relating to building imemction, and herchymollorrrerepresemmives oflhis city taentor upon She QTy. MECHANICAL PERMIT PERMIT ISSUANCE shove-m.mioned Oot for'mspectiou Forpow, (We) agree to save. indemnify and keep hamSless the City of Cupertino against liabilities, judgments, costs andexpenses which may i n any wayaccrae against said City ALTER OR ADD TO MECIL an consequence of the IS ting nl this Permit. AIR HANDLING UNIT(TO 10,000CFM) APPS ICANT ' S AND WILL COMPLY WITH ALL NON,POINT S 1 � AIR HANDLING UNIT (OVER 10.000CFM) Signa roof Applicanl/Contmcmr Data EXHAUST HOOD(W/DUCT) HA]ARDOUS MATERIALS DISCLOSURE Will theapplicantorfarm. buildingomcopomsuneor handle hmmums,material HEATING UNIT (TO 100,000 BTU) as defined by the Cupenino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(x)'1 HEATING ON] 'I(OVER R BTU) ❑Yes ON. VIiNTILAI'[ON FAN INGLF, RES ID) Will the applicant or future building eaupant use equipment or devices which mil havalloos air commninanrs ax ddined by the Bay Area Air Quality Mimagcmem BOILER—COQ 13HP OR I WALsO BTU) BOILER— /IMP (OVER 100,000 BTU) Distict, ❑Yes r-1 No AIR CO ITIONER I have mad the buradopa..,coalarequirea maker Chapter 6.95 of the Cali- NEW ❑SIDEM'IAI. MECH, SQ. Er. folia gcuhh & Safety rre CMc, tiatina 21505,25513 and 25534. 1 understand thm If the Wilding docs not currently have a tenant. that it is my rcxpnnsihility m notify tnwMra,Y. of Ne requirements which must M tun prior m iauanee of a Cenificam of Occupancy. TOTAL: Owner m usall...e l vgcm Data OFFICE L FEE ❑c BUILDING PERMIT INFO 1 fl1.UG ELECT PLUMfl/ ME❑CIi 11 ID❑�-'I/ JOB DESCRIPTION RESIDENTIAL ❑SFDWL Kly.111IN REMODEL ❑ADDITION LUMBING R&PIPE ❑MUL'1'1-UNIT ❑STRUCTURAL MODIFICATION ❑ INTERIOR ❑ CHIMNEY REPAIR IMPROVEMENT ❑ BATH REMODEUREPAIR ❑DEMOLITION ❑ OTHER COMMERCIAL: ❑ NEW BLDG/ADDI'T'ION ❑TENANT IMPROVEMENT OUTLIER ❑ DHMOLI'1'ION ❑ FOOD SERVICE. Ff. FLOOR AREA PAID FEE 400T 161! BUILDING DIVISION FEES PfANCHECK FEE ENERGY FEE GRADING FEE SOILS FEE PAID JI Rc DDealccipt IS TOTAL: BUILDING FEE FEE SEISMIC FEE ELECTRIC FEE PLUMBING FEE MECHANICAL FEE I HOUSING MI'ITGATION FEE PAID Dam Receipt g ISSUED BY: DATE $/SQ. Fr.