S 4334 �APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
[BUILG
ITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATIONMERMIT PLUMBING-MECHANICAL. S 4334
BUILDING PROJECT IDENTIFICATION
DINADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
/ `_5r MoNRo✓/y 1Te y-6—%f
WNE 'SNAME PHONE: CONTRACI'OR:S NAME: LICN/C � LuhA-�P a — P Na5i1 Q/VLy/� / F N/C CONTROLIfRCHITECf/ENGINEER: LIC NO: ADDRESS: r70 AE,/goy/p_1 . BGV ❑
ailf-SS /JL-L.E "Y/
CONTACT, PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
❑ ❑ ❑.
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I hereby aRn mal
n 1 am fiedmensunder provisions of chapter 9 km
ameneing JOB DESCRIPTION
�0IL with Section 7000)of Divinien Sof the Bmarox,mal Professions Code,and my license is
C�� in lull force and effect. PERMIT ISSUANCE
SF x-36 30,5-73 FDWL ED KITCHEN REMODEL
<ZU License Clan LIc.M APPLIANCES—RESIDENTIAL ❑ADDITION ❑PLUMBING RE PIPE
ttao<6 Dam�r+���Contoctnr
F.Dh ARCHITECTS DP,CIARATI( PANELS ❑MULTI.UNIT []STRUCTURAL
Z O'2 Z 1 understand my plans shall W used as public recoors MODIFICATION
oy_M UPT0200 AMPS ❑INTERIOR ❑CHIMNEY REPAIR
Fs. W Licensed Professional 201 I"AMPS IMPROVEMENT [D SWIMMING POOLS
O ;
OWNER-BUILDER DECLARATION OVER 1000 AMPS [IBATH RP.MODEUREPAIR [_1 DEMOLITION
6' 6 I hereby affirm mm 1 em exempt from the Consommes License law for me 1
X 3 LLU following mann.(Section 0031.5,Business and Professions Code:Any city or county SIGNS ELECTRICAL �I OTHER p
which requires a permit m consloca,ahem improve,demolish,or repair any mmcsure
,E] NO prior to its Issuance,also requiresthe applicant fmr such permiumlileaeigned statement SPECIAL CIRCUIT LSC.
y that he is licensed punuam m the previsions of the Contractor's License law(Chapter 9 Q
N (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or TESIRMETER POLE INSL COMMERCIAL:
1 p C that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION G DEMOLITION
y Section 7031.5 by any applicant for a permit subjects the applicant m u civil penalty of POWER D ICES
net more than five hundred out].($500). ❑TENANT ❑FOODSERVICE
Fr Z N IMPROVEMENT
G ❑Lo the warofthe propenyl or myemploades winhwagesastheir(See
compensation, SWIM NG POOL ELECTRIC
�
will Pr she wons and then tructurc knoten's License
era w do s not apply to
an Boniness ❑OTHER
m and any who
Code:The Cmnmmors Llcease law does not apply m it owner of OU .ETS—SWITCHES—FIXTURES
his own
who builds or improves thereon,and who does such work himself or mmugh
his own employees,provided that such improvements are not iyear(if jn offered for EW NFSIDIiNTIAL ELECTIt SQ FT.
tool, however,no h builthe burng en of pemmn issoldhewithin one Wild
or
improve
the 1!13v Q.FT. REA .PT.
owner-builder will have the burden of Droving mm he did not buil)nr improve far pur-
pose of sale.),
❑1,as owner of she property am exclusively cotma dia,with Iicemed emaracmrs m TOTAL:
construct the project(Sec.7046,Business and Professions CodeO The Cammctoes Li- JUL 12 1999
cense law does not apply to an owner of property who builds or improves thereon,and QTY. PLUMBING PERMIT FEE vat V
who contracts for such projects with a corrosions)licensed pursuant to the Contractor's
License Law. PERMIT ISSUANCE ��
❑ 1 um exempt under Sec. .H&P C for this reason
Owner Date ALTER—TRAIN&VENT—WATER(EA)
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
I hereby affirm under penalty of perjury ane of the milnwing decimations:
Fl I have and will maintain o Cenificam of Consent to for Workers Compen- DRAINS—FLOOR.R00F,AREA,COND. ST00.1E5 TYPE CONSTRUCTION
artier,as provided for by Seedon 37M of the Labor Code,for the performance of the
rk for whichphis permit is issued. FIXTURES—PER TRAP J/ •�
1 have and will maintain Worker's Compensation Insurance,as required by Section
39010mi Labor Code,for Ne performance M the .,it for which this permit is issued. GAS—EA.SYSTEM-]INC.4 OUTLETS OCC GROUP APN
MyWoCornier: is Cpptppy 3ytl}n ts�rtcq qv gPol cY No.and Y mum OAS—EA.SYSTEM-OVER 6 TEA)
3CERRTIIFICKATIE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE OREASFANDUSTRL WASTE INTERCEPTOR
(This scetiom mood not be completed If the permit is for one hundred dollars IS I W) BUILDING DIVISION FEES
m leiGRI!ASE TRAP PIANCFLECK FEE
I cenifythan home pof.trocitfthe work far whirlamis Arran is issued,l shall SEWER—SANITARY—STORM EA.200 FT.
not employ any person in any manner sec as e. to the Workers'Co.,.. ENERGY FEE
Z. maim Laws of Calimuma.Date WATER HEATER WIVENTIELECTN /f/.
Z
O Applicant �/ GRADING FF.P.
fn becomeNOTICEsubject
APPLICANT:If.Courts,r makm this Cnsima,of of Exemption,you should WATER SYS'IEM?REATING
become subject to she Worker's nsation provisions of the Lnhrt Code,you most SOILS FEE
forthwith comply with such provisions or this permit shall W deemed revoked. WATER SERVICE
0
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. PAID
7z
{A Iherehy affirm lhunhere isav'nnsWcsinn lending agency fonheperfnnnance of Date Receiptp
P the work for which this permit Is issued Sets.3099,Co.C.)
o Lenders Name TOTAL:
LUkI Lenders Address TOTAL:
M I verily than I have read this application and state that the above infortnmion is BUILDING FEE
fA correct.l agree to comply with all city and county madmances and state laws relating to QTY. MECHANICAL PERMIT FEE
U ,Z building construction.and hereby authome repreeantasives of this city to enter upon the SEISMIC FEE
above-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)agree to save,indemnify and keep harmless the City of Cimerinn against ELECTRIC FEE
liandides,judgmems.cons and expenses which may in any way accrue against said City ALTER OR ADD TO MECH. PLUMBING FEE
V V 5�
b�
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1,NON-POINT AIR HANDLING UNIT 0010,000 CFM)
SOURCE REGULATIONS. MECHANICAL FEE
y1� 74u
AIR HANDLING UNIT(OVER Io,0010.0010CFM) CONSTRUCTION TAX
Signature of Ap icami/C9blmmer EXHAUSTHOOD W/DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicutmrfumre mildin ceetipant storem Aaedle humorous mamrial HEATING UNIT TO 100,000 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code.Section 25532(a)t I HEAPING UNIT(OVER PC. BTU)
r ❑Yee ANo VENTILATION FAN(SI LE RESID) PAIDWilDe¢ Receiptp
�T
• torr the air contaminants
m future buildidetionng y the Bt use equipment or devices which -
emifhazardous air confaminanls as Jclined by the Bay Area Air Quality Management BOILER—COMP PON I00,WU RTU)
�u TOTAL: V
Dinner? AN. BOILER—C P(OVER 100,000 BTU)
❑Ycx
1 have read the humorous mamrials requiremeau under Chapter 6.95 of the Cali- AIN CO ITIONER ISSUANCE DATE
fomia Health&Safety Codi Sections 25501 and 25536.1 umleotand that if me N RESIDENTIAL MECH. SQ.FT.
timidiagdorsnmcurrently haven tem t.Bud it is my responsibility m notify me mcupant
of the requir sax�sWrhi/�hNm�lu�n be nor i',momeofuClcate�GOccima cy
Owner or arch 200 ages v-Daman, TOTAL: ISSUED BY:
OFFICE