99120066 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY L 1 L.V U40(1-1
CITY OF CUPF,RTINO nuuDING.ELECTRICAL PERMIT
APPLICATION/PERMIT' PUIDi NG-MECHANICAL
BUILDING DIVISION BUILDING PROJECTIDFINI'IF'ICATIDN NOW
BUILDING ADDRESS SA61ARY . AI'PI.ICAI'ION SUHMI CIALDXFE- o o T - 8 -� `('OWNERS NAME: PHONE: CGNIRACTOR'S NAhf 1" LIC NII: CObOROLAki V ✓y OARCIiI I GCI'/INGINEER: hIC NO: AI. )I)kI� .
7oV ,7
CONTACT'; PHQNF.; BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) HL1lG ELECT PLUMB MECIi
p/ �j ❑
ucr:Ntir:D CONTRACTORS necLnkgTloN OTy, ELIiCFRIC PERMiT FEE JOB DFSCRII'TION
I hereby efrn i ort I arm licensed under,ro.iIien.of Chapter 9(commencing
W 0'Z with Semina"an of.cyclo hal the Basions arta Pmfes,ions lisle.and m4.license is / RESIDENTIAL;
F0� full force vrM ertecl, p / PERMITISSUANCE ❑SFDWI, KITCHEN RLhlOUlih
CC U E, m [ I I '!
aUU in,foll Clncs Lic.g gPP1,lANCES-RESIDENTIAL. ❑ADDITION PLUMBING RF.-PII'li
vFi ZU Dom Contac ❑MULI'FUNIT ❑STRUM DEAL
ARCHITECTS DECLARATION PANELS MGDRBCATION
Z p an z 1 understand my plans shall be used as Public records UP'll)Zan Ahfi'S
OZ•+0 ❑INTERIOR ❑CHIMNEY REPAIR
Licensed Proac,iomJ 201-1000AMPS FX�IMPROVEMENT 0SN'IMMING POOLS
OWNER-BUILDER IIECLARA'1'ION OVER IIMp AMPS BATH REMODEIJKEPA1R ❑DEMOLITION
CW Q 1 hereby affirm that 1 am exempt from the Contractor's License Law for the OTHER
O y U 1'ollowing reason.(Section]031.5,Business and Professions Coda Any city or county SIGNS ELECTRICAL
Ia131y y which requires a permit to construct,tome Improve.dcnndish,or repair ally xtmnnre
final.its issuance.also require 'be applicant for such permit to file a signed statement SPECIAL CI RCUIT/MISC.
fey thin he is licensed InIcanuo the Pat mmaf'he coreraca(s Live.e Law(Chapter 9 COMMERCIAL:
(commencing with Section 900X)of Division 3 of the Businevs.nd l`rnfccxion%Gxlc)or TEM('.METER OR POLE(NST.
❑NEW HLUGIAD
as a that he is exempt Ihrrel'mm and the hest,for the alleged CIC mptin,Any violation of III'TION [-1UEM(11.1'I'ION
Sation]031.5 byanyapplicant for apermit objects theapplicannn.civil psnahy of POWER DEVICE-S ❑'16NAN'I' ❑FOOD SIiRVICIi
not mom than five hundred della.($500). IMPROVEMENT
=Q 01,as owner of the lanpcny,or employees with wage%as their sole compensation. SWIMMING POOL ELECT RIC El OTHER
p., wdldo New orkvnd the,truc.relx rat intended oroftumd for,ale(See.9044,13rImen, O
a 3 m amt Pme,sions Code:The Contractors License Law docs nm apply to an owner of OUTLET'S-SWITCHES-FIXI'UR,
property who builds or improves thereon,and who does such work himself or through NEW RESIDENTIAL ELT:CTR SQ 14.
his own employees,provided that such improvements arc not intended or offered for SQ.FE FLOOR AREA S/SQ.IT.
sale.B,however,the building or impmmaold within one
year of
van i— compinren,the
ne,lwilder will have the burden of Proving that he did not build or impmvc for par-
Pee of sale.). TO
❑ L a%owner of the property.In,,exclusively contracting with licensed contmemrs to Jf
mswcl the pn9Cct(Sec.9WL Busm—nn l Paression,Cud,)IIn,Contmendx Li-
ase Liv does not apply to an owner of proper ,y who builds or improves thercm and QTY. PI, BIND PERMIT FEEJ V/
who contracts for such pmR'cts with a counteracts)licensed Pursuant to the Contractors
License Law, PERM CB
1 am exempt under Sec. .H&k C for his reason
AU -DRA ENT-WATER(EA) VALUAI'ION((��
Owner Dale 2 (l
WORKER'S COMPENSATION DECLARATION BACK MOW PROT .D' ICE
,� Ibemb,unfirm underiryuhy oft fury one of the Rillawing Awluralinnn
❑I have and will maintain.Comficue ofCorm,,mself.inmrc for Worker's Cnmpeo-
DRAINS ( 00 . HAICONI) S'TORIHS 'TYPE('(mNSTRIIC'IIOD
1 cation,ax provided for by Section 37W of the Labor Calc,for the performance of the FlXTURE.S-PER
work for which this permit is issued.
-'1 have mrd will maintain Worker,Cmnpensation insurance,use required by Section GAS-EA.SYS' N-I/K'C..Ol1T1.F'1'S �APt
] mthe",mCar,moherysfomeaccof Nework for which Ibis permit is issued. (ICC GROUT' �t
hly Worker's a-
focuser artier and Policy number J
Cameo��'T,••rC FaJ/✓A Policy No, ��A-IJ6OILM GAS-EA.SYSTIiM-O d F,A
CEIfTIPICAILOFEXEMI'1'IIIN FKOMWORKHRS' GRE ASFJINUUS'IRL WAS'('. :III'TOII
COMPENSATION INSURANCE BI71pISINC•D�IVI$I(>N Plil�.�
(Gassectionneed not becomple'ed if the permit is Temno hundred dollars(SIM) GREASETRAP PLA m,1ifCCK FHF yam, u h
or less.)
ccnify llmm in lbe perfonmmcc afdw work for which this pCrmitkixsual,lxhnll SEW IiR-SANI'ITRY-S'1'(IRM L'A.21X1 FT. ENP Cy11112E
nom employ vny perm in anY manner m m n,Mcume,uhjcd w the Wnrkcrd Compcn-
Z smdnniaws of Califomia,Dale WAfERHEATERWITESEVELECTR OR AGI'
O O nrplieam 1
z � NO]ICE making this Ccnllic:nc of lisempunn,you should WAI'IiR SVS'I'1iM?REA'1'ING SOI]. rlili
F' hectors suhjcct m the Worker',Cnmpcnmhmm pmvixinns o[the Labor Cr,Je,you must
�� forthwith romply with such pmvisiem er this pcmmit cull is akcmed rcvokW. WATER SERVICE f•IV -
Q PAI Dl
�Z CONSTRUCTION LENDING AG1iNCY NEW RFSIDENI'IALPLMB, SQ,IT. Date Rcaipta
U O I hereby xkinn that there is u construction lending agency for the perfornmnce nl
U.(•' the work for which this permit is issued(Sec.3091,Civ.C.) TOTAL:
Oi.emkr's Name TOI 11U s
r U LCndeLx Addles, BUILDING I HE
1 certify that 1 have read this application and.state thin the abovefo
innnaonn ix
fHS Co.,.I agree to comply with all city and county oninances and state laws relating to QTY. MECHANICALPERM IF FEE SEISMIC FEE (�
U Z building Construction.and hereby authorize representatives of this city to enter upon the
above namticoe]pa co,lir in.ymminn purposes. PERMIT ISSUANCE S ( Iii.EC`I RIC FEE
Dee)agree to save,indemnify and keep hamdess the City of Copcniao against
fiabilitie.s,judgmemccosts and expmms which may in any way acemengamst said City ALTER OR ADD'TO MECII. vLUMHING IFF, 5
nsta,a nee of the granting of this pemat.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Alk HANDLING UNIT(TO 10.000 CPM) MF'CfL\NICAI.PiCli
SOURCE REGULATIONS.
AIR HANDLING UNIT LOVER 10.1XXm CFM) CUNS'I RUCI'ION'fA%
Signmurc of Appli,a IC tractor Dme EXHAUST HOOD OVIDUCT) 1 LOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will'he...lienar of future lwilding uacupam store or handle Muma.,I..'Chat HEATING UNIT(TO I L`0ji B'1'U)
as defined by the Cupertino Municipal Gale.Chapter 9.12,and the Health and Svfcty I]EATING UNIT(OVER IW.M0 ii'1'U)
Core,Section 25532(u)'!
p Yes ❑No VENTILATION FAN(SINGLE RESID) IAIU
Dam Hccei t p
Will the applicant or future building occupant use equipment or devices which BOILER OHI'OR 100,000 HTU)
mil laoa bas air cnraaminanl..as defined by the Ifay Area Air Quality Management O'
District! MOILER-COMP(OVER 100.000 Ell U)
❑Yes ON.
AIH CONU1TIONER =SSSUANCET13�
I hove read the hvnrcluns m:fieriuk eapnrmncnin unJerChup¢r 6.9$of the Call- I C(I{$lJI Y�
food.Iini&Safety Code,Sections 25505,25533 unit 25534.1 undersl.ed that It the NEW RESIDENTIAL MIiCH. SQ.Irl'. 1 Z
building does not currently have a tenant.that it is my res,soadhility to notify file ceerpser
of the«q drean ms which moa he me'Pdor to issuance of a Certificate of Occupancy.
Owner or authovN ,,at
Due Tot ISSUIiD I1 Y:
OFFICE