99080041 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY L �$ 0
CITY OF CUPERTINO RUILDINC-ELE(TI'RIGAL.
'^ BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL4 NO
I BUILDING PROJECT IDF:.1TIFICAI'ION
BUILDING ADDRESS SANITARY NO. APPLICATION SUBMITTALDAT
i z10& `6 IY1 - cows d-a''s3 - P
OWNER'S NAME: PHONE: CONTRACTOR'S NAME LIC NO
G -�f�G��` N/C CONI'ROLn
ARCHITECIY: GINELR: I.LC NO: \V ADDRESS: •J L ❑ [] (^ r"
RIs, - 30 91- ( J
CONTACT: PHONE, BUILDING PERMIT INPO
DECLARATION QTY
R.cNrA.e-� ¢O�j Zq3-Z4roS ❑ Consul12
tend Hf ELPLUMB Mf?
LICENSED CONTRACIUIt;S . ELBC'TRICPERMIT FEE u LJ
I h<reM1y alarm That 1 am licensed under pmvisinns of CM1apmr Y(commencing JOB DESCRIPTION
OSZ with Section 7000)of Division l oflhe Business and Professions Code.and my license is RF_S 7.11 FNTJ tAL
FERMI"r ISSUANCE
F in full force unJ effect. ❑SFDWL JQKITCHEN REMODEL
QZV O.t Q or MC�i ON AI'I'LIANCES-RESIUIiN'L'IAL .ADDITION E]PLUMBING RE-PIPE
F W Dmc� -�T'.DEC ARA
a r ARCHI'1'LCI-S DECLARATION ❑MUhTI-UNIT ❑STRUCTURAL
Z O vi Z I undersmnd me plans shill he used as public records PANELS MODIFICATION
OZ—O UP 10200AMPS ;INTERIOR ❑CHIMNEYREPAIR
I-nn E-W Licensed P-rco imol 201-100IDAMPS IMPROVEMENT E)SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER IIXN)AMPS A BN'H REMODEUREPAIR E3 DEMOLITION
4C C d 1 hereby affirm that 1 am exempt from the Come.cors License Low for the
X 3=Q
following rcmon.(Section 7031.5,Hodnms,nd Pmxsi.. Corr:fe .s Ce:Any oily or county SIGNS ELECTRICAL El OTHER
,q which reyunes a permit to construe,ether,improve.demolish.or repair any structure
F u•OQ
prior its issuance, requires the applicant for such permit m al file a signs'alemem
rtSPLCIALCIRCUIT/MISC.
ger •] Ihnt he is l icen,d ar,ounun'he provisinnenflhe Contmetur's License Law(CM1"oe"'
LL:--pO Icommendng with Scelinn 9IXN))ol Uivisinnl,,f,hc Bminess and PndcssiovI CWc)or TEM P.ME]ER OR POLL INS COMMERCIAL'
a a c z the he is exempt therefrom and the basis for the alleged exemption.Any violation of 9AA ❑NEW BLDG/AUDITION ❑DEMOLITION
��oi Section 7031.5 by any applicant for aperart subjects the applicant to a civil penalty of POWER DEVICES C3 ❑FOOD SERVICE,
tore dna Live hundred dollars(S500).). IMPkOVEMENT
�SaLas owner ofthe rt.orm bees with wages as their.sole coo tion, SWIMMING I'D(d,EL1:CR
O ❑ Proal Y Ye.up Y 6 pens°
F. will doth,work,and the>tmcwmisnm inrenW or
Joffemlfor sok lSec.]Dw, ne
Busiss
m and Prnfcssions Cmle:'Me CommitteesL.ice.m Law docs not apply m an omgncr of OUTLEFS-SWITC ❑0'I'HER
HES-FTXTURfS
�"3.. property who builds in,improves thcrem,and who docs such work harawil"or through
his own employees,provided that such improvements are not intended or opened far NI?W RESIDENTIAL F1 ECTR SQ PT
sale.If,however the building or improvement is sold within one year incompletion.lhe SQ.FI'.FLOOR AREA Slip.FT.
ow errsbuilder will have the burden of proving that he did not build or improve for par-
(hocol'salcJ.
❑1,as owner of the progeny,am creltiuvely contracting with licensed contractors to TOTAL,
instruct the Project(See.7=,Business and Professions Code:)The Contractors Lr-
cruse Law does not apply toanowtier ofpropcnywho builds orimproves thereon.and QTY PLUMBING PERMIT FEE
wborronactaforhaeh projectswill,.,manicons)licensed pursuant lathe Contractors
License Low, PERMIT ISSUANCE
I am exempt under Sec. ,B&P C for this reason
AL 1'IiR-DRAIN&VIiNT-WATER(EA) VALUATION
Owner Dare
WORKER'S COMPENSATION DECLARATION BACK FLOW PRODCF.DEVICE
Ihereby affirm under Penally of perjury one of the following declarations:
(have and salt,mainmtnu Cenifcam of Cometh msdf-inmre lar Worker's Compen- DRAINS-FLOOR,ROOP.AREA,COND. STORIES 'TYPE CONSTRUCFIO:
autien,as provided for by Section 3700of the Lnhor Cole,for the pedonnance of the
work for which this Permit is issued FIXORES-PER TRAP
1 have and will maintain Worker's Compensation Insurance,as required by Section
JpW of the Labor Cole,for the performance oflhe work for which this pemnit is iamW, GAS-EA.SYSTEM-1 INC.40UTLF.TS OCC.GROUP
My Wmkce,Comlcnsmt m Laurance carrier and rohcy number arc:
Cartier: Policy Na.: GAS-EA.SYSTEM-OVER 4(EA)
CUR'BICATE 01'EXEMFUON FROM WORKERS' GRFASFIINDUSTRf.WASTE INTERCEPTORCOMPENSATION INSURANCE BUILDING DIVISION FEES
Glo,wHan need.,,,be completed it lbs permit is for one hundred dol I.,(S 100) CREASE'I RAI'
nr lege.) PLANCHECK 19311
I cenddru in the performanceof the work far which his men a axucd.Ishall SEWER-SANITARY-STORM EA.2W19', - Q
n i enploy any pagan in any Inmumr to horst¢;object pWorkers'Camper- ENERGY FEE
Qz mtiun Law,of Cup,"pns Tale se. - j4J ' 1 WATER HEA1LR W/VLNT/ELIiCI'R
z0 Applicant 1�UL. cknDlNC Feli
NOTICE TO APPLICANT:IL aRcr making this Certificate of Exemption,you should WATER SYSTEMTRIiATING SOILS FEE
I"t
he subject a)the Worker',C...npcaaoon provihions If the Labor Coda,you mow
Q Iimhwith....ugly with such provisions inch,permit Shot]he,dread revoked WATER SERVICE
taa
n' CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PENIS. SQ.FE PAIDr L�
z Ihereby ol'frnn that there is a consuvetion lending agency for the perhvmarm of Dam Receipts
U 0 the work lin which this petmit is i...ed(Set.3(W],Civ.C.) 9UTAL, Lisa
147W
Ofender',Name r,.
,r -lender's Address TOTAL: e
I amity mn,I have read this c,licmio i and sone dot the uhnve information is r .BIU \ c.ILDING fP,FA '
Fa.
tO conect.I agree,.comply with all city and county endurances andwalc laws relating toQTY. MECHANICAL PERMIT
U buildingcomtrucion,and hereby amboriee mpmwntativeso(this city menter uponthe // / 'SEI£M3 IC
none-mentioned property for inspection purposes. + PERMIT ISSUANCE N ELECI'RICFFE 3
(We)agree l,,save,adc.mify and keep h male,,the Cay oT C, i.e.qua,, '
Imbilidexjedgments,costs and expenses which may in my way access,against said City 1 ghIER UR AUU TO MECH. (�, PLUMBINGFCE �•�
sneer of the granting of this Perini,.
AYPI incense( VT UNDERSTANDS AND W .COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,U00 CFM) -'MECHA�'ICAh FEB / r
SOU( EGULATI MS.
q t3 et CI AIR HANDLING ON]F(OVER 10.001 CFM) CONS'1'RUCFIONg X
Signa pp cunUCon soon15nw EXHAUST HOOD(WMUCT) HOUSING MITIGA F
IIAZARI I,5 MAfI[RIAL$UISCLQSIIRIi
N'i11,M1e appli.an,or lmurt uilJingceapanl wore mhanJle harallous mumrial IIIiATING UNIT(9'O❑XI,(Xq DTD)
as defined by the Ce,emo o Municipal Code.Chapter 9.12,and the Health and Safety
Coda Section 25532(,)1 HEATING UNIT(OVER 100.000 BI BE
❑Yes ❑No VENTILATION PAN(SINGLE RES1D) PAID
Date Receipt it
Will the applicant or future building occupan,use equipment or devices which BOILER-cUMP(lHl'OR I Wq)0 BTU)
•nth ha'raulous air co.tnmi....1,ar ddincd by the(lay Area Ne Grainy M.nngemcr, 9'OTAL.
Diwricl" Yes ❑Nn BOILER-COMP(OVER I M000 BTU) -17
❑
\V\
I hove rend the h;vaalnus Turner mluls Icgmn mon m,naChapter 6.95 of the CA. AIR CONUITIONIiR ISSUANCE DATE
fnmia"e & ;a Hy
Code.Sections 255115.255)1 unA 25534.I understand(hat if the NEW RESIDENTIALMECH. SQ.FT. �7 C om"
build n notcunendyhavc'nemb th ix my rtspomihilaviermifythence,,anl / - ( /
ofth etas w h.umt be 'PH. ¢n s ce of a Cenrecme of sea ,
those ugsn Dab.ns, TOTAL: ISSUEDBY: �
OFFICE
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY L �$ 0
CITY OF CUPERTINO RUILDINC-ELE(TI'RIGAL.
'^ BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECHANICAL4 NO
I BUILDING PROJECT IDF:.1TIFICAI'ION
BUILDING ADDRESS SANITARY NO. APPLICATION SUBMITTALDAT
i z10& `6 IY1 - cows d-a''s3 - P
OWNER'S NAME: PHONE: CONTRACTOR'S NAME LIC NO
G -�f�G��` N/C CONI'ROLn
ARCHITECIY: GINELR: I.LC NO: \V ADDRESS: •J L ❑ [] (^ r"
RIs, - 30 91- ( J
CONTACT: PHONE, BUILDING PERMIT INPO
DECLARATION QTY
R.cNrA.e-� ¢O�j Zq3-Z4roS ❑ Consul12
tend Hf ELPLUMB Mf?
LICENSED CONTRACIUIt;S . ELBC'TRICPERMIT FEE u LJ
I h<reM1y alarm That 1 am licensed under pmvisinns of CM1apmr Y(commencing JOB DESCRIPTION
OSZ with Section 7000)of Division l oflhe Business and Professions Code.and my license is RF_S 7.11 FNTJ tAL
FERMI"r ISSUANCE
F in full force unJ effect. ❑SFDWL JQKITCHEN REMODEL
QZV O.t Q or MC�i ON AI'I'LIANCES-RESIUIiN'L'IAL .ADDITION E]PLUMBING RE-PIPE
F W Dmc� -�T'.DEC ARA
a r ARCHI'1'LCI-S DECLARATION ❑MUhTI-UNIT ❑STRUCTURAL
Z O vi Z I undersmnd me plans shill he used as public records PANELS MODIFICATION
OZ—O UP 10200AMPS ;INTERIOR ❑CHIMNEYREPAIR
I-nn E-W Licensed P-rco imol 201-100IDAMPS IMPROVEMENT E)SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER IIXN)AMPS A BN'H REMODEUREPAIR E3 DEMOLITION
4C C d 1 hereby affirm that 1 am exempt from the Come.cors License Low for the
X 3=Q
following rcmon.(Section 7031.5,Hodnms,nd Pmxsi.. Corr:fe .s Ce:Any oily or county SIGNS ELECTRICAL El OTHER
,q which reyunes a permit to construe,ether,improve.demolish.or repair any structure
F u•OQ
prior its issuance, requires the applicant for such permit m al file a signs'alemem
rtSPLCIALCIRCUIT/MISC.
ger •] Ihnt he is l icen,d ar,ounun'he provisinnenflhe Contmetur's License Law(CM1"oe"'
LL:--pO Icommendng with Scelinn 9IXN))ol Uivisinnl,,f,hc Bminess and PndcssiovI CWc)or TEM P.ME]ER OR POLL INS COMMERCIAL'
a a c z the he is exempt therefrom and the basis for the alleged exemption.Any violation of 9AA ❑NEW BLDG/AUDITION ❑DEMOLITION
��oi Section 7031.5 by any applicant for aperart subjects the applicant to a civil penalty of POWER DEVICES C3 ❑FOOD SERVICE,
tore dna Live hundred dollars(S500).). IMPkOVEMENT
�SaLas owner ofthe rt.orm bees with wages as their.sole coo tion, SWIMMING I'D(d,EL1:CR
O ❑ Proal Y Ye.up Y 6 pens°
F. will doth,work,and the>tmcwmisnm inrenW or
Joffemlfor sok lSec.]Dw, ne
Busiss
m and Prnfcssions Cmle:'Me CommitteesL.ice.m Law docs not apply m an omgncr of OUTLEFS-SWITC ❑0'I'HER
HES-FTXTURfS
�"3.. property who builds in,improves thcrem,and who docs such work harawil"or through
his own employees,provided that such improvements are not intended or opened far NI?W RESIDENTIAL F1 ECTR SQ PT
sale.If,however the building or improvement is sold within one year incompletion.lhe SQ.FI'.FLOOR AREA Slip.FT.
ow errsbuilder will have the burden of proving that he did not build or improve for par-
(hocol'salcJ.
❑1,as owner of the progeny,am creltiuvely contracting with licensed contractors to TOTAL,
instruct the Project(See.7=,Business and Professions Code:)The Contractors Lr-
cruse Law does not apply toanowtier ofpropcnywho builds orimproves thereon.and QTY PLUMBING PERMIT FEE
wborronactaforhaeh projectswill,.,manicons)licensed pursuant lathe Contractors
License Low, PERMIT ISSUANCE
I am exempt under Sec. ,B&P C for this reason
AL 1'IiR-DRAIN&VIiNT-WATER(EA) VALUATION
Owner Dare
WORKER'S COMPENSATION DECLARATION BACK FLOW PRODCF.DEVICE
Ihereby affirm under Penally of perjury one of the following declarations:
(have and salt,mainmtnu Cenifcam of Cometh msdf-inmre lar Worker's Compen- DRAINS-FLOOR,ROOP.AREA,COND. STORIES 'TYPE CONSTRUCFIO:
autien,as provided for by Section 3700of the Lnhor Cole,for the pedonnance of the
work for which this Permit is issued FIXORES-PER TRAP
1 have and will maintain Worker's Compensation Insurance,as required by Section
JpW of the Labor Cole,for the performance oflhe work for which this pemnit is iamW, GAS-EA.SYSTEM-1 INC.40UTLF.TS OCC.GROUP
My Wmkce,Comlcnsmt m Laurance carrier and rohcy number arc:
Cartier: Policy Na.: GAS-EA.SYSTEM-OVER 4(EA)
CUR'BICATE 01'EXEMFUON FROM WORKERS' GRFASFIINDUSTRf.WASTE INTERCEPTORCOMPENSATION INSURANCE BUILDING DIVISION FEES
Glo,wHan need.,,,be completed it lbs permit is for one hundred dol I.,(S 100) CREASE'I RAI'
nr lege.) PLANCHECK 19311
I cenddru in the performanceof the work far which his men a axucd.Ishall SEWER-SANITARY-STORM EA.2W19', - Q
n i enploy any pagan in any Inmumr to horst¢;object pWorkers'Camper- ENERGY FEE
Qz mtiun Law,of Cup,"pns Tale se. - j4J ' 1 WATER HEA1LR W/VLNT/ELIiCI'R
z0 Applicant 1�UL. cknDlNC Feli
NOTICE TO APPLICANT:IL aRcr making this Certificate of Exemption,you should WATER SYSTEMTRIiATING SOILS FEE
I"t
he subject a)the Worker',C...npcaaoon provihions If the Labor Coda,you mow
Q Iimhwith....ugly with such provisions inch,permit Shot]he,dread revoked WATER SERVICE
taa
n' CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PENIS. SQ.FE PAIDr L�
z Ihereby ol'frnn that there is a consuvetion lending agency for the perhvmarm of Dam Receipts
U 0 the work lin which this petmit is i...ed(Set.3(W],Civ.C.) 9UTAL, Lisa
147W
Ofender',Name r,.
,r -lender's Address TOTAL: e
I amity mn,I have read this c,licmio i and sone dot the uhnve information is r .BIU \ c.ILDING fP,FA '
Fa.
tO conect.I agree,.comply with all city and county endurances andwalc laws relating toQTY. MECHANICAL PERMIT
U buildingcomtrucion,and hereby amboriee mpmwntativeso(this city menter uponthe // / 'SEI£M3 IC
none-mentioned property for inspection purposes. + PERMIT ISSUANCE N ELECI'RICFFE 3
(We)agree l,,save,adc.mify and keep h male,,the Cay oT C, i.e.qua,, '
Imbilidexjedgments,costs and expenses which may in my way access,against said City 1 ghIER UR AUU TO MECH. (�, PLUMBINGFCE �•�
sneer of the granting of this Perini,.
AYPI incense( VT UNDERSTANDS AND W .COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,U00 CFM) -'MECHA�'ICAh FEB / r
SOU( EGULATI MS.
q t3 et CI AIR HANDLING ON]F(OVER 10.001 CFM) CONS'1'RUCFIONg X
Signa pp cunUCon soon15nw EXHAUST HOOD(WMUCT) HOUSING MITIGA F
IIAZARI I,5 MAfI[RIAL$UISCLQSIIRIi
N'i11,M1e appli.an,or lmurt uilJingceapanl wore mhanJle harallous mumrial IIIiATING UNIT(9'O❑XI,(Xq DTD)
as defined by the Ce,emo o Municipal Code.Chapter 9.12,and the Health and Safety
Coda Section 25532(,)1 HEATING UNIT(OVER 100.000 BI BE
❑Yes ❑No VENTILATION PAN(SINGLE RES1D) PAID
Date Receipt it
Will the applicant or future building occupan,use equipment or devices which BOILER-cUMP(lHl'OR I Wq)0 BTU)
•nth ha'raulous air co.tnmi....1,ar ddincd by the(lay Area Ne Grainy M.nngemcr, 9'OTAL.
Diwricl" Yes ❑Nn BOILER-COMP(OVER I M000 BTU) -17
❑
\V\
I hove rend the h;vaalnus Turner mluls Icgmn mon m,naChapter 6.95 of the CA. AIR CONUITIONIiR ISSUANCE DATE
fnmia"e & ;a Hy
Code.Sections 255115.255)1 unA 25534.I understand(hat if the NEW RESIDENTIALMECH. SQ.FT. �7 C om"
build n notcunendyhavc'nemb th ix my rtspomihilaviermifythence,,anl / - ( /
ofth etas w h.umt be 'PH. ¢n s ce of a Cenrecme of sea ,
those ugsn Dab.ns, TOTAL: ISSUEDBY: �
OFFICE