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99080124 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY O O IZ CITY OF CUPERTINO BUILDING-ELECTRICAL IT NUT BUILDING DIVISION APPLICATIONIPERMIT r1.uM1mlNc-nlr:c11,W1aM. SOOOI 1NIIDING PROJECT IDENTIt'ICATION BUILDING ADDRESS: SANI1AkY NO. AI'I-LICN'ION SUITMI MAL DAP I'. 20103 /U©e- cols So- 72R64 -(g q 9 OWNER' NAME:^ _ PHONI �� C) rRACr 'S(AM.: ,I NO' N/C CONTROLze a CI 111EC'UENGINEER: LIC NO: A )BESS1 6 1 //O(1 ❑ CONTACT: PHONE:: '66 ` 7 BUILDING PERMIT INFO 3!- �l-S X33 ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH E] ❑ ❑ LICENSED CONI RACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE I hercby alum that I an Bcensed under prnvi,imm,of chapter v(commencing JOB DESCRIPTION WOO with sector.700 )of Division 3 efthe Boainea,vnd Pmfessions Cade an ylicense is RESIDENTIAL WOO PERMIT ISSUANCE: ��� in full force anJ CRD. /' ! ❑SIUWf. El KIT REh10DIi1. 4UU License Cl. ` Liaa APPLIANCES-RESIDIiNTIAL El ADDITION ❑PLUM1INING RE-1'IPC yQL Dale Qanlmdmf ARCHI'11iCr'S DECLARA PANELS ❑MUI:f6UNIT ❑MODIFICAlIO �t=Z lundecaand my planssh Ill beusedaspuhlic recur), MODIIsICAIION OZ=O UPT0200AMPS [I HIT"E:R10R El CHIMNEY REPAIR W Licensed PmfessimmI 203-1000AMPS IMPROVEMENT E]SWIMMING P001S C X E� OWNER-BUILDER DECLARATION OVER IINXI AMPS ❑HATH REMODBUREPAIR ❑DEMOLITION y ❑O TIER C W sc ' 1 hereby,aff n that I am mempt from the Contractors License Law for the X p L U following«ulna erten Ito ID5 sir Business anJ Pn,lessiom Coda Any city I,,scantySIGNS IiLELTkICA1. m'3 w y which requires u permit m.canmrtin,atter,imnms�dumnolian,lir repair any-,wewna IE: primmin issuance.also myuim,lhmpplicanl fonuch permino fticasigned aatemmt SPECIN.CIRCUIT/MISC. Eby that he is licensed pursuant o the provisiomofthe Commences License Lew(CmPtm9 COMMERCIAL: W�00 (commencing with Section 7000)of Division J of the Business and professions Code)or TEMP.MITI:R OR POLE INST. c.a e tz shat he is exempt therefrom and the basis for the ullcged exemption.Any violaion of NEW NLDG/AUDITION El DEMOLITION W'm"NSection 7031.5 by any applicant l it a permit subjens the applicanuo a civil Penalty of PUWRR Up]CIES ❑TIiNANT El FOOD SIiRVICE m mune than Five minucel dills..(8510), IMPROVEMENT =O I,as owner of the pmpery,lir my cmploytt,wish wages as thcir,olc eompen,ntioa SWIMMING POOL HLEC'I'RIC (look 2F. willdnthewnrk.and m lhemcmrc is not maradedaOdhed forsale(Sco 70K .Painful, ❑U'1'1{lik W m and Prefewion,Code:The Cummemr',License law ices not apply to an owner of OUTLETS-SWITCHES-FIXTURES property who faults m improves thereof.and who does such work himself or through NEW kESIDENTIAL ELECI'R his awn employccs,provided that such impnnemcros a«not intended or offered for NEW ET FLOOR ARBA YSQ,bfT sale.IL however,the budding lir impm,'cmcnt is sold within one yrnr of completion,the ncr-builder,will have the burden of pmving shut he did mn fniW lir Inmprovc lin par- 00, puse of soled. 'TOTAL: 1,a,owner of are pmpeny.am exclusively contracting with licensed technical.to onswct the police,Islas.7044.Business and Pmfcmion,Code,one Conaaaor'ILi- se law docs not apply hot an owner of property who builds or improves thereon,and QTY. PLUMBING PERMIT FEF. who etmlmms for such ptnjeaa with a I mmauds)licensed pit rsuanuothe Cenracmr'e Lkcnxc Law. KNS NCE I um exempt under Sec. I4 k P C for this«son ALTERN&VENT-WATER IIIA) VALUATION Alwl Owner Use WORKER'S COMPENSATION DECLARATION ROTECT.DEVICE I hereby affirm under penalty of perjury,line of the following declarations: I have and will maintain u Certi licare of Consent m,elf-insure for Worker's Conmlen- OR.ROOF,AREA.COND. STORIES TYPE CONSTRUCIRos ,¢lion,as provided for by Suniaa 3700,,f the Lader Coda for the perfmmana of the ink for which this p.I,is isword. FIXTURES-PER TRAP 1 have and will nmidea.Worker,CmaNn,aiun Insomance.as required by Smlion 3700.fthe tabun Cade.for/tLh�er,�peAonnancc the w�rkYff whhiicchh'�th�iss formutm,issued. GAS-CA.SYSTEM1f-I INCA OUTLETS (KC.GROUT' / /CPN Camer:nk n+�'-�ntiay Niorlm 'e `101217 GAS-EA.SYSTEM OVER4WAI (Y.. 3 AC - CER'1'IFICAIIiOil EXEMPTION FROM WORKERS' GREASIVINDUSTRL WAS 117 INTERCIi19UN COMPENSATION INSURANCE BUILDING DIVISION ITHS (Th%,setian ucednm becompleadifthelcnnil i,foronchundreddollaoffIno GREASETRAP PLANCH[CK FEE ar less.) Loy any phoria in anAnmanrofs In ork becnnwhjectto perthe Wo isissuarouse ..I III SEWER-SANITARY-STORM11 F.p.21X1FI'. not employ any person in any manner so as m fecome subject m the WorkeK Campcm ENERGY PEE Z ,soon Low.,of Gvlipmmiu.Doc WAIT:R HEATER W/VBN`UHLFCTR GRADING FEE ZQ Applicant t ry NOTICE TO APPLICANT:11:after making this CrAificale of liaanpmioo,you should WATER SYSTUkkTRHA1 ING Solt's PER F headline subject lm the wake,',Compensatmn pmvi ens of the Latin Cade,you must W; fnnm Mwith comply with such parviss or pardishall be deemed revoked B'ATIiN SERVICE QPAID CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PI.MEL SQ.IT. Dale ivecTa# I hcrchy alliin that there use amxuudion landing agency for dm perfumence of 2 the work far which this Nautili is issued(Sec.LX)].Civ.C.) TOTAL; I- Lenders Name TOTAL: so r W Lender's Address U JILDING FE C n I cenify that I have read this application and state that the(chow inamans inn is N s reel.I agree to comply with till city and vanity ordinances and.arae laws miming to QTY. MECHANICAL PERMIT FEE SEISMIC ITE U buildingu.n,truction,and herchy nuthonue rcprecntnnve,(It'tht,ahy tin cormilxm the above.nsnlinncd pmpcay fur inspection purrymee. PERMIT ISSUANCE �...� ELECII RIC FEL' (We)agree m ems,indemnify and keep harmless Or City of Cupcni,o ad Cit Iiabilitie,,juderacti .c alarr ieapen,eswhichmaYourry way.cmw'llo sat y AI.TERORADDTO MECH. s� PLUMBING FEE X'� e untfng v1du;Ipermit. - AEItIANDS AND WILL COMP WII'll N.1.NON-POIN"1' AIRIIANDLING ONI' 1j(�BE."CFM1U M1tEC11ANICALFIiIi 5TI(NS. IAIR IIANDLING UNIT(OVER I . G(y'pm) CONST kUCTION'IAX H�SntlCnnmennr ale IiXHAUSI'IIOOD(W/I ULT) {pIISING MITIGATION 1'1:1: HAZARDOUS MATERIALS DISCLOSURE Willmer,licam or fawn building occupant sin«ofhandle hazanfou,macrial HEATING UNIT(TO V .00X1)BTU) as defined by the Cupeninu Municipal Code,Chapter 9.12,and the Hcatth and Safely 1117 INC,UNIT(OVERHA"( U) Gmtic.Section 25532(a)" ❑Yes Ll VENTILATION FAN ISI NGLE RESIDI PAID Dam kcccipt N Will the applicam lir fumrc Wilding accup.,use equipment lir devices which BOILER-COMP OUP OR island BTU) mit hmardous air co mminanl.,a,defined by the Bay Area Air Quality Management TOL' I- �/� Isltict'! L--P!`/ BOILER-COMPDVER IW.IXXIBTU) Yes AIR CONDE HONER ISSUANCE DATE I have dualist,hammom or 'pats reynimmente under Chl(I the C.E. �mmr�eee NYI fumia Ilcahh k S Q Steno,25505.25533 and 25534.1 muMrstand that if the NEW RESIDENT IAL M[CII. SQ.FT. buildingdac,m d h, tenm,thatit it my scsponsihilay In notify the occupant }-' oftherequirem ny(pfnmi ImvoeofaCmif-1 f 'Y. 1 Owner or uuthnri abemml vV" Dmc T0'rAL: ISSUIiU NY: �� OFFICE