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99120059APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING. ELECTRICAL BUILDING DIVISION APPLICATION/PERMI.1• III.DING�IgS7gj: ©fi a VNER'S AME rF G 1'H li: eta I - :CH F.i 'N'. LC D W -FACT PHONE. rez y08)371 ❑ Consultant Flros Paid by Applicant (initial) I hereby affirm that I am licensed under provisions of Chapter 9 (commencing D0Z with Section 7000)ofD,isma3ol'the business and Professions Code, and myliconx is ��2 in full 4vccandelinn G U U I.iccax lac, hit. q N G 6 Datc Canlmctnr RCHITECTS DECLA A 10 ~ h _Z 1 understand my plans shall be used us public ¢mor . OZ�L Q�7._n Licensed Pnrfessinwl ..I OWNER-Bxciola ifi DECLARA'T'ION yaty C ¢ 1 ...... (Sect that 11. cRosin Iain the Cnnions C e I.iAny c Law for Nc iC G (� following rice,. (Seaton 7onsu r, alte.a' and ve,fecaiofi Carc Any city (or county W 3 LL y whicb requires a permit m consumer, abet improve, demunit a or repair any structure Prior m it, issuame. also consirevhc applicam for such pemrino file signed sammem icy that he is licensed punuanuo the provborm, of rhe Concourses License Law Ch -Pel 9 II+�C�O (commencing with Section 7")ofl)ivi,ion 3 ofthe Business and Professions Care)or a that be is exempt Ihemfmm and the basis for the alleged exemption. Any violation of IXil W Section 7011.5 by any applicant foa pe r nal subjects the applicam to a civil penalty of ..y not more than five hundred dclhrw(Sh)(0) t=6❑ D1, as owner of thepopenY, or my cnaloyeas with wagon as their .In nnnpen,;ninn, F. will Bothe work, and the saucwrc is not intended or offered for Hale(Sec.W11T, Business la�j mand Professions Cade: The Cunaomoes Licenu Law does not apply w en owner of �• 3 pmpmy who builds m improves tbemon, and who does such work himself or through his awn employees, provided that such improvements are not intended or offered for stile. If, however, the building or Improvement is sold within one year of completion. the ooner-hailder will have the burden of proving that hedld not build or improve lin par. Paso of 0 L as owner of the properly, am exclusively contracting with licensed commmors to ummicr the project (Sec. 7W4, Business and Professions CarcU The Co r mmssrs Li- ormce Law does not apply ton owner of property who builds or improves thereon, and QTY. who contracts for such projects with a contractors) licensed pursuant o the Contractor's License Law. D I am a tnpt unM, Sec. B& P C for this ru,nn )war, Uma WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declamrium: D IM1ave and will mainaina CeniOmae of Canxnuo slf-inmx(nrWorkersCompcn- mtlon, a, provided for by Section 3700 of the Labor Care, for the FerfomLance of the work for which this Permit is issued. 1 June Lou] w,It tnAmain Workers Cnmtknsation bum;mce, a, touched by Section BdoftbeLabraCod, for the pedmmam<ofinework for which ibis pertnhisissued. MV Wnrkc%x Cmm�cn,Wion lnsumncc curticr end Policy/tulnl�cr�. rci/ awn Nl. I COMPENSATION INSURANCE (Thi, section need not he completed if the pemtit is for ionic hundred dollars (S HOW or less.) IOro ity Ilan in the acyl ineanceto Isework ni which has permitis issued. Ill all on, employ any Penna in any nmmncr sn x., m become subject to the Worker) Cntulxm Z ration Wwsof California, Date z 0 Applicant 'zFJ = NOTICE TO APPLICANT IL after making This Certificate of Exemption, you should Jerome subject to the Workers Compensation previsions of the Labor Cade, you must forthwith comply with such provisions or this permit shall IN deemed revoked. Q rajZ QON]ON INGAGENCY UQ Ihcmhy allinn that saennauctiun lending agency lin the pcdimnancc of E-' the work fur which this p .it is issued (Sec. 3097. Civ. C.) U Lenders Nene rU1,rder',Addma 0. 1 e,mfy that I have read this upplNumn and store that the above Infomlation is ify N corm". I agree to comply with all city and county ordinances and state laws relating m UZUhaddingeon,jr,aon.nadbcrcbynuthoninrepresentatives oil this city menter upon the ahovomcnhoned P o,roy red inspection pur,,,c,. (We) agree to smc, indemnity and keep hands, Ihm City of Cupertinuagainst habilitica,judgnrena, cosy and expenses which may in any way accrue against said City in comealm ncc of the planting of this pemtit. .nog 1r 1 none <Ta NDS AND WILL COMPLY WITH AL1. NON -POINT H) ZA]ii MATERIALS DISCLOSURIi Will Ibe applicam or furore thadding «capam woe or handle hazardous material defined by the Cupertino Municipal Care. Chapter 9.12, and the Health and Safety de, Section 25532(a)? DYen ONo Will the applicam or future bonding serpent use aryip sam nr device, which Lit hamrdaus Dir contaminants a., defined by the Bay Area Air Quality Managanent OYc, C3 No 1 have read the hazanus materials res, mnams radial Chapter 6.95 of the C.ali- Icehh & Safety Car, Seerfnn, 25505, 25533 nM 25534. 1 undersand can if the ..7...............w.,tr.•.,1a ,..L dinnhmyrc,nnn Balla, Io Dourothe,"uPnm ELECTRIC PERMIT PERMIT ISSUANCE APPLIANCES — RESIDIiNI'[At, PANELS UP10200 AMPS OVER 1000 AMPS SIGNS ELECTRICAL SPECIAL CIRCUITIMISC. TEL METER OR POLE INS'E POWER DEVICES SWIMMING POOL ELECTRIC OUTLETS — SWITCHES — VENTURES NEW RESIDENTIAL ELECTR SQ FE T(YIAI.: PLUMBING PERMIT PERMITISSUANCE ALTER — DRAIN & VENT— WA'I'EV CA) BACK FLOW PROTECR DEVICE DRAINS — FLUOR, RCOP, AREA. GOND, FIXTURES — PER TRAP GAS — RA. SYSTEM -I INC.4 OD'r1ATS GAS— EA. SYSTEM -OVER 4(EA) GREASI%INDUSTRL WASTE INTERCEPTOR GREASE TRAP SEW IN — SANITARY — STORM EA. NMI FI'. WATER IIF, ArER W/VENT/FLEC'IR WATER SYSTEMRT(FATING WATER S17RVICE NEW RESIDENTIAL PLMII. SQ IT TOTAL: QTY. MECHANICAL PERMIT PERMIT ISSUANCE Af TER OR ADD 'ID MECIL AIR HANDLING UNIT LTO I0.IX0 CEM) AIR HANDLING UNIT (OVER 10,001 CFM) EXHAUST HOOD (W/DUCT) HEAIING UNIT (TO 104010If IU) =RESIDEN71ALMECIL IT (OVER 101.010 BTU) FAN IS I NGLE RESIDI MP QUIP OR n0kn10 B'I U) MP(OVER H0k001(i IONER N71ALMECIL SQ.I TOTAL: OFFICE FEE: FLOOR AREA BUILDING DIVISION FEES 1'IANCHECK THE IiNERGY FIJI GRADING Bili SOILS ITE. PAID Im, Ruceipin UILDING FEE/\, FEE ,ISM JC PEIiJ y I I [IiC'jrRl 200 I - JIBING I;I:I0 ECHANICAL Igili S. UCf10NTAX HOUSING Mil GAfION FEE PAID Dum Receipt 0 IOIAL: ISSUANCE DATE l_ Zo., 'Zola ro ❑t -- ING PERMIT BLDGEC'f PLIuml,t/ NISCH ❑; 6 ❑ FEE JOB DESCRIPTION RESIDENTIAL O SFDWL 0 KI'ICl IF.N REMODEL I ADDITION ❑PLUMBING RE -PIPE CMULTI-UNI'( 0S'IRUCI'URAL MODIFICATION El INTERIOR 0CHIMNEY REPAIR IMPROVEMENT E] SWIMMING POOLS BATH RBMODITIJREPAIR 0 DEMOLITION 0 (YI'I IER ;01❑ COMMERCIAL: 'W BLDG/ADDITION 0DEMOLI'rION T' NT OFI IOD S17RVICE OVIi j� DOTH FEE: FLOOR AREA BUILDING DIVISION FEES 1'IANCHECK THE IiNERGY FIJI GRADING Bili SOILS ITE. PAID Im, Ruceipin UILDING FEE/\, FEE ,ISM JC PEIiJ y I I [IiC'jrRl 200 I - JIBING I;I:I0 ECHANICAL Igili S. UCf10NTAX HOUSING Mil GAfION FEE PAID Dum Receipt 0 IOIAL: ISSUANCE DATE l_ Zo., 'Zola ro