99110008APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY OF CUPF,R'1'INO BUILDING - ELECTRICAL.
CAL
BUILDING DIVISION APPLICATIONIPERMIT PLUMBINGINPTECTICHAN'IFIC
BUILDING PROJECT IDEXI'IfICAJ'ION
BUILDING ADDRESS:
10696 PoCtr ars C zh �i �o CA 9,5 1t(
( WNF.R:S AME: I'H(INE: C TRATORR E:l I LIC
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1191200=747=1
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❑ 1 %6.
TOTAL:
OFFICE
CONTACT: rnoly e:
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❑ Consultant Fees Paid by Applicant (Initial)
4a� 95S 5353
BLDG ELECT PLUMB NIECH
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LICENSED CONTRACTOR;S DECIARA'UON QTY ELECTRIC PERMI f FEE
I hereby mann mm 1 i licamncd under Provi,hnu mChaple, 9 (commencing
Section 71X(8 ofDickinn S 0 the 1lusinco load Pnefemior, Cale, and my license is
PERMIT ISSUANCIi
in full lime and '(fent.
Licenx Class Lica APPLIANCP_S—RESIDENTIAL
Date Cannmumr
JOE DESCRIPTION
RESIDENTIAL:
❑SI'UWI. C1 KITCHEN RIiMOUISh
�)ITION ❑ PLUMBING REPIPE
❑MULFI-UNIT ❑STRUCTURAL
MODIFICATION
❑ INTERIOR CHIMNEY REPAIR
IMPROVEMENT E] SWIMMING POOLS
❑ BATH REMODF,L/RFI'AIR ❑DFh1OLITION
❑ O'fI11iR
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ARCHITECTS DECLARATION PANELS
I understand my plans shall M used as public receNn
UP TO 21X) AMPS
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Licemed Profc,,umorl 201-1uW)AMPS
( IWNHR-RUILDER Of CLARA'I'ION OVER INXI AMPS
I hereby aflinn thin 1 um ue pt (runt the Coninmmr'x hiicnsn Laos fur the
following mlowm. (Seth 7031.5. I3curies, and Profmxion, Cedc: Any'try (11 '('only SIGNS ELECTRICAL
which requires a permit to cale,met. aller, improve. dcnmli,h, or repair way sm aterc
p,hDor,, issuance.olsn requires the mplicamforsuch permit In file a si,rub],memcnl SPECIAL CIRCU I DIM ISC
that he i.s licensed purser, In the pmvi,iomof Ne Comreaa's License Lnw(Chaptter 9
lcommcncing with Salina 700X) of Division 3 of the Business and Prsefcsions Cock)or TEMP. ML7fiR OR IroLG INST.
Lha he is exempt Ihcrefmm and nM1c basis for Nc allege) cxempsion. Any violnninn of
703 L5 by any applicant for a Permit subjects the applicant to a civil penalty of POWER DEVICES ole'ENANT
not man than Ova hundreJ Aollun ($SW L
Q I. a,nwner er the propeny,or myempl('yeas with wage, ns theirsole cnmpensatiom, SW1h1h11N(i I'OOLIiLECIBIC Q
will do the wurk.aA the structure i s not intended or all tried Ior store (See. 7144. Boniness
and Pmfc%sions Cndu:'The Cennacmrs License Law does tool apply to on nIs r til OUTLB'I'S—SWfrC11115— Yl%TURBti
progeny who build, car intprorcs Ihennn, and who dmx such work himself ar through
his own employees, provided that such improvements lore not intended or offered for NEW RESIDENTIAL ELECfR SQ let
sale. IL havewar.hc building or improvement issold within one year of completion. the
COMMERCIAL'
❑ NEW BLDG/ADDITION ❑ DEMOLITION
❑FOODSERVICE
��t��I11BIIPRO '���1ENT
El0
SQ. FD. FLOOR AREA
$/SQ. FE
�huilder will have the burden of proving Thal he did non bald ur impreve fur per-
furse 'le.). TOTAL:
[�q r of the pinpeny, am exclusively contracting with licensed emarso rs to
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instruct the project (Sec. 7144 Business and Pr('fcesiun% Gvlcq The Contractor'%Li-
came Law does not apply m an owner of pnperty who No (or improves thereon, anti QTY. PLUMBING PERMIT FEE
whnnnamcp fo,ta,to jeep with ecommewr(,) licensed canon, to the Comnmmr'x
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Laxa c Law. PERMIT ISSUANCE
I to. exempt under Sec. �.B&PC Ber this r'axon
(EA)
VALUA'DON
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ALTER —IlRA1N&VL'Nf—WATER
Owner �CLJG[Vl6P I
�~ WORKER'S COMPENSATION DI!CLARATION BACK FLOW PROILCD. DEVICE
1 hereby aflinn under penalty of Perjury one of the hunts ing deductions:
I have and will maintain a Cerifcae of Consent a self.imm� for Worker's Compen- DRAINS— FLOOR, ROOF AREA, COND.
saint, as provided for by Sectirn 3700 of IM1e Leda Gxle. for the Performance of the
work fur which this penin i,s issued FIXTURES—PER TRAP
STORIES TYPE CONSTRUCTION
I have und will mammon Worker's Compensation Insunmce, as required by Section
37h)nfnhn Lalaa Cudc. to, the perRvmance of he work Enwhich this pemot, issued. GAS -17 SYSTEM-11NCAOUTLE S
OCG GROUP s(r�NINO
5
My Worker's Compematino Insurance tamer and Policy number mrd
Comer: Policy No.: GAS — EA. SYSTEM -OVER J (EAI
CERTIFICATE, OF EXEMPTION FROM WORKERS' GREASFJINDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE
�
BUILDING DIVISION FEES
(this section nceJ nm Mccmpleted ifthe penis is(moue hundred ddlam($100) GREASETRAP
or less)
Icmify that are Perlonnance of the, becum whichuM,permiti,ksued.l,hd1 SEWER — SANI'T'ARY — STORM EA. 21X) FT.
nm cmpiny any person in uny mm�ncr sr as m Peanut mbjecuo the Worked Camper-
I'IANCHF.CK FEE
ENERGY FEE
GRADING PEE
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,shun laws of GliGania. Date WAT17R 1113A'IL W/VVN'I'/ELECTR
nnnuram t
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G ❑PAID
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NOTICE TO APPLICANT. 11. after making this Ctaihcac of Exemption, you should WATER SYSTEMITREATING
Masme,.bjca m the Worker's Compensation pmvisiom of the Labar Cede, you must
Ionhwilh comply with such pmnuons or phis Pemmin shallMdecmed revoked. WATER SERVICE
CONSTRUCTION LENDING AGENCY NEW RESIDENTIALPIMB. SQ. IT.
I hereby affirm that is a construction [ending agency for the permanence of
the work for which this permit is issued (Sec. 3097, Co. C.)
Lenders Name 'HYI'AL:
Lender's AJArc.o
SOILS FEE
Uma Receipt,
'DOTAL:
BUILDING FEE
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1 ecnify ibal I hove Dead this application and ,tale the tM abuse infornaninn is
nennd.I agree Io comply will, all city and colony ordinances rationale law, Dealing m QTY. MECHANICAL PFRMIT FEE
bu'ddmgcm,n'tion.and nereny aumrrne npre,emahvm un m. ally mencerupnnnme
SEISMIC PEE
ELECTRIC FEE
uMecmemlrned pmPeny for inspection purposes. PERMIT ISSUANCE
(We) agree m save, indemnify and keep hamkxs the Cry of Cupemno against
Iialainics.judgmenu, cap and expenses which may inany wayuccmeagainst said City ALTERORADDTOMF.CH.
PLUMBING FEE
consequence of the granting of this Peril.
APPLICANT UNDERSTANDS AND WILL COMPLY VorIt ALL NON -POINT' AIR HANDLING UNIT(TO I0,00(ICFht)
Ib11261ANICALFEE IF 11
SOU CEREGULAI ONS
n AIR HANDLING ONI'T(OVER 10,IXXICFM)
III/
�i)NSTRUCTION TAX II III
�ll�)US TI 'I I II
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Signaterc of Applic,m Cnnnmcfor Date EXHAUSTHOOD (W/DUGP)
11A%ARDOUS MATERIALS DISCLOSURE
,menal HEATING UNIT (11)100.0010 BTU)
hanemardoum
Will lhcappli'mnorfame buildingrncup..l .onto De dle l
l
m defined by the Cupertino Municipal Cale. Chapter 9.12. and the Health and Safety HEATING UNIT(OVER INDONI BTU)
Code, Section 25532007
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❑Yes OND VENTILN'[ON IAN (SINGLE REi D)
'PAID' Date Receipp
Will the applicant or future building recaptal use equipment or devices which BOILER—COMP IJHP Uk InoNg) RI D)
..... b,acdous air ecima mania, u, defined by the Hit, Arca An Qudlry Management
/
'DOTAL, a O,
BOII.i?R—COMPIOVICRI(X),(IX)BTU)
Dixlncn�Ycs
❑Nn
I have mad the haruNommamrob p- under Chapter 6.95 of the Cook AIR CONDIIIONHR
quiremcn
ISSUANCE DKTE
(aria Health & Safety Code. Saturn, 25505. 25533 und 25531. 1 adesmnd Non if the NEW RESIDENTIAL MECH. SQ. PT.
building does not currently have a tenant. deaf it is my Desposmibiliry a m aLl the a veupnnt
TOTAL:
OFFICE