S 0529 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-E:LECI'RICA L PERMUNos,
BUILDING:DIVISION APPLICATION/PERMIT PLUMBING MECHANICAL Q 0529 2
BUILDING PROJECT'IDE\TIF'ICATION J .7
DRE
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BUILDING
055: �W /' SANITARY NII. APPLICA I'I(/SUM-ITL DAL
OWNER'S N`AAME: ._.Gv LLCM'RACTOR5 NAME: LIC NO: NIC CONTROL or
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&261�1 1101q,5;
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ARCH] LICNO: ADDRESS:
CI'I
CONTAC/y/,^ /� Pit HE I31111.DING PERMIT'INFO
JQLF I/ may/ 41-/� ��5377- ❑ Consultant Fees Paid by Applicant(Initial) HyDG ELI Cf PLUMB MECH
XI, LICENSED CONI RALTORS DECLARATION QTY. ELECTRIC PERMIT FEE JOB DESCRIPTION
1��/•
1 hereby union that I un,licensed under provisions of Chapter 9 fcounancing
Da
W ac Z with Section 91XX11 nfDivision3ol'the lfwinea'unJ Pmfes.ionsCWc,and my license lO ID TI
�acin full force and effect. - FDWL LlKITCHIiN REMODEL,
N� License Claw Lief APPLIANCES-RESIDENTIAL C:1 ADDITION ❑PLUMBING RE-PIPH
I Date Contractor
w66 pRCHITECI'S DECLARATION ❑MULTI-UNIT ❑STRUCfURAI.
~H Z I understand my Plum slwll be used as public"cards
PANELS MODIFICATION
rZ�nC UPT02IXIAMPS [_1 INTERIOR ❑CHIMNEY R1711AIR
F�nhW Licensed Pr..lesmest 201-1000AMPS IMPROVEMENT E)SW IMMING POOLS
C Y F OWNER-BUILDER DECLARATION OVER IIXMIAMPS BATH REMODIiIJRLPAIR [I DEMOLITION'ca, I hereby off onthat 1 am exempt for he Contremor's License Law'for the
XD W U following mason.(Section 7031.5,Business and Profession.Code:Any city or county SIGNS ELECTRICAL ❑OTHER
W 3 LL y which requires a Permit to canswm,alter,improve,demolish,or repair any smacturc
01 prior to itsissuance.al. '
q the applicant fsuch Permit l file a signed m
d talcent SPECI AL Cl RCUI'1'IMISC.
9p on math :dicr..mmmm p vnlol: Dh c t ,tor 1 1 ICmapherY COMMERCIAL
jyt lYO0 (commencing with Secuan7000)rf Division 3of,hc Business and Prnfessbm Co1e)nr DEME METER OR POLE INS'F.
M Q.o that he is ewmpt therefrom and the nasi.for the alleged exemption.Any violation of ❑NEW BLDG/ADOITION ❑DEMOLITION
X
m Section 7031.5 by any apPlican,Ior a permit subjects the appfcam to a civil)Goran of POWER UEV ICES [_1 TENANT ❑FOOD SERVICE'
at more than five hundred dollar(85110). IMPROVE:MENIF
F=QQI,as nwncn,f IM1e propetY,nnnycmpluyeeawi,hwage.as mcir.wdettnnpenvtinn, SWIMMING POOL ELECTRIC El OTHER
p.
vol room,soak,and theswdum is our mended or nlYercJ retook(See.9OL1.Bminl,
6 3 m and I'ndcwiuns Code:The Cn ancelor's Liccme Law Jam
not apply to an owner of (nl'1 LETS-SWITCHES-PI%'I'l1NES
properly who miles or improves thereon,and who Joey such work himself or through
his own employee.,provided that such improvements arc not intended or offered for NEW RESIDENTIAL ELECTR SQ PT.
EISQ.IT.
sale.If.however.the building or improvement issold within one year ofcompletion.the
Der builder will have the burden of proving that he did not build or improve for put- as
po% ofsale.). TAL: (p�
onownerel IM1 p pent I,s lycontracting w IM1 I' J I act to � p
ant cl IM1 p J I(S 7014 B ss J I I is C J p Ili C 1 to :l i-
con La doe t pplY1 fp pony h builds imp :d ra and QTY. PLUMBI MIT FE-
who Gamlens for such protect with ort t 1)licensedp 11 theC ntract r l/�l ®�� O
License law. , PERMIT ISSUANCE 7x7
J - &P CLoGM1 e�reaxm
CZ
ALTER-DRAIN is VENT-WATER(EA) /'/II VALUATION
Owner )nlc t�
• KER'SCOMPE SATIONDIT L A'1'ION BACKFLOW PRO]ECT.DEVICE r wrtH17N0
y affirm under Penally of perjury one of the following Jeclumtions:
❑those and will maintain a Certificate of Consent mself-unarm far Workers Co.,.- DRAINS-FLOOR.ROOF.AREA.GOND. STORIES 'I'YI'T:CONS'BUCTIOD
.anon,as prvided for by Section 37M of me labor Code.for the performance of the
work for which this permit is i...ed FIXTURES-I'ER TRAP
1 have and will maintain Workers
Comptrmtinn Innumman.as requited by Section
3700al the Luno Code,for IM1e perl'onnonce of the work lin wheb,his permit is Toned, GAS-EA.SYS'IT.M-1 INCA OUTLETS OCC GROUP APN
My Worker's Compensation Insurance currier and Policy normal um:
Caner: Policy No.: GAS-EA.SYS'I EM-OVER 41EA1
CERTIFICAFE OP EXEMPTION FROM WORKERS' GRFASFIINDUSTRL WASTE INTERCEPTOR
COMPIII, SATION INSURANCE BUILDING DIVISION PIES
Choi, o,ionacednat he completed dyne pe.,it is go are hundred dollars(SH10) GREASETRAP
I
or less) 1'LANCHECK PER
Icenilyd in the perforn,ancenf me work too Loch this permit is i...ed,I shall SEWER-SANITARY-STORM I.A.21X1 FT.
not employ any Peon in any exacter so as m become object m,the Workers'Camper- ENERGY PER
O Z setim Laws of California Date WATER HEATER WNENTELECTR GRADING FE.
Z Applicant
h NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SYSTEMffREATING SOILS FET.
become subject to the Worker's Compensation provisions of the Labor Code,You most
foravotb comply with such provisions or penis saill rte deemed revoked. WATER SERVICE
Q PAID
� z CONSTRUCTION LENDING AGENCY NEWRESNEMFIAhPLMB. SQ.I'L Dale Receipt
LJ O lherehy,a irm that there ismcomration lidingageney far the pen'ormuceor
the work far which this permit is issued(Sec.3091.Ci,C.) TODO,:
0 F-' L<tdcr's N. TOTAL:
r WLender's Address BUILDING FEE
a 1 terrify Lha,I have read lois application and.not hat the aMrve information is
nN-I (n ammo.l agree to comply win,all city and con tyanlinmmes and sure laws relating In QTY MECHANICAL PERMIT FEE S17ISMIC FIll.
V Z buildlagcoexpinuun.and hembyaroth im m1mvemmiwa of this city m entmupon the
above-mentioned properly fon Inspection purposes. PERMIT ISSUANCE ELECTRIC PER.
We)agree to save.indemnify and keep humorless the City oI Cupcmino against
llabilities,judgmeno.costs and expenses which may in any way acctueagainst said City ALTER OR ADD TO MECH. PLUMBING ME
in amsnrvenee of the gnawing of permit.
APPLI' N'1'UN iRSTA NOS ApND I,L COMPLY WITH ALL NON-POINT AIR HANDLING UNITGPO IIL(XXICFM) MECHANICAL Flit[
ou LLLC.
f AIR HANDLING UNIT(OVER I0.IXIII CFM) CONSTRUCTION'TAX
g fApphmara Commctor ID c EXHAUST HOUD(W/DUCO HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will lhcappliconte,to,.a building rectfomunrcor handle howardous material HEATING UNIT(F0 100.000 B'FU)
as defined by IM1e Cupertino Municipal Code,Chapter 9.12,and Il¢Ileuhm and Safety HHATING ON('1'(OVER I00,IXX)131'U)
Code,Section 25532(0)1
E3 Yes ❑No VENTILATION FAN(SINGLE RISID) PAID
Doc Receipt p
Will the applicant or future building occupant use equipment or devices which BOILER-COMP(3HP OR IIX.000 BTU)
emit bacardom air contaminants as defined by the Bay Area An Quality Management IDI'AL:
District? BOILER-COMP(OVER IM.000 BTU)
Ye. ❑No
I have read the Lerardon,materials recriminate,under Cbater 6.65 of the Cali- AI R CONDI'IIONI;R ISSUANCE DATE
M33
forma gcalm Rr Scurry Coda Sections.that i 2553)and 25534.1 undersand tout Via, NEW RESIDENTIAL MECH. SQ.FT.
buildingskis ed,ohmyhaat atenant,tha,it is my¢srymsCeroyn,oratlfymeoccupant
of the fequirtmenl5 whieM1 must he ma primam in>uance of a Cetifcam of flcapanry.
Owner or u uthoLed agent Dam TOTAL.. ISSUED BY:
OFFICE