30540 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY C
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT N030540
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BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL J
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
lc � �QH„:SL lQ 1�-46
OWNERS NAME: PHONE: "NSNA 1. ('5`t�� I C NIC CONTROL
RCI Cf/ENGINEER: G�QQ E �UADDRESSit
SK�LV �� ❑ ��
CONTACT. PHONE: _ BUILDING PERMIT INFO
L! 1.6�ZQ ❑ Consultant rises Paid by Applicant(Initial) BLDy ELECT PLUMB MECH
r LICENSF.0 CONTRACTOR S DECLARATION u QTY ELECTRIC PERMIT FEE
1 hereby aline,that 1.,it liwnsed code,provision.of Chapter 9 pro mentlng JOB DESCRIPTION
w0Z with Sectio.70(s ofui 'ionJofine Busincs.and Profnsictt9yy��kCoda,morrylicen•cis DFNTIAI:
F�� in full Eris^an ¢ti t./ PERMIT ISSUANCE
W U / WI. ❑KITCHEN REMODEL
�UU Limnu las isle.# APPLIANCES-RF.SIDIiNTIAI. ADDITION ❑PLUMBING RE-PIPE
yZ' Uam Conmaanr
F.Dm ARCHITECTS DECLARATION PANELS MULTI-UNITp TRUCPURAL
Z p I Z [understand my plans shall loused.,public records M ODIFICATION
O Z4- UP102WAMPS [I INTERIOR [:]CHIMNEY REPAIRF�E"IL Licensed Fear..fees[ 201-1050AMPS IMPROVEME�NsaT��n �v11FTtr
OWN am eUIhDER D[CLARATION F 2 1 1pLITION
r C C OVER IIIlNIAMPS ❑BATH REA1t�IN 1
1 herchy affirm tM1at 1 em exanpt from the RATIO.r[License 1rw for the VV nn�a sVl
x6�1U following reamn.(Section 7031.5.Business and Professions Code:Any city or county SIGNS ELECTRICAL []OTHER
1113 LL N which ovirtima,a permit to construct,alta,.improve,demolish,or repair any structure l l 'I PLG N(IN(1
OS poor to its issuance.also requires the applicant for such Permian rile a signed statement SPECIAL CIRCUTUMISC. -" ”
Ir-
Mi}J Nm he is licensed pursuant m the provisions of the Contmno/s License Low(Chapter 9
`�i (commencing with Section 7000)ofDi,Wsar3ol'the Bn.in.x and Profession.Code)or TEMP.METER ORP INCOMMERCIAL
d 6 oq tMhat he is exempt Nerefmm and the basis for the alleged exemption.Any vicialum of S ❑NEW BhDG/AUDITION El DEMOLITION
�mN Section 7031.56yany applicant for a Pertrdtsubjects the applicanuoa civil penalty of POWER DEVICES ❑TENANT - ❑FOOD SERVICE
man thin Me l undyed dollars($50d,
ZY OTHER IMPROVEMENT
¢< wi Lasownao(Nd pmpain�vireo or employac%wldtwag.atheir(Sec.compensation. SWIMMING PWLEL TRIC
W co andwildothewons andtheaureisnot i Licenseffiarad for sale Low
to an
of []OTHER
{asI^m and Professions he builds Code The Commcepo L nd isI l.do des oat apply m un owner of OUTLEI;S-SWITCHES-F�RTU S
d 3 his own who oyes,or improves thereon,and who area such work himself or through
his own employees,building
that such mentis sold w arc not intended or offered for NEW RESIDENTIAL ELECTR IDS
sale.It.howevcrJhe huilJing orimpnrvunmm is sad within are year fcompletinq the SQ.FT.FLOOR AREA S/SQ.PT.
ovener,builder will have the burden of Proving that he did not build or improve for pur-
pose of sale.). -A
Los owner opr
f the openy,am exclusively nttnmedrg wish licensed comracmrs to TOTAL:
consume,the project(Sec.704,7.Business and Professions Code:)The Contractors Li-
cen.a Law mMs not apply to an owner of property who builds or improves thereon and QTY PLUMBING PERMIT FEE .
who somracis I'or such projects with a contractods)IlceosW porseanao the Contractor's
License Law. 1112RMIT ISSUANCE
❑ltor a nPt under Sec. _,B&PC far this reams
O D . J ALTER-DRAIN&RENT- ATER ) VALUATION
Vtl KERS CO [NSATION DECLARATION' BACK FLOW PROTECT.DEVICE I \
1 hereby affirm under Penalty oerjury f pone of the following declarations: `
i .C]I have andwill maintain a Ceruficme ofConsenaosclf-imure for Wooers Camper- DRAINS-FLOOR.ROOF.ARE,.CONU. STORIES TYPECONSTRUCTION
ation,as provided for by Section 37M of the Linvr Code for the performara of the
work for which this permit Mimed. FIXTURES-PER TRAP
Fl 1 have and will maintain Workers Compensation Insurance.as required by Section
370Xlofthe Lube,Cale,for the perfommrceof the work for which this permit is issued GAS-PA.SYSTEM-I INC.J OUTLETS OCCGROUP AVN
My Workers Compensation Insurance carrier and Policy number are:
Carrier: Policy No.: GAS-IA.SYSTEM-OVER a(EA)
CERTIFICATE OF EXEMPTION FROM WOR KERS'
COMPENSATION INSURANCE GREASIJINDUSTRL WASTE INTERCEPTOR
BUILDING DIVISION FEES
(This section need not be completed if the pemtit is for one hundred dollars IS Kim
r loco) GREASE TRAP PLANCHECK FEE
Icenify Na aheperformareenfrheworit forty 'ch thispeoniI i.iaued.I shall SEWER-SANITARY-STORM EA.21X1 FT.
romemployany navy mann flue WmkcRCompcn- ENERGY FEE
t OZ .urian Laws of aiforn' 'rte WAT17R HEATER WNENT/F,LLCTR GRADING FEE
Z Q Applicant
h imn
NOTICE TO APPLICANT:If,after making this Centic..of Emeriti...y..should WATER SYSTEM/TREATING SOILS FEE
a
bre...te subject m the Wmkcr'a Comp.rsmtirn pmvi......of dtc Labor Cale,van tutus
W a..r fonhwithcomp)ywithsuchprnv¢ionsordtisprmitshallbcdccme ice t;kcd. WATER SERVICE
.0.T. Z CONST RUCTIONLENDING AGENCY NEWRESIDENIHALPLMB. SQ.IT. PAID Data caiP1N
LJ O I hembyzfftrm that be.isamnsauciion lending ageth
agency for e perfcomemaof
Ne work for which this permit is issued(See.3097.Civ.C.)
c)) -'' lender'.Name (st, 1 TOTAL:
Lender,AM., TOTAL'
1 certify that I have mud this application and nam flat the above iafonnotian is BUILDING
FIX
o-F-t N correct I.,me nv 1,with ulleity and amity ordinance,envision,law.rebningta QTY. MECHANICALPERMIT I FEE
U Z building construction,and hereby inhoott reprtttntativex ofthis city to enter upon the 5EI5NIC 1'E O
above-mentioned property for Inspection purposes. PERMIT ISSUANCE
FLY(We)agree m save,indemnify and keep harmless the Ca,of Cupertino against ELECTRIC
liabilities.judgments,coats and expenses which may in any way acerae against said City ALTER OR ADD TO MECH.
in consequence of the granting or this permit. PLUMBING FEF.
AP' CANT UNDERSTANDS A 1)WILL COMPLY WITH ALI,NON-POINT AIR HANDLING ON[1'(1010,000 CPM)
S UR +REE MONS. MECHANICAL PEE
5 1/13/C AIR HA NDLING UNIT(OVER ULXXI CFM) CONSTRUCTION TAX
Si mart fApplicana ontmcto Data EXHAUST HOOD(W/DUCT) HOUSING MITIGATIONP
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant sore or handle hvant material IIEATING UNIT ITO IW.0m)BTU)
as defined by dee Calvin..Municipal Code.Chapter 9.12,and the Health and Safety
Calc,Section 255320)'[ I HEATING UNIT(OVER I W."BTU)
E3 Yes ❑No PAID
VENTILATION PAN(SINGLE BESIDE Data Receipt#
Will the applicant or future building owcupart use equipment or devices which
nit harandous air contaminants as delinW by the Bay Area Air Quality Management BOILER-COMP CUP OR 100.010 BT'UI TOTAL:
District BOILER-COMP(OVER 100,01X1 BTU)
❑Vc. Fl No
I have read the Incautious materials requirements under Chapter 6.95 of dee Calm AIR CONDITIONER ISSUANCE DATE
Lmia Health&Safety CWe,Sections 25505.25533 and 25520,l realrsmadthe,Hthe NEW ICES IUENTIALMECH. SQ.FT.
building doss not vemonfly have a tereem.Nat a is no,mspon.ihifly m ratify the occupant
of the mquimmems which mua be me,prior m issuance of a Cadricare of Occupancy.
Owner or authorized agent Data TOTAL: ISSUED BY:
OFFICE
Limited in size and kept under constant sw;cillanee. -- - -- — i
3. The geaerai contractor shall use a tree se:-vice liceasr_,as defined by California Business and Profession-
a! Code, to prune and cut off the bunches that must be removed during the grading or construcfion.
No branches or roots shall be cut unless at fist reviewed by the landscape arehitecJarbor,'_t with
approval of staff.
9. Any damage to e:.isting tree crowns or root systems shall be repaired immediately byas approved see
surgeon.
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TRACT N' 6919
STEVENS CREEK AMENDED
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Limited in size and kept under constant surveillance.
8. The gcae:al coon-actor shall use a tree service license-_,as defined by California Busincss and Pvfession-
al Code, to prune and cut off the branches that must be removed during the grading or consracdon-
No branches or roots shall be cut unless at iLst reviewed by the landscpe arehiterJarbarist with
ancroval of staff.
•, 9. Anv damage to e:,isting tree crowns or root systems shall be repaired immediam!y by an aneroved fir_
surgeon. I
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8 TRACT Ns 6919
STEVENS CREEK: AMENDED
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