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S 03424 woe CUF Flo z OZ—C aOaC FWOQ N� maps dko� W 1—Za %=C Iai1Fa ' a3- 4 L APPI ICANTTn FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY UPERTINO BUILDING - ELECTRICAL DIVISION APPLICATION/PERMIT PLUMBING.-]IE.CHANICAL BUILDING PROJECT IDENTIFICATION PI§IT NO, J 0342 RES �. /- /I /(� C,4. JI�rCii✓✓11IU FA SANITARY NO. APPLICA BMITI'AL DAT, i: PHONE: C(N'IIRAMORS NAME: ` G raoe 7� / L tl •i NIC ❑ CON'IA(ll.a CHITECfILNGINEER: LIC NO: �— A )UR 6S: 8 e� w �• S CONTACT: PHONE: BUILDING PERMIT INTO ❑ Consultant Pecs Paid by Applicant (Initial) BLDG ELECT PLUMB MIiCx �� -- LICENSED CONI RACIURSDECLARAT[ON 1 hereby arfim, that I am licensed under provisions of chapter 9 amnmencing with Seelm.70WOd Dmi'On3oOhe Buninesaand ProessieyrC.yc dm licenses, in full force and effect. SSS QTY ELECTRIC PERMIT FEE JOB DESCRIPTION R - ID NTIAI.: ❑SFDWL REMODEL. PERMIT ISSUANCE APPLIANCIS—RESIDENTIAL Licens Cl as^ _ Lie N l[ Date Contractor �CHI!N ❑ADDITION PLUMBING RE -PIPIT (]MULTI -UNIT 0$'FRUCfURAL MODIFICATION [J INTERIOR ❑ CI I IMNEY REPAIR IMPROVEMENT [] SWIMMING POOLS ARCHITECTS DECLARATION 1 nndcrsdnd nny plane shall be used .,,ands records PANELS UP TO 100 AMPS anacied professiunel 201-100DAMPS OWNER -BUILDER DECLARATION I hereby affum that I am exempt from the Contractors License Law for the following at (Section 7031A Business and professions Calc: Any city or county ❑ BATH REMODEI/REPAIR ❑ DEMOLITION ❑ OTHER OVER 1000 AMPS SIGNS ELECTRICAL. which requires a pemait to construct, alum, improve, demolish. er repair any structure SPECIAL, C1RC111'I'/MISC. prior its issuance. also requires the applicant for such permit to File a signed.nutemem that he is licensed pursuant to the provisions of the Cnntmctorr License Law (Chaptu 9 (Aurmenving with Section 71001 of Division 3 ul he Business and Professions Gde)nr that he is exempt therefrom and the basis lour the alleged exemption. Any violation of Section 7031.5 by any applicant for a pcon itsubjects the applicant to a Civil penalty of TEM R METER OR I101,1: 1 N S T OMM R IALCN' ❑ NEW BLDG/ADDITION ❑ DF_MOLITION ❑ TENANT ❑ F(IOD SERVICE POWER DEVICES net more than five hundred dollars (8500). ❑Lmowner of the pmpcny. or my emPloYecs with wages as nhcirudc compensation. will do the work, and the structure is not intended oroffcred for sale (Sec 10,14, Business and Professions Calc The Contractors License haw tices not apply to an owner of SWIMMING POOL ELECTRIC IMPROVEMENT ❑OTHER OUTLETS—SWITCHES— FIXTURES NEW RHSIDFN'lIAL ELECT R SV property who hnilds or intprsvcs thereon, mad who docs such work h'nnsdf or through his own employees, provided that such Improvements are not intended or offend I r sale. If. however. the building Or improvement is sold violation, ycvrufcompletiun. the . SQ. PP FLOOR AREA SISQFL owner-budcar will have the burden of proving that he did not build or improve for put- IOTA[ po¢efsale.). ❑ F. as owner of the property, am exclusively contracting with licensed contractors 10 construct the project (Sec. 70aft. Business and Professions CMe:) The Connectors Li - .se law does nm apply at an owner of propcny who builds or i reproves thereon.and who eon 'Is or,roh projects with a comrai a)licensed pursuant to the Contractor's QTY. PLUMBING PERMIT F hi Law. PERMIT ISSUANCE ®vM lame. ndcr Sec._. B A It C fort This ren`m 1lff�o "//////111------%%/111�+k/ ACfF,R—DRAIN .p VENT —WA'fERIG) �T r©n.�^ALUA It6Owner/�/� �(V OWE IVVV! mss //// D WORKE S COMPENSATION DECLARATION BACK FLOW PROTI!CI'. DEVICE. 1 hereby affirm under perahy of perjury one of the following declarations: I have and will maintain a Certificate of Concent to self -insure for Workers Compen- cation, as Provided for by Section 3701 of the 1aMr Code. for the performance of the work lin which this permit Is issued. DRAINS — FLOOR. T(H)E AREA. BOND. STORIES 'TYPE CONSTRUCTION FIXTURES —PFR I RAI' GAS— F.A. SYS'1'13M 1INC.YOU'1'LE'1'S ❑ I have and will Inuinein Worker's Compensation Inwence, as rcqulred by Section 3700ofthe Uthr Gds, for theperformanceofthcwotkfor whichlhi,,anntisi...cd, OCC GROUP AI'N GAS — EA. SYSTEM -OVER Y EA) My Workers Compensation Insurance carver and Policy mmnMr arc: Connie, Policy No.: GRGSWINDUSTRI. WASTE INTERCEPTOR CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE BUILDING PVI INFEES GREASETRAP (This section need not be completed lfthc permit is for one hundred dollars(SINb en,,mat the poliormnanewnrknlinwhlchhls rns hdl nun employ any pectonInnymaner ,, ocet Ixnnc nfire WorkersCorapm I'LANCIIIfCK Illi ENERGY Iq: : SEWBR— SANfI'ARV—S'IYRM BA. 21)11 WA'F'ER HEN] 17R WIV13NT/ELECTR ' cation Laws of Calibaria. Dae Alpplicam j NOTICE TO APPLICANT: If, after making this Certificate of Pisemption, you should ' became subject m the Workers Compensation provisions man, Lab, Cale, Ina must forthwith comply with such .... isionxorthis permitshall be deemed revoked. WATER SYSTEMTREATING WATER SERVICE NEW RESIDENTIAI, PLMB. SOFT.Enc CONSTRUCTION 1.I7NDING AGENCY I hereby affirm that there is a construction lending agency for lire performance of the work for which this permin Is issued (Sec 3091, Cf¢ C.) Lenders Name Rcecipnp IOTA 1.: ID TOTAL: Leaders Address I is UILDIN: 1 versify that 1 have read this application and .vac that the aWve information agree to comply with all city and county ordinances and state laws mlating m connruction, and hereby authorize represcalausesofthis city tocrier upon the QTY. MECHANICAL PERMIT' FEE Tcurmcl.I Jikxbuilding uNwvc-rantionod praKn, for inspection pumoaa (We) agree u)save, Menially and keep harmless the Cry of Cupvnino against Ihh111tles.jud �nrs,cols and expenses which unity in anyway accme against said City PERMIT ISSUANCE F131i "Lustfif GFEE ALTERORAIIII'IUMECH. 'nconscqu ofthegmntingofthi: nrmit. APPLIG UNDERti ND. U WILL COMPLY WITH ALL NON -POINT AIR HANDLING UNIT(T011LUp CPM) MECH NICALI'If1i SOU .F EGULATI S. (� ` AIR HANDLING UNIT(OVER I0,000CFM) CON RUCITONT'AX .'ignamrenf Applicant/C macmr Dart EXHAUSTHOODORMUCr) 110 'NGMHIGA'IONFEE HAZARDOUS MATERIALS DISCLOSURE Will the applicant ortuwre building newmant sure orhundle I i ... liars mrc,nil as defied by the C.Ni ino Municipal Cole Chapter 9. 12. and the Heahh and Safety Cade, Section 25532(a19 HEATING UNI 'I'1'1, 101),INIO BTU) H17ATENG UNIT (OVER 100.000 H'FU) VENTILATION PAN (SINGLE RESID) ❑ye, Fl No BVD Vic Re iplM Will the applicant or future building occupant use equipment or devices which nit hazardous air contaminants as defined by the Bay Arca Air Quality Management 0: BOILER — COMP (3HP OR 100,00013'1'Of TO'T'AL BOILER—COMP-(OVER 100.001)BTU) ) tatidP C]Yes 0 N AIR CONDITIONER ISSUANCE DATE I have aw,he hacarmous maadalsrea,maents under Chapter 6,95 ofnhe Cali. NEW RESIDENT [AL MECH. SQ. I. -K fomia Health R Safety Code. Sections 25505, 25533 and 8531. 1 uMenend that if the (wilding does no currently have a tenant. that it is my msponsibday to many the Occupant of the v,mmnrsn s which most M met prior to issuance of Certificate of Occuponcy. 'IUTAL.: ISSUED BV: Owner or authorised agent Date OFFICE [PROPOSED FLOOR PLAN SPECIFICATIONS: All framing will be with scheduled grade lumbers in required demensions . Sink plumbing will have new vent 'with roof jack. Downdraft control box will be located on outside wall . All designated appliances will have separate circuli breakers. 1 —311 0 ill(l rll MARTIN DEBEER Job Locatlon 1079D Pennisular Dr. , CupertlnoCA. 95014 SCALE > 1/4" = 1 Ft. LOWER WP L WILL REMAIN Ae FASTING f� JVD • � Y•,,._N cmlpss Wl Ea IUBG RNeO LIVINGROOM P T 0 EXISTING FLOOR PLAN ; Martin DeBeer SCALE > 1/4" = 1ff. 10790 Pennlsular Dr. Cupertino CA. 95014 302 T3'11"4 362 C�