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S 2711- APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING - ELECTRICAL BUILDING DIVISION APPLICATION/PERMIT PLUMBING -MECHANICAL BUILDING PROJECT IDENTIFICATION PERMIT N0. S 2711 BUILDING ADDRESS: S Y 1 C•f1 $ SANITARY IS APPLICATIONSURMI'I"I'AI, DATE -3 OWNIiR'.'NAM': PHONE: 1 n ay CO TFOR'S No ME: I.IC No s NIC ❑ CORfROLp ANC( II'1'I[Cf/IiNGINfaiR: .IC NEE : ADDRESS � f✓i! CONTACD PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant (Initial) BLDG ELECT PLUMB NIECI ❑ ❑ ❑ WOO WOO � W� LICENSED CONTRACTOR'S DECLARATION ns of Chapter 9 (ront ro, mat I alit licensed area, Provisiomenim, hereby antde wim SvhPoe and dloot. ount 7WlBnf Divi,4 Sof he Baxinesdand Profession, Ede, andnry license is in full QTY. ELECFRICPERMIT Flili JOB DESCRIPTION RESIDENTIAL: ❑SFDWL ❑KITCHEN REMODEL PERM) 'I' ISSUANCE AI'PhIANCES— RES IDENTIAl. U Q U WDam Lieun,a Cluss I.ic# If 0/ Coma r ❑ADDITION [I PLUMBING RE PIPE CMUUTI-UNIT ❑STRUCTURAL MODIPICAI'ION El INTERIOR [I CHIMNEY REPAIR IMPROVEMENT E) SWIMMING POOLS ❑BATH REMODEDREPAIR El DEMOLITION COTHER g.7 m Z p Z OZ'4Q AIdCIIITECr'S DECLARATION 1 undcfsmnd my plane drill he used as public recoNs PANELS Oil TO 2M)AMPS CYM;OWNER"BUILDER C C Q' ed as U y f"��� X j 6'p0 C. G. a Licensed Professional DECLARATION I hereby affirm that 1 rota exempt firm the Contractors License Law far the following reason. (Section 7031.5, Business and Professions Cale Any city or county which regmms a permit to m ismal, alter improve, demolish, or re Fair any en me rc prior to its issuance, ala) requires the applicant for such pronto file a signedstalernenl that he is licensedpursuam to the provisionsrfine Comractoes License Law(Chader9 fmmtnencingwith Section7000)of Divisirn3of the Business and Professions Code)or that he is esmnPt therefrom and he hasi.x for the alleged exemption. Any violation of 201-10MIAMPS OVER 000AMPS SIGNS ELECTRICAL SPECIALCIRCUIT/MISC. TI3MR METER OR POLE INST. - C Nr.W BLDG/ADDITION C DEMOLITION qu^�Section H ZPlot SQp Sap. W 3w 7131.5 by any applicantfor a permit wbjects the applicant to v civil Penalty of more than Five hundred dollars 05001. ❑ mowner the pntpemyov is a imeyeeswimwagesas meirsolc 044. Itmnex', tapply to anowner os will domcwnrk, andmThcCmcknoOLicensorow red dews r wIc Pot and anywhob Calorime Cosfilmo',License Lawdoessolapplymownerof his ,a y who ruled, or improves t suchn, and who does such work dedohimself ff through his sewn employees, e Provided o, Ppm h improvements ora rat intended or offered for sale lL howeveglM huilding nr impmvemenlhwM wimin one Yeur of unnPldinn,the 1'OWI7R DEVICES ❑TENANT ❑ FOOD SERVICE IMPROVEMENT [I OTHER SWIMMING POOL ELECTRIC OUTIJO:S—SWITCHES—P1X'1'URES NIIW It IISIDIiNTIAL F.LECTR SQ Irl', SQ. FT. FLOOR AREA 8/tiQ. I'I'. toomarlauldor will have the burden of proving Thin he did not build lir Intpmve or pun p xedaNe.). I, i, ostm ul Ihti.... i, ty, nut exclusively contracting with licensed connaro rs tit IYJIAL' onetrmt thti pntjen (Sec. 7044, Yasin.., and Profas,mro Calo:)'ne Cnnnnamr's J- censel,ow does nut apply m an ownerolproperty who buildsor improves Abortion, Paul QTY. PLUMBING PERMIT FEE who co rmets for such projects with o counucrons) licensed putsualn to the Connuaur's PERMIT ISSUANCE License I,aw. ❑ 1 am exempt tinder Sec. . R & P C for this reason Owner Date ALTER — DRAIN & VENT— WATER (EA) VALUATION Wmundcr'SCOMPENSATION DECefolimGN BACK FLOW PROTECT. DEVICE, •fineaco, ) a Thereby alarm under peachy of perjury one of the fallowing dedvmtions: have and will ntainwina Cenificae of Conserv mxlGinsure for Workers Compere- as provided for by Section 37004 the Labor Code, for the perfrni ance of the DRAINS— FLUOR, ROOF, AREA, CONE). STORIES TYPE CONSTRUCTION (( work for which this permit is issued. FIXTURES — PER TRAP ❑ 1 have and will maintain Workers Compensation insurance, as required by Satins 37(X1 of door labor Cnde, for the performance ofine work for which this permit is issued. GAS—EA. SYSTEM -I I qC,40FOUR OCC. GROUP APNI My Wreer's Compensation Insurance carrier and Policy number me: Cartier: Policy No.: GAS — EA. SYSTEM 0' (EA) CHK'I IFICAIP" OF EXEMPTION FROM WORKERS' COM PHNSA'i'ION INSURANCE GIt13ASPlINUl15TRL { INTI3RCEPIVR BUILDING DIVISION FEES (Tette sation nee] na be mmPlnal if len parotin is fonmchundmldnllnrs[511X0 or less.) GIt13ASH'I'RAP 1 PLANCHECK FEE QZ rz r"I ► aracoma aIti U0 V. 0 F" G F y U Z Icenlfy 11m, in the perfurilemec of the work for whlchthisperntit slsamd, lot 11 sol onmloy any person In any manna so see to hes a e+ the Workers' ❑anthem mann Lnwsul'Cnllin'ni°'❑ale , APPliunn SEWER —SANITARY — 4ORM EA. 200 PI'. ENBItOY FBP. WAHFRHFA1HRW/VF 1fFC'1'R GRADING FEE N It .ICAN'1': IL seller m ng rots ( ificu c of Excmpdinn, you should ,roti o the Worker's Crntpensa ina Prov sinrn o1'the Laba Cnde, you must Tnrdhwim co reply with such orovlxiPro; or this permitehall be, deemed revoked. CON51'RULTION LENDING AGENCY l hereby affirm that (hem is a constriction lending agency for me pe,fnrmarecof the work fur which this permit is issued (Sec. 3097, Civ. C.) Lender's Name WATER SYSI'EM/IEEATING WATER SERVICE SOILS FEE I'AIO Da Receipa NEW RESIDENTIAL PLMB. SQ. I'll TOTAL: Lender's Address inquarc ion is DUIL I s'enify that 1 have read this application and state that the above semi I egreeat comply with all city and county ordinances end a tate law, relitingm building conslmelion, and hereby aathonse representatives of this city m enter upon the -entioned om,ny far inspeetim purposes. avembo (We)agree m save, indemnify and keep harmlcesthe City of CuPerien against QTY. MECHANICAL PERMIT FEE 'IN SEISMIC PERMIT ISSUANCE. ELELTRI FEE ALIER OR ADD TO MECIi. P1.UMH . G FF.F. Iiabilitics,judgtnents. ensu and expenses which may in any way across, against said City in conaw,more of the granting of Ilii, permit AIR HANDLING UNIT (TO 10,1X11) CFM) M' LAICAL FEF. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE, REGULARONS NIT Ia,INXI ❑EMI IONTIG TAX , da 03/ 1 [)oil. Si .II of APplicunUCommc ILnr I IA%ARDOUS MATERIALS DISCLOSURE EXHAUST HOOD(WIWCII EXHAUSDH OIJW/DUCT) or, HOUSING MITIGATION PEE TIO I (EATING UNIT' (TO I0Xk000 IGH Will me npplicmn nr future bolding ocePtnm storear handl, ha>.adnu, nafarivl as denied by the Cupunlno Munialpul Cale, Chapter 9.12, send the Healm and Safety Coda, Sectio 25532(a)P C) /JNn Will the applicant m future huilding by the B y A equipment.AirQuIn dmieds which emir hasallous all annaminants sex def red by the Bay Area Air Quality Monagemem Dixtna7 ❑Ycx AfNn 1II7A1'INC, UNIT' (OVER 100,000 BTU) PAID Date Rceci t a V ENTILATION FAN (SINGLE RESID) 1101LER—COMP CHP OR 100,000 PTU) BOILER — COMP (OVER 100,000 BTU) AIR CONDITIONERumler I have mind the hwallous materials rcquiremcn¢Chapter fi.95 of the Call. ISSUANCE DATE" NEW RESIDENTIAL Tania licilth & Safety Cnde, Sections 25505, 25533 and n534.I mtderslaml that Bthe hooliingdovs no, currently have a tenant, that it ismy resMnsibility, to manly the tccapanl /t lite mryirenmnts which sl he met ssuanix aCenificale (kcu Rey, /1 hof FJ r vulonrimingent Loue ` ISSUED BY: >T i OFFICE - APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING - ELECTRICAL BUILDING DIVISION APPLICATION/PERMIT PLUMBING -MECHANICAL BUILDING PROJECT IDENTIFICATION PERMIT N0. S 2711 BUILDING ADDRESS: S Y 1 C•f1 $ SANITARY IS APPLICATIONSURMI'I"I'AI, DATE -3 OWNIiR'.'NAM': PHONE: 1 n ay CO TFOR'S No ME: I.IC No s NIC ❑ CORfROLp ANC( II'1'I[Cf/IiNGINfaiR: .IC NEE : ADDRESS � f✓i! CONTACD PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant (Initial) BLDG ELECT PLUMB NIECI ❑ ❑ ❑ WOO WOO � W� LICENSED CONTRACTOR'S DECLARATION ns of Chapter 9 (ront ro, mat I alit licensed area, Provisiomenim, hereby antde wim SvhPoe and dloot. ount 7WlBnf Divi,4 Sof he Baxinesdand Profession, Ede, andnry license is in full QTY. ELECFRICPERMIT Flili JOB DESCRIPTION RESIDENTIAL: ❑SFDWL ❑KITCHEN REMODEL PERM) 'I' ISSUANCE AI'PhIANCES— RES IDENTIAl. U Q U WDam Lieun,a Cluss I.ic# If 0/ Coma r ❑ADDITION [I PLUMBING RE PIPE CMUUTI-UNIT ❑STRUCTURAL MODIPICAI'ION El INTERIOR [I CHIMNEY REPAIR IMPROVEMENT E) SWIMMING POOLS ❑BATH REMODEDREPAIR El DEMOLITION COTHER g.7 m Z p Z OZ'4Q AIdCIIITECr'S DECLARATION 1 undcfsmnd my plane drill he used as public recoNs PANELS Oil TO 2M)AMPS CYM;OWNER"BUILDER C C Q' ed as U y f"��� X j 6'p0 C. G. a Licensed Professional DECLARATION I hereby affirm that 1 rota exempt firm the Contractors License Law far the following reason. (Section 7031.5, Business and Professions Cale Any city or county which regmms a permit to m ismal, alter improve, demolish, or re Fair any en me rc prior to its issuance, ala) requires the applicant for such pronto file a signedstalernenl that he is licensedpursuam to the provisionsrfine Comractoes License Law(Chader9 fmmtnencingwith Section7000)of Divisirn3of the Business and Professions Code)or that he is esmnPt therefrom and he hasi.x for the alleged exemption. Any violation of 201-10MIAMPS OVER 000AMPS SIGNS ELECTRICAL SPECIALCIRCUIT/MISC. TI3MR METER OR POLE INST. - C Nr.W BLDG/ADDITION C DEMOLITION qu^�Section H ZPlot SQp Sap. W 3w 7131.5 by any applicantfor a permit wbjects the applicant to v civil Penalty of more than Five hundred dollars 05001. ❑ mowner the pntpemyov is a imeyeeswimwagesas meirsolc 044. Itmnex', tapply to anowner os will domcwnrk, andmThcCmcknoOLicensorow red dews r wIc Pot and anywhob Calorime Cosfilmo',License Lawdoessolapplymownerof his ,a y who ruled, or improves t suchn, and who does such work dedohimself ff through his sewn employees, e Provided o, Ppm h improvements ora rat intended or offered for sale lL howeveglM huilding nr impmvemenlhwM wimin one Yeur of unnPldinn,the 1'OWI7R DEVICES ❑TENANT ❑ FOOD SERVICE IMPROVEMENT [I OTHER SWIMMING POOL ELECTRIC OUTIJO:S—SWITCHES—P1X'1'URES NIIW It IISIDIiNTIAL F.LECTR SQ Irl', SQ. FT. FLOOR AREA 8/tiQ. I'I'. toomarlauldor will have the burden of proving Thin he did not build lir Intpmve or pun p xedaNe.). I, i, ostm ul Ihti.... i, ty, nut exclusively contracting with licensed connaro rs tit IYJIAL' onetrmt thti pntjen (Sec. 7044, Yasin.., and Profas,mro Calo:)'ne Cnnnnamr's J- censel,ow does nut apply m an ownerolproperty who buildsor improves Abortion, Paul QTY. PLUMBING PERMIT FEE who co rmets for such projects with o counucrons) licensed putsualn to the Connuaur's PERMIT ISSUANCE License I,aw. ❑ 1 am exempt tinder Sec. . R & P C for this reason Owner Date ALTER — DRAIN & VENT— WATER (EA) VALUATION Wmundcr'SCOMPENSATION DECefolimGN BACK FLOW PROTECT. DEVICE, •fineaco, ) a Thereby alarm under peachy of perjury one of the fallowing dedvmtions: have and will ntainwina Cenificae of Conserv mxlGinsure for Workers Compere- as provided for by Section 37004 the Labor Code, for the perfrni ance of the DRAINS— FLUOR, ROOF, AREA, CONE). STORIES TYPE CONSTRUCTION (( work for which this permit is issued. FIXTURES — PER TRAP ❑ 1 have and will maintain Workers Compensation insurance, as required by Satins 37(X1 of door labor Cnde, for the performance ofine work for which this permit is issued. GAS—EA. SYSTEM -I I qC,40FOUR OCC. GROUP APNI My Wreer's Compensation Insurance carrier and Policy number me: Cartier: Policy No.: GAS — EA. SYSTEM 0' (EA) CHK'I IFICAIP" OF EXEMPTION FROM WORKERS' COM PHNSA'i'ION INSURANCE GIt13ASPlINUl15TRL { INTI3RCEPIVR BUILDING DIVISION FEES (Tette sation nee] na be mmPlnal if len parotin is fonmchundmldnllnrs[511X0 or less.) GIt13ASH'I'RAP 1 PLANCHECK FEE QZ rz r"I ► aracoma aIti U0 V. 0 F" G F y U Z Icenlfy 11m, in the perfurilemec of the work for whlchthisperntit slsamd, lot 11 sol onmloy any person In any manna so see to hes a e+ the Workers' ❑anthem mann Lnwsul'Cnllin'ni°'❑ale , APPliunn SEWER —SANITARY — 4ORM EA. 200 PI'. ENBItOY FBP. WAHFRHFA1HRW/VF 1fFC'1'R GRADING FEE N It .ICAN'1': IL seller m ng rots ( ificu c of Excmpdinn, you should ,roti o the Worker's Crntpensa ina Prov sinrn o1'the Laba Cnde, you must Tnrdhwim co reply with such orovlxiPro; or this permitehall be, deemed revoked. CON51'RULTION LENDING AGENCY l hereby affirm that (hem is a constriction lending agency for me pe,fnrmarecof the work fur which this permit is issued (Sec. 3097, Civ. C.) Lender's Name WATER SYSI'EM/IEEATING WATER SERVICE SOILS FEE I'AIO Da Receipa NEW RESIDENTIAL PLMB. SQ. I'll TOTAL: Lender's Address inquarc ion is DUIL I s'enify that 1 have read this application and state that the above semi I egreeat comply with all city and county ordinances end a tate law, relitingm building conslmelion, and hereby aathonse representatives of this city m enter upon the -entioned om,ny far inspeetim purposes. avembo (We)agree m save, indemnify and keep harmlcesthe City of CuPerien against QTY. MECHANICAL PERMIT FEE 'IN SEISMIC PERMIT ISSUANCE. ELELTRI FEE ALIER OR ADD TO MECIi. P1.UMH . G FF.F. Iiabilitics,judgtnents. ensu and expenses which may in any way across, against said City in conaw,more of the granting of Ilii, permit AIR HANDLING UNIT (TO 10,1X11) CFM) M' LAICAL FEF. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE, REGULARONS NIT Ia,INXI ❑EMI IONTIG TAX , da 03/ 1 [)oil. Si .II of APplicunUCommc ILnr I IA%ARDOUS MATERIALS DISCLOSURE EXHAUST HOOD(WIWCII EXHAUSDH OIJW/DUCT) or, HOUSING MITIGATION PEE TIO I (EATING UNIT' (TO I0Xk000 IGH Will me npplicmn nr future bolding ocePtnm storear handl, ha>.adnu, nafarivl as denied by the Cupunlno Munialpul Cale, Chapter 9.12, send the Healm and Safety Coda, Sectio 25532(a)P C) /JNn Will the applicant m future huilding by the B y A equipment.AirQuIn dmieds which emir hasallous all annaminants sex def red by the Bay Area Air Quality Monagemem Dixtna7 ❑Ycx AfNn 1II7A1'INC, UNIT' (OVER 100,000 BTU) PAID Date Rceci t a V ENTILATION FAN (SINGLE RESID) 1101LER—COMP CHP OR 100,000 PTU) BOILER — COMP (OVER 100,000 BTU) AIR CONDITIONERumler I have mind the hwallous materials rcquiremcn¢Chapter fi.95 of the Call. ISSUANCE DATE" NEW RESIDENTIAL Tania licilth & Safety Cnde, Sections 25505, 25533 and n534.I mtderslaml that Bthe hooliingdovs no, currently have a tenant, that it ismy resMnsibility, to manly the tccapanl /t lite mryirenmnts which sl he met ssuanix aCenificale (kcu Rey, /1 hof FJ r vulonrimingent Loue ` ISSUED BY: >T i OFFICE