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S 0105
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO - BUILDING.ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL S 0105 BUILDING,PROJECT IDENTDTUATLOn BUILDINGADDRESS: SANITARY NO. APPLICATION SUI3MT]TAI.DATE a ( � cel to d u/N Da / G'f re la V ,LTN 'S NAME: . PIIUNH; CONT LTOR'S N ME' /' LIC NO. , If, ,v/Cfl/ /d Yo b-�sr8 O � c� Ja 3-5 7 JO NIC CON TRol.u 0.CHITECT/ENGINEF.R: LIC NO: RESS: `t'' ` ❑ •�-_-. Q 3a Oa Mart 6.0 tlr- BUILDING PERMIT INFO CONTACT. PHONE: off / / y _��&-ao� ❑ Consultant Fees Paid by Applicant(Initial) H_ LDS T:L-I�M/- PLUMB MECH E' f'LONG.�G �.GiNO \L{� ❑ I.ECENSI?O CONTRAC OR'S DI?CI,AItKr10N QTY ELECTRIC PERMIT' FEE ,IOU DESCRIP ION 1 hereby affrnh hall am licensed under provisions of Chapter 9 motmnencing WOZO with Serion7fl(NB of DiviaionJnf the Business and Pmlcs.inns Code.antl my license is PERMIT ISSUANCE: ID in full force and effect. SFIIWI. ❑KI'PCI[EN R17MODEL Lice.Class - Uc'k APPLIANCES-RESIDENTIAL. El ADDITION 0PLUMBING RE-PIPE G G Dom' Crntmcmr ,.;D V, ARCHITECTS DECLARATION PANELS ❑MUI.TI-UNIT ❑STRIJCI'iJkAl. v�Z Iunderamndhmy Plunsshull be used aspoblic accords MODIPICA'I']ON oz- UPUP TO 200 AMPS �, ❑INTERIOR El CHIMNEY REPAIR CLE C Liacnsed Proressional 2o1-I(XXIAMPS IMPROVEMENT El SWIMMING POOLS OWNER-BUILDER DECLARATION OVER 000 AMPS ❑RATE I REMOUEUREPAIR ❑DEMOUHON Q I hereby air rm that um exempt from the Cnnmumars License Low for the icews m U following reason.(Section 7031.5,Business and Professions CMe:Any city or county SIGNS ELECTRICAL []OTHER (v.�-/L.�aw-{ 40-11-.'r�`�yP ^tsj 31L which requires a Permit in construct,alter,imtains ,demolish,or repair any strvnum � 10'�O prior to its issuance,also squires the applicantw file for such Permit le asigredw stamm SPECIAL CIRCUITIMISC. ! ^� ■w p•� f� mat he is licersad purs...I m the prmvismns mfyhe Commcwrs License Law(Chapwr9 W^ Q commencing with Section 10(EO)nf Division 3.101c Business anJ Professions Cartel or TEMP.ME I Hit OR POLE INS'1'. G ly o c that he is exempt therefrom and me hasis for be alleged exemption,Any violation of ❑NEW BI.DMADDITION ❑DF.MOIJ PION 4X1_Iv. Section 7031.5 by any applicant for apermit'ahicctsmeuppllcannnacivil penalty or POWER DEVICES ❑TENANT ❑FOOD SHRVICH >>>acs I mnre them Five hundred dol Inrs(SNXE. FO IMPROVEMENT,C]1,an owner of the property,(it my employee with wages as their sole cmnpensation, SWIMMING POOL ELETPRIC FESS willdothework,andthc smhctem is not intended oroffercd finitude(Sle.]M4,Business ❑OTHER W and Professions Cede:The Contractor's License Law does not apply to an owner of OUT LEI:S-SWITCHES-FIXTURES property who builds or improves thereon,and who docs such work himself or through his own employees,provided mat such impmvemenu arc not intended or offered far NEW HP_SIDENT1AL ELECfR SQ IT. sale.ILow however,the building or improvement is old am yeorrf complaimn,the SQ.FT.FLUOR AREA sISQ.IT. ,mer-builder will have the burden of proving that 1w did not build or improve for put. se sate.) PAID ❑ 1,as owner of the property,am exclusively contracting with licensed contractors I, 1' msauct the project(Sec.9044,Business and Pmfaasions Code:)The Commotions Li- - cen.e Law docs net applymaoownerrf,xiwho bnlldsmhnpmvesthcrcon,laid QTY PLUMBING who FEE JUN 17 RECD who ceramics for such projects with a eonmucwm rEd licensed pursuant the ContmetorLs License Law. PERMI"1ISSUANCE Iamexemp tinik,Sm. ,B&PCforthisrenson CITY ot-, AI:1'F.k-DRNN& ENT- i li L Owner Date WORKHR;S COMPENSATION DECLARATION BACK ROW PR(y1E. .VI !o µ,ms 1 hereby affirm under penalty of prrjrry one of the Yellowing dedaraJons: \ I have and will maintain a Certificate of Corsenno.selfinmre for Workers Compel]- DRAINS-FLOOR,ROO R. GOND' STORIES '1'YI'Ii CONS'I'ItULT101, .onion,as provided Iia M1y Scrtinn 37(%1 of[hon htihor Cada for the performance...the - Jr ask for which this permit is issued FIXTURES-11148*1 RAP ,{ ❑ 1 have and will maintain Workers Compensation Insurance,as acquired by Section •, 37M ufthe LiborCde,Ea the Performance rfthe work far which this permit is issued GAS-EA.SYSTGM-11NO40UTL:'S OCC.GROUT' APN My Wo Cod :n Ismh�hce carrier and Policy n t Policy Nn.: �l/a�"LGAS-EA.SYS1EM"OVER 4(EA) CEk'1'IILCATE OF EXEMPTION FROM WORKERS' GRh:ASI%INDUSTRI.WAST P.I N1'ERCRPTOR COMPENSATION INSURANCE. BUILDING DIVISION FEES (This section rcedrot becompleted ifthepcioi is liaonehundreddollanflish GREASE'rRAI' nr tos,J PLANCI{f?CK LTH 1'L I ready[)out in thcperfmanneeofthewmk Rayshlchlink"not is Lmuk I shall SEWER-SANITARY-STORM EA.2[x717. nm employ my peva n in tiny manner Io as to herons subject to the Workers'Compcn- ENERGY FEE OZ. Icahn Lawsof Cvl'domia.Due WATER HEA1 ER WNITUDELECfR PEE �. O Applicata GRADING NOTICE TO APPLICANT:If,after making this Cenificme of Exemption,you should WATER SYS'I'EMOREATING a ^ become subject m the Workers Compensation provisions of the Labar Code,you must SOILS FEE G forthwith comply with such provisions or permit.shall be deemed revoked. WATER SERVICE Eli Q =) zCONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.EF. PAID QQ�. Thereby afllnn that there inaconawe[inn lending agency fonho lwrfnnnnnco of [)life Retain p U the work for which this permit is i.ssued(Sce.3097.Civ.CJ ELeader's Name TOTAL: I<nder.Address 'TOTAL: G I cera y the I have read this application and state thauhc above abomination is BUILDING 1:1717 ' rn' comma.l agree to comply withal]city and county anlinanees and state lows mimingm QTY. MECHANICAL PERMIT' FIRE. 1 U Z buildingcmnEE sbualor,antiherebyauthorizerepresentativesofthiscitymentorurymThe SEISMIC F uhmve-mentioned property for inspection purposes, PERMIT ISSUANCE (We)agree m save,indemnify and keep harmless the City of Cupeninm against ELECTRIC FEE Iiahilities,judgments,costs andexpenaes which may in any way tiocrue against grid City ALTERORAIIDTOMECH. PLUMBING FEE consequencein of me gron[ing of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFM) MSCI{ANICAI.Plili SOU REGULAT ONS -P? AIR HANDLING UNIT(OVER 10.11110 CFM) CONSTRUCTION TAX gremre rfA plica om.a-. Dme EXHAUST HOOD(WIDUCT) 14OUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will the applicant Estate lmildingoccupantsmrc nr handle hic.rhaininerii HEATING UNIT(TO 100.000 RTIH us def red by the Cupeninn Municipal Code,Chapter 9.12,and the Health and Sul cry Coda,Sea[ion 25532009 HEATING UNIT(OVER 11%I,III%1 B'N) ❑Yes [-1 No VENT I LOTION PAN(SINGLE To ESE DI PA lll m Receipt# Will the applicant or(cure building revulsion use equipment or devices which BGILER-COMP(SIP OR 11%1,(X1(1 BTU) it hazardous air contaminants as defined by the Bay Area Air Quality Marugetnent TGTAL: •aria^ [3 Yes ❑No BOILER-COMP(OVER 100.000 HTIH I I have read the hvnrdnue materials o under Chapter 6.95 hf the Cali- AIR CONDITIONER ISSUANCE DATE requirements p buildigdoes&Safetytly have Sermons 25505,25533tint25594.I to annoy that Ifine NEW ItILSIDIiNTiALMGCff. SQ.PT. of the re does not is whir y have a tenant that it is ua c eofa Cerfi to notify the occupmn of the requirements which must The sun prior]I)Tswana:nfo Cenifica[e of(kcupuncy Owner or authorized agent Date 'TOTAL: ISSUED BY. OFFICE a _ ..c.-- -_, - , -. - _ a .. - - . ... -_ T -f!. r --.. - .- r-. .� - '� , - - ^-4 .e3 ".,3 - _.f a'$F:` -t=_•�3."E.� ar•F-Ta`--J�"i�G '-,es'•sT fi __ i v" y r t a r . t - a-.. .: - _w -,. ". _ -.- J - _. _. a -. Y - " > .: - -" - _ - -9. _ -. -._ >< < rt.>� Wit• ��?! i -•- _ -_ .. ♦ ._ _ - c _::_ _.- r ._ "_.-. _ .. _ ..: - ". - _ :. , _ Tr�,�-rim -- _ �a:.•_h j a r - - - J t = I ♦ •i• Y a. Ji! t K _ - _ - x_ - r C Ae 3 as - _ - - _ - - - - - :�+ "- ( 6• _- _ _ - - - 'tom - - _ _ -.. - _ _ , - , • r - .. _. - q rrpy,`ry��. 4 - - - � IH . 06 fSE3 �N fr a - tuERt1196 O - - S A L`". 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