S 1487APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL vH n'Nn.
BUILDING DIVISION APPLICA'1'ION/PERMI7' PLONIRING-MECHANICAL � 1487
BUILDING PROJECT IDENDF'ICATION
ILDINl1AUDRESS: - SANITARY NO. APPLICATION SCION PIAL DA'I'S
S0 N a.V � . �-t-9 fl-A-
TE. O 'S NAME: PHONE: OMI'RADO 'S NAME: LIC NO:
NIC CONTROL#
71TNG #NEER; LICNO, ADDRESS': ❑
CONIACI: PHONE: 6UILUING PI3RMIT INFO
❑ Consultant Fees Paid by Applicant (Initial) BLDG RLELT PLUMB MF.CiI
LICTiNSRD CONTRACTOR'S DECI.ARAUONQTY. ELECTRIC PERMIT' FEL'
I hereby d5mm that 1 nm licensed under provisions of Chapmr 9 (cotmnemhn, J013 DESCRIPTION
OCZwith SceOinn 7gNl)of DivisinnJofthe Business nnJ Pmfesxi... Ode.oudrylicenseis RESIDENTIAL
FOS in full force and effect. EFRNBT ISSUANCE
W� ❑. NT. ❑ KITCHEN REMODEL
�UV License Class Lic.N APPLIANCES —RESIDENTIAL (TION ❑PLUMBING RE-PIPE
H G L Dote C.ntraemr
1'1
ARCHITECT'S DECLARATION MUI:-IJNII' ❑SI'RUCfl1RAl.
PANELS
z Ott2 z I undentond my plans shall The med as public records MODIFICATION
Oz-o Oil 102WAMPS ❑INTERIOR ❑ Cl IIMNEY REPAIR
[F�F'W Licensed Professional 201-1000AMPS IMPROVEMENT C]SWIMMING TOOLS
OWNER-BUILDER DECLARATIONOVER 1003 AMPS ❑BATH REST I?j{R�41 DEMOLITION
Y' �ya1 d I Thereby nlfimh that I um exempt line the Commetn', License Law tour the
O0. U following n:u.on. (Section 7031.5, Businens i P... hesslmvs Code: Any n1y nr ennmY mmoHER OT
which re n...c, a permit to costed, alter, iprove, delish, nr repair any straGam SIGNS IiLEC'TItICAI. M _
FLLvl0�' prionn its issuance. atm requires the applicant lir such permit life a signed statement SPECIAL CIRCUIT'/MISC.
�Iy> that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
9 �Ja�O (commencing with Serino 700Nnof Divi,b 13 of the Bminma and Pmficobm Code) or '1EMP. METER OR POLE INST COMMERCIAL:
A. c C phot he is exempt therefrom and the bn'is In! the alleged esnnpdon. Any violtnlon of ❑ NEW BLDG/AUDITION ❑ DEMOLITION
iC ti W Seen° 711.11.5 be any ii,iv; t fora permit sohierO me I,ppli,i I (I,. civil ponnlV of FOWEIt DEVICE
W m nm more than live hundred Anllnrs(SSW). ❑TENANT ❑FOODSERVICE
z Y IMI'ROVHMIiN'I'
C=<
ElLa. nwncrnnthe prnpeny, nr my empinyec.v wish waKcs ns theirsole compem:ninn, SWIMMING POOL 17LEC'I RIC
willdomexnd, and Oheumnum is not in¢nded or offered fnhsak lSaA(I4, tlusineas ❑OTHER
W 3 m and Prnfessioas Code: The Contractors License law does not apply in an owner of OUTLE.7s—Simi (CIES — PIXTORES
property who hudds or improve, there.., and who does such work himself .nhnn..to
his own clnple,tow, pr.. ded that ssmh improce nems are no, Intended or offered fnr NI7W RESIDENTIAI, EIFCTR !
solall,however, the building or i.....vcmcmis sold within .,at year°fcompletion, the SQ. 1. E I1,001t AREA $/SQ. PI'.
owner will brae the burden of proving the he did not huilA nr imPmvc lir par-
owne � a
of the property, , B siness aril contracting fiesas with licensedContractors
m A
omvan OM1e pmjeet (Sec. 7(14, liminess nnA I'ndessl.ns,?sl.:)'illc Comrnc.,r'x Li-
stal.uw nom urn apply rale owns of pn,pany echo build, or inq,r.ves thereon.Intl QTY. PLUMBING PERMIT :P,
who ttmm:rts fornuch project, with namtmnnr(s)Iiwnsnl pul'.amm mina Cnntnmtnr'a P A I J)
Licenee Law. PERMIT ISSUANCE
❑ I um exempt under Sec. ,B&1'C anda, reason
Dole AhITiR— DRAIN &VIiNT—WA'IP.H (EAI , Air yA{,UAfIGN
0000p. s COM,H SA'I'ION OHCLARss'I'ION BACK [TOW PROJECT. DEVICE: �� ll�
1 hclMy afOmm under penalty of pc jury nnc of Ohe following Acelomti.na:
'I hxva.ndwill mnintainn CcdifiemenfCnnxunt mself-inmm for Workers Cmnpcn. DRAINS— FLOOR, ROOF, AREA, COND. f(`J 'TYPE CONSTRUCT ON
sstion, as provided for by Section 37M of the labor Cole, for the performance of the
walk fix which this permit is paned. FIXTURES—PER'1'RAI' ,
❑ I have and will maiden. Worker's Com,a,,,ion Imumni required by Semina
37W ofthe Labor Code, for the performance of the work for which this permit is ksha d. GAS —EA. SYS'I HM-I INC, 4 OUT LETS OCC. GROUP APN
My Wn,ker x Cenpensntlon hmmence cunicl—.rad Inlay number are:
C... ic. Volie, No.: GAS — EA. SYS 'I'FM-OVER 4 (EA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GRHASEIINDUSTRL WASTE INTERCEPTOR
BUILDING DIVIS10fi PLT!'
('Ibis section need not he c.mplemJ ifthe permit is fortune hundred dollars ($ Its)) GREASETRAP
.r less.)1'LANCHF.CK HE
I certify that in the pnnonnance ofthe work hxwhichthis permit is mmol. 1, ball SEWER—SANITARY—STORM EA. 200 FT.
not enmploy any....mn in m, mem tar sn as u, become mbjeel b, Ills Workers' C.Inpun- ENERGY FEE
OZ sntinn Laws of California. Date WATER HEATER W/VEWMLECfIt GRADING FEE
Z O Applicant
ti NOTICE TO APPLICANT': If, after making this Cenifieata of Exemption, you should WA'I ER SYSTEM/TREATING
f•-' become subject m the W..let's Compensation provisions of the Labor Code, you most SOILS FEF.
Thnhwith mmpfy with mehpmvi ersorlhis permit ,hall be dermal evoked. WA'T'ER SERVICE
0
CONS' I'RUM TON LENDING AGENCY N IIW RESIDENT'I At, PLM I1, SQ. FI'. PAID
J Z I hereby affirm that Them is a construction lending agency for the performance of Ilene ReceiPtp
U the work for which this permit is issued (Sec. 3097. Civ. C.)
(✓ Leader's Name Tl AI:
{U Lender', Address 'TOTAL:
1 certify that 1 huvc read This application and sere that the uh.vc infonnullmI Ix BUILDING
fail correct. Lmgrec tncnmply with all city and cnnntyuMirome, and slate luw,belaling no QTY. MP.CHANICALPERMI'1' PEE
U building amstruation, and hereby anti iae representatives ofthis city to enter upon The SEISMIC FEE
above-memiorcd pmp'ny far inspection puhpoes. PERMIT ISSUANCE
(We)a give t.save. indemnify and keep harmless the City of Cupertino .,ain't C:LIiLTRICFIE
Iiabilitics,jadgmenla,costsand exKnmswhich may in any w:yacerue against said City ACI ER OR ADD TO MECH.
wnxoqucnce of Ire grunting nfthis pennll. PLUMBING 'Tai
APPLLCAN'I' UNDERSTANDS AND WILL COMPLY WI 111 AL1, NON-VOINI' AIR HANDLING UNIT (TO 10,000 CFM)
SOURCE HI' �ULATI S � MECHANIC 1. FEE
AIR HANDLING UNIT (OVER 10.000 CFM) CONSTRUC"(IN TAX
name: of pplicant/C°mamm me EXHAUST HOOD(W/DUCT') DOUSING SIT E1GA7NsQ11
HAZ RDOUS MATERIALS DISCLOSURE
Will thenppfiwnlnrnature building oceapmnsme of handler earl°mnlntcnul I[RAPING UNI' (I0 I(V,000 BTU)
as defied by the Cupeninn Municipal Codes Ch.pler, 9.12, and the Health and Safety
Code. Section 25532(x)? HEATING UNIT (OVER 100,000 BTU)
El Ycs N°
VENTILATION PAN (SINGLE RIiS1U) TAM Date -Recta.
Will the appficom nr mwre building ncOijun t use equipnrenl.f devices whieh
nIt, hvanbus ;it, umtanninnnts us defined by the Bay Area Alt Quality Mxnngenmm 11011,Ek—COM P (31IP Olt I WON) 11'TO)
f(yfAL:
Buie? BOILER —COMP (OVER 1 00,000 BTU)
p Yes (-I No
I have read the haaurdems materials requirements under Chapter 0.95 of da, Calk AIR CONDITIONER ISSUANCE DA
hem. Ilullth & Safety Cote, Sections 25505, 25593 and 25534. 1 unde,mand hoe if the NEW BESIDES I'[A]. MECIL SQ. ET.
huildtngdwe not.,end, bine a Rnanl,Chat a is my tespmasibilay In unify the oanpann
of the mluiremort which must tic Occupancy.
met prior to issuance of a Certificate of
Owner or audmo,iud agent Date TOTAL: ISSUED BY:
OFFICE