99080079 _CANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY O "U
-[TY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
ING DIVISION APPLICATIONA'ERMIT PLUMBING-MECHANICAL.
_ BUILDING PROJECT IDENorri'ICATLON
BUIL ! DDRESS: nn \� SAN]"I'ARY NO. APPLICATION SUB. .DATE
LNC
NER'S NAME: PH NN' —1 CONTRACTOR'S NAME: L C NO�,
M ^ ��8 I u v—T1 Ii Ii - CONTROLA
lopGHITECI'AINGINEER: LIC NO: ADDRESS'. �lI v•I ❑
CON'I'Aa': PHONE; BUILDING PERMIT INFO
r c./�k �/ _ ��' 2$0-7 ❑ Consullanl Fce9 Paid by Applicant(Initial) BLDG ELECT i PLUMB� MECH
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE L!/ 1_�1/ L,/
1 herchy ardrat that 1 an Eceaxcd amlrr,prnviaiom,of Coal"'v m..nttnmreing JOB DFSCRII'TION
a'0Z lh Section WNX))of Uivisionynfinelfusine,eanJP I C%de,and my beense is RF9IDF lA
a' _ w' PERMIT ISSUANCE
<N� m full Trois unit cRe � 0 � �SFDW L ❑KITCHEN REMODCI.
�UF Licenm Clnsx_ Lic.4
6 U AI'PLIANCIES-It HSIDIENf1Al. ❑ADDITION El PLUMBING RE-PIPE
HZW Dam Convector
:
't ❑MULTI-UNIT STRUCTURAL
'Don ARC S DECLARATION PANELS MODIFICATION
ZOmZ unJwmy plan,shall be not aspantiecutNs
OZNin I UPT0200AMI'5 ❑LNTGRIOR C1 CHIMNEY REPAIR
41 LiccnxJ Professional 201-1000AMPS IMPRO EMFM pSWIMMING POOLS
�+1fj
OWNER-BUILDER DECLANAI'ION OVER I(NIUAMI'S ❑B REMODEVk1EPA1R ❑DEMOLITION
C
n O L W Q 1 hereby affirm that 1 am exempt from the Contractor's License Law for the HER/
xU following rcusoa(Section 70315,Business and Protbmions Crop:Any city nr county SIGNS F.LE ICAL
ala W N¢ which m,ners u permit to ai wimirl,aheu in c,demolish,or mpnir any dnaturc
~u'OJ prior a its issuance.also tequirts the applicant for such Permit rile a signed statement SI'ECIALC]RC)IT/ SC.
E y That he is licensed pursuanno the Travisions of the C..ntrunor's License law(Clupmr9
ad COMMERCIAL,with Seetlun 7000)of Division fol be Busine,,and lknl,.'ions 0,d,,),,, "TEM P.MI?TF. O EINST COMMERCIAL:
E.a c C that he is exempt therefrom..it the basis for the alleged exemption.Any vialainn of ❑NEW BLDG/ADDITION Q DEMOLITION
'1m Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of POWER DEVICES ❑TFNANT ❑FOODSERVICE
a more man live hundred dollars($500) IMPROVEMENT
=Q (]1.as owner of the property.or my emp1,ri'wlmwofun'tu heirsnIn o SWIMMING POOL ELECT
will Jo the work.and the'tmctum is nalintendrdor oRereJ fcrsale(S<.]fYW,Bunines.
6 a oo and Professions Coda The Contractor's License Law docs not app hi an n cr TLIi LS-SWITCHES-FIXTURES
property who build,or improves thereon,and who dues such work ht LiInq
his own employees,provided that said impevemenn arc not in¢ndeJ or alert for NEN RF_SIDENTIAL ELECTR SQ FT.
sale.IL however the building or Improvement N odd.,,Into one count tttmpldi..a dm :Q. lAREA Q.FT.
crbuildrr,will have the burden of proving mat he did not build orimptove for pup- UU 1999
pec of vele.), TOTAL
[:11,as ownrr of the property.em w
em ,ively contracting with liccaecd contracnns to
instruct the pisood(See.7M4,Business and Profevoon,Cale:)The Can ala"I Li-
mhwmssnotapplyto an owner of propcny who bunds or improve.%themon,and QTY. PI,UMBINO PERMIT FEE By
who contracts for such projens wllh u contractors)licetuud pursuant to the Convuetor'x
License hat. PERMIT ISSUANCE
I um exempt under Sec. .II Nr P C far tho mason
ALTER-DRAIN M VIEN'1'-W'AI ER(EA) VALUATION
Dam O GWORKERS COMP1ENSATION DECLARATION BACK FLOW PROTECT.DEVICEi �I hereby a1Trm under penny of perjury one of the following declarations:I have and will maintain a CeNficae-(Comes'to,elf-iosu¢for Wader's Compen- DRAINS-FLOOR.ROOF.AREA,COND. STO 3 TYPE CONSTRUCTION
7,nlr
tras,ae provldeJ fur by Section 37(X1of the Labor Code,farahe performance of theork for which this permit is Issued. 19XTURUS-1'Hk'fRAP
I have and will tmtimain Winker''Cumpei smion Inwmnce,as required by Sectionf of the lltbor COJe,for thu pert posses ofthcwork forwM1ichthis Permitil issued. GAS-F.A.SVSTEM IINC.40UTLE1S OCC.GROUP AP'N ^y WorGAS-FA.SYSTF.M-OVGRJ(EA) a�y�0l.�/.�rrierrj-� � �`�apE cvmePnlicy No.: 3�!/
CLµI'llil'A'1'MPEN ATION'ION FRA WORKEµE GREASEIINDUSTRI,WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(TBis section need not becomplaedif the pendit is(Drone hundred dollars(SIM) GREASETRAP'
nr Irex.) PLANCfIBCK PL'E
Ice ' that uheZffonnanec of the workforwhichthis crmit i,',wed,l shall SEWER-SANITARY-STORM EA.20017.
ow it nny rr n any manna ar subje ten he wo crs'Compem ENERGY PEE
Z %inion uvea ul' In tiu.l ntc WATER HF,AFERW/VIENTfIp.FCPR
GRATING FETE
Z2 Appli m " ,come
.N. NGTIL PLICANT:lf,a ter a ung this Cer ificam of Exemption,you should WATER SYSTEMORPATING SOILS FEF.
hccome mbjmno the Weukm's gansuten In ixions of he Lnhor Coda you must -
L!) forthwith comply with such ptovi%ion%or this permit.ehall be deemed evoked WATER SERVICE
O
= Z CONS'I'kUCTION LENDING AGENCY NEW RESIDENTIAL PhMtl. SQ.FL PAID Date Receipt#
U O l hereby affirnuhat mere is a amaronion lending agency for the performance of
LL F the work for which this permit is issued Nec.3197,Civ.CJ
'fOTAh:
Under,Nun e
WLcid,e,Address TOTAL
a. 1 certify that I have read this application and site Lha the obi inbstr ion is BUILDING FEF.
.F. UJ r rzect.l agree'..con'ply with all any ane county oNinanccrme score laws renting u' QTY. MECHANICAL PERMIT FEE
L)Z building consom iun.and herehyauthormrepre,entatives of this city lnenterupun the SEISMIC FEE
ab..vo-mantloncd progeny for inspation purptees. PERMIT ISSUANCE
(Wo)a c to m
save,indemnify and keep hamdnn c„me City of Cupertiugainel ELECTRIC FEL
pe
liabih , udgm ns.cosh and expenus which may in any wey attme agxina writ City ALTER OR ADD TO MECH. PLUMBING FEE
rmcfacn,c thegmonngafthi.
APPLICANT tNDERSTANU ND W .L COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO ILNX)CPM) MECHANICAL FEE
SOURCE 'ULATIONS.
AIR HANDLING UNI"I(OVER 10.000 CFM) CONSTRUCTION TAX
of A,,Iio,a.VCon. Use EXHAUST HOOD(W/DUCI} HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
a.11111" Will the applicant or future huildlngoccupantslntem handle hazardous material HEAPING ON]'1'(TO INOTIN)Ii1'Of
as defined by the Cupern MuniciPit Cade,Chapter 9.12,and the health and Safety
Code.Semon 2553200^ HEATING UNIT(OVER 100.0110 BT U)
(]Yet, No These",or
VENTILATION RAN(SINGLE RCSID) jVAID "
Will the applicant or Lampe building occupant use cquipmanm devicr%which BOILER-COMP QHP OR 100,000 BTU)
it he ad....air contaminants as Jcdned c Ray Area Air Quality Management TOTAL:
'vitt' BOILER-COMP(OVER 100.0I0 B'fU) _
❑Yes r�JDRr
Nom numJuls m mints under Chapter h95 of me Cali" Alk CONDITIONER I.$ ANCE D TIi
inia Il�p,c,. lhnh
e.Section'_.11.5,2 533 and25534.I understand that if the NI?W RIESIDENT IAL MECH. SQ.Fri.
buildingave a ant.the my responsibility mn..tify the ueupanl
of the mua met p' a Cenificaloof Occupancy. a
Owner on
authorreJ agent Dam TOTAL: ISSUED
OFFICE