29718 .- APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE SALL'POINT PEN ONLY -
CITY OF CUPERTINO . - BUILDING..ELECTRICAL PERMIT No
BOILDINGDIVISION -APPIACATIOWPERMIT PLUMBING-MECHANICAI1' 297.18
a BUILDING PROJECT IDR:MiF•ICA'I'ION '
BUILDING ADDRESS: - - SANI'I'ARYNO. APPLICATION,SIIBMITTALDATE
W0,10L/ja Cr.
OWNCWSN'AME:, - HONE: CONTRACTOR'S NAME:- LIC NO:
L Ci.i No' CON TROI.p' -
- " " ,.a
RCIi I'I'IiCI'/GNGINIi11H: 'hIC NO: ADDRESS:' ED, 's f
coNTACD - PIONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid By Applicant(Initial) BLDG .ELECT PLUMB " SUCH
.
LICFNSLD CONTRACTORS DECLARATION QTY' ELECTRIC PERMIT PEE El E, ❑ ❑
e{yxOyQ I hereby affirm that 1 am licensed u J Provisionsof Chapter (c mmenei
g _ JOB DESCRIPTION
warhser ta ) m 3 floe Baxi almm alsoaC e oo yIicense s
pF.RMII ISSUANCE RESIDENTIAL
Fly mfullRracrad effect d -S-"
FV U� Dac Class Contractor
- - ❑SI'DWi, (]KITCIIIiN REMODI71:
y6 Dare - Cnnvucmr APPLIANCES-kliSIDEN'DAL ❑ADDITION ,e ❑PLUMBING RE-PIPE
ARCHITECTS DECLARATION PANELS ❑MULThUNIT El STRUCTURAL
Z O m Z 1 understand mY plans shall be used m public ncencds - ,
024UP T02(NIAMPS MODIFICATION -
F.VJ(q"{Q� Licensed Professional ID INTERIOR ❑CHIMNEY REPAIR
�bdd„"Ij OWNER-BUILDER DECLARATION 201-I WO AMPS IMPROVEMENT'
CCC 6 I hereby affirthat 1 sm empt from the Contractor's License Law for the OVER IWMI AMPS >*TH REMODEUREPAIR I]DEMOLITION
K 3(CL. m ex
FV following reason.(Section 2031.5,Business and Professions Cash:Any city or county SIGNS ELECTRICAL ❑OTHER
u.�p which y a permitt consumer, II p demolish,or repair y,.t cure
prhou,asrkoor,circs mempli,notf h nonatil, fl gn J t t men, SPECIAL CIRCUIT'/MISC -
that he hean,ldpu: aa the p t. f the C I License Law(Chpeers -.
CCC�a�a�rl0 nalconencia,wom Stan...70(s1)of Division 3ofthe Besuaevsund Pmfcssma,Code)or TEME MI-ER OR POLE INST COMMERCIAL' .
L 4 oy that he Is exempt therefrom and the basis for Ne alleged exemption.Any violation of _
❑NEW BLDG/ADDITION ❑DEMOLITION
liJ�y Section 2(131.5 by any afplieautfor a permit subjects the affix,......civil Pcnvlly of POWER DEVICES ❑TENANT ❑FOODSERVICE
not more than live hundred Julian,($500).
p QI,as owner of the propeny,or my eniplayecs with wages as their cmnpeircian, SWI MM ING POOL BLIMPROVEMENT
IiC'FRIC .. F.NT ,
O ❑ sale
will do the work,uad theormorre is not immndW omllbrnl loss],(Sea 7044,13"n"s •OUTLIiTS-SWITCHES-FIXTURES ❑OTHER
3 and Flotations Cade:Tire Coaanr's L.icenf, ew
e Law ds on,apply ,,an nwner of
property who builds or improves donate,and who does such work himself or through' - - D
his own employees,provided that such impr.vemems are not intended or offered for NEW RESIDENTIAL ELECPR SQ FTsale.I L however the building or improvement is sold wind n one your of completing the SQ.FrU FLOOR AREA pp�+� $/SQ FT. .i
owner-huilder will habetc hharden afpmvingl hnlharld not build orimpravv l'orpm- - b G' P497.d'�
' Pose nfsale). - ,. •'• s
❑1,as owner of the profanity,am exclusively contracting with licensed convectors to T ��� ��
construct the project(SeM4
c.2 .Business and Professions Cade:)The Comracturs Li ((]� s
c lam m w does napply an owner of pmfeny who huilJro
s or impves thereon,and QTY PLUMBING PERM IT FEE 1x7
• who contracts for such projects with a comracions)licensed pursuant to lire Contractor's
Linens,Law. IRSUANCE
I am exempt •• .IC Y'b� laul'CP411N)
under Sec. ,B&P C for this reason PERM I f , �T
ALTLrk-DRAIN&VENT-WATER(1iA)
Owner Ilam � VALUATION
WORKER'S COMPENSATION DECLARATION BACK FLAW PROTECT.DEVICE O 0
1 hereby affunt ander penalty of pc Jury one of thu IiJl.wing dcul.rvtions
I mvevnd will maintain a Certificate ol'Consentto selGlature far Worker's Camper- DRAINS-FLOOR.ROOF AREA.GOND, 't
.don,as provided for by Senior 3200 of the Labor Code,for the unfortnunce m the STORIES TYPE CONSTRUCTION
work for which this permit is issued. FIXTURES-PER TRAP
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3200 of the Lahor Code,to,,the performancefine work for which this perai l is issued. GAS-I?A.SYSTEMd INC.4OU7IJUS
My Workcr's Compensationlnsurance'muricnmJPolicymmahmore: OCC.GROUP. APN
'Carrier: Policy Nn: GAS-EA.SYSTEM-OV ,A
' CERTIFICATE OP EXEMPTION FROM WORKERS' -
COMPENSATION INSURANCE GREASI%INIIUSTRI.-b E L ;YNR
(This section need not be com Iel.1 iftlie BUILDING DIVISIO TES
p permit is rnnme hundred Jnll:m($100) GREASGI'RAP
ar less.) x - I'LANCHECK II?E
toy my pimer in any manern us i becorkome
hjecttoall this permit t.irsu Channel, SEWER-SANITARY-S'IOR .2 FI'.
not employ any perum in any manner m us m buome subject to the Worker'Cnmpem
cation lawa of California.Dane ENERGYFEE
7��) Applicant - - WATER I IIiATER W/VF.NI'/EEE T GRADING FF.B
q lfj NOTICETO APPLICANT If,mftcl looking this Contifirricrof Eincranion,yin.,thmild WATER tiYSTRM/fNBA'1'ING
�,hecti rte sobj"t m the W I Cnopmtsati p soi'Iht Label 1 youmoo SOILS PEES
Gi formov th comply aam such pron,notim,or this perm t h.11 he deemed re oked., WATER SERVICE -
a sj■ CONSTRUCTION LENDING AGENCY PAID
Uz NEW RESIDENTIAL.PLMB. SQ.FT.
U � Ihemhy affirmmanhercuauamtrvctionkoding agency for feRnnvancenf - Dam / RaciptN a
I: hework lir which this partial is issued(Sm.3092,Cis,C,) (r,
FUN Lando',Name s
Lender's AJJress TOTAL:
Fp, 1 certify that 1 have read this application and state that the above information is BUILDING PEI?
(A correct.L agree mcomply with all city and county ordinances and state laws calming m QTY. MECHANICAL PERMIT FEE
U building construction,and herehyauthohic representatives ofthiscity to enter upon the SEISMIC FEE
ab.va-mentioned propeny for Inspection nop a,, I
PERMIT ISSUANCE-
(We)agmen to sane,indemnify anti keep harmless the City of Caper inn against ELECTRIC FIT!
Imbilaws.judgmems,costs it canvases which may in any way.ccme against said City g1.TF.k Ok ADD TO MECH.
in consequence ofthe granting of this permit. - PLUMBING FEE `
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT AIR HANDLING UNIT(1010.000 CPM)
SOURCE REGULATIONS. MECHANICAL ITeC s �
AIR HANDLING UNIT(OVER I0,00007M) GDN$2RGG'IION TnX
Signature m Applicand(Convam.rDam EXHAUST HOOD IW/DUET)
HHOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Willtheit,dwern nr future baildingoccupant store or handle incmes,material HEATING UNL'1'(TO MOM BTU) ..it,defined by IOe Curynin l Munielpal Code,Chapter 9.12,a the He llm and Safeay e
Cally Section 25532m)p HEATING UNIT OVER 100,000 BTID
E]Yes ❑No
VENTILATION FAN(SINGLE REBID) PAN
Will the applicant or future building recipient use equipment or devices which D' R eipt a
mit fortiori air aomaninams us defined by the Bay Area Air Quality Mun5gemera. " BOILER-COMP(3HP OR 100,000 BTU) r
Diaulat^ - 'POTAU
,rya E]N. - BOILER-COMP OVER IlA(m)BTU)
I have rearl the hazardous mamriali 'AIR CONDITIONER ISSUANCE DATE
r5.u 53 ems under Chapter 6.95 of me if th
' fomiv tkallh&Safety Code,Sections 255!1.5,853J and 25514.1 undersmnJ ihm it the NEW RESIDENTIAL MIiCI i. SQ.FT. z
building does not curimdy hive a tenant,that it is nsy respnmihility m oadfy the eiicupam
of the requirements which must be met prior to issuance of it Cenificam of Occuoaar. - -
Owner or authorized agent Data
ISSUED BY: -
OFFICE .,
_ j ,
ERB
m
JD 1=99
7_ v
o V
_N
CO �1
D ran