29602 °
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CJTY OF CUPERTINO - BUILDING-ELECTRICAL. PERM]ENO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL ' - 29602
RGILDING PROJECT IDEN'I'IF'ICA'1'ION
BUILDING ADDRESS. - SANITARYNO. APPLICATION SUBMITTAL DATE
!.3oSa/ rV'
OW 3R;S NAME: ':/ 1 Of'F. CQNTRAC'I'OIt:S NAht l!: ' ' ^ e •LI
r1y 6 l/N) Wl1IV �. NIC -CONTItOI,p
ARCHITECT/ENGINEER: - LICNOo ADDR SS' ❑
( L rf/Z
CONTACT: 1'.I PHONE: - BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) HIAG . ELECT PLUMB MECH
LICENNU CONTRACTORS UI CI ARAl10N QTY ELF CTRIC PGRMII' Pli{?
1 hereby affirm II t 1 nsW uncle p s nl"Chapter9(c name 'ng £ JOB DESCRIPTION
uppo}aZ with Secnon70(DBofD 3 fth/Busine dl f sa....Code,andmylae
in full force and if �j PERMIT ISSUANCE _ RESIDENTIAL:
aUU License Lica �` J - ❑SIDWL [I KITCHEN REMODEL
Q,a Date Conracmr APPLIANCES-RESIDENTIAL ❑ADDITION ! El PLUMBING RE-PIPE
ARCHITECT'S DECLARATION PANELS ...•III ❑MULTLUNIT El STRUCTURAL
iZCOR� I understand my plansahall he,used as public records / ' •; MODIFICATION
OZ UPT020f1AMPS l
W ❑
Luenaed Pmfessmnul ❑
INTERIOR CIiIMNEY REPAIR,
OWN13R BGILDBR DECLARATION 201 IfNN)AMPS IMPROVEMENT'
e41 1 h by'aff thin 1 un exempt R theCommit Licn:e law fn the OVER IINNIAMPS El BATH REMODEIIREPAIR ❑DEMOLITION
3O y U following ea (SaOilin 7031.5.Boviness a and P f'sl C rde Aa,,ryloraomay SIGNS FLfCI RICAI. a ❑OTHER
0 which req ore. a pertain no ronctmcl,alley, p e,demolish, tr repo r any urara re
t a vicamece.alsurc
O priori to
the nhenisions o for mchpennin LBleaei dChaptenl
F�m� gnc SPECIAL CIRCUIT/A11SC.-
} that he is licensed pumuam to the pmvistons of the Commmnts License Law(Chapter9
all 0 (collammaingwilh Secnion]Iagool'Division 3 claw BramuslanJ Professions Gael nr TEMP.METER OR POLE INST. COMMERCIAL'
It. oq than he is exempt therefrom unit the basis for the alleged exemption.Any violation or
rr XMLL
W } Soca5 an dl Rmaritsubjecas theapplicanat tourist plPOWER DEVICS
r ❑NEWBLDG/AUDITION ❑DEMOLITION
not mlme than Ove handled dollars
($500). _ ❑TENANT F1 FOOT)SERVICE
O ❑lo the wso-flhe pop ty try intn al g: Lal i l.mni SWIMMING POOL CLLCTRNIT
IMPROVEMIiMf
willJn the work,endthe out t intended IT Jf 1 (S ]IUgBncssHER
°nit Professions Code The Commences License Law docs not a,I,in as owner of OUTLETS SWITCHES-F
property who builds or improves thereon,and who docs such work himself or through his awn employees,provided thin such imrmements art nut intended moffm l for NEW RESIDENTIAL ELECsale.If,however,the building or improvement is sold within one yearofcompletion,theSQ.FT.FLOOR AREA .VSQ,FT.
cr-builder will have the human of proving ohm he did not build or improve for par-
poe if sale).I,as owner of the pn part lusively t ing wish licensed crmmen rxo, -teethe proJem(So, 7044,9A ndP f ' ns Codccase Law does non apply m an owner ofproperly who bnild,or improves thereonunit QTY. PLUMBING urnswho contacts[or such projects with a contractor(&)licensed pursuant to the Collimators ��� O ����
License law' s PERMIT ISSUANCE
❑lam exempt under Sec: -,H&P C for this recon
Owner ALTER-DRAIN&VENT N'ATI:N MA)
D t _ IiII t l r, VALUATION
S ty ENS err on DECLARATION, xx \ I ,
Iherehy affirm under Penalty of pep ry fthe f II RACK FLOW PROTECT.UEVICC It
.FlIbase.d 'll maintain.CarliForomfCarear toIf i. for Walker,C ilk No. OHAINS-FLOOR,ROOF,AREA,COND. UG TYPE C ONS'IRUCT10N,
union .l 'd is by S f 3]00 I N L b C J tl pet a I the V L�
work .'ad
p rn t d - FIXTURIiS-i'liltTRAP - I_ 1196
h and nil roti nl Workers s Coupe mium I moa a req d by S conn - l S�
3](X1 dlhe Labor Code,l the perfonriance of the wnrkforwhmh this permu is issued. GAS EA.SYS'FRM I INC.4 OUTLETS OCC.GROUT' APN
MyW-rkee m s o Imam cancer and l'olicyn m1¢ re, �I• t VI U�11-• -.
Carrier. Policy No.�?Sr// -Z9 GAS-EA.SYSTESLOVER 4 IEA) LtsI Ulu
.RTIFICATE OF• EMPIION MOM WORKERS' fff - -
COMPENSATION INSURANCE GREASDINDUSTRI.WASTE INTERCEPTOR
This section mad not MemnpleteJ if the permit is Rrrnne hundrul dnlbm IS IfNry BUILDING DIVISION FEES
or less) - GREASGI'RAI' - PLANCHECK THE
' lartify that in the perforntnnc--fthe work for which Oiispermit is k'awn,Ishnll SEWEN-SANITAItY,_9TORM EA.21N1 FI'.
not employ may person in any manner&e as to becmne sohjeeuon the Workers Coupon- LNF.RGY FEE
00 Anion Laws of California.Dine WATER HEATER W/VENT/F.IPCITt
z 0 Applicant - _ GRADING FEE '
y NO[ICF.TO APPLICANT:IL efmr making Nis Cenifcme of Exemption,ymi should. WATER SYSTRWEREATING
a; hecnme xuhjem m the Wodefs Complement-.provisions of Lahr Code,you nmsl SOILS ME
forthwith comply winhsuch provisions or this p marrushlb be deemalm eked.
WATER SERVICE;
G
� z 'CONST RUCTION LENDING'AGENCY P '' - NEW RBSIUENI'I AL PLMIL ,SQ.FT. PAID
UO 'IherebymfOnnohm themlahams0uctinnlendinga"eq I..the"Emnunce of - Data t Receipts
Fthe work for which this punnit is issued(Sec.3097,Civ.C.)
U Landfalls Name
�• Lenders Address -' TOTAL: TOTAL:
Fry 1 certify phut 1 have real lM1is application and nem.het the above infonnaVon is BUILDING FEE
N '--I.l asree m comply with all city it county onli.mmusind nam laws relining to QTY. MECIIANICALPERMIT PEE
U r7a. building commucti-m,and hereby amhorize representatives ofthis city m'enmr operate SEISMIC FEE:�
above-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)agree m save,indemnify and keep harmless the&Y of Cupertino against ELECTRIC FEE
linhilines.judgments,costs and expenseawhich may in any way acerae against said City ALTER OR ADD'fO MECH.
16cgmence of the guntingol this permit., s " 'PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
AIR HANDLING UNIT(TO 10,000 CFM)"
SOURCE REGULATIONS. MECHANICAL FEE
.. AIR HANDLING UNIT OVER 10,WCPM) CONSTRUCI'IONTAX
&gnawrc of ApphcanVCnmracmr
Data EXHAUST HOLD(W/DUCT1 HOUSING MITIGATION PLe'p
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazadoes'm:neriml HEATING UNH(TO 100,000 BTU) ,
as defined by the Cupertino Municipal Cade,Chapter 912,and the Health and Salary
Cods,Section 25332(a)'! ' _ t HEATING UNI'I'()VER IIN),(IINI BTU)'
❑Yes... - 7 N a '
- ' VENTILAI ION FAN(SINGLE RESID) PAID
Will thea licam nr home building Dam Receipt s -
pp g by the Buacequipmentordeviceswhich BOILER-COMP JHP OR 100,0110 BTU
mit hazarduu air contaminants as defined by the Bay Area Air Quality Management ( ) -
istri-F s TOTAL: -
' ! .-I]Yes ❑Nn ,�, BOILER-COhll'(OVER 100,000 BTU)
I have mud the haza I nationals AIR CONDITIONER " ISSUANCE DATE.
requirements nl d Chhp¢r695 or Cult-
f in 11 pl &Sa ty Cal S I .43511. 25533 J 5534.1 J t Wthtit ie NF.W NESIDEN'I'I Al.MECH. 5 PT.
h 'I lin- s t ocn0 r qq f Q
6 1 m H fi sty x :'I luyt ffY
rf the require �w 'ch t he tetpr s Cam ata pal . ,, •i '
Oa, or au rued agent D° TOTAL: ISSUED BY:
OFFICE