S 1810 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
181
CITY OP CUI`FWI'INO BUILDING,-HLECfRICAL PE IFNO. 1 1
ISUILDINGUIYISION APPLICAPION/PERMYP PLJMBINC-MECHANICAL' _ 0
. BUILDING PROJECT IDIINI'1 fICA'1'1(IN /
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
L/7 3 � asoi�
OWNER'S NAME: lZ1 N?-7 -77,77-3 CO TR TOR': 1L: LIC NO:
'I NIC CONTHULp
. AI -HITECI/ENGINEIR: LIC No AI)D E'S �. ❑
CONTACT: PHONE BUILDING PERMIT INFO
9'3
z\ ❑ Consultant Pees Paid by Applicant(initial) - -Bh❑D(; ELECTP uMu Mli❑CII
LICENSED CONTRACT OR S DFCIARATTON
3'b
QI'y ELECTRIC IIiRMI'I' Plifi
nazlhemb,ou rand tI licensed p frbamml maata g : . .� _ JOB DESCRIPTION
wo, dSratlo 70M)ofDvnsro 3 To lm a wnaP ions Garda•.and my license's RESIDENTIAL:
C-Fr-Fo4W wa f�� PF.RM1IIT ISSUANCL.
• Tull Tunerad G!56 CZ Q O/ ❑SFDWI. ❑KITCHEN REMODEL
QUU Licenne Cllm G'�5 Liero 'I'I'I.IANCES-RF.SIDTT9I'I AL CADDHION El PLUMBING RF-PIPE
F+sc ts1 Uate rnam¢l L
`1-71 ARCHI'1'HCI-S Df:C1ARA1'ION PANELS CMHI.1'I-UNIT ❑SI'RUCicArI.
z O H Z I understand my plans shall he used as public recomi MODIIlCA'TION
cz-o Pull 0200AMPS ❑IN'I'PRIOR Ll CHIMNEY REPAIR
u1 Licensed Pmf...must - 201-I0(IBAMPS IMPROVEMENT E]SWIMMING POOLS
OWNER-BUILDER DECLARATION
K� -a OVER 000ANIPS C RATH REMODEIIREPAIR 0DEMOLITION
C 6 I hereby a0imn that 1 ant exempt from the Comraenr's Lie... Law for the
P V following reason.(Scuimn 90315.Ho,mFo,and Pmfe,ion,Code An t t COTI{liR
Any y Fir conn y n SIGNS ELECI'IiICAI.
a
Val-
prior
y which of issuance,
n e,als re tams the alter,improve,dentalmI Firaa ii Iny mennerc
that he is
prs,a mgoins the for Commanr's License Law Chap rT SI'11CIA1.CIRCUIT/MISE.
�a rP'r that he ix licem ed pursuant to prnvisiom of the Gtmlmemr's License Law(Chap 9 '
C Q� l rommenving with Su'IInu901g)at Division 3')fine :'.
fihe loureSs and Prutcxsietn Crste)or TEMMET HIR OR DOLE INST. t ILRrIAL:
=M o K That he is exempt thomiroin and the ba,is For the alleged exemption.Any viulalion of El NEW BLDG/ADDI'PION [IDEModd PION
ill �a. Section 7031.5 by anmi
y applicant Gm a pert.ubieas lie applicant To a civil penalty of WIWhR DEVICIS
��� nounoeman rive hundmd dollars(S5001. ❑TENANT CFQGD SERVICE
F1I.w—wnor afIhe uo'sciy,onny employees with wages as Their compensation, SWIMMING FOOL,ELECT RIC IMPROVEMENT
W IS.C1 will clothe worli,amidur,tmeurn is not imendN orun,rcl for vvle(Son 70FL 11 ire., - - ❑0'THER
L to
3 and Professions Code:The Cnmrarlm"Lieevm Law Atte,not apply to an owner of DO I'LETS-SWITCHES-FIX'L'UR17S
propery who builds or improves thereon,and who Jens such work himself or through -
Ids own mupluyec,,provided Wal such Improvement,arc nut intmlded or offered for NEW RESIDIIN'1'PAL ELECrR SQ FL
sale.If,however,the hadding or lntpmvemunt is sold willon one year ufcomplctlom the SQ.ITT.FLOOR ARE SISQ.IT.
coomer will have the l u boor of proving that he did nut build or improve Tor pur-
Dne of suln),
F] 1,a,uwne,of IF,Prnpeny.Ilett exclu,ivuly conaueing with licensed ,,,,,.;Lou...to TOTAL
ongmcl the project(Sec 9044, a nits,and Pmt e„inns Cmu:)Ihe Comrcm
nr',I., - - r��••��aa e D
se Lawdoesnol applyman ownerofprt) aayuliobuilasorimproven mereunand QTY. (PLUA1EIN PERMIT FEE' ^
who contnects for such pm)ee¢with it contractor(,)licensed pursuant m the Commemr's
IJcenmlaw. - PERMIT ISS
11A JUL ��
1 am exempt under Sec. .R N to C too this reason
At IFit-DRAINVF,. WATBR(EA) VALUATION
owner - Dale Ca.
Ihereby amort inner,lanay of perjaryune of the rehousing declaration,PENSNI ION DECLARAI ION Plow I'NOI'EC'I'.DI? C- UI. 4U('t�'�/N
C L have and rill maintain v Certiftcme of Commas,nsdGinsure for Waders Cumpem D.AINS-PLOOk,ROOF,AREA. D. S'TORIIiS TYPE CONS1'RUCTION
salon as pnrvidel for by Section 37W of the Lnbm Cn le.for he perfommnee of the
work lin,wlllch Thin Permit ix Issued, TX'I UPON-PBN TRAP
�havc and 111 maintain Wurkcr's Compensation Insurance,as required by Section
37W nObc labor Calafor the performance offm I Fork for which this pernut ass issued. GAS-EA.SYS'PIiM-I INC.4 OU,LETS (ICC.GROUT' ANN
My WndulclsC�pmtsu- nlmt rocs cunierdnd Polley�rtthOeryre: �'J (o 1l- GAS-EA,SYSIEM-OVER 4(EA)
Cvrricr Y� and
ulhey Polk,
�®FF g. f� V '
CCHTIFICA'iH OP EXEMITION FROM WORKERS'
COMPINSA'1'ION INSURANCE GkEASU1NIl I15TRL WASTE IM 13RCEPTOl1
BUILDING ULVISION FEES
('I hix,eetion nest nal bdcmtpla¢d it cite permit is ounce hundred dollar,(SIM) GREASETRAP
in les,) - PLANET DICK FHIi
I cenify Thal in The Permomtanecofthe work for whicb thispemtil is inm.J.(shall SEWER-SANITARY-S'T'ORM EA,200 FT.
not employ any perm..in any ammarrso as m bemm
ene subject the Wnrkeri Co Men- ENERGY FEE
0Z ntnion LuwxofCalilon ia.Date - I WATER HEAT ER W/VBNTIELEMR
z 2 Applicata - - GRADING 17EE
N NOTICE TO APPLICANT:IC slier making Thin Ceniticnte of H.Faumim, ,,it should WATER SYS'I ITMOTHAI'ING
a hwo ros s lbjem to fire Workers Cumpenwlinn provision,of the Labor Coal,You mus, SOILS FEE
forhwula comply with such pmvi,nus or this peount,hull he dee tel m,ok.d. WAI'I!S SERVICE
o. Q
COt them I,o'ION LENDING le AG agency
NEW RESIDES LAI.PI MN. SQ.IcI'. :'AID
U 1,hemby whoflinnthauherc iso.ed(S,a3"97,dingagency Taube perbnmwnce of Date - Hca
me wad Inrwmma ani,pemat ix ix,aee(s«.3fim,cis.cJ
W. Lender's Nance _ OTM.:
O L) Lenders Ackms, - InIN'
,Y lZ1
BUILDING EEIi-
Icrffy that Ib mat]this application dao 0;1t b f m,vonn
(n roamer.I agree to curujily with till city and ly oratiances,andLstate laws relating to OIY MECIIANIC.ILPERTFOT F PEE i
L) z build 6 onntrvefa r, dlemlyuulhora nom"maliss,attle 'lye I rupmThu t. SEISMIC ICD
shown promooned property for tnl vion purposes. PERMIT ISSUANCE
pVe)agree m save,indemnify Find scop hannlea the Cily of Cupertino,gains ELECTRIC PEE
nedilities,'i 1,menls,enslsvndexpelse,wllleh may in any wayacemwagoiml said City ALI'17R OR ADDTO MI'CH.
fir
in consequence or the gmnling Fit This pennic PLUMBING FEB
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR IIANGLING UNIT('in insist CFAt)
MECHANICAL FIiE
SOURCE REGULA'T'IONS_
AERHANDIANGUNH`UVER 0JIC1CFM) CONS'I'RUCPION'I X
Signature ofApplicantlCUmmcitr Date EXHAUST HOLD(WNUC) HOUSING MLTIGA 11-17:11
HA9ARD0US MA117RIAM DISCLOSURE
. Will ha,nppliumt lir f hoilding.ecapunl smrc Fir handlo hamnlons mumrial OEM ING UNI'I'CFO 100.000 BTU)
as dened by the Catarina,MunlCipal Code,Chapter 9.12,and Ili,Health and Safety
Code,Section 25532(o)n HEATING UNIT'(OVER 101,000 I'll))
❑Yes C]No PAID
- VIiN'I'ILA'CI(IN FAN(SINGLE:It[;SIT)) Uua RecciptW
•, Will the upplicanl or home mildingueenrytm use cquipmm�l or devi,,,which POILER-COMP(311P OR 100,000 BTU)emit hum
vardous air contamins as defined by due Ray Arca Air Quality Management TOTAL:
Distr e9
❑Ycx ❑No 130ILER-COMI'(OVERIWJHk)11TIJ)
I have read the limarmu,materials requirements under Chapter 695 of the Cali- AIRCONDHIONER ISSUANCE DKTIj'
fonow Health&Safety Code Sections 25505,25533 and 25534.1 understand that if Ne NEW BESIDES PIAL MITCH. SQ.FI'.
building Ja sna,leme'nlI hav I¢jmnl,Ih'al it is mY...pa,mihifny In ramify be 11 y1cant
of the e enlxn mel pnm 1,i...nice of a CubwalnfJkcupal/:vn.
or amumicred agent u I� Dat - TOTAL: ISSUED BY:
OFFICE