29312 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMITPLUMBING-MECEANBCAL
BUILIIINC.PROJECT IUENI'IFICATION 29312
BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DTI
I p%p 2, 1Ew eI 271nyq
6WNHR'S E:� . PHONE: UIOR'S NAME: LIC NO'
/fpm NIC CONTROL#
RCH' TW' 1i It U ❑
/✓ 1S
ADDRESS
I CON1ACE
A✓PHONE: 2 BUILDING PERMIT INTO
1,7y Consultant Fees Paid by Applicant(Initial) `J RUIG Isaic, 4LUMILMECH
LICENSED CONTRACTOR S DECLARATION QTY. F,LECTRIC PERMIT FEE
1 hem-by affirm that I am licensed undo Pmviainnr of Chapter Y(entnmencingJOR DESCRIPTION
CaZ with Section 70011Boloivisian3ol the Hinme..and 11...x,karo Code,and lny ueenva is RESIDENTIAL:
WOO PERMIT ISSUANCE
in full force and effect. CSFDWL C KITCHEN REMODEL
aUU Liccnu Claw Lic.p APPLIANCES—RESIDENTIAL CADDITION 0PLUMBING RE-PIPE
ha a Date Camracam
o,O m ARCHITEC'S DECLARATION PANELS C MULTI UNIT. t� :'s ❑STRUCTURAL
z O m z I understand my plain shall he used as public records MODIFICATION
41_Q UPTO 200 AMPS I TIiR10R CGHIMNIiY REPAIR
F� Liccmad Profuast of 201-1000AMPS VE
�Y3a? OWNER-BUILDER DECLARATION OVER F"AMPS BA I4 EM D'QU A%
# (1 I' fhiFA7�CDEMOI.ITION
W a 6 1 hereby affirm that I am exempt form far Comment's License Law for the
KOc..0 following mawn.(Sectiom 1m 1.5.Business and Por(covans Cole:Any city or county ELECTRICAL
4. which `O OTHCR
813ucnm U f Vf yyW)r Uri J
a quires n Permit construct,alter.improve.demolish,orrt pair any s
B
OJ thathe its mused purls requites the
ovisio sof for such remit tofile aicense ned aw(Cammem CGIRGHIT/MISC.
(commencing with
pursuant to the provisionsofthe
eBusinors License Law(ChapterCode)or
^QnO (commencing won section rf#p)nf Division 3ol the lluninevvand Pmfcasinn%CuJe)or 'r1iM. tft OR roIeINST COMMERCIAL:
o a cy 'but he is exempt ateeform and the basis on the alleged exemption.Any violation of EW BLDGIADDITION C DEMOLi'I'[ON
WM N Section 7031.5 by any applicant for a permit subjects the applicant n a civil Faculty of ER D ENANT C FOOD SERVICE
not..,ban fisc hundred dollars 18500).
H Z Y IMPROVEMENT
=6 wi Ca are work,the areprectur is employres withwred for tltev sale compensation, WI MLNG I_ELECTRIC
will dothewons and thesmnure Fnotintended License
forot apply to
mmeBus,of � []OTHER
ei 3 and professions bra Gde:The Cammorco License Luo tines not apply s if owner of — TCHES—PI%TURES
pmpedy who builAs or improves Ihcrum,and who does such work himself nr Through
bis own cnsplmyces,provided fund such improvements are nm intended or offamd for NEW REST CTR SQ FT
%ele.If.hnwcvee the building ter impnwnnem is mlA withinoneycar ofcontple.inv,the 0 SQ.FT.FLOOR AREA SISQ,FT.
owner-builder will have the M1uNan of Proving that he did not build or impress for Fur-
pox of salol.
❑ L as owner of The porpmy,am exclusively contracting Cak Beano C contractors to
consumer La the project(Seo.roan,Busiowner
of and property
iso ions ds or i TTe Cs famous, nd
selawdoes nntapply to an ownerof Progeny whin huilAs or improves famous,and QTY. PLUMBING PERMIT FEF,
who wmmc's for such projects wish v mnarmor(s711cenud putsuvm m the CommmarF
License Law. PERMIT ISSUANCE
I am exempt under Sec. ,B d P C for dan reamn
Owner Dam ALTER—DRAIN&VENT—WATER EA) VALUATION
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE ^ ��
I herchy allirm under penalty of perjury one of The following declarations:
I have and will maintain a Certilacme of Consent am aallainomm for Worker's Confer- DRAINS—FLOOR,BOOR AREA,Co1NU. tiY)RIES TYPECONSTRUCTRE
minor,as provided for by Saco,3700 Of Labor Cattle,for the Ferfarmuncu of the
work for which this Permit is isound. FIXTURES-PER TRAP LED
C I have and will maintain Workers Compensation Insurance,at required by Section
37M.fthe labor Code,for the pedamanor,mOe weak for which th,Pared is issued. GAS-EA.SYSTEM-1 INC.n OUTLETS OCC.GROUP APN
My Worker's Compensation Insurance carrier and Policy number arc:
Currier: Policy No.: GAS-EA.SYSTEM-OVER n(EA)
CHRI'IFICATH OF EXEMPTION FROM WORKERSGREASF/INDUSTRh WAS TE INT:RCEPTOR
COMPHIsSAT10N INSURANCE BUILDING DIVISION R3ILS
(Thi,actionneed la,b ommplamd if Ne Permit is for nnchmishor Jollats(SIW) GREASETRAI'
or loss.) PLANCUECK FEE
I cenifythat in the prommavice f,he work far which this#e mit is i...to,1%hall SEWER-SANITARY-STORM EA.20019'. WNS
not employ any Person in any manner%o as to become subject to the Workers'Compsm- ENERGY FEE .e
Z, sa ima Laws mf California.Date WATER HGTER W/VENT/ELECfR
z O Applicant GRADINGFEE
NOTICE TO APPLICANT.IL aIle,making Ibis Certificate of Exemption,you should WATER SYSTENIT RGTING SOILS IE
bee comsubject to the Worker's Compensation provisions of the Labor Cable,you must
forthwith comply with such pmvisiors or this Prond.shall he deemed revoked. WATER SERVICE
° 6�5 Z CONSTRUCTION LENDING AGENCY NEW RESIUENTIAI.PLMB. SQ.FT. PAID Q
V O (herchy affirm that them lm uennstmdion lending agency for Pelonnancc o[
~'+ be work lin which do,Pamir is ivamd(Seo 3097,Ci,.C.)
W. fLenders Name TOTAL:
landds AJdrtss y OBUILIIINC 'EE
I codify that 1 have mad this application and mote that the above information is
Fr faA correct.l agree n comply with all city and county eaJinarecs and%tato laws relating to QTY. MECHANICAL PERMIT FEE
V Z building construction,and hereby authorirt representatives of this city to ender upon the SEISMI FEE
alwve-mentioned limped,for inspection Furpo wl. Ph RM IT ISSUANCE
(We)i grcc'o uavc,ini cnutil'y i d stop hurmto,,the City of Cummonn against BLHC RIC PEE L
liabilitics,judgmmiu,costs and expenses which may in tiny way accme again.asaid City ALTER OR ADDTO MEC H.rj&iZioO , 40
in consequence of the grouting of this pewit. PLI1 FEE #.
APPLICANT*UNDERSTANDS AAWO MECIIANICALF,
WIT ALL NON-POINT AIR HANDLING UNIT W."CFM) � I
SOU C REGULATIONS.
AIR HANDLING UNIT(OVER 10,00007M) CONSTRUCTION TA'
Sim reel'ApPIInmVCulnvmnr Don EXHAUST HOOD(W/)UCT) LOU SING MITIGATION iE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupentsbre or handl hreardou,material HIINTING UNIT(TO 100,000 BTU)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Cole,Section 25332pd? HGTING UNIT(OVER 100,000 BTU)
C Yes [7 No VENTILATION PAN(SINGLE RESID)
aipt p
Will the aPP conn earfar
nts abuilding by the tiuxcequipmentat' Marawhich ROILER-COMP(3HP OR loo,aW if I'U)
01, for hazardous sear contaminants as defined by the nilly Arca Air Quality M:magcment
L_thonmJ
BOILER-COMP(OVER 100.00X)BTU)
s ❑No
real the htamduus materials regafnttmmn make Chapter 695 of the Cali- AIR CONDITION17R
al
&Safety Cade,Sations 25505.25531 and 25534.1 undcrsmnd'hat if the NIiW RF.SIIICNTIAL MECH. SQ.FT.
not cumndy hna11 ennnl•Ihu'it is my mspnnsihilltymno'i Ty Ocoecu'rou �}•� I[
oreas which oma hemet Friar toissuanm uT a Cunilicam offkcuponcy.
...Bred agent Data k TG ISSUT:D BY:
OFFICE