99120119 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CA I
.CITY OF CUPF,RTINO BUIL)ING-ELF.C'IRIOAL Has 11
CBANICAL
BUILDING DIVISION APPLICATION/PF,RMIT PING PROJECT IDENTIFICATION
BUILDING I'ItU.IHCI'IDIfN'tIN'IGA'1'I(IN
BUILDINGADDRESS:
;SANIRY NO. APPUCAI ON SUHMI'I'TAL UAI
V%W-� C-4O Elk PHONIi: C[�TtACli)k'SNAMIi
� CON'I'SOL0
RCHITECIENGINF.ER: hIC O'. ALII
Co dyBUILDING PERMITINTO
/�/ �55 consultant Pecs Pail by Applicnnl(Iniriaq n1,DC PLUMB buicu
El til " 1' ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT PEI: JOB DESCRIPTION
I hereby uRum that I son IiccnuJ Boder pmvi,inns of ChaPmr 9[annmeneing
0WZ wiN Section 90104 of Di.d,iom?mnhe ua,ame..ane ProfeNdaa,Code,and my license in RESIDENTIAL:
W 0 1'ERMD'ISSUANCIi
License rce and effen.. A '� g EIADDTI. ❑PLUMBiN RE-PIPE
aUV License Cl ss [� LieN AI'I'LIANCI!S-RESIDENT Ah ❑ADDITION El PLUMBING KIi-PIPE
un Dae Cnmravhs ❑MUTA1"UNIT ❑S'TRUCT'URAL
tCTf TECTS DELI R 'fl)N PANELS MODIFICATION
ZOyZ mY s �I uJ as public records / UPT0210 AMT'S
OZ�y ❑INTERIOR ❑CHIMNEY REPAIR
F. C n: saonel 201.1(NOAMPS IMPROVEMENT SWIMMING POOLS
'.R-BUILDER DECLARATION ;)�)WFR
ER 100AMPS ❑BA'l11 RCMOUI211REPAIR DLMOl.1'1']ON
C C Q 1 hereby aff n Thal 1 am exempt from the Conlm inei License Low for the
3 F following reason(gectimn 90J1.5.Business and Profeminn.CWC:Any city or amnlY NS BLI!C'RICAI. ❑OTIIIiH
y¢ which requites a perms to construct.alter,improve,demolish,or repair any svuetme
.] priorm its issuance,also requites the applicant for such Permit file asigmed statement CIAI.CIRCUITIMISC.
ELL} Lha he i.s licensed pursuant to the provisions of the Contractor's License Law(Chapter COMMERCIAL;
�aa0 (commencing with Section 9001amEil mm,3nfthe Bminc,,.nd Pmfessions Calvin MI'.MITI!R OR IY)Lli N
a a o C that he is exempt therefrom and IM basis for the alleged exemption,Any violation of ❑NEW HLDG/AUDITION ❑DIiMOI.I'1'ION
W-m Section]031.S by any applicant for a permit subjects the applicanttoucivilpenahYnf DIiVICCS ❑FOOD SEkVICIinot mare than five hundred dollars 15500). IMPHOVEM01.as owner of the popery.or my employees with wages as their role compensation. IMM INC,POOL ELECTRIC � �/ &X�C2 We,
F. will do the work,and the structure is not intended or offered for sale(See 10114,Business �OTHI3R
W m and Professions Cale:The Contractor,License law does not apply m an Owner Or CUTLET LS-SWITCIIIiS-FIXTURI?S /r•�COi(/I�/ECT LL�G Mti�-�
a 3— 1'r'Ixry who builds or improves thereon,and who does such work himself m throughWV�-WXTTE
zwexre 12-XII Stl S7*f/O t
his own employees.plavided that such improvements are not intended or Offered forNEWLECfR SQ PT.
sale.IL however.the building or improvement is sold within one yea ofcompletion.theSV FT.FLUOR All. (�(, a. lLSQ.FI'.
er-builder will have the hurden of pmving that he did not build or improve for parry 'V
pose m wle.). TOTAL.:
1,as owner of the popery,am exclusively contracting with licensed contractors to
anemia the pansver(Sec.9dJJ,Business cal Professions Cafe)The Comnaces Li"
ti law does not apply to an Owner of Flattery who builds or improves therein.and T FEE
who contracts for such projects with a contracto s)licensed pursuant to the Contractor's
License law.
I um exempt mater Sec. ,B&P C for Nis reason ,-WAI'h (IiA) VALUATION
Owner Dam ny
WOkKER'S COA1PENSATION DECLARATION HACK FLOW I'H(TI'EC..DEVICE Zx+ �O
I hereby affirm under Penalty of perjury one of the following declarations
J I have and will maintain a Certificate of Consent to wif-insure for Worker's COmpen- DRAINS-FLOOR.ROOF.AREA.GOND. E�C.
ORIES TYPECONSTRUC IO
salon,as provided for by Section 3980 of the Ichor C(Nlc,for the Fcrfommance of the
work for which Nis permit is issued. FIXTURES-PER TRAP
2-1
❑I have and will maintain Workers Compensation Insurance,as required by Section GAS-IiA.SYSTEM. INC.J OUTLE I'S
37M)of the labor Code.for the performance oftbe work for which Nis permit is issued. GROUT' AI'N
Ca WorkerS)wnppyWtty_ 122,can PI YNay� � r�9 I/a GAS-G.SYSTLM-OVIiRJ(IiA) 6-10
Ca S/l%6G!/ 4JT/,
CERTIFICATE OF EXEh1PION FROM WORKERS' GREASUINDUSTRI.WASTE I -:RCEPHIR
COMPENSATION INSURANCE BUILDING DIVISION PERS
(This section need not be completed ifthe permit is forone hundreddollars(SI00) GREASI!TRAP
:PI CHECK Igili
or kssJ
Lay any Chain the anymannrofthe work astobcfar which the Wiisissued.I'Com hall SEWER-SANITARY- ORM LA.2(01T' �rEN: Y .
not employ any person in any manner m as to become subject m the WOrkeri Comttcn- )
Z Nation Laws of California.Dam WATER HEAFERW ENTAB.IiCI'It GRADI46 FITP�
ZO Applicant i
h NMCI7 TO APPLICANT:IL after making this Certificate Of Exemption,you should WATIiR SYSTI' /1'RI!A'1'ING O1�
? become subject to the Waters Comttensation provisions of the Labor Ede,you must S(/ I•LI. r
W '. foMwith comply with such provision,or this permit shall M deemed revoked. WATER SP ICI:
Q PAID
CONSTRUCT ION LENDING AGENCY NI!W SIUEMI'IALPI.MB. SO IT, Un,¢ ccip /!
UQI hereby a03nn that there is a constmetion lending agency for the performance of
U f' the work for which this permit is issued(Sol.309.Civ.C.1 AL:
O U Lender,Nome 'EDTA L:
Lender's AJdrexs BU DI :F
� U
1 comfy that 1 have read this application and state that the above information is
FY) correct.l agree to comply with all city and county Ordinances and sace laws relating to TY MECHANICAL PERMIT THE SEISMIC I:17I4
U7. building construction,and hemby authorize representative,of this city In Corer upon me
aMrvc-mcn0inncd property for inspection Purposes. PERMIT ISSUANCE ELECTRIC I:I!ii
IWC)agree to save,indcnmify and keep hameess the City of Cupertino against
liabi lilies,judgments.cmu'and expcnac,which may in any way accrue ugai net said City AIIU:R OR ADDTO MECH. PLUM111 NGl'E1i
in consequence of the granting ut this premtit.
APPLICANT UNDERS"TA NUS AND WILL co MPLY WITII AL1.NON"POI NT AIR IIAN DLING ON IT(A 010,000 CP. MI!CIIANICN.II!I!
SOD i F. ULAIIONS
�� All K IIA NDLING UNIT IUVI!k 1O ICITv1) CONS'INUC'IION'fAX
Sigt dApid'am tar Date 11X UAUS'I'IKA )(WIDUC' Iuul5IN(;xa IIGRIIONIq!li
IiA OUS MAa PHIALS UESCLOSURF:
Wi"IS
npplicum ur future builAing nmupnnt 4arc Or handle haeurJnux nnttcdul IIIiA'1'ING UNI'I'TTG R .9NI
as defined by the Ca,mian Municipal Cole,Chapter 9.12 and the Hcahh and Salcly IIHXIING ONIT( HR❑ANN)RIU)
CalaS jinn 25532(0)7
El Ye, E:1 No VFNULRHO FAN(SINCLURESIU) VAD)
Dale Kceciplp
Will the ap,deanl Ot future building neeapunt um cquip:nunt or device,which HOILER 'OMP(.1HP OR Pd.0ml BI'U)
ugcnN' I
lir hvaNnns air cmm�minunn nN dclined M1y the❑aY Aren Air Quu111Y Manmm 'IUI'AL `-(
I,16c,C Bid SR-COMp(OVBR1000RIBI'U)
Ycs ❑No
Rt CONDI HONER ISSUANCE DAIT
�� Ihiac resd", oNI,,. ^,v,25505,piircmc an undcrclapmri-caul dmCnli-
- fomio H Ih&$afny Cale.S�IqYan 25516,i,uty and 2553J, a n....y ,don II the NEW ItB51UIiN'I'IAI.MICCII. Sq,Irl'.
I ailed 8t c al meetly ht cu [nand,lhyPit is my rcalxmslhilitymnn111 y Ncocanttnm
n[t n which n: Vaca rmissn:n¢c ntaCc cu et��upu
oo
Ow r iced ngcnl re gll'IAL: ISSUEUH .
OFFICE