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APPUOF CU�CANTTO FILL INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITYMIA
BUILDING. ELECTRICAL FERMI T NO.
fF RTI
I BUILDINGDINIC:: APPWCATIONTERMIT IrwunmUNfr,rTECH,an'IcrlxrrraN 50001 90335
WE -
LICENSED CONTRACTOR'S DECLARATION
I Mrcby aftiun than I all, licemed under provisions of Chapter v (commencing
with Section 70to of Division 3 of the Business and Pmfe wions Cede and my license is
In fall Bncc and c0cm.
License Class Lic. Of
Dane Comrnclnr
ARCHI'I ECI S IIEC,ARAI'[ON
l:mdamm.d nsaRr'MIIaMFctaYd.aumblic ncorJs
ION`RACT- f)R'S NA, LIC NO:
Ills_
,DDRESS:
❑ Consultand Fccs Paid by Applicant (Initial)
ITY ELECTRIC PERMIT FEE
�
PI;RMI'PISSUANCIi 3 1
APPLIANCES - RF_SIDEN'1'IAL
PANELS
UlIT02W AMPS
fled DECLARATION
I hcTl�-nfBu¢.thatj - I xempl from the Cnntracmr's license Law fnr the
following reason. (Section 7031.5 exempt
and Professions Code: Any city ser County
which nquln.e a permit ret consumer, alter, Improve, that1,xh, or repair any humrc
prior ext its issuance, atm requires the applicant for such permit to file a signed smmmem
ded he is licensed pumuanl la the IF "ontsIII the Commchds License Law (Chapter 9
(wmmencing with Section 71)(0) of Division 3 of the Business and Professions Cade) or
that he is excntp' finadrout and the hulls fnr the alleged exemption. Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil Penalty of
not marc than five hundred dollutx (S500.
❑ Lac owner of the pmpenY or my employees with wages as their wle aoml¢n.smion.
will do the work, and the saumum is not intended orofPered far sole (Sec. 7044, Business
and Profession,, Clair: [he Cod-Olt"s License Low does not apply It, an owner of
property who builds or improves thenen. and who does such work himselfor through
his own employees, provided that .,it intpmv warms seta nor intended or offend tit,
sale. If, however, the building m improvement is sold within line year of atmpinion, the
ourver-huilder will have the bunch of proving that he did nut build or improve for pur-
po of Ili.).
Q'I, as owner of the prnpeny, um exclusively contracting with licensed coronations ret
construct the project (See. 7044, liminess and Professions Code:) He ConVm`Inra Li-
nse Luw does not apply to an owner of property who builds or improves thereon and QTY.
who comracm I'oLsuch pmjcas wllh a canwcmr(s) licensed pursntmt to the Gmoamor's
License Law.
�"
❑ 10111 cxcyaa lemic, Sc�,�_� . B & P C=or thy tenyn
SIGNS ELECTRICAL
SPECIAL CIRCU HUMISC.
'I'IiMP. METHR OR POLE INST.
POWER DEVICES
SWIMMING POOL I!LEC'IRIC
OUTLETS - SWITCHES - FIXTURES
NEW RESIDE TEAL ELECFR SQ FT.
I here6yollion under penult fpenury In at memnowmg araarenom:
,J l have and wit l main m(eutc I,Consentmsdbinmre!aWorkc`,Cam,nn-
sation, as provided for by Section 37W of the lahor Cale, Incite, peonamance of the
work lilt which thin Permit is Issued.
1 have and will mainmin Workers Compensation Inwmin , as required by Section
371x1 of IM1c Lubar Calc, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrico: Policy No.:
CERTIFICATE DI' VX EM PITON FROM WORKERS'
COMPENSATION INSURANCE
T hissection need not he cmnptend it thepemtil is Lnmu hundred dnllurs (5100)
or Icss.)
Iccnily Thate Ito any coni ofthe work fOn .hjc Ibis the Worker"
IShull
mol employ any pcmnn in any councilors as Ir become whjcd In IM1c Wnrkec<Contpen-
O,$ .cation Lawsof Cali ford.. Dote
O Applicant Z h NOTICE'f0 APPLICANT: IL after mating this Certificate of Exemption, you should
a ?
lacuna mbjsrl (o the W ..In is Cmnl>ensation provisions of the I,ahur Code, you an%,
forthwith comply with such provisions or this permit shall he deemed evoked.
a�
Z z CONSTRUCTION LENDING AGENCY
U 0 1 herebyal ran that there iso commotion lending agency for the performance of
U. F' the work fit, which this permit is issued (Sce.3097. Civ. C.)
O U Lender's Name
%" W lenders Aminss
1 ccnily that 1 have read this applirotion and nom that IM1c aMwe infonnulinn is
L,,, cnee.l agrecmamaid, withell cityandasumy ordinar—mid state laws relaing to QTY.
U building construction. and M1cmhy uuthomc npnsematives of'his city mender upan, hI,
aluwo-nmmioncil pruperlY Ga inspection purposes.
(We) a,. Ir save, indeardly and keep hermlecs'he City of Cupertino mica
liohil Ibis, juJgmm�u, costs unA expenses which may in any way accrue againn said it
in nama cnwul' the grl of all, Penni..
A PPl. ICANT 1)N DE STA 'D WII. COMPLY W I I I I ALL NON -POINT
", X US MATERIALS DISCLOSURE
Will the applicam or lemic W ilding aeupam wtrc m handle heuNnus ntwcrial
defined by the Collection Municipal Code. Chapter 9.12, and the Health and Safety
de, Section 25532(()?
❑ Yes 1117
Will the applicant or future building occupant use equipment or devices which
Itoaal ux nitt mrnmim nn uv Jcfncd by Ibe Ray Area t Air Qui I'ny Management
V CI!
❑Yes
I have read the Estimators contents attainments under Chapter 6.95 of Ne Cali-
mia Health K Sof y unnc 255(15, 25531 unJ 25534,1 nndco'xnA Ohio if the
dram docs oat 0. all, have a mn .my rospunsibiliry ns notify the wcupa^I
PLUMBING PERMIT
PIIRMI'f ISSUANCI:
ALTER-URAIN6 VENT E'ER IIIA)
RACK FLOW P E . D' I
DRAINS -FLOOR, F.A .CO
FIXTURES - PER TRAY
GAS -13A. SYSTEM -I INC. J OUTI!!!!!!S
GAS - F.A. SYSTEM -OVER 4 (IIA)
GREASOINDUS'I'III, WASTE IN I'ERCEPI OR
GREASE'I EMAP
SEWER -SANITARY -STORM EA. 200 FT.
WATER HEATER WNENFIELECTR
WATIiR SYS'FEM/fREATING
WAI ER SERVICE
NEW RES IUENI AL PLMB. SQ, I'i'.
MECHANICAL PERMIT
PERMIT ISSUANCE
ALIPR OR ADD TO MECH.
AIR HANDLING USE TOO 10,M) CFM)
AIR HANDLING UNIT (OVER I0.0a)CFMI
EXHAUST' HOOD I WBIDC'I')
HEATING UNIT (1'0 100,000ITU)
HEATING UNIT (OVER b)0.0M1 B'IV I
VENTILATION FAN (SINGLE RESID)
BOILER -COME (3HP OR 10.000 BTU)
BDILQR-COMI'(OVI.R I0L0M3113'rU)
AIR CONDITIONER
NIiW R ISIDIiNIIAI, MISCII. SQ. IT.
`�� OFFICE
FEF:
// C
IN
BUILDING PFRMY1' INFO
Cl
El
ELECT � :1 LLMI?❑l
JOB DESCRIPTION
RESIDENTIAL:
❑SIUWL
❑ KI' 1'CHEN REMODEL
❑ADDHION
❑ PLUMBING RE PIPH
❑MULTI -UNIT
❑STRUCTURAL'
MODIFICAHON„
❑IN'TERIOR
❑ CHIMNEY R17PAIR
IMPROVEMENT
[]SWIMMING POOLS
❑ HATH REM0DEUR1?PAIR
❑ DEMOLITION
0O'1'HER
^
H
COMMERCIAL
❑ NEW BLDG/ADDI'HON
❑ DEMOLITION
(-]TE AN[ -
❑1'000 SER VICE
IMPROVFMI,M
❑ O'1'l1EN
SQ. IT, FLOOR AREA I $/SQ. 1'r
MAY 11
BUILDING DIVISION P13L'S
PLANCI IECK THE
ENFRGY FEE
GRADING FEE
SOIISFEE __
PAID
1 all
Rcceipl p
BUILDING ill
FIiE. SI?I. C 'EE
ELECTRIC -il?
PLUMBING FE'
M ECHANICAL FL
CONS'TRUCI'1(1N'TA
I HOUSING MI'I'IGA'I'ION THE
PAID
Dam Receipt a
ISSUANCE DATE 17
F -4
n
OZ=
F -^F
a�w
3a
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41N
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FZ
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APPUOF CU�CANTTO FILL INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITYMIA
BUILDING. ELECTRICAL FERMI T NO.
fF RTI
I BUILDINGDINIC:: APPWCATIONTERMIT IrwunmUNfr,rTECH,an'IcrlxrrraN 50001 90335
WE -
LICENSED CONTRACTOR'S DECLARATION
I Mrcby aftiun than I all, licemed under provisions of Chapter v (commencing
with Section 70to of Division 3 of the Business and Pmfe wions Cede and my license is
In fall Bncc and c0cm.
License Class Lic. Of
Dane Comrnclnr
ARCHI'I ECI S IIEC,ARAI'[ON
l:mdamm.d nsaRr'MIIaMFctaYd.aumblic ncorJs
ION`RACT- f)R'S NA, LIC NO:
Ills_
,DDRESS:
❑ Consultand Fccs Paid by Applicant (Initial)
ITY ELECTRIC PERMIT FEE
�
PI;RMI'PISSUANCIi 3 1
APPLIANCES - RF_SIDEN'1'IAL
PANELS
UlIT02W AMPS
fled DECLARATION
I hcTl�-nfBu¢.thatj - I xempl from the Cnntracmr's license Law fnr the
following reason. (Section 7031.5 exempt
and Professions Code: Any city ser County
which nquln.e a permit ret consumer, alter, Improve, that1,xh, or repair any humrc
prior ext its issuance, atm requires the applicant for such permit to file a signed smmmem
ded he is licensed pumuanl la the IF "ontsIII the Commchds License Law (Chapter 9
(wmmencing with Section 71)(0) of Division 3 of the Business and Professions Cade) or
that he is excntp' finadrout and the hulls fnr the alleged exemption. Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil Penalty of
not marc than five hundred dollutx (S500.
❑ Lac owner of the pmpenY or my employees with wages as their wle aoml¢n.smion.
will do the work, and the saumum is not intended orofPered far sole (Sec. 7044, Business
and Profession,, Clair: [he Cod-Olt"s License Low does not apply It, an owner of
property who builds or improves thenen. and who does such work himselfor through
his own employees, provided that .,it intpmv warms seta nor intended or offend tit,
sale. If, however, the building m improvement is sold within line year of atmpinion, the
ourver-huilder will have the bunch of proving that he did nut build or improve for pur-
po of Ili.).
Q'I, as owner of the prnpeny, um exclusively contracting with licensed coronations ret
construct the project (See. 7044, liminess and Professions Code:) He ConVm`Inra Li-
nse Luw does not apply to an owner of property who builds or improves thereon and QTY.
who comracm I'oLsuch pmjcas wllh a canwcmr(s) licensed pursntmt to the Gmoamor's
License Law.
�"
❑ 10111 cxcyaa lemic, Sc�,�_� . B & P C=or thy tenyn
SIGNS ELECTRICAL
SPECIAL CIRCU HUMISC.
'I'IiMP. METHR OR POLE INST.
POWER DEVICES
SWIMMING POOL I!LEC'IRIC
OUTLETS - SWITCHES - FIXTURES
NEW RESIDE TEAL ELECFR SQ FT.
I here6yollion under penult fpenury In at memnowmg araarenom:
,J l have and wit l main m(eutc I,Consentmsdbinmre!aWorkc`,Cam,nn-
sation, as provided for by Section 37W of the lahor Cale, Incite, peonamance of the
work lilt which thin Permit is Issued.
1 have and will mainmin Workers Compensation Inwmin , as required by Section
371x1 of IM1c Lubar Calc, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrico: Policy No.:
CERTIFICATE DI' VX EM PITON FROM WORKERS'
COMPENSATION INSURANCE
T hissection need not he cmnptend it thepemtil is Lnmu hundred dnllurs (5100)
or Icss.)
Iccnily Thate Ito any coni ofthe work fOn .hjc Ibis the Worker"
IShull
mol employ any pcmnn in any councilors as Ir become whjcd In IM1c Wnrkec<Contpen-
O,$ .cation Lawsof Cali ford.. Dote
O Applicant Z h NOTICE'f0 APPLICANT: IL after mating this Certificate of Exemption, you should
a ?
lacuna mbjsrl (o the W ..In is Cmnl>ensation provisions of the I,ahur Code, you an%,
forthwith comply with such provisions or this permit shall he deemed evoked.
a�
Z z CONSTRUCTION LENDING AGENCY
U 0 1 herebyal ran that there iso commotion lending agency for the performance of
U. F' the work fit, which this permit is issued (Sce.3097. Civ. C.)
O U Lender's Name
%" W lenders Aminss
1 ccnily that 1 have read this applirotion and nom that IM1c aMwe infonnulinn is
L,,, cnee.l agrecmamaid, withell cityandasumy ordinar—mid state laws relaing to QTY.
U building construction. and M1cmhy uuthomc npnsematives of'his city mender upan, hI,
aluwo-nmmioncil pruperlY Ga inspection purposes.
(We) a,. Ir save, indeardly and keep hermlecs'he City of Cupertino mica
liohil Ibis, juJgmm�u, costs unA expenses which may in any way accrue againn said it
in nama cnwul' the grl of all, Penni..
A PPl. ICANT 1)N DE STA 'D WII. COMPLY W I I I I ALL NON -POINT
", X US MATERIALS DISCLOSURE
Will the applicam or lemic W ilding aeupam wtrc m handle heuNnus ntwcrial
defined by the Collection Municipal Code. Chapter 9.12, and the Health and Safety
de, Section 25532(()?
❑ Yes 1117
Will the applicant or future building occupant use equipment or devices which
Itoaal ux nitt mrnmim nn uv Jcfncd by Ibe Ray Area t Air Qui I'ny Management
V CI!
❑Yes
I have read the Estimators contents attainments under Chapter 6.95 of Ne Cali-
mia Health K Sof y unnc 255(15, 25531 unJ 25534,1 nndco'xnA Ohio if the
dram docs oat 0. all, have a mn .my rospunsibiliry ns notify the wcupa^I
PLUMBING PERMIT
PIIRMI'f ISSUANCI:
ALTER-URAIN6 VENT E'ER IIIA)
RACK FLOW P E . D' I
DRAINS -FLOOR, F.A .CO
FIXTURES - PER TRAY
GAS -13A. SYSTEM -I INC. J OUTI!!!!!!S
GAS - F.A. SYSTEM -OVER 4 (IIA)
GREASOINDUS'I'III, WASTE IN I'ERCEPI OR
GREASE'I EMAP
SEWER -SANITARY -STORM EA. 200 FT.
WATER HEATER WNENFIELECTR
WATIiR SYS'FEM/fREATING
WAI ER SERVICE
NEW RES IUENI AL PLMB. SQ, I'i'.
MECHANICAL PERMIT
PERMIT ISSUANCE
ALIPR OR ADD TO MECH.
AIR HANDLING USE TOO 10,M) CFM)
AIR HANDLING UNIT (OVER I0.0a)CFMI
EXHAUST' HOOD I WBIDC'I')
HEATING UNIT (1'0 100,000ITU)
HEATING UNIT (OVER b)0.0M1 B'IV I
VENTILATION FAN (SINGLE RESID)
BOILER -COME (3HP OR 10.000 BTU)
BDILQR-COMI'(OVI.R I0L0M3113'rU)
AIR CONDITIONER
NIiW R ISIDIiNIIAI, MISCII. SQ. IT.
`�� OFFICE
FEF:
// C
IN
BUILDING PFRMY1' INFO
Cl
El
ELECT � :1 LLMI?❑l
JOB DESCRIPTION
RESIDENTIAL:
❑SIUWL
❑ KI' 1'CHEN REMODEL
❑ADDHION
❑ PLUMBING RE PIPH
❑MULTI -UNIT
❑STRUCTURAL'
MODIFICAHON„
❑IN'TERIOR
❑ CHIMNEY R17PAIR
IMPROVEMENT
[]SWIMMING POOLS
❑ HATH REM0DEUR1?PAIR
❑ DEMOLITION
0O'1'HER
^
H
COMMERCIAL
❑ NEW BLDG/ADDI'HON
❑ DEMOLITION
(-]TE AN[ -
❑1'000 SER VICE
IMPROVFMI,M
❑ O'1'l1EN
SQ. IT, FLOOR AREA I $/SQ. 1'r
MAY 11
BUILDING DIVISION P13L'S
PLANCI IECK THE
ENFRGY FEE
GRADING FEE
SOIISFEE __
PAID
1 all
Rcceipl p
BUILDING ill
FIiE. SI?I. C 'EE
ELECTRIC -il?
PLUMBING FE'
M ECHANICAL FL
CONS'TRUCI'1(1N'TA
I HOUSING MI'I'IGA'I'ION THE
PAID
Dam Receipt a
ISSUANCE DATE 17