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S 1275 APP}ICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY _ CITY OF CUPFRTINO BUILDING-ELECTRICAL PESIT NO BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL J 1275 BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: SANITARY NO. APPLICAS'ION SUBMITTAL DAFF. ILF. VE O NER'S NAME: PHONE CONI RAG ORS NAME: ruV LIC NO: IW ' N/C CONTROL# f `ARCHITP.CT/ENGINEER: LIC NO: ADDRESS. [7 ❑ )N LACI PHONE: _ I BUILDING PERMIT INFO ❑ Consultant Pees Paid by Applicant(Initial) BI.DG ELECT PLUMB MSCI I /©`a Olo1 ❑ ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION QTY. ELECURIC PERMIT FEE I hereby affirm that lam licensed under pre,tsmnx m of Chapter v(comencing JOB DESCRIPTION O a00 with Section 9v0e)nf Division3oDho Business and Pm[essions Code,lord mylieervve is PERMIT ISSUANCti RESIDENTIAL' CWr nfullfince:ted el ❑SFDWL [I KITCHEN REMODEL QUU Licau Culnss - Lia#.-b APPLIANCES-RESIDENTIAL []ADDITION ❑PLUMBING RE-PIPE �zW Dnte Cworha Fnm ARCHITECT'S DECLARATION PANELS ❑MUUD-UNIT ❑STRUCI ORA]. z O y z I andersmnd my plana shall be mut as puddle reemol, MODIFICATION Oz,,,- UP TO 200 AMPS [I INTERIOR ❑Cl H NINEY REPAIR F 4tm Licenser Prrdusoonal 201-1000AMPS IMPROVEMENT SWIMMING POOLS OWNER-BUILDER DECLARATION OVER 10100AMPS ❑HATH RIiMOUBI/REPAIk ❑DE LET Pl a I hereby aBlne that Tam exempt form the Contractor's License Law for the `LU folsevi. Section?031,5,Businear and Prefcssions Codc:An t t ❑OTHER ��xi &Aal g wson.( y diyo,nr unto) SIGNS HLNA'I'RICAL 3 h which requires a permit to emaslrnel,alter improve,dmnollsh,or repair any ori _ —V/3 F^(0j0 priormik ivxmnce,aLorcgdlres the upplieam Rh,irbpermit m file asigned,mCmenl SPECI AL Cl RCU IT/NI ISC tbar he is licensed pnrsuanl to the pmvisiens of the Conlmclor,License Law(Chile,9 - �q0 (commencing wilia Section]000nofDlvi,ram 3 of the Business and Profession,Chile)or TEMP.METER OR POLE INST.. COMNCRICIAL, 6i pp,,c that he Is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION Wti Seat a]1131.5byad,ap,decarl forapemdlsubjects the applimmt to u civil Penally of POWER DEVICES ❑TENANT ❑FOOD SERVICE n i more Than five le Wrad dollars($500). - IMPROVEMENT xQ ❑Lo the work,the porpedy,nrmyot ineyees wimwagavrsale re.70:4,Business SWIMMING POOL ELECTRIC F,O will dolhewon,and ilia he Con isnotLicenadedse Law dAs salepplyto 4a owner ❑OTHER and Pmfesions Code.The Gmlmcmr's License Law does nut apply n:an owner of OUTLEI S-SW1TCiIP.S-PIXTURP.S a property who builds or Improves Thereon,and who does such work himself or lhreagh his own employees,provided that such Improvements am not intended or offered for NEW RESIDEN'I'IAI.IAP.CPR SQ FIT sale.11;however(behnildingorimpmvementlssoldwithlnoneyearofcomplellon,the SQ.UP FLOOR AREA VSQ.PE owned builder will have the burden of proving that he did not build or imports,ma PLA, Dave sale.,. IP A i ❑Las owner of the property,am exclusively contracting with licensed contractors It, T(yfAL: - ensurer the project(Sec.7044.Business and Professions Code:)The Conuaamrs Li- - neLnwdomnetapplymanowneofproperlywhohuildxmlmprovesamrcogand QTY PLUMBING PER T FEE, JUL 07 ID who contracts button pmjed,wllb a mmdarams)licensed pursuant m lbe Comramors ( AM LLaiLaw. / PHRMITISSUANCP. 3V_,0 ❑lam cxompt and,,Son ,B&P C for this rcasen Or Ur Gil 11141.1 ALTER-DRAIN&VENT-WATER(BA) VALUATION Own Date WORK ERS COMPENSATION DECLARATION. BACK FLOW I'RGIRCT.DEVICE I hereby uffi m:under penalty of po jury ane of the following dedamtimnsl I have and sillmaintuina Cent ficam or Conseil to self-insure for Worker's Coupon- DRAINS-FLOOR,ROOF,AREA,COND. S'IDRIE.S 'I'YEE CONSTRUCTION vs pm,hld far by Section 3900 of the Labor Gndu,for performance of the t k for which Ibis permil is issued FIXTURES-PER TRAP 1 have and willmhtnwtn Workers Cmapenxmlon Insurance,as requied by Section0oflhe Luhor Codafolithe pedormunce ofthe work for which this pemdl is Issued, GAS-EA.SYSTEM,INC.4 OUTITI S OCC.GROUP APN MyWakeyy((..Q ]py�t pp ye, icr and Polney f$���� Cardec lrC llK IJ(�A1 Polio Nn:6TV, �I� GAS-HA.SYSTEM-OVER 4(EA) CERTIFICATE,OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE. I GREASF%INDUSTRL WASTE INTERCEPTOR Pfhissection normo,becmnplemItheperious for one hundred dollars($100) •R,LUDINg DIVISION PEES ._ or les,.) GRP.A$E TRAP PLANCHECK FEE I certify that in the performance oflhe work for which this permit it isvoi lshall SEWER-SANITARY-STORM EA.200 FE znot employ any person in any manner so as to become subject to me Workers'Compe- ENERGY FEE nation Law,of California.Dam WATER THAI HE W/VEN'1'/HI.HCTR M 0 Applicant t 0 w GRADING EEE SON ICE[0 APPLICANT,If after making this Ce,iGeate of Exemption,you.should WATER SYSTEMTREATING become subject m the Worker,G:mpensmion porvi,me,of the Labor Care,you matt SOILS PEE LkI fndhwim comply withmch pmvisimse,this pgrmil.,hall be dceanxim,oked. WATER SERVICE 1 Q CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PhMR. SQ.1T. PAID z 1 hereby atfirin flat there ixaconstecion lending agency forthe perfornnance of Date Receipts U Q the work for which this permit is issued(Sm.3097,CIv.C.) u' H Lenders Name TOTAL: U Letder',Add... TOTAL.: t d 1 certify that I Lave read this application and sand Thalmo above information is BUILDING FBI, Lir m correct,I agree to comply with all city and county ordinanres had state cow.,ralnttng to QTY. MECHANICAL PERMIT FEF U z buildingmmhouri read hereby eudmrize represenhdive,ofmtsetry mmr enupenmc SEISMIC PPI: abovementloned property for Inspection purposes. PERMIT ISSUANCE (We)agree to save,indemnify and keep hamdess the City of Culren'mo againa ELECTRIC PEE liabilities,judgments,ceelsand ex Ed which may loony way acerucagninstsuid City ALTER OR ADD'10 MRCH. /V in "equence ill the granting oPLUMBING FEE fthis permit. V APPLICANT NO AN !DW PLY WITH ALL NONPOINT AIR HANDLING UNIf(I'O I(I,efNI CFM) MECHANICAL f eE SOURCER-,UL U 5 .O AIR HANDIANG UNIT(OVER IIL000 CVM) CONSTRUCTION TAX nmre)CA acre ntr Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION PEE HAZARDOUS MATERIALS DISCLOSURE Willlhe applrem,trfamre buildn,u,supanl,tore armadillo hvmedoasmalerial HEATING UNIT(TO 100,000 BT U) us defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(0? HEATING ON['f(OVER 100,000 BTUs 0Yes Ll No VENTILATION FAN(SINGLE RCSID) PAID - Dale Receipt Is WIII the ar costa erfurore building by the Btuseequipmenterdeviceswhich emithvmrdde, airconmminanlsnsdefinedbytheBuyArea Air Quality Managmncnl BOILER-COMP(3HP OR 100,00(i 'stria? 'IOTAG ❑Y's ❑Nn BOILER-COMP(OVER 1(1(1,1010 RTU) I have and the Imzvrdnus meertals requimments under Chupter 6.95 of lite Cali- AIR CONDITIONER ISSUANCE DATE fnmia Heahh&S fay Code edion,25505,25533 enJ 25534.1 undctxlund ihntit Ia, NEW RESIDENTIAL MECIL SQ.EL bniidingdogn wnent eatGlasibfe,to not ify the eecnpant eflheen :enuso ort t oat Io Cembe roof Oecnpnney. Dern aulhonzcda 1 � 6 � No TOTAL: ISSUED DY: OFFICE