B 0213APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL
BUILDING DIVISION APPLICATION/PFRMIT PLUMRING.MFCHAN
BUILDING PROJEMPIDENOMI-111TION
P U R M I T Nq�
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HHLDIhG ADDRESS
SAN] IARY N
APPLICATION SUBMITFAI, DATE
.3110679 pucit.Le DRI�IF (),Up C �L I 114 0 og. 950 ILI
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!NER S NAME. PHONE
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CONTRACTUR'S NAME: LIC NO
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CHITEC"VENGINEER: PIC NO:
ADDRESS: -
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CONTACT, PHONE
BUILDING PERMIT INFO
E Consultant Fees Paid by Application (initial)
BLDG ,-r.LFCI PLUMB MECH
VOO L M E TA I CqoS)ALIS-0-97
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LICENSED CONTRACTOR'S DECLARATION
I hereby tiffin. that I .,It licensed ad,, mmisimi Cluman, 9 femprachoing,
with Section 7000) ofDivisims 3,,Fthc Easiness and Professions Care. and in, license is
in full forcrandeffeeet. a Cis 7C
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�Jmc c Clu��� L c. to
),om. C:uouractor
QTY ELECTRIC ERMiT
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JOB DESCRIPTION
RESIDENTIAL
EISFDWL El KITCHrIT4 REMODEL
0 ADDI PION 0 PLUMBING RE -PIPE
DMULTI-UNIF El STRUCTURAL
MDDiFEcxrEON
[I INTERIOR El Cl ININEY REPAIR
IMPROVEMENT SWIMMING K)OLS
[I HAI If REMODFUREPAIR LI DEMOIA1 ION
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PERIOD ISSUANC17
A PPLIANCHS - RESIDENTIAL
ARCHITECTS DECLARATION
I understand my plans shall No, used as public records
PANELS
UPTO 200 AMPS
Accrowd Professional
OWNER-HUILDER DECLARATION
I hereby affirrom that I am exempt Down the Contractor's License Law for the
It ma ... 0, (Section 7031.5. and Profe.itan, Codd: Apy liaor Inum,
which imparm, a parardit to construct, tolte, improve, demolish, ., roped, a, viaticums,
201.1000AMPS
OVER ]Bud AMPS
SIGNSELDCHRICAL
SPECIAL CIRcurryodisc.
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fall as
prima, its i ..... ce,rdso ociptiorm,, dicip,licarrat pa,ach prannitur file signed statement
itiatheislicensMpur�uanitollieprovisi(iii�ofiheContmeto(sLicen�el.aw(Chapler9
that he is escrapt therefor. and the basis Car the allOsed eruption. An, iiii.tion at
Serbian 7031.5 by a, pplictint far. premou subjects thic.pplasout it,. civil Penalty of
I room than five hundred dollars ($500)
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iU dit,he w.,k,..d the toduchom, is not, imendedo,offered for We Sec. 704,1. Business
and P Erosion, C ... It: The Contractor's LiccVw Law due, Out apply Ine. ouno,of
,Tdry, who Inflid,or unpoovol docusab ad is ho does such work IunnwIf.r Ilanm,h
TEMP MIUHR OR POLE
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COMWRCIAI.
D NFWBLDG/ADDITION 0 DEMOLITION
EITENANT El 1700D SERVICE
IMPROVEMENT
El OTHER
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I'Dwint DEVICES
SWIMMING PDOXLECTRIC
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OUTLETS PUT ll;S - FIX I OR
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his own tangloyce.i. provided that such improvements am not intended or offered for
sale, If, theovean, the Imilboo,o, inapiewo cont is old within are,,- _J 11 1-
NEW R/IDENTIAL ELECV SQ
SQ. FT. FLUOR AREA
$JSQ, ITTr
ov, i Idei wil I have the Pan der, (if provi ng that lie did not build or 1 ropme, un Par-
10
usam,ef'.1od,
0 1, as mone, of th. "uperl'. am clusively caribuctim, with licensed cofounders in
1z IDEAL
construct the pmjcci (Sec. 7044, Business and Profittions Cralt,) The Contractor's Li
comic Lt. be, m,I apply 1. a mume, of mFoarty who doold,o, opposes theremi,and
QTY. PI,UMH3IN(I PERMIT
who contracts for such pulgets is ith a compectods) licensed pursuant to the Contractm's
PERMIT ISSUANCE
License Law.
0 1 ent ses"Itande, Sce. —, 13 & 11 C on, th a .... )a
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ALTER - DRAIN A, VINE'- WIT"
40
Date
WORKER S COMPENSATION DECLARATION
1 horch, offina code, pronlyal podit, mom iddic following declarronsion,:
VALUATION
BACK FLOW PROTECT DEVICE
—
DRAINS - FLOOR, ROOF AREA. COND
I Intv.mod will maintain 1. self -i ... refiaWoriker'sCiumpi
stairs., a provided f by Section 3700of the Lodru Coal., for Ow prafforrani of the
STORIES
.11 YEE CONS IRUCPION
—
work for which this wrinut 1 s issued.
FTXr11URES - PER TRAP
0 1 have and will maintain Worker's Comminuation Insurance, as required by Section
—
37M afthe Loolaw Code. for the perfindeparrice ame swrk far .1hich this and, is issued.
GAS - EA. SYTHEM-1 INC. 4 OLPIAS
OCC. GROUP
AIN
M,W 1xi', C mi, I .are carri , and Policy, ..other am
Carrier znj " 2- �� Policy Not,: — v,.- o R z? - D
GAS - BA. SYSI EM-OVIR 4/�,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
low.) (TH',ided 0 cod a,,, be "andileted it the purnal is ori hardood dollars S 100)
GRIIASMNDOSTRL WAY4)11��WCEPTOR
HUNADING DIVISION 171; S
GREASETRAP , Z a
PLANCHECKFE-H. rA
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SEWER- 1�1 Y -STOR . 72(on UP.
I certify Beat in the performance ofthe work for which this ponamil is issued, I shall
act dmIo, on, ,air in itaynomi to memom omovel u, the W tons' C .... For-
E PHE
NERGY
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WATERHEV�P,��ENV NTALECT�
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salionLawsofCaliturnia, Date
Applicant 0
GRADING FEE 'V
NOTICE TO APPLICANT If, after making this Certificate of Exemption, you should
m,ona, uhircro, (too Worker', Counporivairat ...... on, if ho Lrbau Code, You boost
forthwith comply with such provisions (it this parromt shall the deemed revoked.
CONSI RUCTION LENDING AGENCY
............ . ..
the work far which flum pactionat is i ... Od (See 3097. Cie. C.)
Lenders Name
WATER S FXTIN94
SOILS FEE v
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WAFIK( SERVICE 1!I,
PAID
Phil R,.i,t#
/W RESIDENTIAL PLMB. SQ, EF
TOTAL:
Lrm1,,,Ar1dm,,
I GIAL,
BUILDING FEE
I certify that I have paid this ... Hendon ad state that the Am,c nomination I,
commet. I agree to comply viiii, all city and county ordinances and puthe laws platingnO
buildia,c i,anuedon,and hccby roult 'em,em"alati,cs ,I On"i, " mile'tiOnan the
QTY. MECHANICAL PERMIT FEE
—
SEISMIC FEE
PERMIT ISSUANCE
ELECTRIC FEE
above mentioned property, for inspection parmsses,
(We) agree to save, indemnify and keep h..Ic,s,hc City mfCtopmrip. .,.just
ALTER OR ADD TO MECIL
I
liabilities, judgments, rods and expenses which may inary way accome agniam said City
in corac,amwe of the i this pernia.
AIR HANDLING UNIT CEO Hyj0bCFM)
M17CHANICAL FFE
I
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
AIR I ANDLING ON] P(OVER BfEbB CF
CONSTRUCTION I AS
711196
Date
HA�RPDOUS MATERIALS DISCLOSURE
EXHAUST HOOD PWMUCT)
I JOUSING MTTIGAI ION THE
BEAT ING UNI I CI 0 100,00a [I J)
Will (in. oplibmans fatum hombba,00ddstal suarsor handle ha,.ortl... ounnod.1
as defined by the Cuperano Municipal Coke. Chapter 9.12, and de, Health and Safety
PAID
Dan, Rencip, It
I Cede. Section �53200?
El Yea No
Will he applicant no future building occupant use Orpouproandind or devices so hich
�,r
,,,air he ... do., air comaini ... 1, a, dona,d by the [toy A. Air QupN(y Management
Districts
E) Yes 1-1 No
HEATING LINE r (OVER POPE)
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VENU ELATION FA �/NGLE RESIG,
IHALER - COM/31111 OR 100.000 BTU)
1"14� ) 7
BOILER -/MP (OVER 100,0(XI BTID
AIR /_DTTIONER
1 have read the moodeas neacrials mquirentants . undei Chapter 6.95 of (lie Cah-
ISSUANCE DAT17
—
N RESIDENTIAL METAL SQ. FE
fornin Health & Safety Code, Seddora 25505. �533 and 25534. 1 understand thet it the
building does not currently have a mrson, that it is my mspordediality to notify the occupant
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of the mquireari Far, In i"mmi 'if. Coot ficate of Occupancy
4ha��Oarad
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Is
ISSUED BY. I A
Uvancr�uummumilrigatin Dan,
TOTAL:
OFFICE