99120020APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
OFFICE
CFPY OF CUPERTINO BUILDING - ELECTRICAL
PERMIT NO.
BIIILDING DIVISION APPLICATIONIFERMIT PLUMBING - MECHANICAL
BUILDING PROJECT IUF,NTIFICATION
BUILDING ADDRESS:
SANITARY NO.
APP 1 AL DAT]
N2_0 1)u _h rJ A- 9 51)
XN SNAMF,: P ONE: NIRA
l' .�riod
5C
hinipUtipLHITECTM
O SNAMIi: LIC NO:
NIC
❑
CONTROi
INFER: LIC NO'. UURB.'S:
611 Aw-
COMPACT: PHONE.
BUIIAING PERMIT INFO
❑ COnSUIBBIt Fist Paid by Applicant(initial)
BLDG ELECT PLUMB "R
1:1 1--]0 711�XI(�
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT ITEE
1 hCtid,y STM.... in, 1 hitt licensed under provisions of chapter 9 (Commencing
JOB DESCRIPTION
300
with Scroll.7(XXf.f Dlvlslon 3 oDhe Businem and Prufm.lons Calc and my license is
RESIDENTIAL:
q W r
W F•
in PERMIT ISSUANCE
full (..reel, force a c /
❑ SFD W I. E3 KITCHEN REMODEL
UU
-J
ss •
limns ].I,.It APPLIANCES-RESIDG'I'IAL
El ADDITION ❑ PLUMBING RHTIPE
O Q µ6I
Uale Camoem _
ARCHITECT'S DECLARATION
❑MULTI -UNIT [I STRUCTURAL
,pm
PANELS
IunJccaund my Plan. shill be used as puMlc mord.
MODIFI
MODIFICATION
UI' TO ZIXI AMPS
❑INTERIOR ❑S CHIMNEY REPAIR
Licence)Profnsional 201d0IX1AMPS
IMPROVEMENT
(IWNIik-I3UILUITR UECLARAI'IUN OVER IINXIAMI'S
DEMOLITIONPOOLS
(]BATH RfiM0 li1,IRPa'AIR ❑DEMOLITION
dw
d 6
I hereby affirm that I ma esemp four the Comowloi License Law it,, the
(] OTHEk
i i U
following crown. (Section 7031.5, Business and Professions CnJe: Any city or county SIGNS ELECTRICAL-
q. y
whim WgmWa Ti venal to ...... uu.t, aper. improve. demtoH.h, or repair Tiny structure
-
•
Eric, to it,Eco requirC, the applicantfor such tw hu r. le signed statement SPECIAL Cl RCUI'1'IMISC.
;Y
that he is licensed Pmium .,he p ns ofth Courtrai LicLio, Chapter
COMMERCIAL'
/ ¢
,QO
(cot b With uo ]111X11 fU n T t theB .can l l f -Code) or TEMP MI: TER OR POLE INST.
u
on
5
that is exempt therelrom and the b
P osis for the alleged exemption. Any violation of
❑ NEW BLDGIADDITION ❑ DEMOLITION
c
^LL
Section ]031.5 by any applicant far a pemtit object, Ne applicant to a civil Penalty of POWER DEVICES
❑TENANT ❑ Fool) SERVICE
N
of marc than Eva ho used donor. (850).
IMPROVEMENT
^
'.SQp
❑I, as owner f the propery.a my employees with wages as their sale contpen.ation. SWIMMING POOL ELEC TRIC
will do the work, and the structure is not intended or offered for sale Not 7044. Business
TER
03
and P t...i rt, Code:'I he Connamnr's Licence law Joos nut apply o, an owner of UUThFTS-SWITCHES -PI%TURES49.4
1
property who builds or improves thereon, and who docs such work himself or though
his own employee., Provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECTR SQ FT.
FT. Fl,OOR AREA
ESQ. FT.
sale. IC however, the building or improvement is sold within one your o.Y^ntpiniom one
msua-builder will have the burden of proving that he did not build or improve for pur-
pose of sale). TOTAL:
El I, as owner III the proper0, urn exalu lVely cnnu'n.iing with Ilceired a,ntmdnre to
construct the project (Sac. 7044, Business and Porlescinns Cade) The Contrao, nr's o.,
Cease Law does not apply to an owner of property who builds or improves thereon. ad QTY. PLUMBING PERMIT FEE
whn.amracts for such project. with a contiacmas) llccoWd pursuanuo the Contrucmr's
Licence law. PERMIT ISSUANCE
n I am exempt under Sec. . R & P C fill this reason
Ah1'ER - DRAIN & VENT -WATER (EA)
VALUAI'IUN
act Date
WORKER'S COMPENSATION DECLARATION BACK FLOW PRI7TF.CT. DEVICE
O
1 nacrbyanlnttander Penalty of,fCouyonCut tiffnnuwlor decWorke Coo
(�
❑Inm'e Cen37,1e.f Co DRAINS - PLOOH. ROOh,ARISA. GOND.
epeffocr'res,of
STORIES
TYPE CONSTRUCTION
Latmor ore, for he
e 3J(XI of the Labor Gde, for the petli,rmonce of the
Toosidlru..h, Section
,loan, as provided for M1y
work far ,Lich this acinar is issued. PIXTUNIiS - PER 'I'RAP
I, i...
1 have and will maintain WndefCompensation frequired by Section
OCC GROUP �
APN
3700 ofte labor Code, Performtunce of thwork for Whichthis aerator is issued. GAS - EA. SYSTWI-I INC. JOUTLETS
Xh
A1Y Wnrker'� Ixa io "'nonce cam"ou Vco"T GAS -fiA. SYS] liM-0VIik4 TA)
Cama {�eG1LL!_Prdicy
RO
CER"1111CA'I'Ii OFEi%EM11PPolic FROM WORKIiR$' GRGASDINDUSTRL WASTE INTERCEPTOR
BUILDING DIVISION FEES
COMPENSAI ION INSURANCE
(This section stood not heeourpleted ifthe Permit is (no-one hundred dollars(SIW) GREASE TRAP
..r IcnsJ
PLANCHECK FZfi
I certify that In the perk,rmmtaol'The Work for which tors Permit is issued. I shallSIiWER-SANI'T'ARY-S'IORMIiA. 2001TE.
ENERGY HIT
not employ any perm in any manner so as to become subject to the Workers' Cnmpen-
w
Z
Z
s,,act Law.of California. Date WATER HEATER WNENTIELECTR
APplicam
GRADING FEE
Z
NOTICF, TO APPLICANT: If. aRcr making this Cenificale of Focmption, you should WATER SYSTEI IG7REA7"ING
SOILS FFP.
a' 7
becomwhat to the Workois Camlxn,unn provisions of the Labor Cala you must
e
to ith comply withsuch provisions or this permitshall he doctored revoked WATER SERVICE
PAID
CONS'TRUCT'ION LENDING AGENCY NEW RESIDENTIAL PCMB. SQ. FT.
Date Recaptp
UO
1herchy effimslhot here is a comtmctilm lending agency loathe performuneeor
I � ��
�/' TOTAL
U. F
the work for which this,.it is issued (Sec. 30111 Civ. C.)
Leaded Name
Q U
,r
TOTA
Lender's Address h;
IL1, FEE J _U U
Int
I « nify that I have mad this application and stale that the above information is
y
F.N
BU .
SHISM�ICP
collect. l agme to comply with:dl city andcounty ordi..ma. and ,are laws relating t. QTY. MECHANICAL PERMIT FEE
U Z
mildingconaomion. and hereby authorise repmecmatives of di,cay io cnofupol he
above mentioned property for inspection purpows. PERMIT' ISSUANCE
I
EI,k�4"1 RIC FEE
(We) ogoe to save, indemnify and keep harmless the City of Cupcnina against
PEUMBING FEE
Ilabllaica,judgmentacasts mrd cxpolow, whicbmay in any Way nerve against said Cit., ALLIES OR ADD DOMUCH.
in consequence of the granting of this permit.
MECHAMCACIq:E��-
APPLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT AIR HANDLING UNIT (TO 10,0k) CFMI
SOURCE GULATIO@S.
_
�i �� /ZZ -99 AIR HANDLING UNIT (OVER IB.pXI CFM)
CONSTRUCTION TAX
Signomre of Applicant Contractor Date EXHAUSTHOOD(W/UUCf)
HOUSING MITIGA'T'ION PITC
HAZARDOUS MATERIALS DISCLOSURE
W lB me upt icons or mom buildmg oecnPam stoat or bundle narurdous material IIGATI NO UNIT (TO 100,000 BtV)
as defined by the Capetian. Mai Cock. Chapter 9.12, and the Health and Safety
Code. Section 25532(al^ HEATING UNIT (OVER 100.000 BTU)
{
❑Yes ❑No
VEN'I'I LATION FAN (SINGLE RITSID)
YAIU
Date Receipt It
use equipment or devices which BOILER -COMP CHP OR 101i BTU)
Will the applicant or future building by
the he Bt
it hurarJuus air comninuc us ddincA by xy Arca Air Quality Munucnt
mmm
TOTAL:
District! BOILER - COME (OVER 100.000 BTU)
C3Yes r-) No
1 have real the hmaust malaid.], requirements under Chapter 6.95 of the Cali- AIR CONDITIONER
ISSUANCE DATE
formal health & Safety Code, Sections 25505. 25533 and 25534. 1 understand that tithe NEW RESIDENTIAL MF,CH. SQ. E.
bullJlogt not Conically nave a Waaot, that it is my resp.nsinlliry , ao0fymetecum'm
) —2/
/
a
ill there ¢nu which mus t i rare al Cc Beate of OC Fancy.
/T
e
;� r�oC1 %2-2-99
--�
ISSUED BY: 1
O moon loge..] Datf TOTAL:
OFFICE