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B 0483 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILTNG-ELECTRICAL PERMI'TNO 0 4 8 3 BUILDING DIVISION APPLICATION/PERMIT DING P OJECTID MECHANICAL 50001 BUILDING PROJECT IDEN'1'IRICATION BUIIpINNGAD)RIISS. SANITARY NO. APPLICATION SUBMI'TI'AL DATE ff 0� Jciin F(-JIPQ—RA PH,.O�N}E: ^ COM ALTuk'S N -ny1tE CN(I: �J Q �-k (uSr�o�f11N HC% NIC CON'I'Rol.p �ARCHL'IECTIENGINEER: LIC NO: ADDRESS: ❑ t CONTACT: II� q�PHONE: - BUILDING PL"RMIT INFO a'LiSRo'm� ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB M1uicH LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE I hereby alarm Ih:n 1 am licensed under provisions of chapter 9(cooperating .LOB DESCRIPTION MXZ with StamormAEbnf Uivislon9ufthc Baslnessaod P..colors Csde.and my heonso'r, RESIDENTIAL; 6100 w PIik MII'ISSUANCB F 6jF In full horrand elke. ❑SFDWL ❑KI'I'Cl B:N REMODEL �UU Limo Class Lic.N APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING BE PIPE F�w Date Cmatmetor N7h ARCHITECTS DECLARATION PANTilS ❑MULTI-UNIT ❑STRUCTURAL z O H Z 1 understand my plans Stoll he nsW an public records MODII'ICA'DON O z"O Oil F02WAMPS [I INTERIOR 0 Cl IIMNIiY REPAIR -�,r/✓I ad Licersed Pnafe'dine.l 201-I01BAMPS IMPROVEMENT E]SWIMMINGPOOIS OWNER-BUILDER DECLARATION OVER I(MAMPS ❑RATH REMOUEIJREPAIR ❑DEM01.1'I']ON a I hereby affirm that I am eaempl from the Contractors License Low f the 20 a U following reason.ISmion]tU 1.5.Haziness and Professions Code: ny city nr c my SIGNS ELECTRICAL OTHER 6 3 w H which requires a permit m consauct aper,improve,demolish.n y swc F�Oa prior mits issuance,elsnm ircslhc applicam for su penni mfr am memem SPECIAL CIRCUIT/MISE. E�} Ihwhtislicensedpmmecal IhepmvisionzoftheC tar. Litt s 'w( a"I'l) �yL�� Icommeneingwith Sectio "Etif Division3ofthe as a dl's sziom Cnje)nr 'TEMP.METER OR POLE INST. COMMERCIAL: 0.a C that he is exempt Iheref to and the basis r flue aIle ed ess ion. ny violation of ❑NEW BLDG/ADDITION ❑DIiM01.1'I'ION rn Seativn703156yany plicantforapermit objects a applicamm a civil For of POWER DEVICES = n more than five hu red dollars(4 I. El TENANT ❑FOODSERVICE SG ❑ I,vownernfth• ropery,orm employee ithw es v their sole compensation, SWIMMING POOL ELECTRIC IMPROVEMENT will do work.a thenmmu not intended offeredfor sale(Sec.]utas Huniness El OTHER 3 m and Professions Cs C meter's License Law does not apply m an owner of OUTLETS-SWT1'CUTS-FIXTURES property who builds tar lmpr cs thereon,and who dons such work himself or through hit awn employees,provide m,such improvements me act pleaded or offered Inc NI7W RP_SIDENTIAL ELECTR SQ I'L sale.If,hawcvcr.the haddingn it issold within one yeaill'of cmnpinion,the SQ.1'T.FLOOR AREA $INA.I'1'. er-builder will hove dw bur en of proving that he did not build or Intpmve lin pnr- e o L v owner of dm pnapany,um Business contracting with Ilecnee-amactorN m 'I'OIAL: mx0um the prgjcet IScc.]M6,owner oss and Professions ds ori provesnhemon, - cmtsnLawdoesmolapplymnnnwnerofpropeeswho cerandd+rnmema,vea Clacru.tuN QTY. PLUMBINGPERMIT PEE who umtmms fur such pmjwts with a conuaetoKs)licensed pursuant Ia the Cnnnucmrs License Law. PERMIT ISSUANCE ❑Imre ti�Sec .B X PEC farihiz rensnn �J Ovvnrcscatn10. o, ALTER-DRAIN&VENT-WATER(EA) / VALUATION W tKF.R'S COMPENSATION DECLARATION HACK FLOW PROTEA DEVICE. © © a• (1 ryemby of tam under penalty of perjury one of the following Jealandfus: O ❑IheveanJ will maimaino CenlficamofComsennn self-insure fur Workers Canteen- BRAINS-FLOOR,ROOF,AREA,COND' S DRIES TYPECONSTRUCfION section,as provided for by Section 37W of the labor Code.for the performance of the work for which this permit is issued. FIXTURES-PER TRAP 1 have and will maintain Workers Compensation Insurance,as required by lection 37W of the Lot Code,for the performance of the work for whichthis Permit is issued. GAS-P.SYSTEM-I INC.S OUTLET'S OCC.GROUP r /n1'N My Workers Compensation Insurance carrier and Policy number me: � TL yY Cartier. Policy No.: GAS-EA.SYSTEM-OVER Y jI?A)���':L 1 K CERTIFICATE Oh EXEMPTION FROM WORKERS' GRF.ASPIINUUSTRI.WAST"INTI: I?YIOo COMPENSATION INSURANCE BUILDING DIVISION Il ?LS (This section need not be wmpletrd if the permit is for one hundred dollars is 1End GREASETRAP nr less) ( %,`i .ANCHECK FEE I cent fy tint In the Peru orman.vofpm work for whichthis permit is issued,Ishill SEWER-SAN[TARY-S!FORMEAra1NIPl'. + .in employ any ,,at in any ernnner sn.4 to become object In tire Workers'Canteen- I? F.RGY PEE Z cation Ltweaf Gdiforniu.Date WA1'17R HEATER W/VF.N/LiLI?C'I'R O \ DING FEE 7 Applicant G 1w,ame?obj APPLICANT:IL Commakingnprvisionsofof Bxentptinn, .yon.should WATER SYS'PEMITREATI G H � hccmno suhjua m Om Workcr'n Compensation provisions n[the Talhnr Cndc,you must SOILS FEE W Q forthwith cam I with such nmisinns or this aL fly 1 perms shall be decmW revoked, WATER SP,RVICE - G CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL TIME. ++ SQ,FU PAID U z 6 c Receipt p V (forherrhyliffirrinwhich thatthem kaco(Sol.on len ding agency Rothe peHnnnance of F the work for which this permit is issue)(Sol.3119],Civ.C.) V. LanJch Name TO'1'A L: U La tier's Addrev 'TOTAL: 7 1 eerily that I have mad this application and state that the aMwe inhumation is BLIILDTN E F' h correct.l agreem comply witha[]city and county rich noncea and out laws ishougm 0QTY. MECHANICAL PERMIT PEC Z building construction,and hereby msemupon nhorize mpreatives of this city to enter un the SEISMIC FE shiner.mentioned pnapeny far reflection purposes. PERMIT ISSUANCE (Wc)agree to save,indemnify and keep harmless Ne City of Cupertino aEainat ELECTRIC E liabilities,judgments,entsaad exparees which may in any way ocrnc against said City ALTER OR ADD TO MECH. consequencein of the ganting rof this permit PLUMBING APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000CFM) SOUR :GEILAI'10 S. MECHANICAL.FEE 5 � ClIet AIR HANDLING UNIT(OVER 10,000 CEM) CONNTRULTION'fA% SiganihmAjd3ppliounalContraclor Duro EXHAUST HOOD(WMUCID HOUSING MITIGATION FEL? HAZARDOUS MATERIALS DISCLOSURE Will the applicant ar linnre hurtling occupant store or handle haeunlans material I(EATING UNIT(TO 100,000 B U) as fit total by the Cuperano Mwticipal Crate,Chapter 9.12,and the Health mal Sancty Cndc,Norman 25532(I)? /A1,. 1117ATING UNIT(OVER 100,000]if Cl e Ycx NZ PAID VIiNTI1.AT10N PAN(SINGLE RP.SID) Date RecciptX Will the applicant or future building occupant use equipment or devices which BOILER-COMP(3HP OR IIXLII(gl B'TU) emit haznNons air nmtaminanta as defined by the Bay Area Air Quality Management TOTAL-: District? BOILER ❑Yes AIRCO DMONECOME OVER IW.IIBn BTU) I have real the hazanlom materials requirements under Chapter 6,95 of the Cali- AIR CONDITIONER ISSUANCE DATE folia Health k Safety Ede,Sections 25505.25533 and 2553).T understand that if the NEW REMDENTTAL MECH, SQ.FTE building does not clammily have a tenant,that it is my responsibilitym notify the accupent ofthemq ' is whichissuance ofd Cenifieste of OclaInum. V'cL-t e m o 3 ' Owne remhnnx agent Date TOTAL: ISSUED BY: OFFICE