S 1273 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL. PLRp1`V1TND. 1273
BUILDING DIVISION APPLICATION/PERMIT PLUMING.MECHANICAL
IIUILDINO PROJECT IDRNTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICAI"ION SUBMITTALDATE
sI SEE Belles Pier ( ? - Q
OWNER'S NAME: PIIONl: CONTRAC 'S NAME: LIC NO:
ill1 725-1739. V NIC CONTROLp
. ARCHITEC'CENGINEHR: LIC NO'. AIIDRF,SX ❑
CONTACT: PHONE - BUILDING PERMITINFO
❑ C00sBllant Fees Paid by Applicant(Initial) BLDG ELECT VI.IJMB METH
vail + — vp-z70-670 7 ❑ ❑ ❑ d
LIC17NSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE
I heel,affirm dint 1 an 11111iled ander ,provioor,"I Onto,')(rpin;nellcing JOE DESCRIPTION
D0Z with Section91g10)of Division 3 nfthc Bron,,und Professions Code,ond my license is RESIDENTIAL,
% 1- in full force and eRect. ..II PENMII'ISSUANCI3
QUI'" License Clain C,2-0 Lic.p OV�Y' ❑SFDWI. ❑KITCHIiN REhlODlil.
¢ APPLIANCES-RESIDENTIAL ❑ADDH[ON C1 PLUMBING RE-PIPIT
hU Date d�ennv;r
ARCHI'TECT'S DECIARAfION PANELS ❑MULTLUNIT C1 STRUM URAI.
z Ortiz I understand my plans.shall be used as public records MODIFICATION
Oz
UPTO200AMPS^Q ❑INTERIOR ❑CHIMNIiY REPAIR
�:4F'.W licanned l'nol'assionalsic 201-10y)AMPS IMPROVEMENT ❑SWIMMING POOLS
C C C Q 1 hereby affirm char 1 um kaamp Lfrmn the Contractor.,urn License Law far the OVER 1000AMPS El BATH k1iA10DLIlRIiPA1R ❑DEh101.1'I'ION
S O L U following r.,ma.(Section]031.5•Business,and Professions Cale:Any city or county SIGNS ELECIBICN. ❑OTHER
3 m F which reynll'ca a Permit to cmnmrucl,exec improve,demolish.or repair any sonatas
C¢ prior m its i,c......,als.r retinues lhenpplieint lie,such peanut to fileasigned store;nem SPPAIAh CIRCUIT/MISC.
E }'a that he is licensed pursuant to the provisions ofthe Contmerm's License Law(Chapter 9
01 (commencing with Section 7")or Division 3 of the Business and Praressmrs Code)or TEMP.METERORPOLEINST. COMMrRCIAL'
d W o eL that he Is exumpt thcrd'rom and the basin for the alleged ukeinptlnn.Any violation of ❑NEW BLDG/ADDITION ❑DEM01.1'P ON
.=t, Section 7031.5 by any applicant lin apcoun subjects theapplicam no a civil penally of POWER DEVICES ❑'IENAN'T ❑FOOD SERVICE
nm more than five hundred dollars(55 W).
F Z>' IMPROVEMENT
UOC] 1,as owner nf.M1e property,or my employees with wages as their sole calnpcnsntion, SWIMMING POOL ELECTRIC
willdothe work.andthestm.no,kid inuendcdoroffcrd fnrsule(Sca]Od4,Hnsinesv C3 OTHER
L3 m ;tad Professions CM.: I'he Connucmr'.License Law docs nor apply ,,an owner of OUTLE"rs-SW I'ILHES-PIX"N 1209
property who builds or improve,,thereon,and who does such work himself or through
his awn employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELEi R S
,.It.It.however the hulldingor llupl'ovenrvnt issold within one yrarUfcompielrn,the SQ.FT,FLOOR AREA 5/SQ.FI'.
caner-hailder will have We burden of proving that he did not build nr Ilnprove or pur-
1rou of ealcJ.
F1 as owner,of the property,a exclusively commit ng with licensed venture nor '(OTA..
mmmcl arep,,,eel(Sec.9044,B u,iress amt Professi ons C...-,the Gmmmor'.Li- _ -
nuLawdoe:not apply man nwmrofprmpu0y who mlilds or ilnprnves theeon.and QTY, PLUMBING PERMIT
who contracts forsuch projects with n conrracmr(s)licensed pursuanuo dw Contractors
License I.a, PERMI"1ISSUANCE
❑ lamexemptnnders.. ,R&PCra(lo ,....a
Owner Dare ALER-DRAIN&VENT-WATER IEA) VALUATION
WORKER'S COMPENSATION DECLARATION BACK IlOW PRUIECT.DEVICE
I herchy at Furat ander pcoulry ofpe jury one of tire hollow and declarations:
❑ IM1ave luW will muimain oCerlidcmenfCnnsem to adGinsurc far Workers Campen- DRAINS-FLOOR.RUDE,A REA.CON D. S"DORIES TYPE CONSTRUCTION
ration,as provided for iy Section 37M of the Labor Code.for the pednrmanee of the
..,it for which this permit is issued. FIXTURES-PI?R TRAP
❑ I hast,lend will Inuintaio Work,,Can yen.a for Inmenee,rte egnired by Seelion
390s)of0he LaborCtle,mrthe perlinmurc oflhe work forwhicb thi.permit is issued. GAS-EA.SYS'IHM-I INC.4 OUILHIS OCC.GROUT' ANN
My :�kcrs Co ns ono lnenencc artierlbanldicyPoNlinc.y:,nTWies[
GAS-T:A.SYSTEM OVER 4(EA)aWnr
COMPENSATION INSURANCE
Ok1iASIiIINDUS'IRI.WAS'T'E INTERCEPTOR
BUILDING DIVISION Pli&S
(ATissection need no.Mcompleted ifthe permit isfortune hundmldollars($1004 GR1[ASETRAI' - - -- - -
nr le,,s.1 I'LANCHECK FEE
In,troy shut inlin parli,nouncoof stolework for whichthis the it Wlninsnul,leh a- SEWER-SANI'i'nRY-S'IY)RM EA.201)Fr.
not employ any person in any mnmmr so as m irccmme nuhjea to the Wnrkeci Cnmpen- ENERGY IdiE
•Z turns.Lows of California.Dare WATER HEX]HR W/ EWIELE(]R
O O Applicant GRADING F17E
NDF]CE'IG APPI,ICAN'I:IL idler makill Thin Ccnitiattc til Gxclnl should
.�. g ,i"m Yo'1s WA'1'BIt SYSTEM fl BEATING SOILS Illi?
a , Meome nubjeet m the Workers Contpensction provisions rf rhe Labor Code,yell most
forthwith comply with such powisiom or this pe.it shall be deemed revoked. WATIiR SERVICE
Q CONSTRUCTION LENDING AGENCY NEW RESIDES CAL PI.Mn. SQ.F1', PAID
Ihereby affirn that there I,.constmetion lending ngenc,for he perfmm�mee of O ccipt# '
F1 the work for which this permit is issued(Seo.309'/.Civ,C.)
Lender's Nmne qV
O V Lender:Address TOTAL:
I ecNify thol I have read thin.,heno a and sere Thu.Ne above informntinn is - BUILDING THE s"
;F. rn correct.I agreem c.... with ell city ane canary orinances and sore laws rcladngm QTY. MECHANICAL PERMIT FEE
U , building amstmc.ion.and herchy nmhorix rcpresemmives oRhis city to enterupevt the SIHSMIC FIAT
rI se.merionedproperty for i nspection parpi,e, D
(WO agree Io save•indclunify and keep harmless the City ul Cupertino agaimsl PERMIT ISSUANCE Id.ECTRIC FEE
Iiahilines,judgments,...sand expenses which may in any way attmc against said Ci.y AUTER OR ADD TO MECH.
conmyuence of the granting of this orumt. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR I JANGLING UNIT(10 10.000 CFM) MECHANICAL FEL'
SOL' AR[?GUTA'1'I[ S.
AIR HANDLING UNIT(OVER 10,01X0 CIM) CONSTRUCTION TAX
l-/f:V
Sig m n'e of Applicant/Conlnelur Due EXI MUST 11001)(W/IIUC'Id HOUSING MITIGATION FEE
HAZARDOUS MAI ERIALS DISCLOSURE
Wilithe applirm, fuwre buildingocc,samnoeor handle Initiative.,unamrial HEATING UNIT'CFO 100k0(gl
as defined by the Cupertino Municipal Cada Chapter 9.12,and the Health and Safety
Code,Semon 255320)! HEATING UNIT'(OVER 1110,(1%1 B U)
12 Yet 7N
VEN'1"ELATION FAN(SINGLE RES]D) PAID
Dam Rcceild#
Will the applicant or fume building ny The In nsc Atka
Air Qu nr devices which
clait Distictpur�cros air cnnmmi wore its defined by the Bny Neu Air Quality Mnuugmncnt BOILIiN-COMP ON IINI,IA70 N'I'U)
1 FOIAL:
❑ ❑No BOH.ER-COME'(OVER 1(X,000 B3'U)
I hove read the ha.dolls...."naHr N ceder Chunor 695 of the Cali- AIR CONDITIONER ISSUANCE DATE
yuirommr I
fomia Health&Safety Coda,Sections 25511.5,2.5533 and 255311 understand thin it die NI7W RESIDENTIAL MSCI1. SQ.PH
building does not curendy bases tenant that it is my.,Possibility ars nein( twmcaupant
clthe ri...nems which must to net prior no Lauanen of a Cerificnte of Occupancy.
q !
Owner or amM1orized.,carUse UTAI ISSUED BY: j—)Of
OFFICE