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S0001 B0359 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL. PERMIT NO. O R1111,DING DIVISIO359 N APPLICATION/PERMIT PLUMBING.MECHANICAL SOON) BUILDING.PKOJk U1'Inp turICATION SANI rARY NO. APPLICATION SUITMIITAL.DA'II HUILDING ADDIIBSS ( R'S NAME ('HONE: CONTRACTOR'S NAME: LIC NO: 5--7 Q l �INBti{i- _ NIC CONI'ROLp TT 13sCjl. GINEER: LIC NO: ADDRESS: ❑ "°1� Ate,. ppG HULLOING PL'RMFf INFO ❑ Consultant Pees Paid by Applicant(initial) PLUG ELECT PLUMB SPEECH 2�- E Q' ICENSED CONTRACTORS DECLARA'nON Q'FY. ELECTRIC PERMIT FEE JOB DESCRIPTION I ltcrc nfGnn that I ant Ilrenxcd under pinvasion,el Chaptu 9 Bmnnmencing �a'Z wird Seninn 9gM)1 of Uivisi.nJOl the Business and l'mfa...no,Coe,and mY license is RESIDENTIAL' ups in full force and eRca. PERMIT ISSUANCE ❑SIUWL ❑KITCHI:N REMODEL =Ui, Licca Class Lic.M ,-, ' sad Data-Contrvclnr AI'PLIANCER-RESIDIiNTIAI. OceODITION ❑PLUMBING RE-PII'li ARCHI'FECpS DECLARATION PANELS ❑MUCI'h UNIT' ❑STRUC'TIIRAO Z Iunderxwnd myplamshull M meJaxpublic records MODIFICATION UP 10 2IXIAMPS Z 7i ❑INTERIOR ❑CIIIMNIiV REPAIR 91-W Licensed Pmlcssicaal 2014000AMPS IMPROVEMHN'1E]SWIMMINGPOOLS OWNIEWHUILDER DECLARATIONOVER 1003 AMPS ❑HATI I REMODEIIREFAIR El DEMOLITION X WI hm ereby anion Ihol 1 acxumpt Imm the Conmaaor's License Law for the 6U following renxnn.(Sccdna 703 1.5,limn,and Professions Code:Any city m county SIGNS ELECTRICAL O'TI ILR W N which requires a permit to construct,alter,improve,demolish or repair any suunuce �0< prion.its iw aa,x.alsn requires lhe.pplicnnt for such permit In file.signed staemeat SPECIAL CIRCO[TIM ISC. 3y that ha is licensed purnumot to theprovisnms al'be Cannan-ab.License Law fChaPur 9 OMM R IA rp0 (commencing with Sreti.nV(NNB of Division Jof the Business and Pmfessi.ns CIA)or TRMIt METER OR POLE INST. y ea ,hill he is exempt Ihetclr.m and the basis for the alleged exemption.Any violation of ❑NEW 6LDGIADUITION ❑UENIOLIE]ON km1+. Serino 9031.5 by any applicant fora permit subjects the applicant)a civil penalty of POWER DEVICES ❑TENANT FOOD SERVICE ll�rn not more than live hundred dollurs($5W1. IMPROVEMENT -ZQ []has owncrof Ne propcny..r my employees with wages us their sok wmpensaion, S I ING PDOL IiLf:CTRIC will lathe work,and musuaaurc is not intended or o0'crc70W.d forsale(Nor.7 .Business ❑OTHER �[sw and Prufesioa,Code'[he Contract-,License Law door not apply to un owner of OIITLL?TS-SW1'T'HES-PIX'fURES Y popery who builds nr improves there..,and who roes such work himself Or through his awn employees,providedvideJ that such untsmvemene,are not intended or offered for NEW REMDGNTIAL ELECTS SQ FT SQ,FT FLOOR AREA VSQ.14. sale If,however the banding..nufunwement is sold within ane .cut corodcrion.Ihe usener Wilder will have the burden of proving Nal he did not build or improve for pur- ^ e-s mne.fmle.). l(�r 17 6S ❑ I.as Owner of the property,.am exclusively contracting with Recused contractors In I c.nxwct me pmjml ISce.9194.Ba,mo,s and Profcsxiona cod.:)The Convvemrs l i- Om.lawdonsnot apply 1. amoner of property who builds or improves thereon.and Q'I'Y. PLUMBING PERMIT PEE wnocnnoacls forsuch project,with a ennum, I(,)licensed pursuant m the Common v Limnnc Law. PERMIT ISSUANCE /U 1 am exempt under Sec. .H&PC for this mason ALTER-DKA VENT-WAT13R(IIA) VALUATION ,. pale - Z a a WIiun&rSCOMofNrjuON UECLARA'1'LON PACK PLO OTIiC'I'.DEVIG1i 1 rand will mai under penalty oe perjury One of Nc hdlowingW lamlrkIc%Co cave and will maintain aCenificam of Cnnumin self-inmrcfor Wnrkcrs Compen- DRAINS-Fol.(m '.ARI: C(INU. ST(IKIP_S 'I'V PE CONSI'RUCI'10 us pmvideJ far by Section 390(1 nl'the Lalea Code,lin the perhnmanw of the nkfm Nvbiah this Permit ix issued. 1X'IURES-I'ERTR ' -Z© O 1 have and will maintain Workers Compensation Insurance,as required by Section GAS-EA.SYSTEM IN . UTLETS 791m ofthe Labra Codc,for the perNmnance of Inc work for which Nis permiltxisxucd. (ICC.�.fR)Up s va APN�� My Worker'aCompensation Insurance confer and Policy number are: GAS-EA.SYSTEISFOV 4H. Y//y`\/ � SU Cartier. POlicY NO.: 2 CERTI PICAI'E OF EXLM Pr10N FROM WORKERS' GREASFIINDUSTRL.WASTE'MiTERCEPTOR COMPENSATION INSURANCEBUILDING DIVISION FEES (This section need nor bccomplebalBNe Pemlh is for one hundreddollars($100) GRPASETRAP PLANCHECK FFE (f lam any lhm in in anymom;mccoftheworkf re,abcef to the Workers pen-,hall SEWIiR-SANITARY-STORM HA.2tX)IT ENERGY PLr Z� not employ any person in anylnanner so.,to bcennre nubjst w the WOrkcls Cmtps:n- Z .Nation Lawsof Califomia.Dam WATER HENHER W/VENTIELECTR GRADING ' OO ApPlicam t N(YfICI?'I )APPLICANT:If,antro making this Ccnitiattn of ExcmPlion,Yun should WA'I'I:R SYS'FEMnREAHNG SOILS ITT 'a subject m IM Workers Compensmion Nookiuns of the"Nor Code.you man W ti hmhwiN comply with such provisions Or this permit shall the seemed revoked. WATER SERVICE PAID 7 Z CONSI'RUCfION 1.13NDING AGENCY NEW RESIDENTIAL 1'LMB. SQ.FnPAIDReceipt q U O I herebyafhnplhauhemis.urmnnotion leadingenc agy for the perfamence Of D. Pthe work to,,which tbix pemtit is issued Bice.NAP.Civ.C.) T L: IsnJce,Name \ U Lenders Address I I. {TJ BUILDING PP 1 comfy that 1 have real this application and state that the above information is i [aq a rrcn.I agree In co.nply with oil city and manly inicancesand Nmm laws relating to QTY MECHANICAL PERMIT FEE SEISMIC FF:. f Z O U building construction.and hereby autharite representatives of this city m enter upon the abase-mcminned pmpcny for inspcni.n Puryoscs. PERMIT ISSUANCE ELE R Flit 0 S (Wo)agrcc to save,inecmniI,I i keep harmless the City of Cuper inn against liuhilido.ludgmenln,ones vnA expanses which stay in anY wuY ou'nre against said City AhI'RR OR ADD ID MECII. ( PLUMB Glib API.ICuencc ofthekSTANof ANpemtit. APPLICANT LINn1iRSTANBS AND VILL COMPLY WITH ALL,NON-POINT AIR HANDLING UNITITOIO,INI(E CFM) M1fECHAN ALIT[ .SOURCE -GULAI'IONS. 7 AIR HANDLING ONE I'(OVEI110,lNNECFM) CONST ICTIONTA% Si• d l ApplicanVCamna,ba Dae EXHAUST IIOOD OODUCD HOUSING 11'1'R',AT10N PEE HAZARDOUS MAA ERIAIS DISCLOSURE Willtheapplieent ortomre building coantemnnre Or handle hamNous material HEATING UNIT(10 100.000 It I'U) m dclined by the Cupenino Municipal Code,Chapter 9.12,and the Health and Safety (EATING UNIT(OVER I01,00(E RTU) Cade,Section 25532(n)V E)Yes INYn" VENTILATION FAN(SINGLE RESIDE PAU) Dae Receipt a Will the upplicantm tuune buildingoeeupunl use eynipan, nr devices which BOILER-COMP(311POR 00,INN)Ifl'U) nit hamNous air conmmdnants as dchned by the Hay Arca Air Quality Management 'I I' ri.1,110? 11011 -COMP(OVER IOB.IXX)BTU) ❑Yes L< AIR CONDH IONiili ISSUANCIi DATE 1 have read the hmndous materials requirarrnnu under Chapter 6,95 of the Cali- fornia Be dth&Svfey Code 'cc 25 5.25537 and 25534.I understand that if the NIiW RHSLDENTIAL tool SQ.FC �® hnildingd s not camenlly have amnan Ir his niymepenxihil fly,,main,mars,,upant M I n: sato%which must Lie me ' r et issd ace nl n C mfrea of Ocaupursy. or in .gent D m A ISSUED BY: OFFICE