B 0395 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PL'RMIH NO 3 9 5
BUILDING DIVISION APPIACATI0N/PERMIT PLUMBING-MECHANICAL 50001
RUILDIN'G PROJECT[DRNIAFICA1'TON
RUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL UATI
zh� 3sc� r� S_ 13-99
tOWN[RIS NAME: IRIGNE: ;�PQV{�TRAC I OR'S NAME: LIC NG.
IL 2 9t0 rvrc CDN'IltoLw
i
AR'l II'I'ECfrBNGINEE LIC NII: ADDKII. ': ❑
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CONTACT: PRONE: BUILDING PERMIT INFO
--061
E:1 Consultant Fees Paid by Applicant(Initial) pO EIP❑CI' PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMiP FEE rLL�JJ{
1 hereby affirm that I am IicenseA under pmviaions of Chapter 9(commencing JOB DESCRIPTION
9ZaZ with Scram]000)of Division 3 of the litumesstnd Professions Code,and my license is RESIDENTIAL:
WC, m PERMIT ISSUANCE
Fly full farce and effect. ❑SPOWL ❑KITCHEN REMODEL
�U License Class Lic.N AI'I'LIANCIiS-RESIDENTIAL ❑ADDITION 2 , ING RE-PIPIT
(r Z Data Contmnnr
FDcat, ARCIVI'EC'I'S DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL
Z O ttiti Z 1 understand my plans shall Ie used as public records MODIFICATION
UP 10200 PS AM
OZF-`� C1 INTERIOR ❑CHIMNEY REPAIR
F"tnF-W Licensed Professional 201-I00AMPS IMPROVEMENT SWIMMING POOLS
; OWNER BUILDER DECLARATION OVER Pro)AMPS
❑BATH REMODELIREPAIR ❑DEMOLITION
C al Q I hereby affirm that 1 am exempt from the Commemis License law for the
K3 aU fallowing (Section 7031.5.H artiness and Prefibaam Cale:Any city or county SIGNS ELECTRICAL ❑CIPHER
ei which requires a permit to contract.alter,improve,demolish,or repair no,nmmurt
FSO
prior n its issuance,also requires thcapplicaw for such Ce.oil o filcaaignedwmement SPECIAL CIRCUTGMISC.
$., y That he is licensed pursuad to the proikiod,aide Contmwo/s License luw(Chapter 9
s (commencing with Section 7000)or Division 3oflhe Buoreseand Profession,Cole)nr I EMP.M II'1'ER OR POLL INS'1'. COMMERCIAL:
e, o C than he is armod Inereomn iced the basis bar the alleged exmnption.Any violation of ❑NEW BLDGIADDI110N ❑DEMOLITION
iLLl1I, Section 70315 by any applicant lot it Perini(subjects the applicant m en
a civil malty of POWER DI:VICE ❑ ❑ E.
S TENANT FOOD
no(marc than five hundred dollars(5500).
fCQ 1.as owner of the property,car my employees with wages at their sale compensation, SWINISH NO POLL ELECTRIC IMPROVEMENT
tf. will do the work,andlhearucmm is a„,intended orofferW fursale(St .701 Business 001 HER
and Profession Code:The Comrena/s License law does not apply to an owner of OUTLETS-Swill'CUES-FIXTURES
a 3 prtgerty who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvements arc not intended Is,affered for NEW RESIDENTIAL ELECTR SQ FT
sale.IL however the building or impmvemenl issold within one year nfcompletion.the SQ.FT.FLOOR AREA $/SQ.FIo
„wncobuilder will have the burden of proving that he did not build or improve for put-
ose of
❑ Lae owner of the proper(,.tet enclasmely connecting with her ad contractors In .r
construct the project(Sec.70,14,Haxlness and Rolaoions C Aa:)'rhe Cannictre,Li-
cause lawduesnaaapplymanawnerofpropcnywhohuildsorimprnves thereon,and QTY. PLUMBING PERMIT E
whincommets for such projects with a annracsor(s)licensed pursuant tothe Commwor's
Licence law. PERM11ISSUANCE
❑19th exempt mnder Sw. .11 is PC for this..a
ALTER-DRAIN As VENT-WATER(ITA) VALUATION
worm Dae
WORKER nderNCOMPENSATION
..DECLARATION HACK PLOW PROTECT.DEVICE
have
and will mai under Certify of ofConeneofthefollmfor Worker's
Coupon-
Ihmu and will for byneatrat 3700cate of the Laor Codent to mur the Waanniece at thUI2AINS-FLOOR,ROOF,AREA.COND. STORIES TV IF.CONSTRUC'T'ION
smirk,as hickaludthis
for by Ss issu 3]011 of the Labor Cale,for(M1r perlinmanca rf the
work lot which will
Bannon is Worker
PI%TURES-PER TRAP
❑ 1 have and will maintain Wn artc Compensation of
e w work
hi h rcquircd by Section
J]glnithe Labor Code,for the perl'nnnanre of the work for which Ibis lemri(is lssuN. GAS-IiA.SYSTF.M-I INC 40U'171EIS OCC GROUT' ANN
- CW[rA�C� sari n rokee`V(t Policy No.nd :��i��U1 GAS-EA.SYSTEM-OVER 4(EA)
CERTIFICATE OIt LIKE PfION FROMWORKERS'
COMPENSATION INSURANCE GRIiASU1NUUSTRf.WASTE]INTERCEPTOR
BUILDING DIVISION ItiES
(Thin senior need nm he completed time permit is frronchundrcd dollars($100) GREASETRAP
ter Iris.) I'LANCHECK FEE
I certify that in the performance ofthe Workforwhich this permit is issued l shall SI7WER-SANITARY-STORM FA.2110 FT.
nm employ any person in any netmer so as to become subject to the Workers'Compete- EEE] ENERGY FEB
Z
Italian laws of Califomin.Data WAI'HR I ILA'I'F.R WNENTIEECI It
y� Applicant 1 GRADING FEE
q p�j NOTICE TO APPLICANT:If after making this Certificate of Escnnp0nn,you should WADiR SYS'I FNVI'REATING
become subject m the Worker's Compcnation pre inns of the Lubar Code,you must SOILS FEE
forthwith comply with such provisions or this permit shall be deemed revoked. WATER SERVICE
U0CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ,FT. PAID Date Receipt#
U L here by affirm(Permit i issue (See.tionlending agency lino the performance of
thawed:for which this permit is issued(Sec.3097.Civ.CJ
IanJers Name TOTAL:
U Lsmdbe,Addresso' L:
'�Wy I acridly that I have mud phis up,healmin and own ohm the ahoy informwwri is BUILDING FEE
cFr Z) cmrccL l agree In comply with all thy unit county rnlinaeasuad%(um laws raising to QTY. MECHANICAL.PERMIT FEB
U,7�. huilAing ameWetion,and hereby annhoriec rcpresenwtivec of lhivnirymenw.upon the SIiISMIC FLE
uNWe-mentioned pmpe..y for inspection puHmaa. PENMI'I'ISSUANCE
(We)agree In save.Indetandy and keep hornless the City of Cupertino against I?IJLCTRIC FEE
If
linbili(ies,judgmems,costs and expenses whit ay in any waysecrueagainsraaid City ALI HR OR ADD TO MECH.
consequenceofthegrentimgn This pe PLUMBING FEE
UNDER. 5 AN .L COMPLY WITH ALT.NON-POINT AIR HANDLING UNIT(TO 100)(1 CFM) MECHANICAL Fill.
501' EG r /� p
5,/ 7 �/p/ AIR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTIONTAX
Signvmre Pplie (/Comma / Date MHAUST HOOD OVMUCT) 1IOUSING MITIGATION FHE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future h tildnal accupnnt smnc nr handle l a indons mmnrial HEM ING UNIT(TO 10",000 111 U)
ao deYned by he Cupertino Municipal Gds,Chapter 9.12,and the Heuuh and Safety
Cade.S dka 25532(a)] HHAI'INC,ONIT(OVER 100,000 BTU)
Yea t 94ki VHNTILA1'ION FAN(SINGLH RESIDI PAID --
Date Receipt,
Will the applicant or nts a IwiWie!by the B use equipment or devices which
:mit hazardous air contaminants as JcfinW by the Bay Arta Air Quality Management HOILIiR-COMP(3Ii1`OR I10).(100 BTU) TOTAL
L'11'.d,”,
w] BOILER-COMP(OVER 100,1101 B'1'U)
❑YesAIR CONDITIONERIhavetwISSUANCIi DATE
Iadth Yc Safely Cale,Swvion 505,25533 and 25534,1 understand that if the NIIW RISI DENTIAL MECH. SQ.FT.free ort ru e tel lunvmn tha(Il is my respnmibilily ln....lily lherwuparewnamr agent Dee TOTAL: ISSUED BY.
0
OFFICE