S 2625 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATIONMERMIT PLUMBING-MECHANICAL S 2625
BUILDING PROJECT NT
IDEIFICATION
riLDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL.DAT,2r -- `� 212,
-'ZNER;SNAME PHONE. CUNI'RACIOR'S NAME: EIC NO:
� �p• C �D S` Y//_ O NIC �1 CON I'ROL9
CNI'I'ELT/IiNGINEER: •� LIC NO: ADDRESS: ❑
CON'I'AC'I': PHONE: BUILDING PERMITINFO
I3 4e1Q 440_/`4 EJ Consultant Fees Pail by Applicant(Initial) Bh7- ELECTPLUVM1trB n1L(;I I
LICENSED CONTRACTORSDECLARATION QTY ELECTRIC PERMIT FEE LJ rLJ�r
1 hereby affirm that 1 am licensed under provoloos of Chapter 9(commencing JOB DESCRIPTION
DiAkion lnflhc Brame and It feaain oCodeanJm licetl,c ix
�pZ in fullin'.9ugpoi 3 RESIDENTIAL:
Fn full forte and eRem. PERMIT ISSUANCE J
CWH ' � � GSPDWh TCHEN REMODLI.
aVU Liccnsc Clay lit\k APPLIANCES-RIiSFEN1 AL [-]ADDITION El PLUMBING RE-PIPIT
.<,a.W the Con'Z*,lotC
ARCHITECTS DECLARZT N ❑MUETMINIT []STRUCTURAL
Z p w Z nndcrswnd Iny Vlun,nhull Iw used a.public rccurck PANELS
MODIFICATION
UP'11)200 AMPS 20 ❑IN'TERIOR ❑CHIMNEY REPAIR
a F-j Lime,mi Prote,.ioual 2111-1000AMPS IMPROVEMENT GSWLMMDU POOLS
cd O\VNIEk-III11LI7ER DECLARATION
OVER IW(IAMPS G BATH REMODEVREPAIR (]DEMOLITION
Q 1 hereby aBirm that lam exempt from the Contractor's License Law fnr the
X 3 i V following reason.(Section 9011.5,[rosiness and professions CNG:Any city or county SIGNS ELECTRICAL GOITER
W LLN which require.,a permit m co ,mor,alter,imMuse,demolish,at repair any structure
u•0 pii... ila iawunce,also tu4uiss the applicant fonuch pctmiuulilcasigneJ smtemrnt SPECIAL CIRCUI VMISC. QO
thnl he is lecmcd per,te nn the puokionn of the Conanmura Liccnsc Law(Cie.,,.Y
W 6'0� ([eirrou ng with Section 90001 of Div¢ion J of the Rhin,'—and Pm(eoinns Cede)or TIiMP METER OR POLE INST. COMMERCIAL,
a m e y IM1m he is axempn thcrefrnnn and the look for the alleged lWir,linn A,vinlmion of G NEW BLDG/ADDITION ❑DEMOLITION
Y- Section 7011.5 by any applicant for a permit subjects the applicant)a civil pcmd,of POWER DEVICES
—.� GTENANT GFOOD SERVICE
not marc(hon five hundred dollars 01500y.
IMPk(1VIiMl?N'1'
Fl 1. pne,dy,onny cmpinycex wllh wo,c—,thro-irannpm;sulion, SWIMMING I
POOL ILIC'RIC
G OTHER
Hl coin,work.and the soucu re is net imendN nr off red tamale See 7044,Business
W 3 m anA 11 re"iom Gude.The Comm,,...',Levo,law Jces not apply to an owner nI OU'I'LITS-SWI'ICIBS-FIXTURES
property who builds or improves thereon,and who does such work himself or through
hid own employer,provided that such improvemmits are not intended or offered for NEW RESIDENTIAL ELECIR SQ of
vole 11.bnwevu.IM building orimpmv eat in sand within nuc Yemnfcnntpletionlbe SQ.IT. AR A LS It]'.ovner-builder will have the burden of proving that he did not build or improve for put- ,�(/ t✓
p Fcnfsalc.), j
E] 1.an owner of the prepeny,am evelts,nely contracting with licensed contractors to ,l. '
,unuumur the pnrjeta(See.7(44.profiles.,and Professions Cut The Comuacan,Lt-
mile Lawdoes notapplymnnownvrof prnwrty who buildsur intpruves thercor.send QTY, PLUMBING PERMIT FEE
whir contraaa for such projects with a contrecou(s)licensed pursuant to the Conomeors J
License l'aw' f P17RNII-P ISSUANCE 3
E]I am exempt under Sec. ,B&P C for this reason
AER-DRAIN&VENT-WATER(EA) VALUATION
,dowirer IVDan. LT
ORKIR'S COMPENSATION DECLARATION BACK FLOW PROTECr.DEVICE //' 57 ,000
♦ •n
Ih by off d ' .II Ifp[jY ft till gJ I tiros: ! ✓ 0QV
III I have and w'II maintain a Certificate ofC l or%elf-insum for N h :Cnmpen- DRAINS-FLUOR,ROOF.AREA.GOND. STORMS IIYPECON TRUCfIOb
Iatipinividevi hat by Section 3703 life L b C Ne,l the pc f nec of the
EJ Ih FI%TGI2ES-I'likTIMI' 3 0
❑ h1 lie Labor 11 ma main Worker,Cnom lI ran Insal,or whi ax regaved by Section
My ofthOsCoCode,
nsationlhe bouramm�anmr and Polk or this pennitnhmeJ, GAS-EA.SYSI'EM-I INC.40OfLE'1'S
(K GROUT' APN
Ca Workers Compensation Inzumn[c carrier and Policy number arc: �1 O
Cnrn'icc Policy No.: GAS-EA.SYSTEM-OVIiRGIF.A) � 3G
CERTIFICATE OF EXEMPTION I-MOM WORKERS' 0 p
COMPENSATION INSURANCE I C WFJINDUS . 'ASTE 1. RCr:
('I "smans elddubc[antplmcdiflhcpcncrobaf ehnndrNdoll.i$HM) BIIILIlINO DIVISION FEES
or o"') G A'iTHA I'LnNCIeiCK FEE
msilyth, ,I 'O'cnnnuunccot' workfi u ,,h tI rzmil'n i.cruc41aha11 S[ -$ Nl]' V '"[OR IF
notcmplay;my( n ny manners to Na,labject the Worker,'Compcn- h• ill ENERGY FEE
O z satlon La d A it in I I, W" iR If[. :kRNENT/ELECI'NIii
z 0 Applicant GRADING FEE
N NOHCE TO 99,CANfp If aO to mg this Cerimeme of Exemption,you should W, It SVSTEM/I HIiA'1'ING
F-' ;
him vnnc xubjc,l to the Wmkc Cnnnlwtremion provision,of the La or Code you most SOILS FEE
Wforthwith comply with such oviosso or this pcmtit shall be Jccmcd rcwked. AGE
0. Ca
UZ CONSere3%a IONL.ENDINGAGENCy NEW RESIDENTIAL PLMB. SQ,FI'. PAID
V l firwhi,l,thi that Per
I isamn(See 3nlending agency fnnhe performance of are keaciplb
� P the work Ibr,which this Vcnnh is IswN(See 3097.Cie CJ
Q Lenders Name TOTAL:
W Lender,Add.,,
Fa I certify that I have mud this applicnnian nnJ nem thus the above inihnnmion i, BUILDIN, .E
v1 conecLlagme mcumply with all[ity and county ordinances end oars laws rclaung n' QTY, MECHANICAL PERM IT FF-li
V z M1uilding connlmclinn.:mJ hereby uuthnnec repns'enlrum,of this city,,ewer uportme SHISMI EE �• s0
above-mentioned property forimpvettorr purpasec PERMH'ISSUANCE
(Wel a• e m ems,indemnify and keep harmless the City of Cupertino against ELEC 1U R217
liabilities,juti nems,[nad'and cxpenac,which may in any w;p ncen¢ngainsL,aiJ City
ALTER UR ADD TO AIECI I.
in uey a sof the grunting ill this pemtit. LO PLIIMPINOai
APPLIC 'UNDERSTANDSAND 'ILL 'OMIT WI'IHALLNON-POINT' nR HANDLING UNIT GO 10.1100CFM)
SOURC [:GUI ATIONS. MECHANICALH?E O
AIR HANDLING UNIT(OVER 10,gM CI:MI
L CONS ON TAX
Signor real Applicar Commsar ate EXHAUST HOOD(WIDUCP) HOUSING MITIGATION FEE
AZARIIOUS MATERIALS DISCLOSURE'
Will the oppdicamsefmure brildingtncupmu,mm In handle hamrdor,mmenal HEATING UNIT(101(IONX)[I'I'U)
as Jcli net]by Ibe Cupertino Municipal Calc,Chapter 9.12,and the Health and Safety
CNG.Section 25512(a)'! HEADNC,UNL'r(0V FR I q1 mM R'I'U)
(]Yes No PAID
VENTILATION FAN(SINGLE,RFSID)
Will thea Iicam or moue haildin taste ui Date Rred,PP 6occupvn . pmcntotdcv....Or an BOILER-COMPIHPOR 101dKX0BTU
nit Ierm,lmns air cunluminunls us defined by the Ihry Arev Air QualityMvnagemem L )
DisvicC
G (N O I
Yu )(No BOILER-COME(OVER I01.000 BTU)
I have real the Imandaarr...teti.11 termini under Chapter 6,95 of the Cali- AIR CONDITIONER
3 _ SSUANCE I7AT13
millifamalfial t&Safuty Cede.Seniors 255115,25511 and 25534,1 o coaly m that life NEW RRSIIl1iN'TIAL MECIL SQ.IT.
of'he
tcuttcntlyhp�alennm or it is ynepnnCerJycate III Ounc[up:m; 7/
nl'Ihet ref swhic ust be me n .o'utewdu Certificate fO cupanry.
Ouvrisroramosizold-asno 1 a TOT U.
ISSUED B1':
OFFICE
OPP
THE TWO,CORNERS ARE GOING TO BE CUSTOM DONE BY
THE CONTRACTOR ON THE JOB. WE WILL ORDER THE
SHELVING FOR THESE AREAS.
1072'
297 48 30
WE 42R R 4 ALL FILLERS ARE TRIM TO FIT
q
II
42R DISH. 24" : S 33
L1,1-------L_--—-------
,'NL4
I
61 0 0 ; 577
W36 FQ3 ZzO B30 W30
240 ccx�C oq 1 .2D 42
{yy L---
VWB2430 36
VSB42 66
U1524 36" REFR 1
96R OC302496D
30
WR3624 o mic4q
k 84
OVEN CABINET CUTOUT WAS SPECIFIED BY CUSTOMEFZ n:,,=i- . f=
THIS CABINET WILL ACCOMODATE THE OVEN —"
IT WILL NEED TO BE TRIIM TO FIT
n MAR 0 2 1998
iNSPECTiON DEP.vHl V1 CN!
�f v
-7'10F CUPERTiNO
LAIIensions&size Eesi nadons 13006CF3 Design: olmom �g nc.
g THE This is an original design and must Scale:maumum Date : 0]/03/99
ra subject to.nlYen1'caUgn an HOME DEPOT applicable lee has been paid orjob antl atljvstment to lit jobons. order placed. 20153 SOMERSET DR Designer
CUPERTINO,CA MIKE RODRIGUES l2'