B 0341 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY ON CUPERTINO BUILDING-ELECTRICAL PERMITNO.
6 #0341
APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING DIVISION BUILDING PROJECT IDENTIF'ICA'rION 50001
BUILDING ADDRESS: SANT[,\BY NO, APPLICATION SUBMI'TTAI,UA
Oo 1 LP sTadsh K Ci- .
OWNERS NMaTAME �^ 094. a-aa� fQleOR'SNAM': LIC(A1 Tj1O
C� V NIC C NTROLp
,•AHCHITECI'/ENGINIiER: LIC NO. ADI)RFS'$: Ce>n' L 950. ❑
FSeefiva7(XXh.fDm,iu.
PHONE: /VSD c..� DUILDING PERMIT INFO
AN I, (j ❑ Consullanl Feeg Puid by Applicant Qnilihp BLDG C PLt1MH MC ILICI:NS1.DCOWRACIORSDF.CLA]tATION a l/ QTY ELECTRIC PERMIT FEEaffirm that 1 am licensed under provisions of chapter 9(commence, JOB DESCRIPTION
O9ZXh.fDIVlslumSof the Businass and PmfessirnsCale,andmylicenscisRESIDENTIAL:
WOO PERMIT ISSUANCEITect. CID ❑SFDWL ❑KITCHEN REMODE1
WUFLia.p6 U _ AI'PLIAYCF_S-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
m Q C D;nc Can rven+lE
ARCHITECTS DECLARATION ❑MULTI-UNIT ❑STRUCTURAL
PANELS
ATION
OZ- lunderstand my plane Shull he aced as puhlic recoNs CHIMNEY
HIMN YREP
UI"TO 200 AMPS
OZ— El INTERIOR ❑S IMMING POOL
Licensed Prufcsxinnnl 2(U-IgX)AMPS IMPROVEMENT ❑SWIMMING POOLS
C C C 4 1 herehy alOmt OWNthat I amly elmp EfromLthe C mUlON x or's License Law for the OVER IIXIUAMPS ,.,_T�
L4uRIn REMODF:IJREPAIR ❑DEMOLITION
1 LU followingS OI'HIiR
X 3 tcason.(Selling]onstr Business and improve.
doslore Cale:Any tory ns counrY SIGNS IiLECTRICAI.
Irl LL F• which requires a permit,o construct.slice improve,h perinsh, fi repair any structure
�.WN+0 'hat he
to the
Novisiac.ntfoe wchpenniu Dectivsiaw(ChgroOd temvm SPECIAL CIHCUI'f/MISC.
Na he is licensed Dursuanuo the provisions of the a B.ommh Licentt Law(Chapter 9
�CpO that he is exempt
Diaiaan9the hensxnnJPri Any
Coeelor TEMP.ME'1llR OR POLE INS'I: COMMERCIAL
d%o K
that io is exempt tbe¢fmm and the basis far the cvthalleged exemption.a vin violation of ❑ U >„.:_ ❑ OLITION
_4• Savior than hY anydreddum Tinavpeat+;,mbjcet the upplJmmto.civil penalty of POWBH DEVICL.S
W N ❑ NT � ❑FOOL)SI;R 1:
F•Z} not more than five hundrrd dollars(b51M1). yEM 'LII
=6 [] Lo the verof the propeichir,mycmpbyeedero (See
compereation. SWIMMING POOL ELECTRIC
fF0 will Pr Rework,Cock he Conti..eco,inmiense Law offered
Bucincas ❑ R
aim and Professions Crede:The Contractor.License Law eoxs not apply to an owner of OUREfS-SwITCHPS-PI%TURES
propcny who builds or improves thereon,and who dues mur work himself nr Ihmu,b MAY 1 1199 11111
his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL F.LECTR SQ IT
seek If.however,the huilding or lneprovemont is.culd within one Year of eomplaion.the SQ.FP.FLOOR AREA Q.IT
owner builder will have the harden of proving that he did not build or improve far par-
pssc ofxaleJ. Q
❑1,as owner of the property.am exclusively contracting with licensed aontmetnn to A p Y
nconstruct the project(Sec.7116.Business and Professions Code:)The Contractors Li-
eease Law doots not apply ht an owner of property who builds rr i mprovn t hereon.and QTY.. PLO MB INC;PERMIT FEE
who contmcs for such projects with a contractors)licensed pursaanFto the Contractors
Lion,law. e PERMIT ISSUANCE.
❑1 am exempt under Sec. .It&P C for this rtaon
ALTER-DRAIN S VENT-WA'T'ER(EA) ALUATION
Owner Dam /\O
WORKERS CUM PIiNSATION DECLARATION RACK FLOW PR(JT[CT.DEVICE ✓S
1 hand will
under Demalry of perjuryone of the following declarations:
❑Ihave and iced for
Se Cion 370(lofComeei,Code.alf-unsurvethe Worker's Comp cn-the DRAINS-FLOOR,ROOFAREA.COND.
satioefor hick Old for M1y Section 3AXI of the Lvbmr Cede,for the perforancc o[the DRIES TVI'13 CUN5'I'gU("I'It
work have
Nis permit is issued FI%TUNF_S-PER TRAP /qv/1
I trove Lawillmaintainhe krurreds ancerofthenikfor we,av hhus per by Sectiond. v
3700 of the labor Case,for performance of the wnrA for which Nis peat,;,is issued. GAS-EA.SYSTEM-]INC.JOUTLETS OCC GH(1I1P NG
My W ''G pas hnunmce surzicr Policy
O,:
Carie Policy FROM
W aJ 0S 83 GAS
ASUINDSYSTEM RU VER WASIH INT)
CIiHTIIOCA'1'E PE%LMI'110N FROM WORKERS'
COMPENSATION INSURANCE GNL1S1%INIIDSTHL WASTE INTERCEPTOR
('This section need not be completed if the permit is finance hundreddollars 1$100) BUILDING DIVISION I+13$1
nr GREAS
how) E TRAP PLANCHECK FEE
],unify that inthe perfoorunceafthewak forwhich this peon;,isissued.]shall SEW13R-SANITA NY-:
rtem to to become to the Worker'Cron STORM LA 21X1 Ff.
employ pcnon in any mnnncrm as subject Pen- ENERGY FEE
Z .Z ration Laws of Colifomia.Dam WATER I[LATER W/VENT/ELBC'I'R
Applicant t GRADING FEE
IA
NUI ICH TO APPLICANT:IL after making this Cmificme of F,xcerption,you should WATER SYS'T: ffREATING
account vubject m the Workds Ca u,ectionon provisloms of the labor Cash,you moa SOILS FEE
Qforthwith comply with such ve,kine,.,,his peri,shall he deaned revoked. WAFER SERVICE.
UO CONSTRUCT ION LENDING AGENCY NEW RESIDENTIAL PLML SQ.PF, PAID
Dam Receipts
I hercbyaffirthat there isaconame,ion lending agency for,he perforanceof
FNe work f Orwhich,ly I�/�tis i.wei(Sec 3097,Civ.C.)
Ictalcrs Namc�A Y T(yl'AL:
U Lc
ndcLc AJdrcvs '1'OTA(
} I certify that 1 have mad this application and state thm the above information is w BUILDING IIPH
eF. Z) comet.1 agree to comply with all city and county ordinances and state laws mialing ,, QTY. MECHANICAL PERMIT FEE
V Z lim1dingcomorction,and hercM1Y amM1mnze mprescnmtives id this city lomat.upon the SEISMIC
aMrve-mcntim ed progeny for inspection purposes. PERMIT ISSUANCE
(Wc)agree ms:tve.inJummfr and keep bamdecs the City of C.Penino again", ELECTRIC F E f S
Iiabilities.judgmenr,costs and expenses which may in anyway accrue against said City pLTIiR OR ADD 911 MGCH.
nscytmnccof the grunting ofthis permit. PLUMBING '
APPLICANT UNDERSTANDSANDWII.1.COMPLY WITH ALL.NON-N-PPOOHvU AIR HANDLING UNH110 111,0011 CFM)
MECHANICA 1'EE
It
AIR HANDLING UNIT(OVER 10.IXXI CFM) CONSTRUCTIO A%
Signature of Applic.nVCnnmav+r Date 17XHAUSTHOOD(W/UUCtO HOUSING MITIGATION PEE
HAZARDOUS MATERIALS DISCLOSURE
Will,he upplicnnt or future boldin,nccupum Wore nrhandlc hamMuus mwenal HEAT INC UNIT(TO 100.1100 BTU)
as defined by,he Cupcnieo Municipal Code,Chapter 9.12,and,he Health and Safety
Code.Seaton 255321.)? HEATING ON]'r(OVER 10D,000 BTU)
❑Yes PAID
VENTIf"A'F30N FAN(SINGLE RESUH Uric RccciplM
Will the applicant or future building excupant use;eyuipmem or devices which BOILER (3NP OR la).OeAI PTU
mit hasardous air contaminants as define)by the Bay Area Air Qualiy Managcmem )
Dintricro AL:
0Ye" C;.Kr BOILER-COMP(OVER 100.00)BTU)
I have read the hanmdoms macnals"ammeng,utMer Chapter 695 of the Cali- AIR CONDITIONER
ISSUANCE DATE �s 7
bumia Healthn Scurry Cale.Sections255115,is my and 2553).1 to unity
Natifthe NEW RESIDENTIALM1fECH. SQ.FI'. / Y
i baoem,eines nota currently nmeammam.and hi.v my rcxpnnanBey m,naify Ne«ctepam
f tet •1 m7++ rel miono issuance of a Len'v:am�f fecttpytcy.
l wmnud agent 1
De7e6/ TOTAL: �v
ISSUED BY
OFFICE