S 0929 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF,RTINO BUILDING-ELECTRICAL PF.RMI'FND,
ISUII,DING DIVISION APPIACATIONWERMIT PLUMBING Cp IDENTCIIANICAL S 0929
IIIIILDINC PR(IJFCI'IDENTIFICATWN �J
BUILDING ADDRESS: L.y SANITARY NO, API'L.ICAHON SUBMITTAL DAH
OWNER'S NAME: O P NE: CONTRACTOR'S NAME: LIC NO, r
N/C CONTROL#
ANCHITELT/ GININ iEE —_ LIC NO: ADDRESS: A ❑
CONTACT: PHONE: d�-� /T! BUILDING PERMD'INFO
Cj tm�ti,` C'/ 7 ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUME MECH
ado }}ac as q—� AX cTcb' � ❑ ❑ ❑
LICENSED CONTRACT'OR'S DECLARATON QTY. ELECTRICPERMrP I' E 10R DESCRIPTION
I hereby affirm tbm I am licensed under prolkillas of Chaplet 9(commencing
QaZ with Section V(XN))of Division 3 ofthe Businessland Professions Cade.and my license is RESIDENTIAL,
WO, PERMIT ISSUANCE
F in full force and effect / ❑SFI3Wh ❑KITCHEN REMODEL
QVU License Clm. _ de.# APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
pate Contrast
p.Z U
ElMULTI.UNIT ❑SI RUCTURAI.
to ARCHITECT'S DECLARATION PANELS
F 1 de....no my planhall be used as pal lc raeards MODIFICATION
OZ � uns sUI"102IXIAMPI ❑1N11:RIOR 9CHIMNEYREPAIR
Licensed Prof e..oral 201-HREAMPS IMPROVEMENT SWIMMING POOLS
OWNER-BUILDER DECLARATION
OVER IINNIAMPS EIBAIH CTIE NEMODEIJRHPAIR DEMOLITION
Q I hereby affnn that I I S exempt from the Cvoons o e:Any
Law for the �-1 e�J Ll w�o.
x�x O d U fallowing reason.(Section 703 L5.Business and Prafessinns Code:Any city or county SIGNS ELECTRICAL
❑OTHGN -#Iy._-�-
-W 3 a0 F' which mquires a Iwnan eat construes,alter,improve,demolish,or repair any swcwre ,tD 1 !I fel e
O prior to itsissuance,aha requires the applicant for such Permit to file a signed statement SPECIAL CIRCUIT/MISC/
that he is licensed promm to the previsions of the Conanr's License Law(Chapmr9
>. r.
W QQ (commencing with Section]INXFofDivkmr3 ofthe Nosiness and Pndessinns Code)a, TEMII METER OR P0/1 NST COMMERCIAL
Ihn(he Ix exempt therefrom and the Imo,far the oll,ed exemption.Any violauan of ❑NEW RI DCUADDITION ❑DEMOLITION
DC k, Scctinn]o315 by any applicant for a prmilwhica, he npoicarl mucivil termly of POWER DEVICES ❑'I IiNAN'I' ❑FOOD SERVICE
w notmarethan fivehundrdda0ms(S500).
EZO
C]1,as owner of the Property,or my employees with wages as theirenle cnmpcnsatmr, SWIMMINGP OLELECTRIC IMPROVEMENT
will dome work,andtbeslmcture is not intended or offered forsale(Sec.70,111-J.' OIHHR
Wand Pafessiom Cash:The Contractors License law docs not apply to un owner of OIfIL.IT.' SWITCHES-FI%TUNES
6 3 property who builds or improves thereon,and whir does such work himself or through
his own employees,provided that such imptovemems ore not intended...offered for NEW fSIDENTIAL FLECTR SQ FT.
sale.If,however,the building or improvememh,old within are year of comp-......,the SG Ff.FLOOR AREA S/SQ.14.
cr-builder will have the burden of proving thmhc did not build or improve lin put- P A I b
poo,of clad.
❑I,as owner of the properly,am exclusively contracting with licensed conaon m
tmTOTAL: Ahb I}
...read the provet(Sec.7044,Business dad Professions Cade,The Camraa..rs Li 11 ANS'D
wase law does not apply to an owner ofpmpvny, improves
who builds or thereon,and QTY. PLUMBING PERMIT PEE M/'It\
wh irommas for such Fathers with a eoamcbmid licensed pursuant to the Contractors
License Law. PERMIT ISSUANCE ClTy Ur
r� �3700
lnmeiemptur Sec. ,B&PCfor this mason ANTER-DRAIN&VENf-WA'P13k(M) VALUATION
Date
er WORKER'SCOMPENSAI]ON DECLARATION RACK FLOWPROTECT.DEICE (, , ,o-aI hereby affnit under penalty of perjury one or the following declumboss:I forward will nuimuina Cenifcam of Cnnsemmself-insure for Wo.kcesCootpen- DRAINS-FLOOR,ROOFAItHA.COND. STORIES TYPE CONSTRUCTI@on,as provided for by Section 37W of the Lab r Code.for rhe perfomonecof the
rk far which this permit is issued. FIXTURES-PER TRAP
1 have and will maintain Workers Compensation Insurance,a.required by Section
of Ne Lahr Calc.hmhe performance of the work for which this Fannin is issued GAS-EA.SYSTEM-I INC.4 OUTLETS OCC.CROUP APN
oomlmies Ca ;2aion,�{ urancfi carrier and Policy numter are:
- Carrier:�'.L�A. *x-^-'r Pul'my W.: GAS-EA.SYS HEM OVER 4(EA)
CERTIFICATE OF EXEMPT ION FROM WORKERS'
I COMPENSATION INSURANCE GI113ASIANDUSTRL WAS'I'Ii IN' iRCEPTOR
This section maul not Mcomp-.ed ifthe Iw.I,is ha me hundred dollars S1W) BUILDING DIVISION PEES
orless.) GREASE TRAP PLANCHECK IEE
,1 leriif,dad afmaerfounrourofthe work forwhwhdtisgmanitis ismed.:shall SEWER-SANITARY- 'O RAI EA.3(N)ll'.
1 nor employ any person in say manner so ns m beeome mbjecuo the Wurkeri Compen- ENERGY II;E
Z cation Laws of California.Date WAT17R HEATER ENTIELECTR
Z Applicata GRADING PIiE
i-sNOTICE TO APPLICANT:It,after making this Cenili.ae of Exemption,yon should WRIER SYS'1'. /TREATING
}11" "N" became suglcet to rhe Worker's Campenvtion prookit of the Labor Code.you must SOILS Flili
Lak1 rt forthwith comply with such pmviomis lar 11b,pernad,lill hedeentedrevoked. WATER ,RVICB
0
. ' ZCONSTRUCTION LENDING AGENCY NE ESIUENTIALI'LMB, SQ.14. PAID
I hereby affirm that there is a consru.ion lending agency for the performance of Uma eiptp
^u3y O the work for which this permit is issued(Sec.3097,Cie C.) If r
e'10 w Loader's Name TO' 1.:
Lender's Address TOTAL:
0. I centry that I have read this li'dicmina and roam that the above immolation is BUILD-NC
I�ih wrtecr.l mgreemannply with allairy andc�unty ardlnancesnnd.mml�ws rulwingm QTY. MECHANICAL PERMIT JIEB
UZ Building,lumeacti....,aad MrcbyamhoriIc miacsemmivc,al this cky blean"upn mie SCISmIc ITIF
shave-ohnimbed property for inspection purposes. PERMIT ISSUANCE
(We)agree to m
save,indemnify and keep hadea
ss the City of Cupertino gntalnELECTRIC PI':
liabilities,judgments.assts and expenses which may in any way arecaeagaiam said City ALT ER OR ADD TO MECH,
PLUMBING TEE
Aconseque ce Nthe RSTAN Sthispermit.
APPLIC TUNDF.RSTANUS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT RO 10,000 CFM) MECHANICAL 'E
OUR .REGULATIONS.
AIR HANDLING UNIT(OVER 10,0(CFM) CONS'IRUCHONTA
.Ienemre ofApFllcmu/Conowt Date EXHAUSTHOOD(W/DUC'11 HOUSINCINUI'IGATIONF
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant car future building occupant store orhandle haa#rdnus material HEATING UNIT(TO 100.001 11 FU)
as defined by the Cupeninn Municipal Cale,Chapter 9.12,and the Health and Safety
e.Scdion 255JNe)'! - NHA1'ING UNIT(OVER III .( OTG7
❑Yes 6rllo VENTILATION PAN(SI ERE.SI DI PAID
Will the applicant or future building occupant use equipment or devices which
emit bromidnus air contaminants as defined by the Huy Area Air Quality Management BOILER-COMP(3 OR IINf,IMlI BTU) Due Receiptp
'1 UAL
Distract? HOILHIt-CO OVER 100.X00 HTU)
Dy. - �• No
I have read the hvmdnus materials requiremcros ander Chapter 6,95 of the Cali- AIR CO TIONER ISSUANCE DATE
,roma Health&Safety Cede,Sections 25505,25533 and 25534.1 understood that if rhe N- RESIDENTIAL MECH. SQ.Ef.
tough,does not currently have a recent,that it is my rexrysrt laid:y to narify the o vette nt
at,
of the requirement ich must Moet rionoicsuancc of a Cenifemeo Qe nncy.
Owner or autoriae gen Dam TOTAL: ISSUED BY:
- — - —_ OFFICE — - -