27188 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUIL"
.L, 'IRI AL PEMrr NO.
APPLICATION/PERMIT PLUMB NO-MECHANICAL 27188
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BUILDING DIVISION BUILDING PROJECT IDEN'1'IFTCAIION L o
UILDING ADDRESS: SANITARY NO. APPLICA'f10N SUBMHTALDATE
V UNITp LOTp W q
OWNERS NAME PII E: C ACTOR'S NAME: LC O: N/C ( 3NTROL
N o 6
RC1 'fEC'1'/BNGI iliR: LIC NO: KESS: ❑
CONTACT: PHONE: "
QTY, ELECTRIC PERMIT FF.F, BUILDING PERMIT INFO
BLDG ELIiLT PLUMB MECH
PERMITISSUANCE ❑ ❑
ICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL ION DESCRIPTION
QWz, I herebyaftiw Nes Jam licensed tmderprovisionsuf Chapter 9(commencing with
700 Seaitor7000)of Division 3 ofthe Businessand Professions Cade,and my license is in PANELS
full forceand effect. UPTO200AMPS
6g ty License Lic.p
yay
act.DI OVER
AMPS
R FOy� A IIITECTS DECLARATION OVER 100(IAMPS SQ.PT.FLOOR ARLA $/SQ.Iq'.
O Z I undersnmd my plans s all be used as public records.
tu,Y1 SIGNS ELECTRICAL modlqwl
Licensed Professional
ACUOWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC.
1 hereby nfit.that 1 testi exempt from the Cnntrxamrs License Low for life
W Say following reason(Sation7031.5,Business and Professions Cadc:Any city or county TEMP.METER OR POLE INST.
ON a which mimics n permit to construct,alter,improve,demolish,or repair tiny structure
errtena.I}M prior to its issuance,also requires the applicantorsuch permit to filen signed statement POWER DEVICES
taaj <o Net be is licensed pursuant a the provisions or the Connecto/s License Low(Chapter
a4o� 9(commencing with Section 9000 of Division 3 ofthe Business and Professions Cade) SWIMMINGPOOLELECMIC VALUAIION
W_rn or Nat he is exempt henchman and the basis to,thealleled eaemptimt.Any violation of OUTLETS-SWITCHIS-IIXTURES
QSection 9031.5 by my applicant for a permit subjects the applicant eecivil permlry of
O
not more than five hundred Jollare($$Iq). NEWREMDENTIALELECTR _SQ.PI. STORIESTYPECONSTRUCHON
❑ Las stick. it the loralo nis no,mandeeewitfficed mthei(Site 7(94.Bu atioa,
e will domestick.and a no Cureisnm's License
Law
snot apply to
owner
of
ss
end Professions Cale:The Comraceor's Licrose Law does not apply to m owner of
property bohuildsor improves thanourand whndat,suchwork himself or thrmghhis
own employees,provided thatimehimprovements arcane imendedoroffered torsade.If, OCO GROUP RES.UNITS
LA
however,the building Or improvement is sold within one year of completion,the owner-
builder will have the burden of pmving that he did not build or improve for purpose of
sale.).
❑ 1,asownernDhepropeny,.me clusivdycommaing withlittns cont comto QrY' PLUMI PERMIT FI7E FLOOD ZONI' APN
roman t the Project(Seo.9044,Business end Professions Cade:)The Contractor's
License Law does nor apply eoanownerofpropeny,whobuildscrimproves theresm.and PERMIT ISS CL
who contracts mrsuch projects with aauttructags)licenced pursuant to the Contractor's
License law. ALIER- RAIN&VENT- TER(EA) FEE SUMMARY
❑ I an,exempt under Sec. ,B&P C for this reason BA FLOW PRt9 ECT.DCV E OLFr.qTDEE
SANITARY YN
Owner DareRAINS-FLOORROOF .CONK RECEIPrp
, ,
WORKMAN COMPENSATION DECLARATION SCHOOL9'AX Y N
❑ I hereby affirm that l have a certificate ofcansetn m self insure,or a annuitant of FlK'1'URES-PI?R TRAP RFC I p
Woken'CompensmionlnsumnceorecenirLe copythereaf(Sec.38M.I1 bCJ whit PARK PEE Y N_
coven sell employee's undenhis L RE i1PTp
Penni GAS-EA.SYS INC.40U I:TS
Pnlicyp BUILDING 14VISION EEL'S
Company S. .SYSTEM-OVER 4(EA) PLANCHECK FEE
❑ Cenified copy n hereby famished.
❑ CenifieJ copy ie LleA with Ne city inspection Alvisi NDUSTRI.WAS'TF NTER EPTOR GRADINGFEE
CERTIFICATE OF EXEMPTION FROM ORKERS GREASETRAP SOILS ME �a
COMPENSATION INSURAN P.
(I hisse tionmecd not bewmpletedifthe permit lion onnhunIf
in) MEWL - A nt! -S EA.20 FT. ENERGY FEE
or less.)
I cwifyfiat to theperfnsmunceofthewodforwhiuh isperm itill 9tR IIEATIiR W/VCNT/ELIitoe employ any person in any manner so as to become subject to PAID
Compensation Lxweof Culifomia. Date WATER SYSTENOTREATI ---V77 Rcceiprp
,Z Applicant
Z0 NOTICE PO APPLICANT:If.aftermath,this Certificate o acmption,you should NF.WRESIDENTIAL MB. SQ.FT. TOTAL:
F fA becomeaubjectto Ne Worker's Compensaimpmvisionsofeh Labor Code,you must
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