S 2961APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUD.Orar. - ELECT R
BUILDING DIVISION APPLICATION/PERMIT RLUJu31NG-NIECUAI
INILIIIN'O PROJECT 1DKN-
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❑ Consultant Fees Paid by Applicant (Initial)
BUILDING PERMIT INFO
131 DO i ELECT' _ PLUMB _ VIECH
Lrr' L^l/ lr-0.-I/
LICENSE CONI RACIOR'S DECLARAI'[ONR•I
I hereby afrrm that I con bc„hacd ..odor provloon, of Chapter v (commencing
Q'ry ELECTRIC PF,RMI'I' FEE
JOB DESCRIPTION
PERMITISSUANCE
with Scnion]OXq of DivisionJof the tiusines>anJ Rofea,ions Ctdc. and my licca..is
in 1.11 force and etheg
RESIDENTIAL;
❑ SFDWL ❑ KITCHEN REMODEL.
APPLIANCES -RIiSIUENI'IAL
hicen.e LOS Lic.M
Da¢ Cummc
❑ADDITION ❑ pl.UMBING RIi PlIPE
❑hlUCfl-UNIT ❑MODIFISTRUURAh
MODIFICATION
INTI?k10R CHIMNEY REPAIR
IMPROVEMENT E] SWIMMING MILLS
A 'ball he nee D1iCL�ATI(l 1,
undcrntanA my Plunv sMJI be aced to public nanAs
PANIiIS
UI"rU 210 AMT'S
Lieva-d Prefcasional
201-1000ANIPS Do
OWNER -BUILDER DECLARATION
loot , Llccnse Law dbr the
I hereby adMn that I am eanat l from the Cl r
following rean. (Section 7031.5, Ifncsa and PodhWlnn.v Code: Any oily of county
musl
Ll BATH REMOIIELREPAIR ❑DEMOLITION
❑ O'i'111iR
OVER 1000 AMPS- - LLICLM CA
SIGNS ELECTRICAL
which h..guhea a neons to crowen , antic improve, demolill, or repair any structure
S PLC I A I. C I RCUII IM ISC.
flit,,, it, ioli:moc,a6n..... ties the aPldlan, lar pndi,nnil to ti le assigned son amcal
that he is licensed pursuant it, the provisions ill the Contractor. license Law (Chapter v
(.nminencins with See, i,,n Il1M)Of1),vin3 of the Business and Professions Cad,) Or
Thal he is .adopt thcrclh a lad tha buds Ibr the alleged exemption. Any vlol,ain I of
Section 7031.5 by any.applicam li,ru pcnnit.,nnjecl.v the applicam macivil pcnahY of
BBM R METER OR MILE INSIl
COMMERCIAL:
❑ EW IH.DGIADDITION ❑ DEVIOLI'DON
IiNAN'I' ❑FOOII SIiRVICIi
W)WI:R DI?VICES
rn more than rive hundred dollars (1500).
❑I, no, owner of the properly, only cotPluycca with wages its thele vole compensation,
44. Baa'can
cv not inteed Or .11 cost faraalu(See 90 n
wi 11 do the work,and Ihcsoacmrnd
and Processions. Code: The Comracmr's License law does not apply It, an ounce of
PROVFAENT
OIIII�R l
SWIMMING POOL ELECTRIC
ZI UTLEI"S- SWI rCHRS- FIX 'IORES
NEW RESIDENTIAL FLECTR SQ TT.
(
pr,perly who he ld%nr'mproocs thereon, and who docs such work himxif nr h
his own c adnyces, provided than such inpunvcmcnls arc nut Innrdal u. otic.
sale If.h,.,c,.mc huiliingor impmvna,rl k oild vilbitione Year of complaliam
SQ. I'1'. 1'LOU12 AREA
pSQ.lel'.
0 cr-builder will have the burden of proving that he did nor build or improm a pur-
pascafaWc.).
❑ I, u, owner of the properly. an, exclusively conwaing wink Luensea comrue o
L AL:
answer the pmjcw (See. 7044, Bnsinc,, and Profession, C,dc:) The Comraera, L -
ml.aw docs nutapply to an owner of property who build, or'nnprovm thereon one
PLUMBING PERMIT FEF.
whn.nnvuns li,r tech pmjcns with v cunanctnr(v) IicwneJ vur,n:un m mu Canna
License lex'.
❑ I all] caempt under Scc. �`�h 13&P C for thNousun
prryrJ' ISSUANCr:
DWmt,r Done
WORKER CONI LNSAI'10 A' N
"R -Il &VENT -1 'IR TEA)
VALUATION
�}' O bD O D C>, o lt
BAC O 'ROILCI. D.
II hy fl p 'h4. (pert Y t'Il roll g I 'r n'
C II" u h-
Ili d'll Cnf'h f16
DRAINS ROO:ARI;A. )NO
9
$1 )kliis
'IYPECONS'HRUCHON
shim p Jed f ai Section t]11) f the4
work for 1 i d', R t I.
A -
fl{ff
,
IX'TURES YI'RT
❑Ih II I W k C I 11 4 ,Sine
1710 Of he LaM Cad f 1M1 pct kf 'ti> J.
My Wh,,.k.r.Canhpen..man RiZ,;I e c nhee
Carries", It, Pulley No.,.
OCC. GROUP
)
AI :N
GA AR.M I INCA OUTLI. .'
A.' VS ) EA)
COMPENSATION INSURANCE
frhi.... ion nmdnul be cn.nplcled it he cuoul is foam. handreddollan(S b
or It,,,.)
I cenify that in the performance of the work for Which this pemhit i, issued, I shall
nut mupluy any person in any awner, so a, a, he.onte whject m the W WWr,' Compcn-
Z. ..Minn I,nws of Culidi,mia. Dam
Z
Applicant c
NOT ICE G) APPLICANT if. alter looking this Crnilk.le of l semi.. n, you should
F he.omc..bjcw tomeWod.edsCo,npenaatioop... .'inits at 'he Labor cam, you muni
frnhwim comNy WBh such provesions or ods perm, .hall he deemed revoked.
A
CONS'I'RUC❑ON LENDING ALCNCY
UO ( hereby affirm thin there is a conswnlon leading agency for the perfooriance of
Pthe work for which mi, permit is issued (Sec. 3097, Civ. G)
U Lcndcr', Nauw
r Lcuder,AJdres,
y I cenify mal 1 hoot, .rad this applicau,,n and rune that the aAr< inGnmwinn is
aFy N
correct, 1 agree h) comply with all city and county ordinances and state laws relining to QTY.
U holding eonamed,,n.and hereby aanhadac..peWithave, onh'a dtyw caner upon the
.Nwelncmioned property lith inspection purposes.
(Wel agree 1. ruse, indenmify and keep hamdc,s the City of Cupm'no against
nahinlin.jodgm sal.. co.u;md expenses Wedeh ,,ay i n ....y way acme agaiw.v
uaid City
in n.egacnce of the granting onhi, Perot.
APPLICANT UNDERSTANDS AND WILL COMPLY W11 ALL NON -POINT
SOURCE REGULATIONS. - / a
HAZARDOUS MA'I'17RIAI S DISCLOSURE
Wdi the ep,juni l nr future building oceapanl score or handle hauardou, mmerial
as defined by the Cupertino Municipal Cale. Chapter 4.12. and the Health and Safety
Co u, Sedion:55J2(,d7
[-I Yes 0 N
L1 Wit the applicant nr future building occupant use eguipmem or devices which
ut le,onluus aI, to n tunin en% us defined by the tiny Arca Air Qmllty Management
D'Nrin9
❑Ye, C] No
1 have real the huaaeduns nulcnals reguirenenls under Chapter 495 of the Cal'-
loona Heald, & Safety Code. Section, 255115. 25533 and 255A. I understand but if the
hall hp ng doe, m1 e� ansa n tanam. thin n i, my Iellta sihuit'to not' y me as
EA. 200 IT.
WA'1'IiN Ifl!A'1'lIR WFXJ➢f !f�f.L"p f < so,r -
WATER SYS'I FmG`REATING
wxl FR SERVICE
NEW RESIDENTIAL PLMB. SQ. FI'.
MECHANICAL PERMIT
NCIi
YF:kh11T ISSUA
AI:I'ER OR ADD 10 MECH. 1?t(ljnV
AIR HANDLING UNIT (TO 101100 CFTI)
Ant HANDLING UNIT' IOVHR I n'ton CPMI
EXHAUST HOOD (W/DUCT)
I11W LNG ON[ P LTO 100,000 I3'1'U)
HHAI ING UNIT (OVER 100,0X) BTU)
VENTILATION FAN (SINGLE RESID)
BOILER - COMP (311P OR 100.000 BTII)
BOILER - COMP (OVER 100.000 BTU)
AIR CONDI' I'IONIiR L d H
NEW RESIDENTIAL NIECH. SQ. FT.
p CDC
G , FEE
S IL: 'EE
PA
Owe Receipts
O2: ,
HUH.DING hili IZg '7
FEE
SEISM F . U
pliGhiliICAh
IrEE %C'HONTAX
III
HOU. NG MI HGATION FEE
PAID
Dara Reccits#
I
C�i '2
I SSUUANNCCE DAT13
ISSUEUBY:
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