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29527 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY .CITY OF CUPERTINO BUILDING-ELECTRICAL. PERMIT NO. ' PLUMBING ,MECHANICAL BUILDING DIVISION APPLICATION/PERMIT BUILDING PROJECT IDENTIFICATION 29527 9J27 BUILDING ADDRF. SANITARY NO. APPEICATION SUBMITTAL DATE 1 OWNER'S v Lr/ PHONE: CONT ACfOH'S NA vz CLIC NO: —61 z -NIC C091 SOL . =CHI /LN NEER: LIC NO: ADD I:SS: ''�cIe it C..��IC9. El75C��tr/iur Si_ CONTACT: PHoN 3: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG /ELLEEECCf T PLUMB MF,CH LICENSED CONTRACTOR'S DECLARATIONFEF. ❑ ` ❑ ❑ I hereby affirm that I um liwnad undo provisions of Chapter(uQTY. ELECPRICPERMIT nnmenclnB JOB DESCRIPTION O KZ with Section'/000)ofDlvision 3 ofthe Business and Professions Code PERMIT ISSUANCE RESIDENTIAL and my license ix O1 WE, inense force Class effect DSFDWL El KITCHEN REMODEL �UU License Class Cmun - APPLIANCES-IIESIDENI'IAL DADDITION ❑PLUMBING RE-PIPE ARCHITECTS DECLARATION y GZ 6 Uete - L F.Dm ECLARATION - PANELS DMDLTLDNIT - []STRUCTURAL MODIFICATION Z O m rZ. I understood my plans shall be used as public records MODIFICATION OZ�D UPT0210AMPS [3 INTERIOR [I CHIMNEY REPAIR r 4�Uii Licensed Professional 201-1000AMPS IMPROVEMENT a F J1 dam I..exempt fr m CEASATION OVER 1"AMPS D BATH REMODEUREPAIR D DEMOLITION y= fY a 1 hereby offimr that I am exempt from the Connector's License Line for the ly+•7j 36 U following reaum(Section 7031.5,Business and Pmfesions Care:Any city or comity SIGNS ELECTRICAL D OTHER W which requires a permil to consumer,alter,improve,demolish,or repair any structurey0� prior to its issuance.also requires the applicant for such permit to file a signed statement SPECIAECIRCUIT/MISC. y That be is licensed pumuanno the provisionsof the Canrnco 's license Low(Chapter 9 Immmcncing wish Secuan 7000)af Division3 ol'the Busineu and Professions Ctde)or TEMP.METER OR POLE INST. COMMERCIAL: d y ce K that he is exempt therefrom and on,basis for the alleged exemption,Any violation of D NEW BLDG/ADDITION D DEMOLITION iC 4. Section 7031.5 by any applicant fors permit suhjects the applicam o civil penalty of POWER DEVICES W-s ps DTENANT ❑FOODSERVICE FZQnot more than five hundred dollars(5500). D I,as owner s of the property,or my empi,obs with wages atheir sole compensation. SWIMMING POOL ELECTRIC IMPROVEMENT will do the work,and rbe mmcmre is not inmaded or offered for sale(See.7044,Business D OTHER W cad Prnlesskme Code The Contractor's License Law dues not apply 1.an owner of OUTLETS-SWITCHES-FU TURES d 3 property who builds or improves thereon,and who does such work himself or donugh his own employees,provided new such improvements arc not intended or offered for NEW RESIDENTIAL ELECTS SQ ET sale.If,however,the buildingor lmpn,coenrin sold within no year of completion,the - SQ.FT.FLOOR AREA ownerhuilder wi 11 have the burden of proving that he did not build or improve for par- posofsale.). - 1,as owner of the prnpeny,am exclusively contracting with licensed coatracturs to .nswa the Notices(Sec.7044.Business and Professions Code:)The Commences 1,i- MAR AR D 2 /Q terse[caw does not apply to an owner ofproperty who builds or improves theren . and QTY. PLUMBING PERMIT FEE Ir' 1996Q who contacts fa such projects with a antmpursu couri)licensed ant to the Commennes as License Law. PERMITISSUANCE GuY UI LIUe'GTI I IIVU ❑ I am exempt under Sum. ,B&P C for'hisreason ALTER-DRAIN&VENT-WAT I' Owner DaVALUATION WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE I hereby affirm under penalty of perjury one of the following de[limanon, ,•D l have and will maintain a Certificate ofCtnsenrto self-insure for Worker's Cooper. DRAINS-FLOOR,ROOK AREA,COND. STORIES TYPE CONSTRUCTION satin,as provided for by Section 37m)of the Labor Code for the pimira n ince of she work fur which this permit is issued. FIXTURES-PER TRAP D I have and will maintain Worker's Compensation Insurance,as required by Section 3700 orthe Lal, Code,lin the Par...nanceof dre work for which this permit is issued, GAS-EA:SYSTEM-1 INC,4 ourrimS OCC.GROUP DPN. My Wnrker'e pens Insurers artier and Policy mbeoarc' n Policy No ` GAS-EA.SYSTEM OVER 4 BDO CERTIFICATE 7EXEMPTION FROM WORKERS COMPENSATION INSURANCE GREASI%INDUS'FRL WASTE INTERCEPTOR (I is section need not be completed if the p mout is for one hundred dollars IS 100) BU I LDING DIVI. TIN FEES m less.) GREASETRAP - PLANCHECKFEB Icandy thin in the performance ofthe work f.rwhich this permit is issued,I&hull SEWER-SANITARY-STORM LA.NO FT. not employ any pennon in any tonne.so esus become subjecno the Woken'Compem ENERGY THE Z satum Laws of Cnlifomia.Date WATER HEATER W/VEMUELECI'R ZO Applicanl GRADING FEE !'n NOTICE TO APPLICANT.If, it,,making this Certificate of L'xatnptlon,you should WATER SYSTIiM/TREATING. a ^ hecame sobjecuo the Wtrkcr'e Compensationprat mono;of the Latin,Cale,you must SOILS FEE G forthwith comply with such provisions.,,his permit shall hedeentedo,,mad. WATER SERVICE - a CONSemisacONLENDING AGENCY NEW RISIDENTIAL PLMB. SQ,En PAID I herebyumrmthat permit i isacol(Site 30lending agency for the Ncrfnrnnccof 0 keceiptp w� the work l'nr is this permit is issued(Sec.9097,Civ,CJ O U Lendces Name - TOTAL: Lender's Address TOTAL: yI certify tint 1 have read this application and note that the above inrnrmutinn is BUILDING 5 h correct l agree to comply with all city and county nNinancesmal Imre lawsrclmingm QTY. MCCHANICAL PERMIT FEE U Z building construction,and hereby authorize repreeematives tfthis city to enter upon the SEISMIC F17. above-mentioned Ptolemy for inspection purposes' PERMIT ISSUANCE(We)agree m save,indemnify and keep harmless the City of Cupertino against ELECTRIC FEE IiabilitieS,judgmems.costs and expenses which may in anyway acame against said City ALTER OR ADD TOMECIL in consequence of the Seaming of this Permit. PLUMBING FEE 'APPLICANT NDERSTA ID AND WIL OMPI \' 'H ALL NON-POINT AIR HANDLING UNIT TTO 10.000 CPM) $ Ce =1 TO MECHANICAL E AIR HANDLING UNIT(OVER W."CFM) CONSTRUCTIO 'AX Sj are of Applicanil m mcmr Date EXHAUST GOOD(WIDUCT) HOUSING MITIGA' ON FEB HAZARDOUS MATERIALS DISCLOSURE Will the up'remn nr future building occupant more nr hanJlehmardoun materiel HEATING UNIT(TO IW,IgO BTU) as defined by the Cupertino Municipal Cale,Chapter J.12,and rhe Health and Sul'ety Code,Section 255321a)7 HEATING UNIT(OVER 100,000 BTU) ❑Yes Fl N. PAID VENTILATION PAN(SINGLE RESID) Date RmdptI Will the applicant or future building occupant use equipment or devices which cordo haeardous air contaminants as defined by she Bay Area Air Quality Management BOILER-COMP(JHPOR I00,000BTU) Orono? TIAL' ❑Yes 7N BOILER-COMP(OVER 1110,0011 Ii'1U) - I have mad the hazardous materials tuniremems under Chatter 6.95 of the Cali AIR CONDITIONER I p ISSUA EDATE fomiaHealth,dews&Safety dylCame,Sections25505,is 533 myand25534.1ilit, cunt,th thatifthe NEW RESIDENT IAL MECH.' SQ,IF. huildi redoesnae.,whit yhave a,met that it ismyeofir luifiNenfythestin, of Ne rtquiremenu which must be and Flri.r m issuanm of n CeniR<ase of Occupanry. Owner maathodzW agent Date TOTAL: ISSUED BY: — a� OFFICE