S 1737 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL, 1737
'- BUILDING DIVISION APPLICATIONWERMIT PLUMBING-NIECHANICAL
BUII.DING i'ROJI?Cf IDF,NTIFiCA'I'ION
BUILDING Af)IJRh � SANITARY NO. A�.IC�N��AI,DKI'li
(IWNE :SNAMIi: - PHONI?: CON'I'RAC'I OILS NAME 1`UJy� ru,�LICNO'.
e.Y)Y7In / -SAa
- NIC CONTROI.p
ARCHITECT/ENGINEER: C. }NO: ADORES S: ` ❑
CONTACT: PHONE: BUIfAINC PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) B.0 PLAY]'r PLUMB MECH
❑ ❑ ❑
LICENSED CONI RACI OR S DECLARATION ARATION i
QTY. ELECTRIC PERMIT' PEE"t
inermy arrrd,tl tl ,osis J 1 p '.' rcnapmr9lnnntn ' g .� JOB DIiSCRIPp10N
"Z with Seetion 7000)ofT vision 3 ollh Lioness and Professions Code,and my Evense RESIDENTIAI.
WO, in I'LHAIIT ISSUANCIi
-w= full force and effect ❑SPOWL ❑KITCHEN REMODEL
t y_u License,Class Lie p APPLIANCES-RESIDENTIAL El ADDITION Ll PLUMBING HE FEE
h<L Dam Comntcun
ARCHITECT'S DFCLARAI'ION ❑ ❑
MULTI-UNIT STRUCTURAL.
O m Z I. ..ly" an,t Iny Pnuns tuff oc-ed as pili ie Icaold. PANELS M011ll'ICA'I'ION
z
OZ`4- UP 10200 AMPS ❑IN'IPRIOR OCHIMNEY REPAIR
F N.,F.cc Licce,d Pmfesni.ual 201-10N)AMPS IMPROVEMENT E]SWIMMING TOOLS
�,;�-I OWNER-BUILDER DECLARATION
X Y C Q LafrtOVER 00AAP5 �IPtA9'Ii REMO IC
AR LITIO
c. y pnN
U following reason.(Section 7031.5,Business ant rude......CNe:Any ol,orcoumy SIGNS ELECTRICAL OTIiIiR
1+13 y,I-
F� ¢ Loch m MI n omurrc. gerimports,JI_h painy smtemre
oas
ymJ
,for t t al thapplicantI hpe a freeg Istatement SPLCIALCIRC'ID NC,
41 p'
that he Ip tl thep III C Ime L IChupua9
�Q (10 g 'I S 7000) fD .1 III Il dl I .: 'C nknu, ILMP.MLI'HR OR POI II INS' COMMERCIAL'
C.Q.ey 'hal hes uenpl tl vsl n n and the bas's for the alleged evou,n t Ary viol,inn d ❑NEW BLDG/ADDI'LION 0 DEMOLITION
W genion 7031.5 ey any applicant for a permit nunjccis lhe.pplleam o a<Iyd penally of POWER DEVICES - ❑'TENANT [I FOOD SERVICE
F.F. y of more than five lmdred dollars($5110).
=Q ❑Las owner ofthe unpeny,or my emPEoyees with wages as their side compensation. SWIMMING POOL,ELECT IMPROVEMENT
F will do the work,and thcsoucmre isnot nmendeJ proffered forsa]e(Sec.BA,L Easiness ❑DTIBiR
W�m
and Precolons Code:The Contractor's License Law does not apply to an Owner of OVI'LI:TS-SWTfC11ES-
C 3 pRt
r.,ay who bmlds or innpmves thereon,ant was does such wmk himself nr through
Itis own employ.,,nmviJed Ont such improve ms am apt intended nr oaf d for NEW RESIDENTIAL.F.J., IR PI'.
od,If,however,the building nrinipmvene,nl'dnnld woltinone yevrolcnlnp10in l,the SQ.FIL FLOOR ARE - S/SQ.FL
introit,build,will have the humtr of pnrviltg pho he did not build or 1 Our par- -
C] 1.as owner of the property,am exclusively contracting with licensed contractors to 'TOTAL:
ommot the mcc,1Sce.7000.Business and Profession,CNet)The Comeari Li- -- - , - 6
sc Lawdn,s ,,topplymanownerofpn,penywhobuildssnimpmvesmemun,ane QTY.' „PLUMBING PERMIT) -' ' ,FEE "- ' D
who contracts((it such pmjocs with a comm"Ons)licensed pitrstaimlahe Contortoises c
Lucie,Law. 1'IiRMI'1'ISSUANCE 111
(] I am exempt under See. ,B&P C italhis.,on I,
ACI'liR-DRAIN&VI?N'I'-WAI ER(BA) VALUATION
Owner Due,
WORKER'S CO ENSA'IION D ILARATION BACK FLOW PROTECT.DEVICE
r (+(J/-[j.11lry�
• [have
wnllimintaicr polity n0 ofConeneolthefnlnswfngdedaers Camper-
aV
_ � Ibme arowillforbineCion 37 m of the Laor Code.for the Workersce m ire DRAINS-FLOOR ROOI'.AREA,GOND, STORIES TYPE CONS"1'RI1Cf10N
,.,it f r Ounch hi for M1y is issued.
3]00 of the Labor Code,for the performance mine I
work for which this permit is issued. 19%'1lIRE5-PER TRAP
❑1 have and will maintain he crf's um,v l Ili,w rk Fo, 1hi as required by Section -
9]n0 of the Labor C,xlq kit the pert'nrmaneenl the work finwhich'his pennil 1,iasuui. GAS-HA.SVSTEMd INC.4OUT'LE'FS OCC CRO'(' APN
My Worker's Cnnipcnnalinn hismacce cIII'fiel and Policy t u roen,re
Cartier. Policy NO GAS-PA.SYSTEM-OVER 4(HA)
CER'11IiICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE CREASETSDUSTRI.WASTE INTERCEPTOR BUILDING DIVISION FEES
('llikayfinnnaedirm ScuumpEted iOhe permit is furore hundred dollars 09100) frREASETRAP
or less.) PLANCHECK FEE
L certify that in the per(ommuce Ofthe work for which this permit is issued,l shall SI7WER-SANITARY-Sir ORM EA.200 IT,
not employ any person'uI any manner s0 its m feature me sobjeco the Workers'Compcn- ENI?HGY FEE
0y NOlicantDAI'PLICAN'1':IL after Makin 'his Ccn' WRI'HN HEATER W/VI3NTII3LI3C'fR LEADING FEE
w.Omc
CE
O NOTIIcam
b loans of Exempt inn,yous...11 WA'T'ER SYSTEM/1'ItliAl'INC \
hocamesubject y it Work-,Compensmiis crnv.ons oftheLuton Cute,you mel SOILS FEE
wfimnwith comply with such provisions or rymtit shall be deemed read.eJ. WATER SERVICE
.:) z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL.PLMB, SQ.FE PALO Dale eip t N
U O Thereby affirm than there is a constmnion lending agency for the perfnnnanec of
the work to,which thio pemnl is issued(Sea.309],Civ.C.) -
OV I.enders Nene TOTAL'
ULender's Address 'I'OIAI.:
y I certify that I have read this application and ante that the aMrve Inlimnallon a BUILDING FEE
correct.l agree to comply with all city and coned,ordinances and sure lawn iclatingm QTY. MECHANICAL-PERMITFEE.
U ,Z building consuuctinn.and hereby authorize teptcsenmtives of this city u,enter upon the SHISMU FEE
abiollemencided property for inspection Purinnes. I',Rmn ISSUANCE
(We)agree it,save,indemnify and keep hmmless the City of Cupertino against IiL[Cfl11C FEE
Iiahilities,judgmetrs,n,su and espouses which.nay in anyway accrue against said City AI,TERORADDTOMI:CH.
PLUMBING PEP.
in ttnequence Of the grunting of this permit.
APPLICANT UNIOERSTANDS AND WILL COMPLY WITH ALI.N)N-POINT AIR HANDLING UNI"1'(10111,1100 CItM)
OU CE II.AI'I 1N MECHANICAL hEI?
AIR HANDLING UNIT OVER 10,000 CPM) CONS'FRUCRON'[AX
Sigitallnep App anVCn mor Dec EXHAOST 11001)1 W/DLJ(-T) HOUSING MITIGATION FIiIi
11 DO'S MXITRl _ DISCLOSURE
\wRmeap,liean rburebtlddingrcc amore Orhirdlehamnlons mate..] III?ATLNG ON[FCFO InfIxp BTU)
as defieed by the Cupcnine Municipal Code,Chapter 9.12,and the Health and Safety.
Code,Section 29532(a)] HEATING UNIT(OVER 100,000 BTU)
Ycs El No
VI:N'1'ILACION PAN(SISOLE 121351D) PAID Date Receipt 4 -
'� Will the applicant our more,building nccupanl ase e9uipmcul Or devices which
omit hcaudius aircnmanumad,as defined by the If.,Area Air Quality Management BOILER-COMP(MPOR 1110,0.50BTU) TOTAL:
Disbim9
LJYec [I No BOILER-COMP(OVER 100,000 BTU)
L nave read the lui,or us material,nes,drene,ms under Cl c,6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE
nmia Health K Suleay Cut,Stolons 25505,25533..it 25534.1 u id mound mat If the NI1W RIISIDENTIAL MSCIL SQ.14.
hulldingdoc tmcm'icner,havcakneel,Ih,dir'm any rcIfneeihll'uy In realty the ncmipam ,
of the re rnemen's which must N mel into In issuance of a Cenlfic nc of Occupancy.
Owner or lmthoriral ager] Dwc TOTAL: ISSUI?D BY:
OFFICE