30158 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY - / -
CI'T'YOFCUPERTINO BUILDING-ELECTRICAL PERMITNr
BUILDING DIVISION APPLICATION/PERMIT PLUMBING+MECHANICAL O. 30158
IIUILIIIN(:PROJECT'IDENTIFICAI'ION
BUILDING ADDRESS: f, •, ,SANITARYNO. APPLICATION SUBMITTAL DATE
OWN '$NAMR' I'HONP:�• � CONTTON'S NAME: hIC N(J:
rr� Tr NIC COMI'ROLM
ARC[IITECT/ENGINEER: LIGN : ADDRESS: -
E2n! o n1 CE 5325
CONTACT: PHONE: - - HUILDING PERMIT INFO
(�,sJ C_
yob' y06 •�?4CEj .,:.
VUAJ 'peTL- C ❑ Consultant Fees Paid,by Applicant(Initial) BLOC ELECT PLUMB MECH
8 NCP 4 , o 0
LICENSE D COM RACTORS DLC1ARAI ION QTY ELECTRIC PERMIT FEE
I hereby anion that it..licensed a do p m of Chapter 9( mine ng JOB DESCRIPTION
X00 with Section7000 ufD Sul the Bus dProfession,C d bd Ifden. i
�I— f y PERMITISSUANCE:' r RESIDENTIAL:
WF- in full!m anJ ett61. ❑SFDWL 's C KITCHEN REMODEL
�FUO License Class L10.M APPLIANCIIS-RESIDIENfIAL
N4L Dam Coma"mI s EIADDITION I CPLUMBING RE-PIPE
7rn
ARCHI'I'ECI'S DIECI:ARAI' PANELS ION ❑MULTI-UNIT ❑STRUCTURAL•
p. -
Z O Z I undemanJ my,plans shall be used as public o«oN.a - - MODIFICATION
OZ O UPT02ia AMPS ❑ NTERIOR, . CCHIMNEY REPAIR
� I
41j Licensed Pmfe,emind 201-1000AMES MPROVEMENI'
5 O.,I am 3Uento for.
Crim ION OVER I(eN1 AMPS El BATH REMODEIJREPAIR DEMOLITION
qx I hereby affirm That 1 am exempt from Ne RATIONrs License Law for the
W 3 L UF following reason.(Scetion]011.5,Business and Professions C.de:Any city or ceuntY SIGNS HLEC'BICAL C OTHER Q s
r�r t J which requires a Feril to cunsRud,eller,improve,demolish;or repair any swcture I A�'�-' JPA
pre,ji,its i...once,ulimmilmocs lhcapplicant for suchperit to ftle.,igned statement SPECIAL CIRCUIT'/MISC.
Ea�p.
that he is licensed pumuanto the pmvisionsofthe COnwctors License Law(Chipler9 - -
W�C� (emnmencing with Section 7WK)of DiviOO.fthe Business and Profcs,or,Code)., TEMP.METER OR POLI?INST. - COMMERCIAL:
6.m C The,he is exempt Ihcrefromand the basis for the True ed exemption.Any violation of ❑NEW BLDG/ADDITION ',0 DEMOLITION
n^�LLO, Sectinn]OILS by any applicant forapermit subjects the applicannnecivil penuhy of POWER DEVICES ❑TENANT ❑FOOD SERVICE
t more Ihun five hundred dollars($50().
C %Las owner of the norm employees with wa es as their sole mm IMPROVB.MENf
(vl props y yemp y g pensatiun. SWIMMING FOOL ELECTRIC
f� Il do the work' de:and Elm swcture is not monedcd m offered for..le(Sea]044,Business COTHER
W and Professions CoThe Commerce.,License Low does not apply m an owner of OUTLIETS-SWITCHES-FIXTURES '
property who builds m improves thereon,and who does such work hinrsell ur through his own employees,provided Out such improvements am not intended or uttered for NEW RESIDENTIAL ELIEC SQ FE
sale.IL however,the building or improvement is sold within one year of completion,the s SQ.FL FLOOR AREA $ISQ,FE
owner-builder will have the harden of p-roving that he did not build or improve for pur-
1 pose ofsalnJ.
C 1,as owner of the property,am exclusively contracting with licensed contractors to XL: •r �� 9'� ,''
constimet the project(See 74044 11usurew air]P I'e s Cod )The C t r s Li-
cerne Law does not applyt an owner ofpropmy ho builder inapieve,theme .and QTY. PLUMBINi FF.E AUGwho c m Nf ti la 1 I' 'll my I rOm
licensed dpu:u l the C mrums - A $•
1999
Lice. L PERMIT ISSUANCE 96
C l am axe n trader Sec E is 1 C for this mason
Owner nr'M ,Toe
ALTER-DRAIN&VENT
- V4TER(E a) VVALUATION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE.
I hemhy ofr..n under p roa ty of perjury..,,if the follOwing deductions: '
❑ I have and will maintain a Certificate of Consent to self-insure for Worker's Compen. DRAINS-FLOOR.ROOK AREA,COND. STORIES 'TYPE CONSTRUCTION
sntion,as provided for by Section 3]1X1 of the Labor Code,for the perfoanunm of the - -
workforwhichthispennitisissued. FIXTURES-PERTRAP
C 1 huvc and will maintain Wuror,Comracrot inn Insurance,as required by Section -
37M of the Labor Cotte.for the j+erfomtanwof me work for which this peril is issued, GAS-IIA.SYSTEM-I INC.4 DO I'LETS
OCC CROUP AI'N
Worker's Comns
pensation lunmce carrier Policy number are:
Ca -
'- Carrier: Policy No.: OAS-IEA.SVSTI?M-OV ER4(IEA) )
- CERTIFICATE OF EXEMPT[ON FROM WORKERS' GREASfIDNDIJSI'NL WASTIi INTERC[I'fOR
COMPENSATION INSURANCE. - •, -
('This,redan need not be completed tithe peri,is former hundred dollars($I W) BUILDING DIVISION FEE'S
or less) - OREASIi TRAP. PLANCHIiCK FLEE ,
I certify char m the perf rn antt of Ne work for which this peril is issued,l shall 9,6
not crato an SHWER-SANITARY-STORM EA,200 FT.
p y ypersnn in any manner snnsto beenmesuhjmnotha Workers Cnmpem ENERGY FEB
satin.Laws of California.Date
Z O Applicant - _ WATER HF,ATER,WNENT/F.LECI'R GRADING FLEE
V) NOTICCTO APPLICANT.If,after making this Certificate of Esemptiun,you should WATER SYSTEM/TREATING _
F^ become subject to the Worker's Compensation provisions of the Labor Code,you mustSOILS FEE
fonhwith comply with such provisions or this peril shall he deemed revoked WATER SERVICE
' CONSTRUCTIONLENDINGAGENCY NEW RESIDENTIAL PLMB. SQ.IT PAID +
U O I hereby effimuhat them is a construction lending agency for the perRtrunce of s _ Dna c pIM"
o p•t Ihework for which this permit ix issue)(Sec.309].Civ.G) -
U Lenders Name - - TOTAL:
Lenders Address TOTAL:
1 eerily that 1 have mad this pplicut' r t that the b vino is J _ BUILDING FE
vJ wrren Legrce to comply m II u)andc tY b' end tt I -mtingm QI'Y MECHANICAL PERMIT FEI3 -
U "l�- building oustmntat. be turnery calliorize p tf v�f0 ' 'IYt ie he SEISMIC IEE
tomee-mcnonned property for Inspection purposes. PERMITISSUANCE ,
(We)agree nt save,indemnify and keep harmless the City of Cupertino against ELECTRIC
Iiabilirics,judgmeau.costsand expenses which mayor any wayaccrueagainosi id City ALTER OR ADD'IO MF.CHI - ^}
in nseyuenceof the gfamingof this permil.' PLUMBIPT5E
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO Iq(kN)CFM)
SOURCE REGULATIONS. - MECHANICAL FE
AIR HANDLING UNIT(OVER 10,000 CPM) CONSTRUC'ITON A%
Signature of Applant/Ctomenur + Date EXHAUST HOOD(W/DUCT) HOUSING h1IT'1- 'PION PEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material IIGTI NG UNIT(TO 100.000 BTU)
as defined by the Cupertino Municipal Calc,Chapter 9.12,and the Health and Safety '
Calc,Salina 25532SU - I IEATI NO U NIT(OVER 100.00 13 PID
❑Yes '[I No. •. PAID
- VENT'I LAI'ION FANS INGLE RES ID) Dam Recciptp
Will the applicant or future building necnpouse e equipment or devices which ..l{OILBH-COMP IJIIP OR 100,0(A)BTU)
emir humorous air contaminants m defined by the Bay Area Air Quality Management TOTAL:
�Dixrncr7. a - .z
•C Yes' ❑N. BOILERp COMI'(OVER 100,000 BIT)
•
-
t -
1 have read the limitations maarials regoircments under Chapter fi.95 of rte Coli- AIRCONDI'TIONER ISSUANCE DATE
fomin Ikons&Snfey Code Sections 25506,255]]and 25514.1 unekrsmnd that if the NEW RESIDEN'TI AL MFEE. SQ.FI.
building does not currently have a tenant.Oat it is my mspxmsibility,us notify the occupon
Of the requlmmenis which lndst M1e met prior to issuance of a Ceniricam of Occupancy - -
Owner or aothelo d agent Date - TOTAL: ISS FED BY:
ti -
• OFFICE, ,
L
r. •\ r it � _�, � + � r .. .. . , ; ,,
r
r