S 0407 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY '
CITY OF CUPERTINO RUJUDING-ELECTRICAL PERM]P NO,
BUILDING DIVISION APPLICATION/PERMIT 1'LUh1111NG--IECIRNHFI I.
-BUILDING PROJECT',IDI{NTIFICATION „ ESANITARY NO. KM
M11'fAl,DATE
BUILDING ADDRESS:OWNER' AM': TIO CON'1'ItACT(lHS NAME: - LICNO4CH ECT/ENGINE IAC ADDRESS:CON ACT: I{O i*(11UILD 'l `
❑ Consultant Fees Paid by Applicant(Initial) BLDG E PLUMB MECH
ro
LICLNS-DCONIRACI ltSDLC AR TION / /
F ? t B DESCRIPTIONQTY
1 hereby affirm that l ea licensedantler provisions(if Chapter 9(commencing JO
OWZwith Section 7(NNO of Division laflh B s ess endP f sons Ede,and myhur. Is PERMITISSUANCE �/ IfIDENI'IAL:
a,F in full force unde0ect ,yWl. ❑KITCHENREMODF,L
aUU Liccn.ve Clusv hiu.M APPLIANCES-RESIDENTIAL ADDITION ❑PLUMBINGRE-PIR'E
FFZtil Dae Connowlta URAL
VrQa
ARCHITECTS DECLARATION ❑M111,T1-UNIT' ❑MODIF'ICATIO
~h Z I undnsoad my plum xbml W user m public rca.Ns PANELS MODIFICATION
OZ�� UPT0200AMPS [I INTERIOR El CHIMNEY REPAIR
F'3 uI Loetwed P...I..onal 201-I(NNIAMP IMPROVEMENT' (]SWIMMING IKH)LS
OWNE -BUILDERDECLARATION OVER I(MNIAMPS El HATH RIEA1UOEURIi1'AIB ❑DIiMO1.I'fIQN
C,Q 1 hewby affirm the 1 am exempt from Ne Cantrucmr's License Law for 1ne ..L1
XLX y U following reason.(Section 7031.5,Business and Pmfesxinm Cade Any city or aunty SIGNS ELECTRWAL 1
W O vFi which mature,a Permit u."mama,xlteu improve,dcnmlisb,or repair any arucmre _
is
to he
tmavipiicant for snormufmm License
Law(Chapter
SPECIALCIRCUIT/MISE.
W } to lie is IicenwJ pursuant Ia IM pmviannx of the Cnnwemrs License Law(CM.pmr 9
Ep0 (commencing with Section 700(1of Division 3 of the Businessand Professions Cl.10or TEMP.METER OR POLE INST.
d p,o a da,he is exempt Iherehum and the basis for the alleged exemplar.Any Aulv0on of ` 441IN.I:W BLDLG/ADDD'ION El DEMOLITION
Semon 7031.5 by nay applicn I fon.permit xiii ce s the aliplicannn a civil penulry of POWER DEVICES D,I IENAN7`�{i 1-IAtU• ❑FOOD SERVICH
FZ ore than live hundreddollar,S5W1. IMPROVIEME _
a as owrerofthe imperry.re my anployees with w,m,mv their...lecion,iiition, SWIMMING POOL ELECTRIC
0=G rill El OTHER
do the workunu
andtesam is not intended or offered ftxxale(See.9014,Business ,
fy ' and Professions Code:The Contractor's License Law does not apply to an owner of OUTLETS,S WITCHES-F1XTIIRIS
Q' papery who builds or impnrvvx thereon,and who docs such work himself or through
his own employees,provided that such Improvements are not intended or offered for NEW RESIDENTIAL HLECTR SQ PI'.
sale If,however.the Wilding or improvement is sold within one year asmpletior,lhc SQ.FI'.IB.00R ARIi SItiQ.PI'.
cr badder will have the burden of proving that he did not builA nr improve for pus- ' 31 !6
o f ),
❑ 1 f the Property, x lu ly contracting with licensed contractor,I
reconsumerw project t apply
t1an Business dry f Cod i The C t t 1 - a •. J u / �..a
cen. Law doe not pp1Yi on fp pent h builds p ' eC d QTY t PI:UMBING PERMIT. / +_ •tr FEE j' `,(w/ 4/,/{11/1,
wh I I'f such prnlensx)ha nnuvvmrOTwn.edp mu IM1e C<nt acres.
I,i a Law PERMIT ISSUA
1 ex nptu er Sec B&I'C for Oli. n
ALTER-DRAT VENT-WA EAG VALLAION
weer �ons ���
•, WORK R'9C0 iNSlary on DECIARA DN SACK PLOW P.
. . EVICE,
Ihandwill mai to cr Penulty dficat p Juryoneo tire self-iollawing declaratWorker's
❑Ihave and will for by etion 374)of ConsentsCode,for
Worker'sceofth- DRAINS-Il. tOOlip OND. *Receipt
IES TY I'Ii CONSI'R IJUI']ON
worklas hick dd for ra Section 37W of the LnWr Code,for the peHnrmann of IM1e
work for which this permit is issued. IOXTUHIiS-PtiH TRAP
❑ 1 have and will muimvin Worker'N Cnmpensalum Instance,nx required by Section 3700ofthe LaborCode,bathe performance of the work farhich this Permit is issued. GAS-IiA.SYS'T'EM IINC.401 i S OUI' ` APN
My Wmkers Compensation Tnmrance carierxnd Policy numberam: •V\Cial Policy Na.: GAS-EA.SYSTEM OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS' GHRASIJINDUST&I.WASTEINIIRCEPTORCOMPENSATION INSURANCE J .(VISION FBI;S
(IdiseetionneeJnolbecomplened iflhepennd isRsroneM1undreddidlinASIMB GRIiASE1RAPI cen ify that in the performance ofnhe work for which this pemtll is issued.5 shall SEWER-SANITARY-STORM EA.LIO FEnal employ any person in any manner Naas m account subect to the Workers'CmnPery iz .mien Laws of California.Date WATER fIIiATF,R W/VEN DELICTIz0 Applicant 1 NOTICE TO APPLICANT:If,after making Nis Ccnificate of Exemption,you should WATER SYSTENIG BEATING became sabjrelm the Winker,C..... .ion previsions of the Lid nr CWe,youstud
limwith cant ply wit such previsions nr Nix proud vhnil be doemtxl mvnk,d. WATER S17RVICE
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.1.7.. him
PAID
(hereby affirm that there is a vinwbanion lending agency for performance Heceiptp
W [0. the omllfor which this permit is issued(Sec.1097,Civ.CJ IGIA1:
Qled' , Nae TOIAI
Li Le dr.Adl :
U
0. I rfy i that 1 have read this application and ane that 11131 DINE I E.
c t I gr t reply wnM1 allcryund county oN'nanc d.ctcl srclatngloQ1Y J '1 MECHANICAL Pf:RMIT E FIRE tt SEIShH -3:
U Z b ll' b nmat xi nn aul hvmby oath.-x mprexsd Ives OI N-vi ryt nu'upnn Nc
uhowe-merdlaaed prnpeny far inspection Imposes. PERMI'TISSUANCE ELECTRIC 1117
(We)agree to save,indemnify and keep harmless to City of CO, ino against
Iildiddies,judgments,costs and expenses which may in anyway accme against said City
pITEH OR ADD TO MECH. PLUMB[ 'IEE '
in setmenec of the granting of this permit.
APPLICANT UN ERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNI'T(To 10.000 CFM) MECH (CAI.FF,E
SOURCE& GUI TIONS. � 'I
AIR HANDLING UNIT(OVER 10,000 CFM) CONS'RUCI'ION TAX
Signamrcaf App com/Cont ear Date o EXHAUST HOOD(W/DUCT) HOUSI ITIGATION FEE
HA'LA)OGS 1-ERIALS DISCLOSURE
Will the applicant ar future building occupant store or handle haaamI material HEAPING UNIT(1'0100,00011111) -
av defined by the Cupenino Municipal CNe,Chapmr 1,11,and the Health and Safely '
Code,Senior 25532(a)'I BEATING UNIT(OVER 100.01N)I3'1'U)
❑Vcv [7 No VENTILATION VAN(SINGLE REBID) PAID - -
—Dae imeipt W
Will the applicant or future building occupant use equipment cr devices which BOILER-COMP DNI'OR 100,001 BTU)
emit hmanlow;air vi,m n dusts as defined by he tiny Area Air Quality M.mg,am nth TOTAL:
Dstrim7 BOILER-COME(OVER Ino,oOO BTU)
❑Ycs nNo
lhave mal the hazardous ramflalsrequirent under Chapter 6.95 of the Cut, AIR CONUITIONEIt ISSUANCE(
forria Health&Safety Code,Sections 25505,25533 and 25534,1 undersand IM1e if the NEW RF,SIDENGHAI,MECH, SQ.14.
- building Jowl not currently have a leant that it is my responsibility to notify the—rapvm
of the re,moca encs which most b,met prior m ivsuance of a Cerifcate of Occupancy.
Owner.,and orimd agent Date TOTAL: ISSUED IIY:
OFFICE