29802APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING -ELECTRICAL PERMITN029802
. /A `9- /1 O L/'N
BUILDING DIVISION APPLICATION/PERMIT PI.U.MBING-MECHANICAL L
ADDRESS:
❑ Consultant Fees Paid by Applicant (Initial)
1 hemby offirm that I am licensed under provisions of Chapter 9 (commencing
o„m.L with Section t(00)of Division3 oflhe Business and Professiom Code,andnte license is
�� W 0 in full force and effect.
U U License Class Li. . p
In 6 L Date Commetor
ARCH11 ECTS DECLARATION
Z Fp.n Z 1 understand my plans shall he used as public records
IOZ 9z
F 4 �j y Licensed Professional
g C2 rya? OWNER-BUILDERexemptUECe Contractors
ON
yp. 1 hereby affirm tont 1 1. exempt from the Commmols License Law far the
'ad34Ufoll.vwhich inguiresaaw, Section ]OJLS, t, alter,
and Professionsh. or tatoAny city or county
4417 LLO which requires a permit to construct, alma improve, demolish, or repair any structure
MO
pat he is
purse aqui res theapplisofthe Contrarmi'micense Law
y Not he is linnned pursuant me pnrvisionr of the Convenor's License Lvw (Chnpa 0
�in
C, IcommencingwithSection7.1of Division3oflhe Businessund Professions Code)nr
6 {y M K that he is exempt themfmm and the basis for the alleged exemption. Any violation of
pXJ LL• Section 7031,5 by any opplicam far a Permit subjects the applicant m a civil penalty of
tsome than Eve hundred dollars ($500).
CC I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the stmcwre is not intended oroffered forsale (Sec. ]Df4, Business
and Professions Code: The Contmcmr's License Law does not apply man owner fiJ 014
a' r progeny who builds or impmvcs thereon, and who dues such work himself or through
his own employees, provided that such improvements am not intended or offered for
sale. If, however, the building or improvement is sold within one year of completion. the
owner -builder will have the burden of proving that he did not build
or
impin for pur-
e of a1eJ.
L o owner of the property, am exclusively contracting with licensed contractors to
OC ct the project (Sec. 7W4. Bus ss and Professions Code:) The Cmuseacmr's Li-
cense Low does not apply to an owner of property who builds or improves thereon, and QTY,
who contmet& for such projeas with a commends) licensed purmam to the Contmemis
License LayJ✓-1 �f
n l am ta(ednl under 5 1 . B& P C for this reason
I hereby affirm under Penalty of perjury one of the following declandaime:
xw Ihaveendwill
mon, aprovded firnthSaenCieartnifi3c7
aI0
teooff CthoenLseuntbamCsialoi,nsfurrehfoe rpWero0rrtkmernsnGccrmofthe
work for which this permit
is issued.
❑ I have and will maintain Workersr Compensationofthw rkfor which
required t i Saban
3]110 of the Labor Code forte performance of the work for which this permit is issued,
My Worker s Canpensation Insurance carrier and Policy number ere
Cartier. Policy FROM
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSA9']ON INSURANCE
(This section need not he completed if the permit u Some hundred dollars (Slip)
or last
1 certify that in the perf rmtance of me work for which this permit is issued. I shall
Out employ any pmam in any rammer so as to boar subject m he Wmro,W Compcn-
o Z action i Cut mo ia. Data
Z Applicam
f..t fq NOTICE TO APPLICANT. If, after making this Certificate of Exemption. you should
hecome subject to the Wnrkels Compensation provisions of me Labor Calc, yen mail
Loki fndboim comply with tech provisions Or permit shall be deemed revoked.
Q
CONSTRUCTION LENDINGAGENCY
I, 0 I for by which
thi the mit i is a ed (See. 3M7 lending agency for the performance of
U. OF the work Na which this permit is issued (See. 3(19], Civ. CJ
U Lmdcls Name
{1J LendelI Address
1 certify that 1 have read this application and stem that the shove information to
Val correct, lagree to comply and with all uband bscounty nNinancessof and city to enter
upon the QTY.
U building construction, and hereby authodrereoses. Lives of this city mercer upon the
alevc-mentionedpropene for inspection keep o.
(We) agree m cove, indemnify and keep harmless the City of Cupertino nd City
liabilities, encs of thecams o, m aenses which may in anyway uccme against sail City
Aconsequence of the granting mats pe WILL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1. NON -POINT
SOURCE REGULATIONS.
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hanudous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code. Section 255320)? '
E3 yaw ❑No
Will the applicant or future building Occupant use equipment or devices which
emit haurdous airccomp arson as defined by the Bay Area Air Quality Management
District?
❑Yes ❑No
1 have may the haasrdous materials requirements under Chapter 6.95 of the Cali -
firms Health As Safety Cale, Sections 25505.25533 end 255311 understand door if ache
building does not carnally have a tenant, that it is my responsibility to notify the Occupant
Of the ov,damems which roust be met prior to issuance of a Certificate of Occupancy.
ELECTRIC PERMIT
PERMIT ISSUANCE
APPLIANCES -RESIDENTIAL
PANELS
IIP TO 200 AMPS
201-10MAMPS
OVER LUMAMPS t
TEMP. MITER OkL
POWER DEVICES
SWIMMING POOL ELF. v `C
'1lITLETS -SWITCHES - PoK
NEW RESIDENTIAL Eli
SQ IT.
.is"'
tT A -U
SQ. FT. FLOOR AREA $/SQ PT.
PLUMBING PERMIT FEE
❑ ❑
I
JOB DESCRIPTION
RESIDENTIAL:
OSFDWL
❑KITCHEN REMODEL
❑ADDITION
❑ PLUMBING RE -PIPE
❑MUITI-UNIT
❑STRUCTURAL
TYPECONST
MODIFICATION
[I INTERIOR
❑ CHIMN17Y REPAIR
IMPROVEMENT
GAS -EA. SYSTEM -OVEN 4 MA)
❑ BATH REMODEUREkPAIR'1,CIDEPMOLITION
O OTHER
GREASETRAP
PLANCHECK PEE
SEWER -SANITARY -STORM EA. 200 FT.
-
1A n
COMMERCIAL: ,APR
'`7x+V
[I NEW BI621 QDUrION
El DEMOLITION
❑TENANT "U'D
FOOD SERVICE
IMPROVEMENT
Date Receipt p
DOTTER
TOTAL:
SQ. FT. FLOOR AREA $/SQ PT.
PLUMBING PERMIT FEE
BUILDING FEE ii AAA
SEISMIC FEE
ELECT RIC IEE
PERM IT ISSUANCE
ALTER - DRAIN & VENT- WATER (EA)
I QLALUAT
( D 0
RACK FLOW PROTECT.DEVICE
DRAINS- FLOOR, ROOF, AREA, CONI,
STORIES
TYPECONST
FIXTURES -PER IRAP
GAS - EA. SYSTEM.] INC. 4 OUTLETS
OCC. GROUP
APN
GAS -EA. SYSTEM -OVEN 4 MA)
GRFASFJINDUSTRL WASTE INTERCEPTER
BUILDING DIVISION FEES
GREASETRAP
PLANCHECK PEE
SEWER -SANITARY -STORM EA. 200 FT.
ENERGY FEE
WATER HEATER W/VNNT/ELECfR
GRADING FEE
WATER SYSTEMI'BEATING
SOILS FEE
WATER SERVICE
PAID
NEW RESIDENT IAL PLMB. SQ. FT.
Date Receipt p
TOTAL:
MECHANICAL PERMIT F
BUILDING FEE ii AAA
SEISMIC FEE
ELECT RIC IEE
PERMIT ISSUANCE cic
ALTER OR ADDTO MECH.
PLUMBING FEE
AIR HANDLING UNI 'I'(TO I0.000 CFM)
MECHANICAL FEE \
AIR HANDLING UNIT (OVER 10,00(1 CFM)
CONSTRUCTION TAX
EXHAUST HOOD IW/UUCP) -
HOUSING MITIGATION HE
HEATING UNIT (TO 1000011 BTU)
HEATING UNIT (OVER 100,100 BTU)
PAID
Date Receipt
VENTILATION PAN (SINGLE RESID)
BOILER -COMP (3HP OR FOLD 0 BTU)
TOTAL:
BOIL17R -COMP (OVER 100,000 BTU)
AIR CONDITIONER
ISSUANCE DATE ^
NEW RESIDENTIAL MECH. SQ. FI
1 IAT']y ISSUED BY:
OFFICE