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30190 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 1 Q CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO. 3'O 19 O BUILDING DIVISION APPIACATION/PERMIT PLUMBING.MECHANICAL BUILDING PROJECT IDEN'FIFICA'ITON BUILDINGADDRESS: // SANITARY NO. APPLICATION SUBMITTAL DATE .5—? it fes' /y��/j ] (` DWN A r PI(DG,2 " CO V'W' J 1, " 99• CON G N/C TROLM Amok ARC I I h /ENOINLI? : LIC NO. ADORE ❑ Oil, z CONTACT: PHONE: - BUILDING PERMIT INFO ❑ Consultant Fees Paid By Applicant(Initial) BLDG ELECT PLUMB MECH ❑ ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT FEE L hereby cairn mm i ore li«nscd uneer provisions of chapter 9(commeraing JOB DESCRIPTION ynd'Z th Section]g1U)nf Division3of the Nusinesr on R essinns Code.and my license is PERMITISSUANCE RR clpT'IAL' FOO In full force and effaadr�TT Q , LicenseC v `- Lic.p r 4?1 ❑SFDWL ❑KITCHEN REMODEL Z Dam Cut rotor APPLIANCES—RESIDENTIAL p' ARCHITECT'S DECLARATION — CD ADDITION ❑PLUMI31N0 RE-PIPE Z O N Z I understand my plans shall be used as public records PANELS ❑MULTI-UNIT ❑S ULTURAL )IFICATION O Z t�" UP'rO 200 AMPS r4t Licensed Ptofusiounl ❑INTERIOR HIMNEY REPAIR aey OWNER-BUILDER DECLARATION 201-101)DAMPS IMPROVEMENT �yqx+ 1 hereby affirm that 1 am exempt from the Commi License Law for the OVER It00AMPS ❑BATH REMODEUREPAIR ❑DEMOLITION W 3 a U following reason(Section 7031.5,Business and Professions Cede:Any city or many SIGNS ELECTRICAL ❑OTHER F B O[^_ which requires a permit to construct,alter,improve,demolish,or repair any structure rn prior to iia issuance,also requires the applicant for such permit o file a signed statement SPECIAL CIRCUIT/MISC. / that he is licensed potation mine previooloofthe Cnnoucmr's License Low(Chuptcr9 y�d00 (commencing with Section 7")of0ividoo 3 ofthe Business and Professions Codom TEMP.METER OR POLE INST. a W y that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ DDITION ❑DEMOLITION .m. Section 7111 LS by any vpplicamfnrepermit auhjecu the appllcvm macivil penalty of POWER DEVICES ❑TENANT ❑FOODSERVICE •Z not more than five hundred dollars(5500). IMPROVEMENT 9Qp ❑ I,as owner of the progeny.or my employees with wages ns their sole compensation, SWIMM LNG Pool.CLEM RIC W= will do the ssrk,and the swcare;anotimenledoraftered for In(See7044,Business []OTHERWM 3 and Professions Code:The Cuntmcmrs License Low does not apply to an owner of OUTI.F.TS—SWITCHflS—FIXTIIR pmpeny who builds or improves thereon,and who dues such work himself ar through his awn employees.Provided that such improvements arc not intended or offernl for NEW RESIDENTIAL ELEM ;TOWTAL: axle.lG however,the buildingnr lmpmvemem is,ld okhmone year nl complctinn,rho SQ.FT FLOOR AREA S/SQ.PT. owner-builder will have the burden of proving that he did not build or improve for pur- pose of sale.). ❑ I,us owner of the property,um exclusively contracting with Iicenaed contractors to construct the Project(Sec.]044,Ruslness and Profusions Cod...The ContractorcenseLawdoesnotapplymanownerofproperlywhobuildsorimprovesdirwon.und QTY. PLUMBING PERMIT who contracts for such pn)jms with a contortions)licensed pursuant to the Contacurs License Law. I'EkMIT ISSUANCE Owner um exempt under See. ,B&P C for this reason ALTER—DRAIN&VENT—WATER(EAI Owner Date VALUATION WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE 't( haVrchy n04rtn under penalty of perjury one of the following declaration Cvud WlllnlaintxlnaCenlRcateDf Conwnttuself-insurefor Worker's Compen- DRAINS—FLOOR.ROOF,AREA,COND. STORIES ]'YPC CONSTRUCTION ration,as provided for by Smion 3700 of the Iahor Coale,for the performance of the work for which this pcond is issued FIXTURES—PER TRAP ❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700ofl , rG c,forthe performance of the work for which this permit is issued GAS—FA.SYSTEM-1 INC.4 OU9'LETS OCG GROUP APN My Work r do urvra artierand Policy noyyycpyzet/' Cerncc Policy No: ����1Y� GAS—PA.SYSTEM-OVHR4(EA) /s ,t CERTIFICATE GI'EXEMPTION FROM WORKERS' GREASPANDUSIRL WASTE INTERCEPTOR COMPENSATION INSURANCE BUILDING DIVISION FEES (This section need not be completed if the,rant is for one hundred dol hna(E 100) GREASETRAP or Icse.) 1certify thein the Performance o artwork for whichthis permitisissued,Colshall PLANCTIENERGY FEE FEL? not employ any person in any manner so nrtubecome subject to Workers'Com m SI%WC:µ—SANITARY—STORM FA.20019'. Z sation laws of California.Due 1 pt ENERGY FEE O WATER HEATER W/VENTMI.ECTµ GRADING FEF. yko NOTICE NOTICE bj AP.the Wi ker'sf.after making Nis Cnimosmof Exempdon,you should most WATER SYSTEM/1'RIiATING f"! home subject[.thethe Work ds Coons or this provisions of the Labor Code,you mu,n 5011.5 FEE LfS�I I'ntlhwith comply with such provisions or permit shall he Deemed revoked, WATER SERVICE yup � z CONSTRUCTION LENDINGAGENCY NEW RF.SIDENTIAh PLMD. SQ,FL PAID WJr k far hy which thi thauhemssued X .30l Cing agency for performance of Dam ReceiplM lL (~ the work for which this permit is issued(See.3097,Civ.CJ O Lender's Name TOTAL: W Lenders Address TOTAL: y I cenify that 1 hove real this nppliemimn and state shut the above information is BUILDING ITE H correct.I agree to comply with all city and county ordinances and state laws relating to QTY MECHANICAL PERMIT FEE t,1?y huildir,emstmetion,and herchymillimiae representatives ofthi.seity to enter upon the SEISMICFEE aMve-mealioned progeny,far inspection purporea. PERMIT ISSUANCE. (We,agree ave,indemnify and keep harmless the City of Cupertino against ELECTRIC IPE l inhililies,judgm s.eostsvndexperees which may in any wnytoemenguinslmid City ALTERORADDTOMECH. the..equena flon,mntingnftilknemnit. PLUMBING FEE APPLICA NDERSTA'DS AND WILL COMPLY WITH ALL NON-POINT piµHANDLING UNIT(TO III,f00CIoM) SOURCE .GULATION. MECHANICALFEE AIR HANDLING UNIT(OVER 10,000CF10) CONSTRUCTION TAX ro of Applicant/ on northi am EXHAUST HOOD(W/DUCI) HOUSING MITIGATION FEE MATERIALS DISCLOSURE Will Ne applicumorfuturt huilding«cuµrestore orhandle hazardous me¢nal HEATING UNIT Go 1(1(1,000 BTU) in defined by the Cupertino Municipal Code,Chapter 9.12,and One Health and Safety Code,Section 25532(u)'1 ' / HEATING UNIT(OVER 100,000 BTU) ❑Yes [(}X6 VENTILATION PAN IS I NOLL RESID) PAID Will the applicant or future building«cuµnt use equipment or devices which Date Receipt p mit hmandous air contaminants as defined by the Bay Area Air Quality Management BOILER-COMP OHP OR JOR0 6 HTU) /� Istrid? / - TOTAL: •/ L �}QO BOILER—COMP(OVER100,1X0BTU) rev ehamrdons mdmrialsIR CONDITIONER ISSUANCE DATE requiremenu trader Chapter 6.95 olthe ClCali- Health rely Code Sections 25505,2,5533 and 25534.1 wdemand that if the NEW RESIDENTIAL MECH. SQ.FT. tcumently v count,that it ismyiesponsibilily tonotify Ne«crrrupostal mesa who .(rue wtto ceofuCeniforizW gent TOTAL: ISSUED BY: OFFICE RLL STREZPRRLI 4 '37 I CONSULTING m 0 V-�0 ........................ ......... .... ................. ......... . ..................... ............ ........................ p ........ ........ .. ....................... ......... ... ...... ..... ......... ............... • ...... ..................i....... ..... ............ ............... .... ............................. . .................!................?...._..J.................!. .. .... ......... ....... ...... .... ...2. _J ..................... ..................i........:.........:........'. .......... ..... ....... ........<..... ........ ......................... ........ ............... ....... .... .......... ................. 7 . ....... ......� . .......... .........i......... ...... .......i............... ........ ......................... .................. .......... ..................?.......I................ .......... .......... ............ ............... 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