S 0635 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
'C
CITY LO
UPERTINO BUILDING-ELECT RICA], PERMIT NO,
BUILDING DIVISION APPIACA•FION/PERMIT 'PLUMBING-MECHANICAL S0635
BUILDING PROJECT IDFWI'IF'ICA'1'ION
BUILDING ADDRESS: SANITARY NO, APPLICATION SUBMIT AT,[)ATI:
2 I o , FC. ys ?4K
OWNE NAME: P ON T CONTRACT' 'S NAMIi^ f.iLN
L — z �`+oe)36G— 7 ah fur JF NIC C°N R°''"
' ❑
/sRC111TECflENGINf:CR: LIC NO: ADDRESS:
Moa4UAav Feil-f•- l
CONTACT: O PHONE: BUILDING PERMIT INFO
&ro) ❑ Consultant Fees Paid by Applicant(Initial) RLDG ELECT PIAMR MECH
LICENSED CONTRACTORS DECLARATION QTY. ELECTRICPERMIT FEE JOB DESCRIPTION
1 herehy affirm Bar Into licensed under 1vmieivm of Chupar 9(commencing
DMZ with Scction 7lXXllnfCassPERMIT ISSUANCE:
ion 3ofthe Business and PonfesamnsCode,and mylicenseis RESIDENTIAL,_
41 p
F p intuit
F- JeRed.
❑Sl)WI. ❑KITC{EN REMODEL
U UW Lic aClassLic h
F.ZyDart Commcur APPLIANCES-RESIOOMIAh ❑ADDITION El PLUMBING RE-PIPE
fA66 ❑MULTI-UNIT ❑STRUCTURAL
ARCHITECTS DECLARATION
TION
Z FO H N7J. I understand my plans shall be umd to public records PANELS CHIMNMODIFEY
REPO
p m UP'T02W AMPS [I INTERIOR ❑CHIMNIiY REPAIR
r4g Licemscil P..fesaiona 201-II)TOAMPS IMPROVEMENT []SWIMMING POOLS
••1 OWNER-BUILDER DECLARATION OVER 1000 AMPS ❑BATH RF.MODEUREPAIR ElDEMOLITION
1 heathy otTnn that 1 em exempt from the Contractors License Law for the
i�py(5,O0.U following ramnn.(Section 703 L5,Business and Pmfcsainns Conic:Any city nr imntY SIGNS ELECTRICAL El O'DIER Co
Tal•3 t^ which requires a permit to imswct,alter,improve,demolish,or repair any structure11\o
F.
0 prioro its issuance,also requires Neappluabt for such Permit file asigmed statement SPECIAL CIRCUIT/MISC.
� 'i
that he is licensed purmantto the provisions ofNe Conivel 's Liecroo Law(Chapter 9 OMMF.R .IA
�QCp
(commencing with Section 7")of Division 3 ofthe Business and Professions Code)or TOME METER OR POLE INST.
a q p C that he is exempt therefrom and the hnsis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DFMOI.ITI°N
u%1 I+• Section 90315 by any applicant for a Permit subjects the applicant to It civil pemthy of 1'OWI7k DEVICES ❑TENANT El FOOD S17RVICE
t mart than five hundred dollars(4500). IMPROVEMENT
�^Q
E]1,as owner ofthe propary,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC
C will dothe veak,and Nestoamre is not intended or ofted foranle(Sce.7(W,Business 0DTHfiR
W .,Profession,Ceste:'Me Comractnrs License Law dreg urn apply m an owner of OIITI.f!TS-SWITCHES-FIXTURES
property who huilds or improves Neram,and who does such work himself or through
his o wn employees,provided that such impmvinems ore not intended or uttered for NEW RFSIDENTIAL ELECI'R SQ FT.
sale,IL hawmcm the huildingor improvement is sold within one year of cnmpletian,Ne SQ.FT.FLOUR AREA LSQ.IT.
erbu lder will have the burden of proving that he did not build or improve forpur-
ulcJ,
Ws 1,as owner of the progeny,am exclusively contracting with licensed contractors to P Pit,
TOTA
onstrct the project(Sec.71M4,Business and Professions Gxte:)The Contractor's Li-
cause law dmea not apply to an owner of property who builds or improves Hereon,and QTY, PLUMBING PERMIT O
who contract for such pmjeets with a amtmcua(O licenced pursuant to the Contractors wsp� M
24 CI
License Law. PERMIT ISSUANCE �b� n[
❑I am axempt and ,R&P C for Nix reason CCCClfff
IO er Dam 1111-GRAIN&VENT-WATER(E1) (Jr
NOROEA bfJMPCNSATION DECLARATION BACK FLOW PROTECT.DEVICE Ury
I h affirm under penalty of perjury one of the following dcclamtions: —
❑ (have I will malnmina Cenificme of Cansmn mself-insure far ,Worker,Compen- DRAINS-FLOOR,ROOF AREA,GOND, S'T'ORIES TYPE CONSTRUCTION
sation,is provided for by Section 37M of the Libor Cale,for the Performance of the
work for which this Permit is issued. FIXTURES-PER TRAP
❑ 1 have and will nounain Worker's Compensmion Insurance,as acquired by Section
3700 of the Labor Cabo,for the perfomunce of the work for which Nis permit is issued. GAS-EA.SYSTEM-1 INC.4 OUTLETS OCC.GROUT' APN
My Worker's Compebsathat Insurance earlier nM Policy mmider are:
Cardin, Policy No.: GAS-IIA.SYSTEM-OVER 4(IIA)
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASIYINDUSTRh WASTE INTERCEPTORCOMPENSATION INSURANCE BUILDING DIVISION FER.S
(Thissemion bond not he completed ifNc Permit is norone hundred dollars($100) GREASETRAP
or less.) PLANCHECK FEE
I certify that in Ne pedormanc,vfmc work for which this Pemtil i,issued,I shali SEWER-SANITARY-STORM F.A.201 FT,
not employ any Penob in any manner sat as to become subject m the Workers'Compeb. ENERGY FEF.
z7, sation laws of California.Dae WATER HEATER WNENT/ELEC R
C Applicant GRADING Fiili
NGFICETOAPPLICANT:lf.alermaking this Cenificate of Exemption,you should WATER SVSTFiFVfRLATING
a .N. SOILS IEE
, became subject to it Workers Compensmion provisions of Ne Libor Code,you must
LTI fonhwilh comply with such Pnwieions or this pamtit shall boJemnad rcvokW. WATER SERVICE
CONSTRUCTION LENDING AGENCY
NEW RESIDENTIAL PLMe. SQ.PE PAID
I hereby anion Nanhere isi eomwetiun lending agency for the Ferfommnce of to ceipt#
V w�-t
the work for which this permit is issued(Sec.3097,Civ.C.)
Q U Lenders Name TOTAL'
Leader',Address TOTAL:
'1�.•.tt C 1 certify that 1 have read this application and stili that the above information is BUILDING Bili
F.t to correct.l agree to comply with all city and county ordinances and Stam laws relating to QTY. MECHANICALPHRMIT FEE
U 71 building consmction,and hereby amhorire mpresenativesuf Nis city to enter u,ondic SEISMIC FF.0
abwcmemioned properly for inspection purpmms. PERMIT ISSUANCE
(We)agree to save,indemnify and keep harmless the City of Catarina,against ELECTRIC P:E ,
liabilities,judgments,costs and expenses which may in any way Banc against said City ALTER OR ADD TO MECH.
PLUMBING '
in consequence Nthegmmimg SNis permit.
APPLICANT UNDER.TANDS AND WILL COMPLY WITH AL1.NON-POINT Alk HANDLING UNIT LTO 10.000CFM) MECHANICAL F
SOURCE.kECiULAT
AIR HANDLING UNIT(OVER IQOW CFM) CONSTNUCI'IONT
ignimre ofA aroma Dam EXHAUST HOOD(W/DUCT) HOUSING MITIGATR I'EE
HAZARDOUS ATERIALS DISCLOSURE
Wilt .applicnm it fuuuc builAing nccupabt.aone or handle humMo.,mamrial I[EATING UNIT(TO 1X9,00011'fU)
as defined the Cardin.Municipal'CMc,Chapter 9.12,and the IleaIN oral Safety
Code,Section 25532(0)? HEATING UNIT(OVER 100001 PTU)
❑Yea ❑No VENTILATION PAN(SINGLE RFSIU) PAID Dam Ra iPt#
Will tlm applicant tie made building occupant use equipment or devices which
emit hasnrdous air camamibants as defined by the Ray Area Air Quality Management BOILER-COMP(3HP OR 101,1101 BTU) - TOTAL:
Divrlet? ROILF.R-COME POVER IDEON)OTU)
❑Yes CIN.
1 have mud the hazadous malednlsAIR CONDITIONEN ISSUANCE DATE
myuirtmena under Chapter fi 95 of the Cali-
, fomiu Health&Safety Civic.Sections 25505,25533 and 25534.1 unit unNnd diva if the NEW RHSIDENTIAL MECH. SQ.IT.
building dBs not currently have u omni that o is ua ce responsibility Ce ity toteonotify the ancy
of Be requiremenu which must at met prior to issuance of a C ility to of the racy.
Owner or authonaed agent Date TOTAL ISSUED BY:
OFFICE