S 0063 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.•ELECTRICAL. C „ PERMI'I'NO.
BUILDING DIVISION APPLICATION/PERMIT PLUM1IBING,-MECHANICAL 3
BUILDING PROJECT'IDENTIFICATION WYws✓w
BUILDING,ADDRESS: SANITARY NO. APPLICATION SUBMI'GI'AL DATE
f, I,J e a l!
O 'R'S NAME: erts"C�I{ONP.: 9 1 ONTHA SRT NAIHQ&. ^ u L NO: Qlo NIC CONTROL al
ClIk
ARCHITECUEN INEER: LIC NO: A)DR.SS: 7 < �J JOE p' t ❑
CONTACT: PHONE: / VK BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUM MUCH
LICENSED CONTRACTOR'S DECLARATION QTY. IiLECTRIC PE:RMiT
I beach,nation mat 1 am hcenved under provisions of chapter 9(commencing JOB DE RIP'PION
�a'Z thSection 700(hof Division Sof the Business and Professions Codeind my license is RESIDENTIAL:
�Op with PERMIT ISSUANCE
n full frac and effect. ❑SFDWL ❑,KITCHEN REMODEL
;ZW Data Iron x'34 Can �� APPLIANCES-RESIDENTIAL ❑ADDITION / BING BE-PIPE
{.�Z W Date Can DELL
NQL �'— OMUI.TLUNII' ❑MODIF5CNAl.
CHITECTS DECLAHA'fI
z 012� PANELS h10D1I9CA'f1ON
I undersusnd my plans shall he used as public records
OZtQ D1-1000IAMPS ❑INTIiRION ❑CHIMNIiY REPAIR
F-4�LW Licensed Professional 201-I(NOAMPS IMPROVEMENT E]SWIMMING['DOS
gg y 28 OWNER-BUILDER DECLARATION OVER IM)AMPS ElBATH REINODEUREPAIR ❑DEMOLITION
C W Q 1 hereby aRma that 1 am exempt brands,hCo aturac's License Law far the
iiqq$$p0.0 following reason.(Section Ind 1.5,Business and Pnffcisions Cale:Any city or county SIGNS ELECTRICAL El OTHER
which requires a pit to construct.alter,improve,demolish,or repair any ewcwre
permit
prion,its isa tmer,afm requires Nc applicant forouch permit N Ole rnlinedstaamem SPECIAL CIRCUI'f/MISG
than be is licensed pursuant In the provisions of the Contractor's License Law tChspar9
�ap0 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or TEMP,METERO LE INST.
a y Nat hen exempt them ear and the basis for me alleged exemption Any violation of I]NEW NEW IIDG/ADDITAiS DDEMOLITION
N Section 7031.5 by any applicant for a pemft subjects the applicant,,a civil penalty of POWER DE I:S []TENANT O FOOD SERVICE
p, nolI wmBvehundredJollnm(SSW). OMPRO
THER
d� I]Las than fivehandledcy,nnn0000).yeas wltb wages as Ncirsnle entnpemsminn, SWI NO POOL ELECT RIC (nNpfgN{-HF-
wtll duthe work,and the I'meture is not imunded or offered for sole(Sea.7044,Bminess ❑O'1'HIiN
and Pmfasinns Cade:The Contractor's License Law does not apply to an owner of TLEI'S-SWITCHES-FI%TURFS
property who builds or improves theater,and who dors such work himself or moral OF GlitrwIlkill
his own employees.Provided that such improvemcros ort non intended,r offered for NEW RESIDENT IAL EL[CTR SQ f4.
sale.If,howm
cr,the building or improvement is said within one year ofcomplenion,th< SQ.FL FLOOR AREA 5/SQ.FT.
owner-builder will have the intake of proving that he did not build or improve for pun Ise
,is.at cola). -
1,m owner of the propeng um exclusively contracting with licensed contractors In TOTAL:
commit,the pmj Per(Sea 7044,Bminess Ind Professions Codc)'Me Contmem,'s Li-
cerise Low does car apsaymanowner ofpropecywho builds or lmprovns thereon,and QTY PLUMBING PERMIT FEF.
who contracts for such projects with a c,ntmrmrRl licensed pursuant It,the Conaticrols
License Law. PERMIT ISSUANCE
❑ lain exempt under Se c. ,B&PCfonhisreann 47
AI:TER-DNAIN&VENT-WAI'BH(EAJ VALIJA'1'ION
District Dam
WORKER'SCOMPof ab ATI ON DECLARATION RACK FLOW PROTECT.DEVICE
I hereby affirm under Penalty of perjury one of the manwing Jmlomtio m
❑Ihave and will for
ineCion 37M ofCe Labor Code,sure for Wurkers Crmpen- DRAINS-m.00R,BOOP,AREA,GOND. STORIES TYPE CONSTRUCTION
smirk,t, provided for by Ss "un 3100 of the Labor Code,fur the penistmance of the
work for which this permit Is isstad, FIXTURES-PER TRAP
❑ 1 have and will maintain Worker's Compensation Insurance,us targeted by Section
37M mine LnMt Code,fonheperfommrce of the walk havihich this permit is issued. GAS-IiA.SYSTEM-I INC.4 OUT OCC.CROUP AI'N
My W np lQa in amm recartictral Policy nutphu arc:. ' GAS-EA.SYSTEM-OVER 4(EA)
Can rZ.t Policy No.:
'ERTIPICATE OP %EMOTION FROM WORKERS' GREASFIINDIISTRL WASTE INTERCEPTDR
COMPENSAI'[ON INSURANCE BUILDING DIVISION FE 7.S
This section need not be completed if the penult is forone hmtdrcd dollaa(S 100) GREASE'I'RAP or less.) PLANCIIECK ITE
latmythatin Nepetlormance nfthewmk farwhich mispenuit lsissucd.10all SEWER-SANITARY-STORM I'A.2(X1 FT.
not play any person in any manners 1'�[YM bj r he Worker,'Compcn- ENERGY PF.E
on Lawa a Celifomia�_�lJte +s V s� WATER HEATER WNEM'/F.LF.CIR
s pplicam GRADING IEE
� F-t LCB TO APPLICANT If,n)er making this Cenifcore,f Ttptinn,you should WATER Sys rEM/TREA'1'ING
abacnme subject to tiro Winker,Cnmlwnsation prockinas of the I.uhar Colt, .act I SOILS FEE
Ll7 forthwith comply with aachpmchem.,or this pemait Shull be deonsalmsoked. WATER SERVICE
Q
5 z CONST RUCTION LENDING AGENCY NEW RESIDENTIAL FUME. SQ.FT. PAID Date Nec<iptp
I hereby affirm that them is a construction lending agency for the performance of
LJ� the work far which this pcnnit is issued(Set.300,Civ.CJ
w Lance,Name TOTAL
WLender's Address TOIAL:
04 1 racily that I have read this application unit state than the aMwc information is BUILDING FEE
U2 enren.l agree to comply with all city and county ordinances and store lows relating to QTY. MF.CHANICALPERMIT FEE
building construction,and hereby authorize representatives ofthis city to enter upon the SEISMIC FEE
above-mentioned property for inspection purposes,
PERMIT ISSUANCE ELECTRIC PEE
(We)agrm to save,indemnify and keep taintless the City of Cupertino against
liabilitiee,jndgairms,costs and expenses whichrol,in any weyneeme againslsnid City ALIHR OR ADD TO MSCI I.
in crnscqucnce of the Braining ofthis mail. PLUMBING FEEAPPLICA UND- STAND'A Will, 'ITH ALL.NOWPOWT AIR HANDLING UNIT(TO 10.1X0CFM) MECHANICALpEE
SOURCE . ,ULATIONS.
7 AIR HANDLING UNIT(OVIiR 10. 'PM) CONSTRUCTION TAX
,10oS nature Annie 'nninor Data EXHAusliHOOD(W/DUCT HOUMNGMDUGATIONp13H
A9ARDOU ATIiR1ALS DISCLOSURE
Willtheapl cam nr fmuat huilJNgoccupam score rr hmWle hnzalloue material HEA'L'ING UNIT(TD I , 0it rut
as defined by the Cupertino Municipal Code,Chapter 9.12,and the health and Safety
Cade,Section 25532(1)1 HEATING UNIT ER 100,000 BTU) •/
p Ycs C]No VENTILAT PAN(SINGLE RESID) P/RD
X� I
Dole Hcttipt p
Will Thr applicant or future building cecuptnt use equipment of devices Which BOLI -COMP(31{1'OR IORWO BTU)
emit hazaedous air contaminants as defined by the B.,Arca Air Quality Mic anarce 'f0'CAL. Ntqa
District? ILER-COMP(OVER 110,(%X)BTU)
I]Yes F1 No
I have re.it Neh,alt,Ss materials 5.2353 sunder Chapter 6.95 of Nc it AIN R17SIDIONER ISSUANCE DP�TE
Inmia Ilthe &Safety Calc,Sections 25505,25513 and 25534.1 nnJerstund that if NEW RIiSID13NTIAL MBCA. SV.14. //IIq'/y/�
building Nxs ppl curtendy hn e: n,Price i yresponsihility nnunily the occupant
of Nere kntswhf emeJ Price ,,n nee eof.mi Ce ' �t lcof Oce,
EMS
'nen euthodz agent Oma TOTAL: ISSUED BY
OFFICE