S 0182 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
TY OF CUPERTINO BUILDING-RLF.CIRICAL PE IllNO,
,4-BUILDING DIVISION APPLICATIONIPERMITPLUMBING-MECHANICAL0182
BUILDING PROURcr IDKIIIF'ICATLUN
BUILDING ADO ESS�O � • SANIIANY NO. APPLICATION SUBMITTAL DST]' 1
To 7qj
O :R'S N4Mh PHONE: TRACT'OR'S NAME: LIC NO'. I �
'u y NIC CON'IA(ILM
ARCHITECUENGINLCR:
lot
I LIC No DRE NZ'` N,�/� ❑
COTACC PHONE: ✓e1T J BUILDING PERMI'I'INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDLEC
G ET I. ECH1 IMI{ M
� 9�os-pis z�s ❑ ❑ � ❑
I.ICIiNSLDCO RAMOR'SDECI.ARATION QTY ELECTRIC PERMIT FEE
I nearby om.am he,I am licensed coder norkicas of chapter 9(commencing JOB DESCRIPTION
OQZ with Section 7000)of Division 3ofthe Business and Prrdensions Cale.and my license is PERMIT ISSUANCE RESIDENTIAL:
�WD in full force and smell. ❑SFDWL ❑KITCHENREMODEL
aVV linins,Class Lie.11 APPLIANCES—RESIDENTIAL ❑ADDITION [I PLUMBING R&IsIPE
I.ZW
Date.Contractor
❑SULTI-UNIT ❑S'I'RUC-JRAL
g„Dw A3PANELS
MODIFICATION
Z C)Z I undcmmod my plans shall be used m pebic mcord%
OZC_ UPTI)2WAMPS [11 INTERIOR OCHIMNIiYREPAIR
F+4t:W Lumnord Proo,,iuual 201d10M)AMPS IMPROVEMENT E)SWIMMING POOLS
OWNER BUILDER DECLARATION
aC W Q I hereby affirm thin I um exempt from the Contractor's License Law far the OVER❑ 10AMP5 �OTNFIkLAfO EPAIR Dli 0 ETI N
k 3 6 V following reason.(Section 7031.5.Business and Pmfessmns Code:Any eny or count' SIGNS ELECTRICAL
W W vFi which copies,a pencil to as rvari altar,improve,demolish.or repair any W Vaarc
F"1='0g prions,its issuance.also¢quires theapplicam forwab .it mfileasigneJ stalemcm SPECIAL CIBCUIT/NISC 1
$ } that he is licensed posuan in the provision.,ofmhe Commmod License Law(Chapters
�rQQ (commencing wish Section 700(ouf Division 3 of the lousiness and Professions Gsdq or TFCMP.Mli1'P.R OR POLL INS'T. COMMERCIAL;
dy ea (hal he 1,exempt thaml}nm and the hosts for the all.ged cxearniun.Any violation of ❑NEW BLDG/ADDITION ❑DI?MOLITION
WmN Sector 903156,any at,liernt for a permit nalrar,t, he applicant a civil penalty of POWER DEVICES ❑TENANT' ❑FOOD SERVICE
not more Than five hundred dollars(5500). IMPROVEMENT
Sp ❑ Lm owner noon[property.or my employees with wages as their.sole compensation. SWIMMING POOL ELECTRIC _
F. will do he work,sural do,mocmm is not imle
cndero,offered far sa (See 7rDy Business ❑OT'1113R
W m and Professions Code:The Contractor's License Law Jens not apply to an owner of OUTLETS-SWITCHES-FIXTURES
property who builds or impm s.,Income and who does such work himself car through
his own employees,provided that.such improvements am not intended or oR.r.J far NEW RESIDENTIAL ELECTR SQ FT. SQ.IT,FLOOR AREA &SQ.FT.
sale.If,however.the building or improvement is sold within one rear of Caudde ion.'he
owmar-Imilder will have 0e burden oTpmving'lot he did nm build or Improve lin par- f IBJ 11 I��ts
pnxc of'rode.). TOTAL RECER
pV, ll 11
1, f owner of the pmpcnY•am exclusively amhncting with IicenxJ cnnanctnas m I�
construct the project(Sec.7014,Business and Professions CraleJ Thr Contractors Li-
cesolawdoesnetapplytoanownerofpropertywhobuildsorimprov,thereon.and QTY. PLUMBING PERMIT FEE JUN 2
who contracts for such projects with a sanatoriums)BcenscW pursuant the Contemnerx O 1997
Limnos law. PERMIT ISSUANCE
O l am exempt under Sec. ,B&P C for this crown n
ALI ER—GRAIN&VENT—WAFER ILA) bLae.
ECIrVfV'(JNEPARTMENT
Owner Dam
WORKER'S COMPENSATION DFCLARATION BACK FLOW PROTECT'.DEVICE CITY OFCUP
I nerehy amen ander pnoahy,of s.
perjury one(If)he following declaration
❑ I have and will maintain a Cenifcam of Coroners self-mme far Workers Conten- DRAINS-FLOOR.ROOF.AREA,COND. SOWES 'I'Y1'E ONSTRUCTIOb
cation.as provided for by Section 37M of the)Labor Code,for the performance of the
work for which this permit is issued FIXTURES-PER TRAP
Fl 1 have and will ammain Workers Coope vatina Immance,as required by Section
3700of the Labor Code.fill the performance of the work for whichlhis pemmil is i...ad, GAS-EA.SYSTEM-I INC.4 OITITEI:S OCC.GROUP APN
My Worker's Cs,mpen.sa ort Insurance canner and Policy scanner are:
Corrier: Policy N:s: GAS-IiA.SYSTEM-OVER 4IPA)
CHR I'IFICAI F;OF EXEMPT ION FROM WORKERS' GREASIJINDIISTRf.WAS')li lN'IT3RCEPTUR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(Chis section need not be completed tribe Front is for one handueddollars H Fi GRLASETRAP
or less) VLANCl11iCK 193E
Icerodythat in the afforriance robot work for which this permit kissucl.I%hall SEWER-SANITARY-STORM EA.200 FT.
not employ any perm in any munner.so as m bttnme subject to the Workers Compcn- ENERGY PIAT
Z salon law,of Celifomia.Data WATER HEATER W/ L
VENELECfR
z2 Applicant GRADING 11:11:
y NOTICE TO APPLICANT.If,a0e,making this Cenifcam of Esempmion, ,on should WATER SYSIHNU'REATINC.
f'^ become mbj.c, ,,the Wnraca,Compenolin'cr ninoflhe Labor Gdo
Code you nn SOI LS Il3H
Wbonawilh comply with such provisions or this Iscrnnmt%hull be deemed mooted, WNIP to SERVICE
a Q PAID
CONSTRUCTIONis.camLL3NDINGAGENCY NEW RE5IUEN'IIAL PLMH. SG.I°L pate Receipt Is
V� (hereby affmnhauhere isaconstmmion lending agency for performance of
the work far which this permit is slued(Sec.30N7.Civ.C.)
'TOTAL:
Lenders No.
[ ds Addres., TOTAL
U Iead .
I certithom 1 hove read m this application and Sta,alcohol the mmte infmmminn is BUILDING PER
it 0 correct.l agree to comply with all city and couw
nty ordinuns and nam law,relating to QTY. MECHANICAL PERMIT FEE SEISMIC FEE
V huilJing cnnstru.tinn ...lyra ' rcpra%umativt,n(this city to cnNntpnn the
abwc-mcnlinncdmilding
s 'liar vv try.%c,. PERMIT ISSUANCE F.LEC'I'RIC FEE
(WO np mif Ak.- hrrmles,Ile City of Cupertino againniabili'iccju e sr.' my inunywoy swemori,mtsrid City AI:fER OR ADD TO MECH. PWMBING PEE
comequ cIn APPLIC UN .L COMPLY WITH ALL NON-POINT AI R HANDLING UNIT(TO ID000 CFM) MECIIANICALFEGR sR � AIR lIANDLING UNITQ)VER looks)CFM) CONSTRUCTION TA%
Sign ureofAppour Dam EXHAUST HOOD(W/UUCP) HOUSING MI1IGAIIONIT313OUS MAT ERIN 9 DISCLOSURE
Willtheare building occupant suite or handle hasaWous material HEATING UNIT TO I MOX)OTU)
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532m)' !(BATING UNIT(OVER IBoApoM)(OTU)
E]Yes [_1 Not VENTILATION FAN(SINGLE RESID) PND
Dam Rtt'cipl p
Will the appliand nr furore buildogue....at ase equipmtn'or devicm'which HOHA;R-COMP OR IIM.000{TU)
emit baeardaus air sarmminerw,as delinal by the Bay Area Air Quality Management 'IOI'AL:
�Do rid? BOLLHR-COMP(LIVER 1000 )I3'1 U)
❑Yes ❑No
I have read the h omdous materials requirements under Chapter(INS of the Cali- AIR CONDITIONER ISSUANCE DATE
famia Health&Safetyrro toyCode.have
Sections 25505,is my and 25531.I to mifY d Ihm if the NEW RESLUENTIAL MECII. SQ.FT.
building rices nM currently hastf tenant,the o is ua-'Feasibility Cility to e o ft'Be poesy cat
arid r.;aireurcm,which run he met prior m issuance of a Cenificam of Qcuryncy.
Owner or authmised and Data TOTAL: ISSUED 1{Y:
OFFICE