30856 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN.ONLY '
CITY OF CUPERTINO BUILDING-ELECTRICAL - . PERMIT NO.
BUILDING DIVISION APPLICATIONTERMIT PLUMBING-MFICH30856
ANICAL'
BUILDING PROJECT IDIPWIFICATION
BUILDINGADDRESS: - - SANITARY NO. APPLICATION SUBMITTAL DATE
Am 3 L ' 4 "s. J �b r cT I -tr47
NER'S NA E; PHONE: C NTRACIOR'SNAMIO .510LJ 2 N/C CON'I'NOLM
ARCHITECIENGINEER: - LIC NO. A RFS, 3 Ie_ {��/ �G - E
I ( '
CONTACT: PHO�NEE:�s-f rQ�x - • - 13UILDING PERMrr INFO
/• �( 61 \'-r v� �I G.ZZJI79✓ ❑ Consultant Fees Paid by Applicant(Initial) ' B II ELECT PLUMB ,MEECC14
kFLI•CEN1lS•E-D CONNTCBA OR' DECLARA'T'ION (,�E^ �-
F :.y� QTY ELECTRIC FE3RMIT FEE JOB DESCRIPTION
I hereby nl'tinm Bmt I ant Ilcensed mdcepmvisinm ell Chapter 9(commencing
DMZ with Sati.nlOqA fDiyisi.n7dNe Busine�'a'il-Pr fecourn Coda-mi an Iicenseis
I�OO ���f�7r-, �,,.•;ya_ o PERMIT ISSUANCE@ESIDENTIAL
F full force and i^-'. t
C W N m Y . DSFDMI. C KITCHEN REMODEL
<U V Lice ¢ .lazs Lic.is— _ - -
��W Dm Contractor •s.,." APPLIANCES-kESIDENTIAL CADDrHON CPLGMBING RF.-PIPE.
P,Oy ARCIII'IECT'S URCLA T GMULTI-UNIT CSTRUCTURAL
'01
PANELS
Z O y Z I undersmnd my plans shell be mud as public recinnls ' MODIFICATION
OZ- \" ` . OPT0200AMPS El INTERIOR CCHIMNEY REPAIR
I-, {l Licensed Professional201-1000AMPS . IMPROVEMENT ,
res
OWNER-BUILDER DECLARA'I'10\ OVER Il10OAMPS '
yuy 6 I hereby affirm that 1 run exempt from the Cntnrunors License L..Forum
C3 BATH REMODEURF:PAIR [:1 DEMOLITION
1d36U following ressoa(See..7031.5,Businessland Professions Code:Apy ciiyor countySIGNS ELECTRICAL
DOTHER
F O m which requires a permit to construct,stile improve,demolish,or repay limy•structure
prion,,its i+wan,,,almrequires the applicantfor inch Permian file a sigrird tribunal SPECIAL CIRCUIT/MISC.
} Nat lie is licensed pursuant to the provisions ofthe Contmclor's License Law(Chaple;9
GAO (commencing will Section'/B(X)of Division 3ofthe Business and Pmfellacm CMC,m TEMP.METER OR POLE INS'I'. COMMERCIAL .
qxc m
that he is exempt therefrom and the basis for the alleged exemption.Any violaGen of� 1'y f� D NEW BLDG/ADDITION D DEMOLITION
W^m Section 7031.5 by any applicant for a permit subjects the applicant a civil pendiy-.fs "� POWER DEVICF_S � IIY ur I✓VI HiINO CTFNANT [I FOOD SERVICE
not more than five hundred dollars S500). Z
C p ❑ I,us owner of Nepmpeny onny cmpl,,yccx with wages us their sole eimtpe.,tin q``\\ SWIMMING POULELECTRIC- IMPROVEMENT -
5252 willdo Ne wark,and the structure is ronatended oiofferrA for sale(See,9194,11usiness s COTHER
W m and Isix2l ro;Ctdc�The Contractor's License Law doesnot apply m m owner of OUTLEI:S-SWITCHES-FIXTURES
a'3 property who builds or improves thereon,suit who does such work himself,,,through
his own empl.yees,provided that such improvements arc not intended ar offered for •NRW RESIDENTIAL ELECTR SQ FIL
side.If,however the building or improvement is sold within one year ofcampledon,the \ � SQ.Ff,FLOOR AREA $/SQ,IT,
owner-builder will have the burden of proving that he did not build or improve for pur. '
poseofsale.). s
D I,as owner of the property,um exclusively contracting with licensed contractors to l '` TOTAL:
com urt the project(Sec.]044,Business and Professions Codc:)TheCommcmrsLi-
censeLaw does not apply toanownermpropedy who militia or improves maroon.slid Q'I'Y FEE
who contracts for such projects with a contrscumis)licensed pursuant to fle Contractors
Lialmse plan chec comp e I n
Li 1 sm exempt under Sec. P&P C for this reason P
(Own�e{r cce �c
Owner Dam A mplem VALUATION
WORKER
under Penalty
DECLARATION B 0 rad db0 %
1 hereby sRmt under penalty of perjury one.(Ne following dalnmtinnn:
•D [have and will maintain a Certificate of Consent to self-insure for Workers Carton- Ddifl - n! 75T RIPS TYPE CONSTRUCTION
s own,as provided for by Section 3900 m the I.uhm Cade,for the perfornturee of the ,p
walk far which this permit is issued. FI \x `.XIINpA I,
❑ and I have will maintain Worker's Compensation Insurance,as required Dy Section
3100ofrhe Labor Cole,for Ne performance ofrhe work for which this permit is issued. G v -
thi
My War neat Insumpce s d PolisV&N OCC GROUP APN
Currier k��/�rsyf4 I'nluy FROM
GAS-EA SY59.Md)VER4 ) s V ,�\
_J CERTIFICATE OF C%EMPTION FROM WObM _ \ A "ate"' ✓ /
COMPHNSATIONINSURANCIE G USTR, STE1 CEPJR` s
(Fossec�tinjnYttadn'oTtbecum feted fill serval, foGrnne hundmlJullars 151001 BUILDING DI IONF
or less.) r 'A apC nnt � ,�ft GREASETRAP
f ft p[ A:e St`M1- / - PLAN-CHECK PEL•
Lee
the t ewnrk for wMc thin permit is isaud,ishall • e .
oat nnpl.y,any person inanymanttggst�$1n peL� subjectmNe Workers Compen- SL I�Wsp-S9 e YFEE -
O Z section law of Cslifryry Date ''TT ��J/Gl"� WATER BEATER WNENT/R E k
O Applicam� k 1�a �;yZ .V GRADING FEE
y NOTICE TO 1 A1G'i^It!ult irnnkmgr sC moLLxemptinn.you should 3VAr, i
a became subject 1.the Worker's Compensation previsions ot'the Labor Cala.you must - °\1a`\ SOILS FER `Y
testi
forthwith comply all such previsions or this permit shell be Deemed revokeJ.
WATER SERVICE A1Vs -
0
Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLM. SQ.EL PAID
I hereby affirm that is a cometrnetion lending agency for the performance of. Data RcceiptN
'� the work for which thin permit is is,ned(See.NN7.Civ.C.) `
O U Lender's Name - �.�4'*< TOTAL:
Lenders Address - TOTAL:
y 1 moify that 1 have read this application and...that the above information is BUILDING HE
�^ y7 sorted.I agree mcomply with all sly and ammy ordinanmx and„true lawn,timingm QTY, MECHANICAL PERMIT FEE
Ut,7 building corewmon,md hirmhyauthortm repl,coluivecol'thlxcirymnuerupon the SnISMIC'AIf\,
above-otcnuonW pima,y for inspection purposes. PERMIT ISSUANCE \
(We)agree m save,indemnify and keep haranless the City of Cannella..gains, ELECTRIC FBE
Imbilities.judgmenn,costs and expenses which may in any way aleme against said City ALTER OR ADD TO MECH. \
in consequence of the granting of this permit, PLUMBING FEL\s
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI,NON.POINT AIR HANDLING UNIT(TO 10,000 CFM) gs l;
SOURCE REGD TIONS. MECHANICAL FLE S x
,x 1n ry AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCr10NTAXis”.
Sigmmrc of ApplicunVC.nwmnr Data. EXHAUST HOOD(W/DUCt) HOUSING MITIGATION F'E
HAZARDOUS MATERIALS DISCLOSURE \ '
Will Ne spplicsm or(uwrc huilding acupant store orhundle hazallousrm¢Tial HEATING UNIT(TO 1011000 BTU)
az defined by are Cupenin s Municipal Code,Chapter 9.12,and the Health and Safety \� '
Code,Seen..25532m)9 HEATING UNIT(OVER 100,000 BTU) s�Y\
❑Yes E]No VENTILATION PAN SINGLE RESIDI PAID
Will the applicant or future building occupant use equipment or devices which
Dine Reaiptp�;'
r e t hazardous air centenarians as dallied by the Bay Area Air Quality MmugememBOILER-COMP(3NP OR 100,000 BTU) TOTAL: \x
District? ,BOILER-COMP 100,01X1 BTU)
E]Yes F-1 No I -
Ihaveradthehs" cosmartrids AIR CONDITIONER - ISSUANCE DATE
r5,2553 ensu arch Chapter 6.95 of the Cdi-
fumia Health&Safety Cahc,Saunas 25505,25533 sp 25534.1 undersmnd thin if the NEW RESIDENTIAL MECH. SQ.ET.building does not currently have u mount,that it is my resp.mihility to nmify the tccnpam.
of the re ui em to which must hemet pri o issuance of a Cenilicme of Occupancy.
Owrsmhori sent _ ate
neTOTAL: ISSUED BY:
OFFICE