30509 �'PLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY arg Q
CITY.OF CUPERTINO BUILDING-ELECTRICAL. PERMITNO. O V O V
BUILDING DIVISIOJ!nq PPI C TIO flat' 1 PLUMBING-MECHANICAL
LK BUILDING PROJECT IDENTIFICATION
BUILIIINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
CuPca�lao V;LWGE og UVo1{z- POAp c0JJUO
UWNER:SNAME: PHONE: 41S-OSS CONTRACTOR'SNAME: LIC NO. l
slr-11a10 V(L"46 ASS.{,yV'�i {lC. O xyqlim IVC, N/C COM Rol.#
I ECDENGINEER: LIC NO: AIDRESS: ❑/a Q AAail
Com' 0 2101 0 bR cE 1VOWUT
CONTACT: PHONE: BUILDING PERMIT INFO
€RIe -� Qos-366 1886 ❑ Consultan[FcesPaiUbyApplicant(Ini[iaU NLDG �u-CC PLUMB MF-CH
9 - 3 r �[P-- ❑ ❑
hICENSI?DCONTRACOR'SDECLARATION QTY F,LECPRIC PERMIT FEE
I hereby arena that I am licensed under pmviorer,of Chapmx 9(commencing JOA DESCRIPTION
W Opp wult Semkn]001B.fDivi,mm3.fdm Ba,ine,s Tad Pmfessi.m Cnde,andmy licenxis PERMIT ISSUANCE. RESIDENTIAL'
Flys n full force and effect. G ❑SFDWL ❑KITCHEN REMODEL
UU License Cl ass Y Lie.a
N6a Date C'SDECr—,�MM11C /'nJIIW�Lh1t•,J APPLIANCES-RESIUIiNfIAL 0MULTI-UN ❑PLUMBING
URAL 'IPIi
Dm ARCHITF;CI'S D[CIAR (OAT N ' 1 PANELS ❑MULTI-UNIT ❑STRUCTURAL
Z p m Z 1 undernanA m phmc shall be used us public rise ds MODIFICATION
OZ-0 UP TO 200 AMPS [I INTERIOR ❑CHIMNEY REPAIR
FE�,~ul Licensed Pmfe,siomal p 201-IWOAMPS IMPROVEMENT
zg F� OWNER-BUILDER DECLARA:rioN OVER 1000 AMPS [I BATH REMODEIJR ❑
EPAIR DEMOLITION
a:C)a
CL W 1 Intel of ine Ill.,1 um exrnt t trop the Cumrtaulls License Law for the
U following reason,(Section 7031.5.Business and Poressions Cale:Any city orc.unty SIGNS ELECTRICAL OTHER
W 3 tL F which requires a permit to conswct,alter,improve,demolish,or repair any structum
.�.�L0 prion its issuance.al,)regnirm lbeaplocmn forsuch ponell In Ne a signeJxm¢mem SPECIAL CIRCUIT/MISC.
E } (hal he is licensed pursuant set the pmvinuns of IM1e Comramor,License low(Chapter Y
R (commencing with Section'NW)of Division 3 ofthe Business and Pmfenniuns Cafe)m TEMP.METEROR POLEINS-L COMMERCIAL:
d ax e (hal he is cxanpt tierefmno and this hasis for The alleg,d excarxion.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
Warn Section 9071.5 by tiny applicum for a permit subjects the applicant to a civil Penalty of POWER DEVICES LITE ANT
❑FOOD SERVICE
F Z Y not mom than five hundred dollars($50(). ,Ul`J IROVEM E-N[
❑=Q ❑1,ax nwncntl the pntpcnY,or my cntplaycc with wages..lhcirsule,umpet,anom SWIMMING POOL ELECTRIC R�1_(J CR �, _
2p, will do the work.and lhe,moomre is not inendedmofi red form(See](kq,Business OTHEr \'-
W-� end Professions Code:The Cmarso s's License Law does no apply m an owner of OUTLETS-SWITCHES-FIXTURES �13 RT. Lingl R0
0. .. pmpeny who builds or improves thereon,and who doesnuch work himalf or through
his own employee,,provided Thal such mr smvemenls arc not intended or one ed lin NEW BESIDES [A],ELECTR SQ FT.
sale.IL howmeq IM1e building orimpmvemcm is sold within one yemof,omplaion.the ��Je-• y G SQAT.FLOORAREA S/SQ.FT.
owner-builder will have the burden of proving that he did not build.......e for par- G /v •
P,we of xaleJ. /b
❑1,a,owner of due ppy,am exclusively conn cltmn
ing with licensed amun to TOTAL:
construct the project(Sec.]Dtq.B.,inea and Profession,Code:)The Cudia 's Li. e D
cense Law doe,nntapply to an owner of propcny who builds or Improve,thereon,and QTY. PLUMBING PERMIT FEE OoI
who constants pursuant m
s for such projects with a commnrD)licensed pursuano the Coracu,6 O[�
License Laws. PERMIT ISSUANCE f�i
❑ Ium exempt under Sec. .13&P C fur this encor �V
ALTER-DRAIN&VENT-WATER(EA) A'1'ION
Owner Date
Winton r'p COMPENSATION DECLARATION RACK FLOW'PROTECT.DEVICE
I hart will
under penalty of perjury nnc.t this following Jeclarr's Co T
nts
Qlhavc aro will maintain boCion 37 a of the LaluoCivicnsure foie entraceo t - DRAINS-FLOOR,ROOFARIiA,CONU. STORIES TYI'Ii CONSTRUCTION
anon, r provided for by Section 3]W of this labor Civic,for the performance of the
work Ib. and this aintaiix issued. FIXTl1RE5-PER TRAP
❑I have and will maintain he Performance
r Compensation work her
hi h his Per by Sectionsud.
37W of the Labor Cafe.for the performance of the wak fm which this hermit is issued. GAS-EA.SYSTEM.1 INC.i OUTLETS OCC.GROUP APN
y Wurkcr' Cotnpenau Ins trance wirier send Policy nu her vre:
k a roll
Carrier, fa uLCLJ MtA� Policy Na: GAS-EA.SYSTEMOVER4(I?A)
CERTIFICATEOPISMI PTION FROMWORKERS' GREASFIINDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIV ISIO' ,>FS
.('Ihisuctinn nmJna hernmplcTed lOhe permit is for nna hundreA Jollnn(Ellxry GREASETRAP l
notes..) O� �J
I teddy that in the perfmmunce of the work for which this p,rmit i,issued,Ixhall SEWER-SANITARY-STORM EA.2W ET. PLANCHF.CK IEE
notemploy any person in any manner,n as to becomesnbn
jeoo the Worktts'Cn osm- ENERGY FEE
,z cation Laws of California.Date WATER HEATER WNENT/ELECTR
z Applicant GRADING FGE
`•Iy NOTICE TO APPLICANT',If,after muking this Cenificalcof Esc.nptlun.you should WAP BR SYS1 EMnREATING
a > became xubjmt to the Workers Compensation provisions of the Labor Cede,you inno SOILS FEE
W foMwilhcomplywithsuchpmvisi.nso,thixpermil shall be Jcemedrevok,d. WATER SERVICE
7z CONSTRUCT ION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FI'. PAID Uate Rc ipl('
U 0 l hereby affimr that them is aconstruction lending agency for the isafomance of
W r. the work for which this permit is issued Isis,.7(19],Co.CJ
O TOTAL:
U Lender',Name
r Lender,Address TOTAL:
1 1 versify that I have m Nix applicmion and nate(bat the above infurtnmio r is BUILDING F E o7 tie
rN ensurer 1 agree nt comply wi all city and county ordinances toed smm laws relating a, Q'CY. MFCHANICAL PERMIT PEE /a
U z building construction ondh eby authorise rcprezenwtives of Thi,city m enterraon the SEISMIC PEE
above-meminneJ propcnyf rinspenion purposes. PERMIT ISSUANCE
(We)agree to save, ulemniry send keep harmless the Cly of Cupertino against ELECTRIC FEE
liabilities.judgmentx,conte nd expense..which may in any wayanme against said City ALTER OR ADD TO MECH.
in con.quence of the Bmn ngafdoor pe 1 PLUMNING PEE
APPLICANT UNDERS'T NDS AN ELI.COMPLY WITH AL1,NON-POINT AIR HANDLING UNIT(TO 10,000 CFM) MECHANICAL FEE.
SOURCE REGULATII
012-L lob AIR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTION TA
Si auris of Appli G rade. tum EXHAUST I IOOD(W/DUCT) HOUSING MITIGAT )N FEL
HAZ DOUS MATERIALS DISCLOSURE
Will theopplicant 11more building arratentsmuror handle haxarJous material HGTING UNIT(TO 100,000 BTU)
an defined by the Cupertino unicipal Calc,Chapter 9.12.:md the H.I,h and Safety
Cede,Section 25532(x)? / MINING UNIT(OVpR IWJgO BTU)
E]YOS VENTILATION FAN(SINGLE RLSID) PAID Date Receipt#
Ig Will the applicanl or future building sccupanl use equipment or devices which
hhRaNOa,air c.nmminanls as defined by the Bay Area Air Quality Managemrnt BOILER-COMP(3HP OR IW.WO BTU) TOTAL r
D"urict? BOILER-COMP(OVER 100.0(x)BTU)
❑Yes
Iba,smadlhehaxaN smmeriat requiremctas under Chapter h95 of NC Culi- AIR CONUIIIONEN ISSUANCE DATE`. (
f.min Health&SalcD Cttde ',aionx 2551)5,255]3 and 25571 I unJecuanJ Ihm il'thc NEW RESIDIiNTIAI.MECH. SQ.I'I'.
building docs nm currently h eamnmm.that it is my resperaidulky to notify the orcupanl
of the r yuitcmenrs wM1ieM1 the ssuaoce'if.Cenificam if cy.
a 1✓
Owner or auNnn'rAa I am TOTAL: ISSUED BY:
OFFICE