B 0402 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICALPER ITNO,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL �¢ _ JM 0402
BUILDING'PROJECT IDENTIFICATION V �^
BUILDING ADDRESS: SANITAR O. APPLICATION SUHMII 1AL DATE
4ER A PH NP CONTRACTOR'S NAME: LIC NO:
NIC CONTROL#
ARCHILEC71"GINFE C NO: RESS. ❑ I
CONTA : BUILDING PERMIT INFO
r b ❑ Consultant Fees Paid by Applicant(Initial) BLDG— ELECT PLUMB` MEc}y
LICENS O RACTORS DEC R IION - QTY. ELECTRICPERMIT `�;y- FEE JOB DESCRIPTION ,�
I hereby affirm that I licensed d p f Chapter 9(comm g t,
OOZO with Section 7000)ofD"vaion3 ofthe Business and Professions Code,and my license is PERMITISSUANCC SI
CF in full force and effect WE El KITCHEN REMODEL
UUU License Class Lic.A APPLIANCES-RESIDENTIAL []ADDITION F1 PLUMBING RE-PIPE
F W Doe Continuant -
m 1 ARCHITECT'SDECLARATION -- - ❑ ❑
MULTI-UNIT STRUCTURAL
FSH
v� 1 understand my plans shall be used as public records PANELS - MODIFICATION
OZ— UP TO 200AMPIS El INTERIOR 1:1 CHIMNEY REPAIR
1. pc Licensed Professional ME61 DIOAMPS IMPROVEMENT', 0SWIMMING POOLS
f61 C5G!� OWNER-BUILDER DECLARATION OVER i AMPS ❑BATH RHMODEUREPAIR El DEMOLITION
1 hereby aflin a that 1 am oxennt
pr from the Compactor's License Law for thio
ip5.00.0 r allowing reason.(Section]031.5,Basins.and Professions Code:Any city or county SIGNS ELECTRICAL. - DOfHER
r++ EvvJ"J which mgnires u pennh m earmwet,alio,improve.demolish,or repair any structure
F+Ny; poor,.us momew,also rcgairra the applleant mrsuch lead,m rleasignW muccaut SPECIAL CIRCUIT/MISC.
Y that he is lkensed pursuant to the provisions ofthe Contractors License Law(Chapter 9
tgi (commencing with Section 9IXq)of Dlvfslon3of rhe Rusinecs and Professinns Coda)or TEMP.METER OR POLE INS'1'. COMMERCIAL:
W pt o a that he is exempt therefrom and the basis fur the alleged exemption.Any violation of - ❑NEW BLDG/ADDITION ❑DEMOLITION
Sapient 7031.5 bynnyapplicamt fora permit subjects the applicrd te a civil penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
Gnot more than five hundred dollars($500). IMPROVEMENT
i]l,as nwnerof_the properly,on myemployees with wngos as their sole cmnpenmtion, SWIMMING POOL ELECTRIC DOTTER
will do the work and Nestacwmis notlmended onrRerel far sole(Sea 2!164,Rosiness� ;m and Prnfa,ioas Code: The Cme.1dds License Law does not npply to an owner of OUTLETS SWITCHES-FIXTURES
0property who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvements are not intended or priced for NEW RESIDENTIAL EL R SQ FT.
sale.If,however the buildingof improvement i,old wiminoneycer efcnmpletion,the - - 'ISQ hT.PLOORAREAy/''� E/SQ.Irr.
owmcr-
builder will have the human rd proving that he did not build or improve for par- ( x
pmse svleJ.
.as owner of the property,am exclusively contracting th licensed commerms to 'FAL'
instruct the lro)ect(Sea 20,14,Biomass d Pmfir,simv CcxO)Urp Churchmen s L -
censeLaw does not apply toanowmerofp pay, h h"Id. n p 'there nand QTV. -s ',PLUMBING PER ,FEE
who annhaets for such projects with a conhum Hs)licensedpursuant tthe Conraemrs - W • 2���
License Law. PERMII ISSUANCE f/l
l am exempt under Sec. ,B&P C for this reason
ALTER-DRAIN&VENT-WATER VALUATION
Owner Data
WORK.R'S COMPENATTON CLARA'rION BACK FLOW PROTECT.DEVICE r yV_t �
I hereby a[Brm under penalty of pujury o of the follnwing dcelinuum s: - {JJ
❑ I have and will maintain a Certificatemf Con. nvpself-imsurefmr Work es ComNn-, DRAINS-FLOOR,ROOF,AREA,COND. STORIES TYPE CONSTRUCTION
action,as provided for by Section 3700 of the Labor Code,rot the Performance of the ,
work for which this permit is issued. FIXTURES-PER TRAP
❑1 have and will maintain Workpp`c Compensation Insurance,as required by Section
37M ofthe Labor Code,for the performance ONO,work for which this permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS OCG GROUP APN
My Workers Compensation Insurance carrier and Policy number am:
Ceniert Policy No.: GAS-EA.SVSTEM-OVER 4(EA)
CERTIFICATE OF EXEMPTION FROM WORKERS' CREASEIINDUSTRI,WASTE INTERCEPTOR COMPENSATION INSURANCE BUILDING DIVISION FEES
Rh:: f head not be mnplmed Pth permit I, n hundred d Ilan ($1 W) GREASETRAP - - - -
-
pal B - PLANCHECK FEE
I Ify tht'n the performanceofth kr which his Permit:issued,l shall SEWER-SANITARY-STORM EA.200 IT.
not employ any person in any manner so to become auccat tothe WorkersCompen- ENERGYP
z sauna Laws of California.Data WATER HEATER WNENVELECTR
Z O Applicant I GRADIN E
Hs,y NOTICE TO APPLICANT:If,after making this Carlifiente of Exemption,you should WATER SYSTEM/I'R RATING
I-' became subject to the Wmker'e Compensation p ncisinn.c arthe Labor Code,you most SOILS F of
N
forthwith comply with such provisions mthis permit shall be deemed ravagetl. WATI.R SERVICE
WWW Q
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. PAID
heeby affirm that there isa consuuction lending agency for performance of me RcceiptA
W. the work for which this permit is issued(See.3097,Civ.C.) T(
O U Lenders Name TNPA e
W Lmakos Address !
1 candy that 1 have read this application and shute that the above immolations BUILDING P59 _
rr 0 comm.I agree to comply with all city and county ordinances and state laws relating to •QTY fMECBANICAL PERMIT-i FEE
bolding conswehon and hereby authorize representatives ofthts city to enter upon the SEISMIC FEE• 3. O
above-mentioned property for inspection purposes. /
(We)agree to save,indemnify add keep hmmless the Cil,of Cupertino vghinst PERMIT ISSUANCE ELECTRIC FEE
_.liabilities,judgments,costs and expenses which may in any way accrue against said City ALTER OR ADD TO MECH.
PLUMBING FEE
In consequence ofthe granting ofthis permit. ,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT G'010.000 CFM) MECHANICAL FEE
SOURCE REGULATIONS.
AIR HANDLING UNIT(OVER IO,BtMI CfiN) CONS"rRUCTTON TAX
AppliammCommc Dale EXHAUST HOOD(WMUCT) HOUSING MITIGATION PEP,
HAZARD 1S M TERIALS DISCLOSURE
a Will the applicant or future building occupant store or handle recen us material HEATING UNIT TO I Oli BTU) I O
as defined by the Callihan Municipal Code,Chapter 9.12,and the Health and Safety -
Code.Section 25572(al" HEATING UNIT(OVER.100,000 BTU)
❑Yes ON. VENTILATION FAN(SINGLE RESID) PAID Dam Receipt#
Will the applicant or future building occupant use egmipmetn or doviceu which BOILER-COMP(3HPOR 100,0(10 BTU)
emit hazardous air contaminants as defined by the Ray Arca Air Quality Management
Dlstrid?I BOILER 100,(100 BTU)
D Yes ❑No - t
� n
1 have mud the hazard ma materials requirements undo Chapter GAIR CONDR TONER95 of the Call- ISSUANCE DATE
forma Health&Safety Code,Seafpms 25505.25533 and 25534.1 understand Nat if the NEW RESIDENTIAL.MECH, SQ.Er. G� O
P building`does not coantly have a meant,that it is my respanaiblllty tomad,rhe occupant
ofdrreq ' mens which must be met prior to issuance of a Certificate of Occupancy. -
tit zc vgem Vale TOTAL ISSUED BY:
OFFICE