S 2335 (2) AFFLIUAN 1 IU FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING.MECHANICAL. S 2335
BUILDING PROJECT IDENTIFICATION '
BUILDING ADDRESS?: y ) � 7 SANII'AkY NO. APPLICATION SUBMI'1'I'AL DATE
�� -J CA21v`JN.I 41- W Al iO
OWNER$�11�. 9P73�-�ayo CONTRAOR'S;WyME:y �,i LIC NO. J N/C CONTROL#
ARCHITECTMNGI BER: LIC NO: AID ESS: �Yj''{{II.-
or 0
CONTgC'C PHONE: -
BUILDING PERMIT INFO
rD I--, COn581tant F¢09 Paid by AppllCent(Initial)
'U BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby amain mmr 1 mm him...d under pmvlebns AChapma 9[commencing QTY. ELECTRIC PERMIT FEE ]OR DESCRIPTION
=�P with Snmion 7(NIO)of Business and Pmfessiore Coda and mY lieenve it -
FK�� in roll foacomdelf PERMIT ISSUANCE RESIDENTIAL'
U License Class a# +f Xl—`f ? ❑SFOWL
lki
Q U ❑KITCHEN REMODEL
Fz{al Dille Commetor_ APPLIANCES-kESIDBNTIAI.
mQO, �� M El ADDITION El PLUMBING RC-PIPE
F7m ARCHITECT'S DECLA ION
Z O y I underswnA my plans shell he meed as public records PANELS El MULTI-UNIT ❑STRUCTURAL
UPT0200AMPS MODIFICATION
F�1"'LL1 Lrensed Pndesconal - ❑INTERIOR El CHIMNEY REPAIR
r4
OWNER-BUILDER DECLARATION ID
I-1000AMPS IMPROVEMENT [I SWIMMING POOLS
yS OVER IMOAMPS
y W Q I hereby-firm that I um exempt from the Cmicamor's License Low for the ❑BATH REMODEIJREP91R ❑DEMOLITION
x 3 d F following reason.(Section 7031.5,Business and Profccsions Cale:Any city or county ❑(YTHER g.4 o /iM. COI^
W 0. SIGNS ELECTRICAL.
y O y which require.n permit to construct,-lire improve,demolish,(or repair any structure t� -4y Cly k
m, overt r '.. v]sr q th pp]ica tf hp roto fl 'y Nsmmmea SPECIALCIRCUIT/MISC.
Qher he licensed p rsu rt he pro.vOtime,Ofm Contractors LL (Chapter v)
x..00
(commencing winSect TXIO)OfD'insi 3 of the Business andProfessions Code)or TEMP.METER OR POLE INST COMMERCIAL
6 q o pq that he is exemp'therefrom and the bots for the-Negri eechrom .Any violation ill -
kU^m Section 7031.5 by any uppi icaatfor a permit subjects the spot icam to a civil pEl NEW BLDG/ADDITION El DEMOLITION
enahy(if -POWER DEVICES
Fq. } hilt..or than Five hundred dollar.,PSOEL ❑TENANT ❑FOOD SERVICE
d � ❑I,ac nwn0r of the propery,onny employees with wage.ne theirsule compensminn. SWIMMING POOL ELECTRIC IMPROVEMENT
m wdldothew... and thesw0mrcis not intended ornRered for sale[Sec.]044,Busineac THER
0. and Professions Code:The Contractor's License Law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES
'}'.. property who builds or improves thereon,and who does such work himselfor through
his own employees,provided that such improvements are not intended or Offered for NEW RESIDENTIAL ELBCTR SQ FT.
note,If,howeveq rhe buildingnrlmpmvement is sold witbihone yemofanmphniom Ne Q.FL FLOOR AREA $/SQ.PT
owntinhoulder will have the burden of proving that he did not build or imprnve for pt,
,wee o[ssle').
❑1,as owner of the propeny,am exclusively contracting with licensed contractors in - TOTAL:
construct the project(Sec.70yj Business and Professions Codep Dhe Contractors Li-
cense Law does net apply to an owner of propeny who builds or improves deacon,and QTg 'PLUMBING PERMIT FEE
who contracts for such projects with a comnrs
rnm(e)licensed puuaat to the Contractors _
License Law.
❑ I nm r,ml under Sec. ,B&P C for thisreacon PERM]T ISSUANCE
Owner Dnte ALTER-DRAIN is VENT-WATER(EA) VALUATION
WORKERS COMPENSATION DECLARATION
• l hereby Orion under penaltyf BACK PLOW PROTECT.DEVICE
n Perjury self-insomfor Workrclons
❑ Ihave
as tend will maintain stion 3710 ofGe Liborntio sole,m;roferWformace of the DRAINS-PLOON,ROOF. GOND.
stolon,as provided for by Section 3]tq of the Labor Code,for the Performance of the S'I'ORIE9 TYPE.CONSTRUCTION
work for which this permit is issued.
FIXTURES-PER TRAP
❑ have and will mainmin Worker,Cnmponsatinn Insurvnre,as myaired by Section
3700,othe LaborCone,far the performance of the work for which Ibis permit is issvN. / GAS-EA.SYSTEM-I INC.4 OUTLETS O
My Workersq rqp mina insLr�n�canter and Policy number arc: OCC.GROUP APN
Carrier: IOW-sQry(i Policy No.: Al"25i5(�T�� GAS-EA.SYSTEM-OVER 4(EA)
CF,RTIPI:ATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASUINDUSTRL WASTE INTERCEPTOR
ices)
(This section itinerant newmoleted ifthepermnudism it is burn, uism della,,Hoon GREASE TRAP DIBUILDINGVISION'FF,ES
er -
I ecnify that in rho peromrnnu of me work fpr whist;this
]then
PLANCHECK PEE
permit is issued
noic. .. oypcmonany m-nnerwa-m necome suhjed mlM1C Workeri Gmrpmr- SEWP.k-SANITARY-STORM HA.200 FI'.
Oz ,-thatlanwsof CnliforniO.Dale HNERGY FEE
O Applicant WATER BEATER WNEN'/LLECTR
h
NOTICE TO APPLICANT:If,atter making cls Cerdficnm of Exear,mon,you should WATER SYSTEM![kEATiNO
a ?
became smm the Worker's Cnmpeoiprovisions of the labor Code,you muss E
W Q
forthwith
Provisions wmly with such pvisinnv nr this
permit shell he deemed revoked. WATER SERVICE.
1
i7. z CONSI inthem RUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT.
use I for
reby which thithat thereis.
sued Ser,3097,
agency far the performanceof De t#
(L rhe wed Cor which this permit is issued(Sec.309],Civ,CJ
U Lender's Name
Leaders Address (^� TOTA
H y i verily that 1 have rend this application--it late the''he have inhrmtatico is TO L. f:
V BUILDING FEE
1r 0 cone".I agree to comply with n0 city and county mJinanees and smte l....elating m'-QTY MECHANICAL PERMIT
U building construction,and hereby aumpdve representatives ofmicehyro enterppon the SETS
Dom)a ed vmpany indemnity
n impmapn keep ha ••.
(We)agmen to rove,and expenses
and keep hatless the City of Cupertino a ninsl PERMIT ISSI1gNCE
liabilitics,jud ts,cops and ex P g ELECTRIC FEE
in groes pemasmit, may in any wiry sc0rue egatnsr said City ALTER OR ADD TO MECH.
onICANTc Nthegranting Sthispermit. PLUMBINGFEF.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO O.090CF r
SOURCE REGU�LATIONS. MECHANIC E
L VA.L. /.. M I B� S� AIR HANDLING UNIT OVER 10,000 CFM) CONSTRUCT] T X
S�tyTSatture(311 pplieant/Coromemr Date EXHAUST HOLD(W/DI]CT)
BAZAR DOUS MATERIALS DISCLOS ORE HOUSING MITI TION FEE
Will thetpplicant nr finite building eceapanteloreof handle bac-Nousmmedal HEATING UNIT(10100,(X10 BTU)
as defined by the Cupertino Municipal Coda Chapter 9.12,and the Health and Safety
Code,Section 25532(-)4 HEATING UNIT(OVER 100,000 BTU)
C]Yes ❑No
VENTILATION PAN(SINGLE RESID) PAID _
' Will the applicant or future building n7upant use equipment or devices which Date Receipt#
emit limitations air corm unaats ns defined by the Bay Arca Air Quality Management BOILER-COMP(3HP OR 100,0(10 BTU)
Dlndet7
❑Yes El No BOILER-COMP(OVER III0,080 BTU) TOT L:
r
1 have rend the hazardous dSematerials 5,2553 an under Chapter 6.95 of the Cali- AIR CONDITIONER
foods Health net curre Code,e a Sections 25505,2553)and 25534.1 undeamnd that if rbc ISSUANCE DAT
buildingJces nmcunemly huveamnnnt,mm it is my rcsponsinililym notify the occupant NEW RES IDF.NI'IAL MECH. SQ,FT. C
bf the rcquimment which must be met prior to issuance of a Ceri117m of Occupancy I-J
Owner or aathoneedngmn Date TOTAL ISSUED BY
OFFICE