S 1551 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL P1pRp11T NO. 15 51
BUILDING DIVISION APPLICATIONIPF,RMIT PLUMBING-MECHANICAL ``vv
BUILDING PROJP.C'F]DF.NT CATION
BUILDINGADDRFSS SANITARY NO. APPLICATION SUBMITTAL.DAIF
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Li is C \Z CIA 2\1 �l o ��]�I L(•22-�t 9
OWNER'SNAE: PIW �S Z CONTRACTOR'S NAIVE: LIC NO: NIC CON ROL#
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ARCHITECT 1ENGINEER: LIC NO', ADDRESS: ❑
AMES IIA
CONTACT: PHONE: BUILDING PERMIT INFO
---1�-^ T ❑ Consultant Fees Paid By Applicant(Initial) BLDG ELECT PLU-MB MECII
L�,� L � I -6 3 E] 1:1CLQ ❑
LICENSED CONTRACTOR'S DEC RATION QTY ELECTRIC PERMIT FEE
1 hereby alarm mat 1 am licensed notice powmosel of Chapin,9(cammencdng JOB DESCRIPTION
"Z with See..700)of Division tribe Basincssand Prof s..am,Cndc,tradicense is _ RESIDENTIAL•
FI-0 any in full force and elf 1 PERMIT ISSUANCE ❑SFDWL ElKITCHEN REMODEL.
�UU I-icense Class CLie.om APPLIANCES-RESIDENTIAL ❑ADDfrION ❑PLUMBING RE.PIPE
in<1 Dam Command'
ARCIi1TECP5 DECLAI ❑MULTI-UNIT ❑STRUCNRAL
PANELS MODIFICATION
Z O— UPIY)2
Z 1 understand my plans hall be used es public records
OZ— 200 AMPS El INTERIOR ❑CHIMNEY REPAIR
F X.1".0.1 LicenxeJ PnslOWNER-BUILDER DECLARATION'rWonal 401-IHDIAMPS IMPROVEMENT [I SWIMMING POOLS
y C Q 1 herehy affirm that I am encmpt Rmm
om the Comcr's License Law for he OVER 1000 AMPS ❑BATH RP1r10DE1/REPAIR DEMOLITION
X 9 0.V fallowing reason.ISecOon]031.5,Business and Prefcsslme,Cede:Any ell, county SIGNS ELECTRICAL C1 OTHER r
W LL N which nature, ti
ua permit to common, on.improve,demtlish.or repair any structure eC
�.�'.0< prior to its issuance,also requires the applicant fn,smh permit to file asigned,,bleno , SPECI AL Cl IrcurrIMISC.
that he is licensed pmsumut the p,mvisions of the Costumes License Low(Chapter 9
ua1�J<�O (commencing with Section 7001)of Division 3 ofthe Business and Professions Cuts)or TEMP.MEI'ER ON POLE INST. COMMERCIAL:
tL�L(o q LLthat he is exempt Nendrom and the basis lir the alleged exemption.Any violation of [INEW BLDG/ADDITION ElDEMOLITION
u1I, Section 7031.5 by any applicant for a Permit subject,the applicant to a civil Penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
not more man Iivehmalred dollars($500). IMPROVEMENT
�gF^.Tq ❑L as ownerof Ne puped ,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC
R�a GGG❑GGG❑ will do the work,radthe smature is notmanded tethered for We(See.]W4.Business ❑OTHP
W m and Professions Calc The Cenci License law does not apply to sea swan aI OUT LEI'S-SWITCHES-FIST'U RES
progeny who builds or improves daemon,and who does such work himself or through
his own employees,provided that such ingnovemcas are an
intended nr offered for NEW RESIDENTIAL ELCCrIt SQ ler.
sale.If.however,me building or improvement is sold withrome yeaofcnmphinum.the sQ.FT.FLOOR AREA SISQ.FT.
own
er-builder will have the burden of proving that he did not build or improve far pur-
pose or e sale],
1, owner of me progeny,am exclusively contracting with contractors m TOTAL:
m-
vmnru.I be ounce,(Sec.71,14,Business and Professions Co..:,The Contmcar's Li-
censclawdoesnotaMlytoanownerofprogenywhebuildsorimprove%thereon.and QTY. PLUMBING PERMIT FEE
who contracts for such pmjeet with a comeremAs)licensed Pursuant to the Commetarn
License law. I I PERMIT ISSUANCE
Ej I..exemptunder See .B&P C for this reason
AL'1'IiH-DRAIN&VENT-WATER(PA) VA
Owner DIO
WORKER'S COMPENSATION DECLARATION BACK FLOW PR(yRCr.DEVICE
1 herebyoff ai lainand,,a penalty to ofComencofthefollowingdeclarations: -
❑Ihaveandwill tarry e3ctm of the Labor
Code,for the
Workers Campers- DNAINS-PLOOR,RWF.AREA,GOND. STORIES TYPE CUNSTHUC)'ION
cation,as provided li+r byI,issued
Section 171X)of the Lahar Code,for performance of the
work for which ms pelma is issued FIX'1'ORES-PER TRAP
❑1 have.,,it will maintain dor Compensation Inra
sunce, "aided by Section
4700 n1'the Lnhnr Cnde,fnr thne.perfnnnonct of the work far which1,"aided this penmit is issued. GAS-EA.SYSTHid-I INC.4OUT.ETS UCC.GROUPAPN
My Workers Compensation Insurance carrier and Policy number are:
Commie Policy N., GAS-EA.SYSTEM-OVER 4(EA)
CERT]FICATE OI'EXEM PTION FROM WOR KERS' GNEAS[JINUUSTNL WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
('ITisvectionncWna,heirstnple(edlfinepermitlxforanchundreddollnm($]N)I GREASE TRAP
ar les.) PLANCHE K I'LER,
Icenify that;,me daymannce,so theas I work far rotor W isms'Cunha-ued.I shot] SEWER-SANI'T'ARY-STORM EA.200 FT.
nm employ any person in any moaner so as I.Mcome suAjecundhe Wnrkect Campers- CNF.R Y E
zZ cation Laws of Califon ja.Date WATER HEATER WNENT/[LECTR
O Applicant GRAD Clt
V) NOTICE TOAPPLICANT:IL arm,making this Certificate of Flanni am.you should WATER SYSTEMOXI;XrlNG S 6 r
h Imo` become subject to the Watkins Compensation provisions of the Labor Code,you must
UJQ forthwith comply with such Pmvixints nr this penmlfshnll be deemedrevaked. WATER SERVICE UY UC WV. t„+,s
U O CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT.
I nearby affirm that is a construction lending agency for the performance oil Dane Rec
— the walk far which this permit is issued(Sec.4(19],Or,CJ
Lenders Name
W LTA L:
0 Icndcr'X Address TR'I'AL:7FEE
WI certify than 1 have read this application and sans tha the shove infonnmion is BUILDING FTH
Cis
correct.l agree do comply withal]city and county ordinances and state laws reining to QTY MECHANICAL PERMIT Zbuilding construction,and hereby radiative representatives ofthis city to enter upon the SEISMIC FEEIll
above-mentioed Impctry lr inspectionpurposes. PFItMITISSUANCE(We)ae to and gresave,indemnify keep harmless the City of C.KefiroELECTRIC Fimhirci lilies.judgments,costs and expenses which may in any way accme against said City ALTER OR ADD TO MIKE. PLUMBING FEE 9in con q t o mingof,lik,armit.
A (CANT UNI)F.Ij}ITANTIS ANDWILLNWITH ALL NON-POINT AIR HANDLING UNIT(TO 10.0310 CFM) MECHANICAL FEE
S( IRCE REGUI. 'fUNS. AIR HANDLING UNTT(OVER 10,01 CFM) CONSTRUCTION A%
Signal oral c mnracto, DalEXHAUST HOOD(W/DUCT) IIOUSING MI'I'1 ATION FEE
HAZARDOUS MATERIALS DISCLOSURE
WIII the applicant or future building oacupan,store or handle bmardtus material GRATING UNIT TO 100.00d HTU)
0krined by are Cupertino Municipal Cede,Chapter 9.12,snit the Health and Safety
Cale,Section 25532(a)1 HEATING UNI'P OVER 100,000 BTU)
❑Yes C3 No VHWILAT10N BAN(S INGLI:RESIU) PAID
Dm Receipt p
Will the applicant or future building uscapmu use equipment or devices which BOILER-COMP(3HP OR 100,000[1 TO)
emit haurJaus air contaminants as defined by the Bay Area Air Quality Management TOT . /
pisbimP
❑Yes ❑No BOILER-COMP(OVER 100.000 BU7T
I have read the hazardous materials requiremems under Chaptcrfi 95of The Cali- AIRCONDITIONER ISSUANCE DATE
famja Health&Safety Code,Sections 25505.2553]and 255311 understand that if the NEW RESIDENTIAL MECH. SQ.PL 7- z Z -9 ,g
building does not comply have a mount,ma,it is my reXlamnjbility m notify the ocruoum
of the reqummeents which must be met prior o issuance of a Cmllicatc of Occupancy. -
Owner or authorimJ agent Dam TOTAL, ISSUED BY:
OFFICE