S 2708 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELEC'I'RICA], PERMIT NO.
rLUMu1: - I
BUILDING DIYISIO APPLICATION/PERMIT uUILDING PROJECT IDENTMIFICGIIUN Q 2708 7OO
BUILDING ADDRESS SANHARY NO. APVLICA'1'ION SUBMITTAL TOM
/ D3S`{ - j6 51, 1244o w
OWNUR'S N , I'IIONIi: CON'IAMI?-0T6- N 60
10
4 av , C p� ��� Vam�� NIC CON'l)tUi.p
ARC]111Et:TENGINEER: LIC NO: ADDRESS ❑
S2 COA ,/cL-6-4,eSN VA E
CONTACT PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) RLDG ELECT PLUMB MECH
❑ ❑ ❑ E�
LICENSED CONT'RACTOR'S DECLARATIONQ'TY. ELECTRIC PERMIT FEE
I hutch,alfinu rant I L Iiro,tad ander,orviai of w
Chaa 9 m .
... nreein, JOB DESCRIPTION
�aZ willSort 0900nill'DlviximCinOne Ensure,and Procvion,Cndc:mdmy keens is RESIDENTIAL;
WOO PFRMITISSUANCE
CWF Iofull force and cflcct. ZD Vol ❑SPDWL Q KI'I'CHEN REMODEL
QUU hiccnsc Cla.- Lica APPLIANCES-RESIDENTIAL. ❑ADDITION ❑PLUMBINGRE-PIPE
NQ 6 Dulc Contractor
ARCHITI?LIS DECLARATION p\YEfS ❑MULTI-UNIT ❑STRUCI'URAI.
Zp.+Z I understand my plan hull Mosel aspublic records MODIFICATION
O Zr-n0 UP TO 200 AMPS ❑QVI'ERIOR [I CHIMNEY REPAIR
F 1LW Licensed Professional 201-11N�AMP5 IMPROVEMENT []SWIMMING POOLS
dmf oWNI?WBUILDER DECLARATION OVER EXPAND'S ❑BATHIEMODEUREPMR 0DEMOLITION
C C Q I hereby if fine that I am astrals,from he Conuumor's Llcet¢e law lattice W U fAluwin,mason.Ni,,Iio 0 7031 5,Hmin,,and Poe—ions Code:An t t ❑Dri 113R
y An, vtmrnY SIGNS ELECTItICAI.
3 a,N
winch iegatmv a purn,h m unmaacl.:dlei,impawc,dalm,lisn,or repair am swaatc
I"'LLONg prinnuas issuence,ilnn rcquircslbc Tplicatn forsueh permit to Eleesigned,hrodaem SPECIAL CIRCUIT'/MISC.
EY ,bar he is licensed pursuant mthe provisions of the Contractor's License Law(Chapter)
ItY C (a,mmcncin hh Section pNXq ell Di vieicu.34the liusinesvend Rofeasionn Csv3c)ns COMMERCIAL:
g xi TEMP,METER OR IS)[.[:(NST.
a as o IY that he is exempt therefrom and the basis for IM1e alleged exemption.Any swirl on of 10 ❑NP—BLDG/ADDITION ❑DEMOLITION
X^1i- Stttinn l031.5 by any applicam forapermitsuhjauthc applieanneaeivil penalty of POWER DEV ICES
WMy !NANT ❑FOOD SERVICE
t more than live hundred do.Ims($51X0.
F Z Y iPROVEMENT
d 0Las owner of,he proNny.or nay employees with wages as their.sale compensation. SWIMMING POOL ELECTRIC
SSG will du he work.and,hca,,a,, c isnot intended oroRered forsnle(See 9044.Bminsw []OTHER
Yeo
L5m :ual city bons Code:'1'nc Cnnlmarco Lndw Lee Jcucnutapplye, anrthro of OVI'LP.TS-SWI'1CI11?S-FI%TURES
prnpern winoyce,o tide cr then mJ who Jnm such work hlmadf offered for
his own have-,
ve-, he provided that such i ent v d wort not intended or offered for NEW RESIDEN'T'IAL Iil.l'C'I'R
sale.rdmilder will
have the burden or
ithat he id nuitncye,ofwmpletfoq lM1c SQ.isl'.FLUOR AREA $ISQ.PT
cry side.),will have ILc harden nT pm ing that M1c did not MiIJ or improve for put
-
Else nLsalc.). v -
1,as owner of the prnpcnt am exclusively contracting with licensed contractors to TOTAL
construct he project(Sec.IIW4.Business and Profession CedcU The Cont,aod U-
c Law does no,apply m an owner of property who builds or imroY
pves thereon.and QTPLUMBING PERMIT 9
xfio....1 a 1,fim,drh pr jcc,with a enmmctor(s)lice iLed prearm to the Contractor's
License Luw'. PERMIT ISSUANCE ( 1.
El I a,n exmnpt under Sce. .E{&P C for this nonan
0"', Dmc AUT'17R-DRAIN N VENT'-WATER(EA) L ^ 5 1999 VALUATION
WORKER'S COMPENSATION DECIARAI'ION BACK FLOW PRODRZT.DEVICE M
I hereby affirm under Anally of pe jury one of the folLwing declarations:
AR
I have and will maintain a Certificate ofComenuoself-innurt for Workers Compcn- DRAINS-F1.00R.ROOF.AREA.COND. STORIES TYPE CONSTRUCTION
sa,iond as provided for by Section 31(0 of me Labor Ctdc,felt the performance of the
work far which this permit is issued. FIXTURES-PER TRAP
❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code.for[lie ferfommnce of the work for which this pane is issued. CAS-EA.SYSTEM-I INC.IOUTLETS (ICC.CROUP APN
My Workers Compensation lmnnmce..trichina Policy n toner :
Carnes Policy No,'. u me
GAS-EA.SYS'I HNI-OVER4 LEA)
C17RI IICNI H OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASFJINDUS'I Rl.WASTE INTERCEPI OR
(Thss section need not becompleed if thepennil is furore hundred dollars($110) BUILDING DIVISION FIFES
or Icss.) GREASE TRAP PLANCHECK FEF,
I ectifYthat inlhc permanurceoohe wmk fill hi,hthis Nerad is issued.I shell SEWER-SANfFARY-STORM F.A.2tXl FT.
not employ any person in any n,annce su as to brume senjed ,,,he Worker'Cumpen- ENERGY FEE
,Z vtuoa Laxiof 9� Ua/. WATER HEATER W/VENT/ELECfR
Z
O Applicanlh )( q (T li1Ns-� cicnOlNC FEE
NOTICE TO Il PPLICAN' B,d a 1 .-ng this COmn'the of Exemption.you should WATER SYSTEM/1'RE ANG
hemracmhjee„n the W..Ur',Compensation pnotmon-ol the Labor Code,ynumust SOILS I111i
forthwith comply witharch provisions m this lsciiiii,ball bedccmcdrevoked. WATER SERVICE
a �
= z C(INSTRUC TION LENDING AGENCY NEW RF.SIDEN'1'IAI.FUNDS. SQ,PI'. PAID
U 0 T hereby ahthak,on,i isaail(See nnlceding agency Tanis performance of Bae ccip,p
U Lvrldc kfor which lM1is lwnnil is issued(Sec.3fY)9.Civ.C.)
U Lenders Name TOTAL:
r Lll Leader,Address TOTAL:
1 1 certify than 1 have read this applica,inn and state that the above information is BUILDING FF.F,
F (n nmec,.l egreemn,.,Iy withall city and cuuntyordinaneesund ane le—orlmingm Ql'Y. MECHANICAL PERMIT FEE
UZ bulldingnmtrue,inn,and hereby namorizereprecaudiesol this city,aenter uponthe SEISMIC IEE
abs l] ri,,Ooy I center p ry
PERMIT ISSUANCE 0 f;LEL'I'I11C hili
(W) f t 1 'fy Ik ph' I SI ya,Cuy fCpn' dCity
lion...u,are aoffla, ting laami,Dewhahnvyi,uryw,yarnc ga'n,ts,id City
in v nsnlaence of the running of this permit. ALTER OR ADD 10 Af ECf{, PLUMPING PER
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING WYI"PITO If1.000 CFM)
SOURC tEGU1.AT10NS(� MECHANICAL FEE
F �V� \ ]. �`�,�� AIR HANDLING UNIT(OVER 10.000CFM) CONSTRUCTION TAX
Signature oCApplicamUtud . // EXHAUST HOUD(W/DUCT) HOUSING MITIGATION FEE
HA%ARDOUS MATERIALS DISCLOSURE O
Will the applicam or fturre hulWing occupant store or handle hasanlous motorial HEATING ON[T(TU l M.1)(NI RTU) Z
is dcliucd by the Cupenlna Municipal Code.Chapwr 9.12,and the health and Safety
Code,Section 25532(a)1. HEATING UNIT(OVER 100.110()BTU)
E]YL, c4l PAID
c VENTILATION PAN(SINGLE REMID Date Retni IX
Will the applicamnrfuwrcbuilding occupancy Area Air uordeviceswhich BOILER-COMP 110,000 BTU)
mi,hmadnus air,cnntaminunl.,uyJefincd by tnc Bay Arca Air Quality Management T IAl.
Distract'! f�-„(`/
Yes POILER-COMP(OVER I WINO 9TH)
IM1ave recd the ha,mlons nmtuiuR,equircwins mndcrCMptoa 695ofthe Call- AIR CONDITIONER ISSUANCE DAIH /t
timid
Health
s&Sanely Ciate.Ss2i255JJ:and 25534.'understand thatt fhe NEW RESIDEN'fAl,MICIIbroli "loo' "moo cj`mhladIusI'll tell umibirillifl m SQFL
It I hie 11, rle",,swarm ofn Cenireatu foot
amhorizeJ agent he TOTAL: ISSUED BY:
OFFICE