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B 0329 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING.ELECTRICAL. PERMrr No. ti 0 3 2 9 BUILDING DLVISLON APPLICATIONWERMIT PLUMBING.MF,CHANICAI. SOoo� f/��(` nw LDING PROJECT[DENT[CATION ❑WILLING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE p E . ESFH s 17� a — �2— OWNERS NAME: PHONE: CONT 1'r ULtS NAM LIC NO: ?b V C, oV' 2 N/C CO.Yr ROI.% ARCI I I ECf/ENGINEER: IC NO'. ADDRESS r V - ❑ rs $ CONTACT: PHONE: BUILDING PEIiMITINFO D J �k ' � ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUntI� MICH LICENSED CON'I'RACI'OR'S DECLARATION QTY. ELECTRIC PERMIT FEE Lra�Jl/ ICJ LrfJ! 1 hereby aRrm Nm 1 am licensed ander provisions of CM1npmr 9(commencing JOB DESCRIPTION F�f�Z with Senian 90W1uf Divi.vionlof tM1e Rosiness and PmfcszinnsC e,and my licenu is !`D RESIDENTIAL: OO in full fiimc and c 'cel. PERMIT ISSUANCE J �U_ License Class Lic.p ❑SFDWL L'I'CHEN REMODEL Q U APPLIANCLS-RESIDENTIAL ❑ADDITION El PLUMBING RI PIPE. NQ w Date Conlmetw HI ;CTS DECLARA'I ❑MULTrUNrr ❑STRUCTURAL I_D nn PANELS ZOrnZ Iundellem m used asp n MODIFICATION OZ n?Q UPT02MAMPS L.V ❑INTERIOR ❑CHIMNEY R17PAIR F417II Licrewd Pmfcssion 201-10X0AMPS IMPROV17NIENT SWIMMING POOLS C x Q 1 hereby anion thin 11 m sempt formme Contractor's License Law for the OVER 1 W0 AMPS ❑BATH REMODEUREPAIR ❑DEMOLITION aODU 3 W U following reason(Section 0031.5,Barium,and Professions Code:Any city or county SIGNS ELECTRICAL D OTHER m which n'gmras a prom to construct,ahem Improve,Jcmoliah,fir repair uny soucmre zo f"�zo prior to its issuance,also requires the applicant for such permit to file a signed.udvment SPECIAL CIRCUR/MISC. thin he islicesedinraanttothe p..Ito.tsoftbeContractors License La.(Chapter 9 we 0 fcommencing with Section 9W0)of Divivien 3ofthe Businussand Professions Cc)or TEMP.MFTER OR POLBINS'I COMMERCIAL; a L e C that he is exempt d arefmm and tba he sis for the alleged excmpbinl tiun.Any vinn of ❑NEW BLDG/ADDITION D DEMOLITION Xmu, Section by any applicant for a pm1mtsubjeets the applicant to a civil Penalty of POWER DEVICES o' El❑'I'HNANT -1 FOOD t mom than five hundred Jollure S500). IMPROVEMENT =0 01,as owner of the properly,or my employees with wages as their sole comperoeion, SWIMMING POOL ELECTRIC ae L will do the work.and the structure is not intended oroRered for sale(Sm.9015.Business ❑OTHER 13 m and Prtdasiuna Code The Contractor's License Law does not apply to nn nwn,r of OUTLETS-SWITCHES-FIXTURES '496) �--�'^ Propmy who builds m improves thereon,mW who rices such work himwlf fir Ihmugh his own employers,provided that such improvements are not intended or oncred for NEW RESIDENTIAL ELECTS SO F1'. sale.If.howevernhe building or impeocamat is sided within enc year ofromdetion.the n$Q.F. OOR AREA 'V.FL n1rr.buBder will have the harden of proving that he did not bold or improve torpor- "I as ow,. o MAY MJy ❑ 1.:n owner of the proPcny,am exclusively contracting with licensed nmtracmrs as TOT mstma the Project(Sec 9014.Bosineas mud Profeasiorts Calc:)The Coulmaor's 1,i- nsa Law dens not apply to on owner-ofprvpeny who hands or improves thereon.and QTY PLUMBING PERMIT FEE who contracts for such prjats with a connotations)licensed pursuant to the Committers License Law. PERMIT ISSUANCE 3 I Ey D 1 am exempt under Sec. ,R h P C for this reason --•�� Owner Date AUVER-DRAIN A,VENT-WATER(EA) VALUATION WON K17R'S COMPENSA[TON DECLARATION BACK FLOW PROTECT.DEVICE ® p 1 hereby affirm under penalty of perjury one of the following dcdartions: D l have and will maintain a Certificate of Consent to self-insure for Workers Contain- DRAINS-FLOOR,ROLE AREA,COND. STUI IES 'TYPE CONSTRUCTION codon,as pryvided I...by Section 391n of the Labor Cal,,far the performance of the work fur which this permit is issoed. FIXTURES-PER TRAP !/ D I have and will maintain Worker's Compensation Insurance as requited by Section I/ 37N)ofthe LaborCde fur the perform...cof the work for,,hich this permit is iaw,d, GAS-EA.SYSTEM-1 INC.40U'TLETS - OCC GROUP MIN My Worker's Compensation la,mance rimier and Pul icy number are: Cartier: Policy No.: GAS-EA.SYSTEM-OVER 4(BAf Z �? CERTIFICATE OFEXEMPTION FROM WORKERS' GRLASMNDUSTRL WAS TE INTGRCEI'I'OR J CUMPmpletu ON INSURANCE (fhis sstiun need not be cwnPlnM if the penrvt iz faronc hundredJollars($Imp) BUILDING DIVISION EELS or]ess.) GRCASG TRAP PLANCHECK hili ccnifY tm:n in it rformtuccnf We volInr which his Permit is issued, SEWER-SANITARY-STORM IIA.200 F, not employ any perm m ny mannermas lgye m Io the Worker,Co.,.- ENERGY PER O Z cation laws of Ca'n - .D to [� WATER HEA112R WNF,NTNLECTR Z 0 Appliamt h GRAVING FEE y NOTICI3'rOA L a a Excmpunn,you should WATER SYSTEM?REATING a > become subject m the nmpensation Prvv si ns of the Ir r CNc.you must SOILS IEE fnnhwilh comply wit su.M1 Promsinnsfir this pemnilaholl W devoted atWATBR SERVICE a � CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMe. SO.FL PAID C.L Q Thor halt that iso mi Ser.3(07, len ding agency for the performance of 1 rte ReceiPtp It,work Na which chis permit is inxucA(Sce.3(N)9,Civ.CJ Lender's Name TOTAL: F0. (,"oily Ihm l reud dhi iT ialinn and rate that the uhave infmmatiou is BUILDIN rp curtect.l agree nh m y"with all city and county ordinances and state laws relating to QTYMECHANICAL PERMIT FEE U Z Wildingcon.rmc' ,and hereby authorize mgmsentntives ofthis city to enter upon the SEIS E nhnvcmcrah, np,ny fur innPttYion puHahscs. pP.RMfC ISSUANCE (We g to save,indemnify and keep harmle%s the City(if Cupertino against . _O EL 1 PEE O lia biluic. it, cars, is andcaPcnu.1 hila on an way name again said City trice quen of the gr ling of this permit ALTER OR ADD TO MIiCH. PLIJh I{ 'G FEIi AT [CANU 1; "' NUS WI 'OMPLV WI'I'll ALL )N-POINt' AIR HANDLING UNIT(1010.00(CFM) S R NS. �� ME NICAL FFE l AIR HANDLING UND(OVER I(IjXMC[MI CONS'rR CTION TAX Signammod ilia tenor r D EXHAUST HOOD(W/DUCT) HOUSING TIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will h,itplinerra Lima,building ocmupanl_ran:fir handle hnzmdrns mmetind HEAl1NG UNIT(fD IWOM B'IU) as defined by the Cupertino Municipal Code,Chapter 9 I and the Health and Safety Csda Section 25532m)? / HEATING UNIT 1010011 BTU) D Ycn VENI'I LATION FAN IS INGLE RESI D) PAID _ WII Ne upplic or future(wilding occupant use mpapmrnt or devices which Date Receipt p 'emit hazardous air : is as dr0oed by the Bay Area Air Quality Management BOILER-COME OR IWAM RTI) District) � T ,: r D Ycs mm.{]No BOILER-COM11P(OVER IW.gK1 BTU) I avis r d tint ;mloas amarnk H r AIR CONDI'I'IONHR ISSUANCE DATE squimn Is nndcrC 'r695oftheCai- feet eulth Safety alk,secs. 8505.25 and 25534. on rand that if the NEW RFSDHNTIAL MECH. SO.FT. hu i doe have. n,thin't sibil' to motif he capital5ur crena' c ilieae nf0 , Owner ora em TOT © ISSUED BY OFFICE