S 3337 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL Plitt I NO. 3337
CAL
BUILDING DIVISION APPLICATION/PERMIT rINCPROJ CT IDENNIFIC
I4UILDINC i`ROJI[fa'ID4:N'1'IFICA""P]ON
BUILDING ADDRESS. SANITARY N(1. nPl'LICArIONSU MI'1'1'ALDA
1IL16 1717 v '
( NAM1 IF ^ 'll( .'I"R 'T(1R" AME: LIC 60: ���
/1 N/C CON'I'ROLN
is ARCHUTECr/ENGI '.ER: LIC NO: 60MERS: ❑
CON'I'ACl': PHONE: BUILDING PERMIT INTO
O //rs ❑ Consultant Pees Paid by Applicant(Initial) hD ELECT PLUMB MECH
2_ ❑ ❑ ❑
LICENSED CONTRAC'TOR:S DECLARATION QTY ELECTRIC PERMIT FEE
I hereby affirnt Thal I ala ficense miner pravisionh el chapter n(emminem'in, JOB DESCRIPTION
WOO InSalional(M rflfvj% oflM1e Businessn I �rer_cinns CoJeone yliccnse is
610_ ml PIiRMI'P ISSUANCE RESIDENTIAL
N ; full Toast etB.
IVF Liccnc Qlays LIC.n ❑ADWL ❑PLUMBING
REMODEL
G V APPLIANCES-RPSIDENTIAI. []ADDITION ❑PLUMHING RI PIPE
v~iQy Dam fcool
(„ ARCIFMCP TI( ANEL.S ❑MULTI-UNIT ❑STRUCUIRAI.
z o h z omen ane my plans shall be usable,public recamis, 59117 ANISE
OZ- ' - I UPT02W Ah1I'S ❑INTER[OR A1NF,Y RIiPA IR
Liceosm Pnd,s.ionul 2014000AMPS INTER
/��
OWNER.BUILDER DECLARATION ❑SWIfs1h11NG POOLS
C C Q I hereby affirm their 1 am exempt from the Contractor's License Law for the OVER 1000 AMPS ❑BATH REMODEL/REPAIR ❑DEMOLU ION
3 y U lollouing neo t.fS"'I'm J03L5.Inionee and Pmt a ns Cmr:A cit,or county ❑OTHER
61 l.. -fie. - v ,r ^Yr Ys' ^Y SIGNS ELECTRICAL
=�y whim mgman n pemm ar cnmlNel,applicant
for c,dcn.if 1 : reputr any ammmr,
I5' �i fpri oil he,hbaor ce.alsuiey,,iesme aeintont The Comm�rrnit Lica av La.ummmem SPIiCIALCIRCUIT/MISC.
���� Ont he i.fccnmJ punuunt ei the pnrvisions uf,tc Cnnuucmr's Liccnm Lsw lChupmr9
�C, (commencing with Section 7000)of Divi.i....3mfahe Hucines aml Prefacsion.Calc)or 1,17M P.NE'IERORPOLEINSr, COMMERCIAL:
d d c C I],at he is exemia aheref..at and,be basis for,be alleged uempaiun.Any violation of ❑NEW BLDG/ADUI'I'ION ❑DEMOLITION
�y N Section 7031.5 by any a"boba l lin a permit suhjcn's the applicant to a civil penally of POWER DEVICES ❑TENANT ❑FOODSERVICE
nor more than five hundred Jolles($500) IMPROVEMENT
f=C ❑I,as Owner of the pmprrtY,rnmY employees wish xagrz ah aheirwle compensation. SWIMMING POOL ELECTRIC
F
will dnthewmk.:mdthesmamll'c Man ialendedorol'fmd force,(See 7O,W.Itusinea El 01
[ail�aao and Professions Code:The Contractor's Gren.c Law docs no,apply lo no owner of OUT LETS-SWITCHES-MIXTURE,S
A' .. properly who build,ur Improver memur.and who does such work himself or through
Id,own cmpinyccs,provide Thal such improvements are not immnded or offered for NEW BESIDES rT AL ELEC!'R Sp F1'
sale.If,however,the building at improvement i.stold within one year of completion,'he Q.F LOORAREA $/SQ.FI'.
owncobtfilder will have the burden of proving that he did not build or improve far pur-
cmf sated.
E]
, TITA L
construct the project(Sec.70H4Busnes and Professions Code:)*Me Commmors :
Li-
ahoweuahnmapplymunnwncrofproperlywhobuilUsorinlpnrv�s,hrrttiq ane Q'rY. PLUMBING PERMIT FEE
whoeonuvas fornachprojects with^conlrvemr(s)licensed punuanuOahe Commaors
Lleeme Law, PERMIT ISSUAN'C,
❑l am excnml nn der See ,13&PC fur Boom—,n
(twos, Dine AL'I LR-DRAIN&VENT-WATER(EA) VALUATION
WORKER'S COMPENSAI entar, N DECLARATION HACK FLOW PROTIiCT.DEVICE ^—
I Land w aft ai under penally of perjury one of the followImmo,mg dmlker's C s: s--vV
Ibave Prov willmaintainfor bynoction ica¢ofCfe Labor Colt-Ioreier Worker's Compen- DRAWS-FLOOR,ROOF,AREA.POND' STORIES TYPE CONS'TRUCTIL
anion,as prnviJad for by Section 391X)of the lainor Cmu,for We performance OI the
war forwor forty ee is imrker PI%'1"11RE5-PIiR THAT
have.mJ w' In WorAcr's Compensation Iacurana,ac mquirW by Sectio
3 trCode.wll fns , andePalirk fnrwl ieh 11�rt:-D,fIf <111.� GAS-HA.SYS'1'1?N-I INCA OUTLETS OCC,CROUP ANN
Carrie' ' //�/pnlicy Nn. r GAS-EA.SYSTENTOVER J TEA)
CERTIFICATE OF E.XF,MPI'ION PR MW !'.o tS'
COMPENSATION INSURANCE GREASIYINDUS DA,WASTE INTERCEPTOR
('Ife,,oamanee not he uimplae if the qu or is forms,hundred d011un(S 100) 1 -'-- HUILDING DIVISION IIiF_S
or less.) RIiASE TR AP PLANCHECK ITE
Loy any than int he Perommarany mnnereof lhewmk for whirs Itis the not Workerued,s'
Co LPer- i".IWER ZSANfli\ Y-Is MITA.
nal employ any penton in any manner co as to lxnime whjecuorhe Workcti Cn,'at' 54 ENERGY FEE
2 of Lows of California.Dam
O 'WAIT"HEATE W E,Yp/E E R
NI
Z
Applirnnl - 11 GRADING FP
NOfICI!'li)AI'1'IJCANT.11;alter nmking this C'eniticate of Exanption,you should I µ'ATTR SYSTF. /TI(CAT{
> beronne subject ai the Workars Cnmpmsalio i previsions of the Lahor C^de,you mus, SOUS FT?
fimbwith comply with such provisions or this permit shall he deemed revoked. WATER SERVICE
ao
z CONSTRUCTION].ENDING AGENCY .NfW,131$IDEN_llN.J:LMH. 'Q.FI'. PAID
].ENDING
V l hereby affirm that them is a amswaion lending agency for prfonmance of Ic ReomfaA
F ,be week for whichdin,,amit is iscucd(See.3039.Civ.C.)
O Leine',Name TOTAL:
V4 Lender's Address TOTAL'
Ir+ Q. I i,nd,Ism 1 have eand Ibis apt,inat ion and a,am that the uMwc immarr ion is
IlU1LDIN ISLE
N emrea.l agmen comply withal)61,and.Ounl,ondinance.andxunc laws mlmingm QTY. MECHANICAL PERMIT FEE
on
V Z
building construction.and hereby authom<representatives of this city to enter uparde SEISMIC FE
otnvc-Increnoncd pmpcny for inspcmlmn pnrpms.
(We)agree^i save,indemnify and keep harmless the City or Cupenin0 ugaia PERMITISSUANCE ELECTRIC FEE
liabiliricsjudgment.ows andexpenms which may in anywayaccomagainsl said City ALTER OR ADD 10 MECU.
sc,uc n(the g,a.,u O,hi.perm,. PLUMBING FEE
API'L tr eUNDP tSTA )S AND WILL COMPhY WITH AyyyL N' R(lI T AIR HANDLING UNIT(TO I(LfOU CFM)
SOI' " UiG �� /� / I MECHANICALIEE
/ 1 1" AIR HANDLING UNIT IO.fNq CfM) CONSTRUCTION TAX
Stg.'am t_A,1jm/C7.yImvImr Data EXHAUST HOOD DV/DUCT)
I IAZ RDOUS MAT17RIA LS UISCLOS URE HOUSING MITIGATION FEE
Will the applicant or fulum buildingoerupanl.Uorc or handle hueaMouslnl,,I HEATING ON[T("1 )111UtbBB B'IU)
as defined by the Cupertino Muni pre Cee,Chapter 9.12,and the health and Safety
COdu.Secoo l 25532(x) HEATING UNI',(OVER 110,00(1 BTU)
pYes .11
VENTILATIONTIIATION FAN(SINGLE RESID) PAID
Date Receipt N
Will the applicant or future building occupant use equipment or devices which
emir hamreous au conmminam asdefned by the Bay Arca Air Quala,Manugommrl BOILER-COMP LIHP OR 100.000 BTU)
Uivlria7 Fl BOILER-C'OMP(OVER 100.00BTU) 'fD'TA L:
Vca O
I ad he h:vaJous ma 'al.myuimmenu tinct Chupmrfi95 of the Cali- AIR CONDITIONER
ISSUANCE DATE
fomin c:Jt .Surely Cele,ser- s 255 i and 25534.1 unJcnmm ram if the NIiW RESIDENTIAL MECII, SQ.F I'. 'l
mai y v l i,is'.
s my r. sinilir`mnmi fy ae"pun, C
irnm wa prinrm ihmamee mr eni .ant ata
Owmer m amnurved agent ate TOTAL: ISSUED BY.
OFFICE