29578 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITYOFCUPERTINO BUILDING-ELECTRICAL PERM[(NO, ^^ ria^
BUILDING DIVISION APPLICATION/PERNIIT PLUMBING.MECHANICAL L J4 aVl 1/ V%
BUILDING pp6JECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMI'P[AL HATE
o,q�.
OWNER'S NAME: eA,fL PHONE' i CONfRACfOR:S NA LIC^
_ -_I _ `�1 NIC 'ONIROha
'A1RCITE NGINIs ER: IC NO. (DRESS: _J
CONTACT ` and'HOgG �, w^'_ BUILDING PERMIT INTO
iMIn`OEra'� 00 �I J`�'V75V ❑ Consultant Fees Pail by Applicant(Initial) BLOC_ ELECL PL MECH
• � •� JI 4 (c�/` L��`l
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby mfinn that 1 atm licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
Wp)� with Scdion]0(Ilp of DivisinnJof the 9uzines.and Nnlessirru Cwc.and my license is PIERMIT ISSUANCE 1 TIAL,
in lull tierce and effut. WL ❑KITCHEN REMODEL
aUZU License Chis Lica APPLIANCES-RESIDENTIAL
ADDITION ❑PLUMBING RF;-PIPG
y6i num Convunar
F,Om ARCHITECTS DECLARATION PANELS MULTI-UNIT ❑STRUCTURAL
Z O�� 1 understand my plans shall he used as public records MODIFICATION
OZ-1 UP TO 200 AMT'S C1 INTERIOR C2 CHIMNEY REPAIR
F�nIrW Licensed Professional 201-1100AMPS IMPROVEMENT
OWNER-BUILDER DECLARATION OVER UMAMPS ❑BATH REMODEIIREPAIR C]DEMOLITION
C W Q 1 hereby affirm that I am exempt from the Contractor's License Law for the
4�y U followin rt(Section 7031.5.Bovines and Professions Code:An t S ❑OTHIik
�( g ream Y city m corny SIGNS ELECTRICAL
l-!30se which its issuance.
anpermit to dmswm,alcor,improve.h scolit t orropy anyawemrc
I"�•�Q tpror hat ho,I Issuance.also requires the pro,kilicantformc such U-me Law(Catemem SPECIALCIRCUIT/A115C.
o^�C�QE (commeccemed pSection rnhc pmvisioion 3 of cBusiness Lheo.m Law(Chapmr9 COMMERCIAL'
Tal?�Q O (act he is
withthcmio ih 0homod ofDivisi for am aee,cit cvsandmi.An vi Code)or TEMP.AtITEH OR POLE INS"f
d e Shut io is exempt therefrom and for basis for use alleged exemption.Any violation of ❑NGW BLDG/ADDITION El DEMOLITION
:20 -IF]
Senior 91131.5 by any applicant lixa pemtiS subjects the Applicata ntacivil penalty of POWER DEVICES 'TENANT ❑FOOD SERVICE
^.Z.y S more than five hundred dollars(5500). ROVEMENT
=6 C] Easosta the property.nr my cmpluyet with wages as their sole compensation, SWIMMING POOL ELECTRIC
�F.,� will do the work,and She structure is notimenJW ondfercJ for sale(Sce.]B4f,Business I:k
W 3 m and Professions Code:The Contractors License Law does but apply to an owner of OUTLETS-SWITCHES-FIXTURES
property who builds or improves there m,and who does such work himself or through
his own employees,provided that such improvements arc not intended or offered for NEW RESIDENTIAL ELECT R SQ FT,
vile.It.however,the buildingnr improvement—old xilloo.ne yemof chmplaion,the •� `!1,/SQ.FTFLOOR AREA Who.FT.
ner-builder will have e burden of proving that he did not build or improve for pur- V .O
poN
se of arae.). Fi' 1 1 L,�.► J
n Tax owner of the property,am exclusively contracting with licensed emanicmry w TOTAL: 9
construct the project(Sec.7IW4,Business and Professions Gde:7 The Conrado.Li
cense law does not apply it)an owner of property who bui Ids or i mproves thereon.and Qrry. PLUMBING PERMIT FEE 4ocn iS
who contracts for such projects With a contractor(s)licensed pursuant)the Contractors
License Law. I PERMIT ISSUANCE
i]IamexemptorderSec. ,B&PCforthisreason
ALTER-DRAIN&VENT-WATER IEA) VALUATION
Owner Date 1�3 2 —
mundca WORKERS COMPENSATION DECLARATION BACK PLOW 1'ROTF,CT.DEVICE
ISdeby ul3inn under penalty of perjury one of the following Acdurmioro'.
In. %and will for by Se Certificate of Comcm to Code.forth,Performance
of the
DRAINS-FLOOR.HOOP,AREA,COND. STORIES TYPE CONS'IHUCI'[ON
work(us hick provided for an Section 3]W of the Labor Code,her the performance of the
work for which this is issued. II%TUItliS-ITER TRAP
❑ I have and will maintain Worker's Compensation Insurance, mermby Section
5]00 of �LuAer Enda for the perl'nrmmcc ofth,work for whichh Chirs permit is issued GAS-EA.SYSTEM.I INC.4OUTLETS OCC GROUP p )s.p APN
MY kc i t"Mut 'rg 4P c re: E 6/
GAS-EA.SYSTEM OVER 4(EA)
cr
V NI "Y"f a 7 GHEASEINDUSTRL WASTE INTERCEPTOR
(Thissection need nm he eomplded d am pcnmtls l'oronshut7Wdol1(S.a)) B �G IY ION FEES
or less.) GREASETRAP V(f
PILAjYCII[CK FEE g$ OO
I certify that in the par(onnnnceofthe work I,,,which this permit is issued,Isbell SEWER-SANITARY-STORM P.A.201 IT. _, BVI'
not employ any permm in any mafie
some so to bome subject ae She Worker: dr
Cr ,t HNIERGYMF. Cfi IInL) 31CO
z. action l,uws of California Date WATIEH HEATER WNEN'E:LECTR
2 O Applicant GRADING FEE
h NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should WATER SYSTEM/TREATING
abecome subject to the Worker's Compensation provisions of the Labor Code,yon mug SOILS FEE
Wforthwith comply with such provisions or this permit shell M deenSeJ revoked. WATER SERVICE
a• Q CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ,FT. PAID Dam Rcceipta
U 0 l hereby affirm that there is a comtruction lending agency for the performance of
the..,it for.arch this permit is issued(Sia.3099.Civ.CJ
0 U Lenders Name 10'IAL'
Lenders Address - TOTAL: 1
y mrify and 1 have ad Nis application and state deet the above infraction is BUILDING CE 1 fie
iF.fA correct.l agree to comply with all city and county ordinances and sameSEISMIC FEE wlaws relating to QTY, MECHANICAL PERMIT FEE "1O,
U Z mildingcon.xrudion,and hereby uuthodoc represenmtivcsoftbir city t0 enter upon the
ahnvomemioned p.,,by fur inspection purposes. PERMIT ISSUANCE •(�(
(We)agree So save,inde nily and keep humdcss the City of Crlda o against ELECTRIC FE6
Iiabilitics,judgmems,costsand eapemes which may many wayaccmeagaimt said City ALTER OR ADD TO MECH. PLUMBING FEE •4r
in consequence of She granting of this permit. 4171//�S
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT TT 010.000 CFM) MECHANICAL FEF. Y•I
S0URCP t'LATLO'S,
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRUCTIONTAX
wOffearAp,he.d/Co oae, T EXHAUST HOOD(W/DUC) HOUSING MITIGATION HE
HA GOODS MATERIALS DISCLOSURE
Will thcappl'mant or future buildingscupamsmremhanllehazmdnm material HEATING UNIT(TO 101.000 BTU)
as defined by She Colston,,Municipal Code.Chapter`),12,and the Health and Safety
Cade,Section 2553260? HEATING UNIT(OVER 100,003 BTU)
❑Yes ❑No VEN'I'I IATION FAN(SINGLE RESID) PAID
U:nc Receipt#
Will the applicant or furore building by the B me
use equipment or devices which BOILER-COMP UHT OR 100.000 BTU)
agadnus air nmmminams as defined by the Buy Area Air Quality Managent TOTAL;
igdc0 BOILCR-COMP(OVER 100.000 BTU)
❑Yes No
I have read the hmurdouv materials requirement,under Chapter 6.95 ruts,Cali- AIR CONDITIONER ISSUANCE DATE
forma Health& commnlymSections25505.25533and 25534.1understand oonly mthatiftae NEW RISIUENTIALMECH. SQ,FL
building does no Safety
Cahave a tions 25505 it is 53 responsibility m notify She tat it me
of the OvI deent,nts wbich amd he met prior o i...once of it Cer ificotn of Occupancy. 10
Owner or authnriud agent Uam TOTAL: ISSUE[)BY;
OFFICE
QJ0 0G) ti � N ti � � m ti ; w n H � m N t
< D m S D O = D S y D m 2 D X -1 zm-
m r z C> z rn c 5 z 0 n z : C 0 z m m 'A o m=
Z r m x C m D x c F x C
O a Z T p m 2 C T Z Z T N y� Z m a y m N
D y n y � rp m � c � ti N c F+• 00
r o 1+ W <
o Z m D o 1 m m N m O N �mm
> ab v, O a a N a m N '.1 xya
N T 0 II a 0 0 V1 V Cyd , J (DD c 1< y n o
GD z a s �� m I h+ n w IN.� t�D Phi z�'-yi 0 ' c . .
a Z D II o I� ,w N fD e N (D O moz -��° o £- ^
m / D a o d I� I 'P N W (D W 5zw .nom cn
m !! �+ �C > m5
( m m n II jj G M C N Iw.' i7 0 M Vim' ' A
r O I ,' �I O `Q K F- pry Boz M�
A
I� 11 1 N a M O p zZm v�
�-
Om m qt' r
Z O 11 n � II 1 M N O C W �/+m m i -
K o M,Z
°z ct
D3 A z n .7 P. W W N N m=� 5;
D (t c a N !•• A N O m m
(7 W m r W Ih N on0 A �� L
O p z � �' � � � W 9v LO O n -Dire O
ti Go
T m mm m m m m m m 1w'1 N �vz
MCL m D hi 10• D) ti D1 =D 9 N
�+ kQ
D I it �G M A N m(D ti0 0 Z !�r
m m F' m Fh m V
t+ 11 1 1 to N w N F+ O <
O n G I! N a N m- '
W ii n i iIi A co o Z
m rlo
N
�D 1 I II II K m m -4
O� I� ><
n