S 0469 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.-ELECTRICAL PERM]I NO.
BUILDING DIVISION APPLICATION/PERMIT 111,11,MIING-MECHANICAL
BUILDING PROJECT IDENTIFICATION
BUILIIINGADDRI S: INI�IARYO. API'I.ICATI()NSUI{MII'1ALDA'rliOWER'.SNAXE IONE ACTOR'S NAME: LIC NO, CONIRoI.R III'FECF/IiN SNEER: LIC NO. DRE'S:
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CONTACT: PHONE: BUILDING PERMIT INTO
❑ Consultant Pecs Paid by Applicant(Initial) I;L)G ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT PEE JOB DESCRIPTION
I hereby ulfirn that I am licenced under pnwlsiom of Chapter 9(commencing
�aZ with Sceootnaxp nr olvisian3onl,a amne„and rrofealimn.code,Dan lily nrcmeix RESIDENTIAL
PHRMrF ISSUANCE ❑SI'DWL ❑KITCHEN REMODEL
a° �t a lore Ilttd en'e.,.
FQ-UU Lore IIs p�A Lie.# APPLIANCES-RESIDENTIAL ❑ADDITION 71 PLUMBING REPIPE
NQL Ua1e' 1- — Comramnr P�— ❑MULTI-UNIT ❑STRUCTURAL
ARCHI'T'ECTS DECLARA'T'ION PANELS MODIFICATION
Z O N Z I understand my Plans xhall be used as public earned, IIP TO 2(X)AMPS OZ�O ❑INTERIOR ❑SW1M [NG['REPAIR
OL
licanscd Plale,ouriA 201-1000 AMPS IMI'ROVEMP_N'1' SWIMMING POOLS
OWNER.BUILOER DECLARATION oV ER 1000 AMPS ❑IIA'FH REMODEL/REPAIR I]EEMOLI'IION
CI&Q I hereby uffmm that 1 an excmpl from the Contractor's License Law for the ❑Ol'HP
X O6 U intimating reason.(Scatter 7031.5.Bmodr,,and Professions Cade:Any city or county SIGNS ELECTRICAL.
W 3 a H which requires v permit to conslrucl.thee,improve,demolish.or repair any xrucmre
_u'og pro I. eq ' ,a ppl If . hp a fl signed statement SPECIAL CIRCUIT/MISC.
tzrNath licensed p a theprovisions- fth C I' to L 1 w(Chapter9 COMMS 2CIA1.:
QOM R"nmcni ng w'IL l:.aio 9lxHp ofD ve'unJ nrdhl Bt- s IP {ssio sCd)n FFMP.METHRORPOLEINST. El NEW ItLDGIADDI'1'ION ❑OICMOLI'fION
L ai c,e m that he is exempt therefrom ad he basis fer the alleged excmpfion.Any vlamdimn or
Wim Section 7031.5 by any applicant file a permit subjects the applicant a civil penalty of 1.OWCR DEVICP_S ❑'l FNANI' L]FOOD SIiRVICIi
ma more than five hundred dollars($50(t). IMI'ROVEMIiNT
SD (] Las owner of the propcny.nr my cmployrez with wages us Neir sole ttunpensatier, SWIMMING POOL ELECTRIC
❑OTIfIiR
p. willdOthe wod.anJthestructue,is rmirearabdmuffored(orsale(Sec.9044.Business OUTLETS-SWITCHES-FIXTURES
i 3 w and PmfcWo-Cade:The Conlractnr',license l.uw it,.,and apply m an Owner of
pmpery who hnllds or improves Ihcecon,and who docs such work himself or through NEW RESI E L FI.BCfR SQ IT.
his own employees,provided thud such improvements are not intended of"acted her SQ.MT FLOOR AREA A/SQ lel'.
sale.If,however,the building or improvement is sold within ane year of completion,the
ner,lmilder will have the buNcn of pemving flat he did not Wild he improve for 11
post,Of sole.). TOTAL
I]I,as owner ill the propery,sun exclusively contracting with licensed contractors to
onzlNcl the project(Sec.TIR4.Business and Profms tars Com:)no Cantrucmr'x Li- FEE
e ,c Luw doesnol apply m an owner ofp,ON.y who hold,,,,improves thereon.and QTY. PI! MBI
vhnwntrsforInchp iacts with a mnlmcmr(,)Licensed pucsuvnuO the Comeactors
License Law. PERMIT ISSUANC11
1 am exempt under Sec. .B&P C for this masan
ALT RAIN&VENT- 'ATE 1 VALUATION
Owner Dart Se o
• WORKER'S C(IMPENSA'TION DECLARATION H FL ' (yFGCT.DEVICE
I hereby rZ under penalty of perjury ono althe following declare nm
I have.,,it wi 11 maintain or Canifcate IfConsmm til salI il,,ucI IN ke"Cumpcn- DRAINS-PLO( , OP RIiA,COND. STORIES TYI'Ii CONS'IRUCHON
,tion,i,provided for by Section 3700 of IliaLabl,Calc,for the Ndonamme Of the
work for which this permit is issued. PI%'NR[S T P
1 have Ind w ill maintain Wnfors Compensation Insurance,as required by Staff.
TIDO of the Labor Codefile the performance more work far which this pemit is issued. GAS-EA.SYS'..I- NCAOUTL S OCC.GROUT' APN
My Workers Compemmion lm um ham currier and Pnlicy number are: GAS-EA.SYST EM-O 'R iA
Cartier: Policy Na.;
CF.RTIFICA'1'17 OF EXEMPTION FROM WORKERS' GREASDINDUS'I RL WASTE INKEN "TOR
COMPENSATION INSURANCE BUILDING UI V SI(lN iq°.:
(DiksectionneWnothecamplcied ifthe,ohnno i,faronehundeddallars($10()1 GREASETRAP PLANCHE,CK PER
ter lens.)
I certify that in the performance of the work(or which this permit is issucal.I shall SI7WER-SAN ITARY-STORM EA.200 FT, ENIT YFEE
net employ any person in any manner.m as to become subject to the Workers'Compen-
z ,totem laws"'Ca"b” WAFER HEATER W/VENT/ELECIIf GRADING IEE
Z Q Applicant '
.Na NOTICIi TO APP ANT: .after making this endicam of Eaempdion,you should WATER SYS'[EMITREA'1'ING SOILS ITE
become subject to ole Nbrl ds Cnmpenraeon provisions Of the Lb,r Code,you must
U.1
funhwi anart,ly with suchpralkion,m Nis peemif shall be deemed revoked. WAFER SERVICE
(� PAID
�" CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT. On Receipt is
Ihereby Titian that Nem i,a commaction lendingagency Inc Ne peAarmmmea Of
U
U be work for which this permit is issued(Sec 3099,Civ.C.) TOTAL.
�E"I Lami Nome TOTAL]
} G Izndcr',Addmn, BUILUINGP 3 1 od
0. 1 certify that 1 have read this oppliamicn and faro hill the the aMvinternalis
f Z) eorecL l ageccu,comply with all city and county ordinances and sum laws mlaingm QTY. MECHANICAL PERMIT EEE SlilShtl .E Q
•U Z building comamnion.and hereby authorize representative,of this city Or enter upon the 0
vbrvomcernmed prnpeny for ine"nom pur,a"'. PERMIT ISSUANCE CUTCI' C
(We)agree to neve,indemnify and keep harmless the City of Cullanlno vgainvd
limbilines.judgments.costs and expenses which may in any way marine against said City ALTER OR ADD'IO MECH. IIj.GkHHNG
in enwchrerce of Ne gmming Of this permil. V
APPLICA NDERST SAND WILL COMPL LTH ALL NON-POINT AIR HANDLING UNIT(TO 10.(XN)CPM) MET HANII s f :VT
SO' LATIONS
AIR HANDLING UNIT(OVER I0,01)tI GEM) CONSTRUCr10N'T Y
vane of dieanUGmlmctur ]).to EXHAUST IRIOf)(W/DUCT) HOUSING MITIGATION VVE
HAZARDOUS MATERIALS DISCLOSURE
dl the applicant or future building Occupant store or handle hamrdous material HEATING UNI'I'('1'O I(X),INIO BTU)
as defined by the C.,wasmo Municipal Code.Chapter 9.12.and the Health and Safety HEATING UNIT(OVER Royally BTU)
Cede.$eefian 25532(a)9
❑Ye, All
� l VENTILATION PAN(SINGLE RESID) PAIDData Receipt N
Will the mpplicanl ars linea building'x's'upnnd me cquipmcnl urs Jcvices which BOILER-COMP QF{p ONI(H).011 ill Go
mid theardnux air cunmmin:nus as defined by Ne Bay Arco Air Vualhy Manvganual T(yl'A h:
District! ��`��' BOILER-COMP(OVER El Ye, KNotJ\\ AIR CONUITIONIiR "� ISSUANCE DA'I'I>
1 hove rcaJ the b orb, ustime, 55 5,25533 an under Chapter 695 of the Coli / T
Noll Hculth&Safcty Cnde.SCrliilns 25505,25513 unJ 25534.I understand the ifthe NEW RESIDIiNI'IAL ME `T ^/D .� 4huildin• nodculrcnd huvmucnunl,thattis my mihlllly In Deifytherccupmttt tents w ' al I'riotlm i, v'mfnCe ole mf(k'na arcnotizcd agent D. ISSUIiD BY: �,
OFFICE
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MORALES CONSTRUCTION REPA%S OF &MGED SERO ASSOCIATES
PLAN, SECTION COMPANY A WO M15 CEDAR aw.
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021 MEDFORD AVE ARY A 15VWM�
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AND DgTAILS GENERAL CONTRACTOR
HAYWARD.CA .41 "MRVIN0, CV