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S 0129 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY CITY DP CUPERTINO IIUILDING-ELECTRICAL. PHRMITNO. CHANICAL BUILDING DIVISION APPLICATION/PERMIT PING PROJECTIDENTOFIC S 0129 BUILDING PROJECT IDENITFIL'ATION BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL.DATE zi006r /sari cowq OWNER'S NAME: HONE: CONTRACfOR:'NAME: LIC NO: )N NIC CONTRULX R'VTECT/I:NGINF.F. : LIC NO. ADDREtiS: ❑ N v� CONTACT: PHONE' - . .y / BUILDING PERMIT INFO D �e ff (N t7 �T/ ❑ (,L09nlfant an aitll_byy Applicant(Initial) .PLIIAN ELECT PLUMB MIECH Ir LI ENSED CONTRACTOR'S DECLARATION QTY EI.F.CTRICPERMIT FEE � pW 1 herchy affirm tbnl I am licensed under fnrvisionn of Chap¢r 9(commencing JOB DESCRIPTION F I�Z with Section]IXIB)of❑ivision7of the Nosiness and Professions Crate,anJ my license is RESIDENTIAL, �- in full fommnd effect. PERM I .UANCf? ❑ WI. [I KITCHEN REMODEL NlU" Li¢nse Chis Lic.X AI' IANCES—REMDEWAL DITION C1 PLUMBING RE-PIPIT Z W Dme Contractor �n 66 MUL -UNIT ❑STRUCTURAL 5,7rn ARCHITECTS DECLAMATION PA IS Z 1 underamnd my plans shall W used ar public records MODIFICATION ZOZ-O p 1PT02 [I INTERIOR C3 CHIMNEY REPAIR [.. ¢I Licensed Professional BBB IMPROVEMENT ❑SWIMMING POOLS tJq' S�aj OWNER-BUILDER DECLARATION .lA S ❑ ATH REMODEIJREPAIR [3 DEMOLITION I hereby air,.that I am exempt from the Contractor's License Law for the O y U following reason.(Section 7001.5,Business and Professions Cash:Any city Or county Sl r 'CTR OTHER O which requires a permit to c mm on,alter,improve,demolish or repair any stmcwm prior to its iseuunw,vlsa mature,thoap1I amt for such mat 1.flea signed syatemam SPECIAL ' IT/ .C. INy} that he is licensed pursuant o the pmvisinns of the Commutes License Law(Chaper9 10 COMAHfQA' �µ'QD (commencing with Section 7")of Division 3 ofthe Businessund Professions Code)Of TEMP.MFTF.R L' dy e C that he is exempt therefrom and the basis for the alleged exemption.Any violation of - NEW TO. DITI ❑DEMOLITION Dlmy Section 101111,any uppfcum font perminsulicetsthc appllcam ,,a civil penaltyal' POWER DEVICES A [3 FOOD SERVICE 4477 tame than rive hundred dollars($500). ❑L as Owner ofthe property,or my employees with wages is their stale compensation, SWIMMING POOL CLE C 'E FysdEFl will dothe work,and the swcmre is not intended muRered for sale(See 7044.Business us,. ' R� 18 lis and Professions Carlo:The Cmrtmcon,License Law dues not upply to ua owner Of OUTLETS—SWITCHES—FI TURES .x property who builds or improves thereon,and who docs such work himself in through his own employees,provided that ouch improvements arc not intend eJ or oRered for NEW RESIDENTIAL ELECTR SQ PT. sale.If.however,the building or improvement is sold within, year of completion,the SQ.FT Fl.(K)R AREA SISQ.Ff. er farilder will have the harden of proving That he did not build or improve for par- posc of olcJ. /O ❑1,as owner of The Profen&arr exclusively contracting with licensed contractors to T V ii crmwet the project(Sec.7014.Business and Professions Code:)The Commutes Li- cense Law does not apply to an owner of property who build or improves thereon,and QTY. PLUMBING PERMIT FEE 1 C7*� who contracts for such projects with a contractors)licensed pursuant to the Common's `'.7 License Law. PERMIT ISSUANCE ❑ I am exempt under Sec. .B&P C for this mason ALTER—DRAIN&VFW—WATER(EA) VALUATION Owner Date IO WORKER'S COMPENSATION D[CLARATION BACK FLOW PROTECT.DEVICE pr'�r/�C„ l will mai under Certify Certificate ofComene of the foli re for eclaer's Co V r]Ibeve and will main by an.. 7M of Con senna Code sunfor Workersce Comfort. DRAINS—FLOOR,ROt]F,AREA,COND. 5'I'OMIB TYPE CONSTRUCTION work(as provided for mi Section 37(X1 of the Labor Code,for the perfnnnunce of the work far which this permit is issued. FIXTURES—PER TRAP ❑ I have and will maintain Woreces Compensation Insurance,as required by Section 3700.17the Litho Cods.for the performance ofthe work for which this permit is issued. GAS—EA.SYS'TEM-1 INC.4 OUGAITS OCC.GROUP APN My Worker' nm ns ti n Insurenc Policy number icy No.: GAS—EA.SYSTEM OVER 4(EA) CERTIFICATE OF : NFROM WO ENS' GRFASFJINDUSTRL WASTE INTERCEPTOR COMPENSATION INSURANCE DIN DIVISION FEI3S (This section need nm he completed litho permit is for one hundred dollars($100) GREASETRAP or less.) PLANCH I verify that in the performance ofthe work for which this permit is issied.I shall SEWER—SANITARY—STORM EA.200 FT. not employ any person in any manner so as to become subject to the Workers'Compere- I?NERGY 9;1 iisis ,Z onion Lows of California.Data WR'I'ER HEATER WNENTIELECTR 0 Applicant GRADING FEE ti NOTICE TO APPLICANT:IL after making this Ccnificate of lixcmption,you should WATER SYSTEMTREKfING become subject to the Waimea Compensation provisions of the Lelmr Crde,you most SOILS FEE Oj forthwith comply with such Provisions or this permit shall W devoted revoked. WATER SERVICE WW Q CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMD. SQ.FT. PAID V p (hereby oRnn that herc isaconstruction lending agency for the performance of Dole a nX rr the work for which this permit is issued(See3097,Civ.C.) 0 U Lender's Name 'OTAL: Lenders Address �a 0. RUILDINC IL Isi, FLr I certify that 1 have read thisapplicationun and stone that the above information is % correct.lagrcm agree with all citytyand nJ ccounty ordinances rod state laws reading to QTY. MECHANICAL PERMIT ��slzi-sfvdcUU 077, building concoction.and hereby authorize repremtmivcsofthis city tocnler upon the E ahssve-mentioned property for inspection purposes. PERMIT ISSUANCE (We)agree m save,indemnify and keep harmless the City of Cupertino against ELECTRIC FEF. Iiabilities,judgmentx,costs and expenses which may in any way mcme against said City ALTER OR ADD TO MUCH, PLUMBING FEU inconsequence of theming of thio permit. N APPLICANT UNDERSTANDS AND WIT COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(1'O IO.BIIfI CFM) MECHANICAL .F. SOI/R :GUI S. AIR HANDLING UNIT(OVER WANT CFM) CONSTRUCTR Slinature of fplicant/Contrac Date EXHAUST GOOD(W/DUC) HOUSING MITIGATION HAZA U ATERIALS DISCLOSURE Willthenpplicanto future building occupant store or handle hazardous material HEATING UNIT(TO I10,000 BTU) as defined by the Cupertino Municipal Cale,Chapter 9.12,and the Health and Safety Cade.Section 25533007 HEATING UNIT(OVER 100.000B'fU) El yo, 0N VENTILATION PAN(SINGLE RFSID) PAID Date Receipt p rdou Will the applicant ar future building mcupanl use equipment or devices which .it hazas air contamnts ianm defined by the Bay Ana Air Quality Management B(]ILER—COMP(3HP ON 100,0N)BTU) TOTAL'. atnnl BOILER—COMP(OVER 1(10,(100 BTU) ❑Yea C]No I have mud the hazardous materials requirements under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE forma Health&Safety Cade.Sections 25585,25533 sand 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.FT. building does nm currently have a reran,that it is my responsibility to notify the Occulted of the requirements which must be met prim to issuance of it Cenificme of Occupancy. Owner or authorized agent Data ^I ISSUED BY: OFFICE