28211 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILHI .-ELKCI RICA], PI:RMU-NO.
APPLICATION/PERMIT PLUMBING-.MECHANICAL /� O I�
- O BUrLDING DIVISION BUILDING PROJECT I EbrrIFICA'1'ION L o G
t 11
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMI II'AL DATE
D3�3 UNIT# LOT
WINE NAME: _p.110NE: C GTO R'S NAME LI NO:
N/C CONTROL#
C 11'E f/ENGINEER: LIC NO: ADDRES'. ' � �d ❑
__.T_
O TALI: �y ,�PIIO„NE�'ry,(L QTY. ELECTRIC PERMIT FEE BUILDING PERMIT INFO
%!A/�'����,5 eT BL LF.Cf I'IAMjL/� MEC
PERMIT ISSUANCE �_ �IlP�r/'
LI that
CONTRACTOR'SDECLARATION APPLIANCES-RESIDENTIAL BDFSC ION
000 (hereby ofrmtha0 amlicensed lumiunder provisionwfChape. nd(commencing with
u�100 full fanelmaryofeset.,on3 of the Ouu'iness and Professions Cada.and mylicenxis in PANELS
y full msec mad erred.
FZy) Lianx Cl +s Lie.# L- UPT0200AMP5
m=y Data�Cnnaanor (K 201-I(XIO AMPS SQ.FI'.I1,00R AREA $ISQ.FT.
1—y L_ RCIIITECTS DECLARATION OVER Egg)AMPS
Z O m 1 understand my plans shall be,used as,public records.
O Z F_�
SIGNS ELECTRICAL
<y Licensed Professional
Wyde6 OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. / .I
KOyU 1 hereby affirm that I am exempt from the Contractor's License Law for the
m "oo,
following reason.(Section 70315,Business and Prafcssmrs Calc Any city or county TEMP.ME HER OR POLE INST.
F O'j which requires a permit to construct,alms.improve,demolish,or repair any structure
F,[✓[yy'}� priorto its issuance.also requires the applicant(orsuch permit to file a signed statement POWER DEVICES
ty�jC�O that he i.s licensed punuanuo the provisions of the Conrtwor's LiecuOu Law(Chapter
ddo�' 9(commetain6 with SemionTOoo)of DivisionJof the Business end Professions Codc) SWIMMING POOL ELECTRIC I, ,^/VLALUATION
to or that he is exempt therefrom and the basis for the alleged exemption.Anyvioladonof - / / / 1 - (��
F.ZQ Scmion7031.5byany applicant Era permit subjects the UPPli.oltoacivilpenullyof OUTLETS-SWITCHES-Fl%TURES '/ 7 v
S_20 not mom than five hundred dollen(5500). NEW RESIDENTIAL ELECIR SQ.FT.
dt: ❑ 1,asowncroftheproWny.ormyemployeeswithwagesastheirsolecampensation, STORIES TYPE CONSTRUCTION
y 3r O_° will dmh,,knis and the he Cionomm's License
o w does
.apply TIN4,Business
and Professions Code:The Conover...License law does not apply lf an um,lb of
is
propcny who bu Idsorimprova them...im .vers who dues such workforeseef dthrough his
employecs.providnl that such improvements arena imcndedoro(feted(newts..If, OCC GROUP RES.UNITS
however,the building or improvement is sold within one year nfcompletion,the owner
builder will have the burden of proving that he did not build or improve for puryou of
este.). QTY. PLUMBING PERMIT FF F APN
❑ I.as ownerofthe prupeny.am exclusively contracting with licensed emiloomrsm
construct the project(Sec.TOOL Business and Professions Code:)The Contractor's
License Lawdne,not apply or ownerofpmpeny whobuilJ.wrimproves thereon.and PERMIT ISSUANCE
who eummets for such projects with a contortions)licensed punuanuo the Contractor's
License law. ALTER-DRAIN&VEN' ,WOHR(EA) FEE SUMMARY
❑ I am exempt under Sec. B&P C fm this rtamn BACK I1,0 W PRO'I'F,Cr.1 C OUTSIDE EES
SANITARY Y N
Owner Dale DRAINS-BOOR,Rtbr .BEA.CON iCHI1TM
WORKMAN COMPENSATION DECLARATION SCHOOLTAX N
❑ 1hereby affirm that l have a cerifcme afcatiOnl toself-insure,or acertifca¢of FIXTUNIS-PERTRA' ECEIPT#
Workeri Compensation Insurance or a certified copy thereof(Sa.38110,Lab C.)which ARK 1:1 Y N
coven all empmyec's under this permit. GAS-EA.SYSTEM-I INC.4 RF.CEIIT p
Policy# UILUGD rte
Company GAS-EA.SYSTEM-OVER 4(FA) PUNCH K -
❑ Cenified copy is hereby monitored.
❑ Coifed espy is TJcd with the city inspeminn Division. GREASININDUSI'RL WASTE INTERCEPTOR GRA G Eli
CERTIFICATE 01;EXEMPTION FROM WORKERS' GREASE'IRAP SOILS FEL
COMPENSATION INSURANCE
I'ITis section need nm be completed ifthe perm is for one hundred delta.(S 100) SEWER-SANI'T'ARY-S'T'ORM EA.200fT. ENER
or less.)
Icertify that in the pedomwnee of the work for which this fruit is issued,Ishall WATER HEATER W/VLNT/ELECR
not employ any person in any manner so as to become subject to the WOrkers' PAI
ComRnsmionlawsof Califomia. Dam WATER SYSTEM/DdEATING D:e Receipt#
U z Appli,it
Z2 NOG ICE TO APPLICANT:ILafter making this CemEma,Of Exemp1mit,yuushuild NEW RUSIDENTIA[,PLMB. SQ.FT. TOTAL:
FcG become subjecuo the Workers Compensation provisions ofthe labor Code.you must
� ; forthwith comply with such provisions or this permit shall be deemed revoked. BUILDING FIE /
L1.1 FCONSTRUCTION LENDING AGENCY SEISMIC FEI
z I he.ebyaffrm that here is acomuuction lending agency forth,performance of
ELECIRICF3E
UO rhework for which this pert islnuW(Sm.3099,Civ.C.)
mi
Lender's Name PLUMBIN IEE
u' F Lenders Address QTY. MECHANICAL PERMIT FEE
U I certify that 1 Luso read this oppliwlinn and arra thm the above m ornmion is
lJJ corral. (agree mcomply with all city and county ordinances end stare laws alining In PERMIT ISSUANCE22 MECHANIC I.Fedi
I--' � building construction,and hereby euthorim repremouniveeoftlikeity loenteruponthe CONSTRU IONTAX
U z abavuamain red property fur in.spoction purposes ALTER OR AUDIO MECH.
We)adgm nt save,indemnify and keep harmless y Ciry of Cupcn...against
lidb i .'dgmems,costs, dexper¢es who may in any wayaccm against said Ciy AIR HANDLING UNIT(I'O IO,IXp CFM)
in a E6 taOr the grvt neol'thln
AIR HANDLING UNIT(OVER 111,1%1!1 CI'M)
Si azure Of ApplicnnUContmctor Dam 6EXHAUST HOOD CVMUC) / PAID
HAlARDOUS MATERIALS DISCLOSURE HEATING ON]'I'(TO I W.000 BTU) Uate RecOlpt#
Will the applicant or future building occupant store or handle haromhous material MEANING UNIT(OVER 1(10,1100 BTU) TOT
m defined by the CoNriiw Municipal Csale.Chapter 9.12,auto,Health and Safety
Cast,Section 25532(a)9 VENTILATION FAN(SINGLE RESID)
El Y. 11 No
BOILER-COMP LiHPOR I00.(MU BTU) ISS AN BDATIit
Will the aconta mart Us defines.by, he BUY A .Air Quoit Man i,mout T
amts vs air contaminants m defined by the Bay Arta Air Quality Mmagemem BOILER.COMP(OVER 100,000 BTU) V" a Q
Dlstrida
❑Yes ❑No NEW RESIDENTIAL MECH. SQ.FT. JUN
Epp(
I have read the huxamous materials regnimmenu Under Chapter fi 95 of the ^a/
Califomia Health&Safety Code,Sections 25505.25533 and 25534. 1 undentsnd that
if the building docs not currently have a tenant,that it is my responsibility to notify the
Occupant of the requirements which must he met prior to Issuance ora Certificate of 1.1
Occupancy.
Owner ornuhorianl agent Usti, 1.: ISSUED.
,. n OFFICE - t
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Home Owner: Vi Good Contractor: Showcase Kitchens, Inc
Address: 20363 North Cove Square 12333 Saratoga-Sunnyvale Road
City: Cupertino Zip:95014 Sarataoga, CA. 95070
Project:Kitchen Remodel California Contractors License # 665395-B
New Cabinets, New Counters,Appliances,