S 1607 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.ELECTRICAL. /PE IT NO 1
BUILDING DIVISION APPLICATION/PERMIT PLUnTBINcMECHANICA'" I 1607
R' 'Cy'{ IU TI( ''� �`
BUILDINGADDRESSI VJIARY O. APPLICATION SUBMITTAL DATE
' ,9 l� �
OWNER'SNAME: PHONE: CON'FACTO NAME: LIC NO:
Ang The O'Brien Group 650-377-0300 The O'Brien Grou 691513 B r025�
c�N'IFol.aARCIIHECWENOINEER: LICNO: ADDRESS:Pacific Peninsula Arch. 605755 718 Oak Grove Ave. Park 9 �(
CON''AC'1': PHONE: ) BUILDING PER: NFO
Gerry Plook/Director of Purchasing ❑ Consultant Fees Paid by Applicant(initial) 'BLDG ELECT PLUM MCC
The O'Brien Group650-377-0300 "p UY Eli- t
LICENSED CONTRACTORS DECLARATIONFEE
W�O�Z WI /
Q'
1 hereby oaffirlicensed1 am licensed under provisions of Chapter 9(eowfY ELECTRIC PERMIT nencing JOB DES RI''TION
� th Stnion 7(x]p)of Divinion3 ofthe BusinaxanU Professions Code,and myLieenw is
PERMIT ISSUANCE RESIDENTIAL, l '
oven force Class Lic.p and cRcct. ❑SIUWL f O KI LcURN RESIODEL.A
4 U Date w
rFis Zw Dam Cnmrunnr APPLIANCES-RCSIUEN'I'IAL []ADDITION ❑PLUMBING RE-1111111
ARCHITCCLS DECLARATION ❑MUUfI-UNIT ❑STRUCTURAL
F O ti PANELS
zbt2z understand my plans shall he used a%public rcsUml 4 MODIFCHIMNEY
HIMN YJUIN
c
p$.. UP 10 2fl11AMPS
LhnnucJ l'ndu.inntl 20I-IaNx1AMY9 IMPROVEMENT SWIMMING POOLS
Oat I
OWNER-BUILDER In'the RNI ontr ON cto
OVER IWl1AMP5 [_1 HAI ❑DIiMDLI"''ION
1 he-as affect that 1 am exempt frank the Comms.Cas License Law for the
peg 3 LL F following reason.(Section 7031.5,Businer,iandmp Professions h.oc Any oily or tmumy SIGNS ELECTRICAL []OTHER
y which requires a permit to<onxwd,alter,improve Jcmolish,or repair any stmcwre 0
FNO; pdono its issuance.also requires the applicant for such permitto file a signed statement SPECIAL CIRCUITIMISC.
f } that he is licensed pursuant to the provisions of the Contractor
License Law(Chapter9
tat (commencing with Section]000)of Division 3 of the Business and Professions Cadc)or 'TBMP.METER OR POLE INST. / COMMERCIAL,
c. c IX that he is exempt therefrom and the basis far the alleged exemption.Any violation of Lk ❑NEW BLDG/ADDITION ❑DEMOLITION
XmLL Section 7011.5 by any applicant for a permit.subjects the applicant In a civil penally of POWER UEVICGS
LL^rn E3 TENANT ❑FOODSF.RVICE
-
nor more than five hundred dollars H500).
EZi+ IMPROVEMENT
d ❑Lasowncrs+fthepropti yctu mytmntended widhwogdsuxlhei...lacnmpBrashiess SWIMMING POOL ELECTRIC
{$SFA it lldothework,ande tire
muurider,Lurcod orawdo,notsale[Sen 7044,Business - ❑HIT IIiR
µ)am italwhob CnJol Tho Cenwelrma Lnti oo Loos such
nmrk hi elf rthrough (RJ'TLI!TS-SWITCHES-PIX"IURI?S
property who boilss or sided that
thermal,a and who Jtsx mach work himself or through
his awn all. the provided that such sena, old v me not intended or oOvcJ lie NEW RI!SIDENT L P-LGCTIt SQ 1'I'.
sole If hoocvcc the huilJing nr impmvenmm Ls snlJ whhin nnc yea of romplelion.the SQ.FT.IT.00R AREA SISQ.I'[
er-builder will have the burden of proving that he did not build or improve for our-
Powofwled.
❑I.as owner of the property,am exelusiealy contracting with licensed contractors m TOTA y/y���('L/_J/,j/p/�J,)�I',�•�}.�I
construct the es act (Sec 71)14,Business and Professions Gsde:)The seafarers nd
c Law Jtcs sol apply to an owner of property who builds or improves Hereon,and QTY. PLUMBIN M FEE
xho ontmets lin such projects with amnwclur(5)licensed pursuant to me Commences
License Lbw. PERMITISS E J,
E)l am mounts under Sec .B&P C for this reason ,��w•K,� eS
Owner Date ALI'HE-DRAIN .'W" '?I HEA) as�O `,y, Us ION
WORKER'S COMPENSATION Uf:C1.ARA'I'ION HACK FLOW PROA PCI'. 23
its I bemby nation tuWmp unity of Jury agent'lire following Jedannar,: T
❑ IhaveandwillwuinwinuCeninwmnfConscar oxelf-insure for Workers Compem DRAINS-FLOOR,ROOF,A REA,COND.
STORIES.
sntion,as provided for by Section 37W of the Labor Cale,fur the perfawance of the '1'YPIi C( S'TRUCTION
hich this permit is issued. FIXTURES-PER TRAP
have trod will maintain Workers Compensation Imumnce,a restricted Section
7W ofthe Later Coal,funhe perfomence of the work far which this permit is l...c& GAS-EA.SYSTEM-'INC.40G1'LFTS (ICC.GROUP AI'N
My Workers Compensation Insurance carrier and Policy numb'ore: 1
Canter. Policy No.: GAS-EA.SYSTEM-OVERT(EA)
CHRI IFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASWINDUSTRL WASTE INTI?RCEPLUR
1NG DIVISION':CIS
('ik,ecoon nein nal berumpletul iOhep,rinit is for.,,.hundred dollars f$IW) GRCASETRAP
nr la.<.1 1'hANCHEC FCC .0
I oy any into,person
in I many
man n r so no i work fav which this permit is issued, .roll SEWER-SANITARY-STORM VA.21X1 Irl'.
nutnt,La y any person in any manner.n m w Hccnlul subject In the Worked Conryren. I?NI?KGV 1:1 I? 0
0 .wliun and ol'6;lihmda sate WA'I'13R IIEA'fF:R W/V F:N'TIBhI!C'B
Q Applicant ' GRADING FCB -
w. NOTICE T(1 APPLICANT:L(,after makin this Co opeate of Exemption, should V) g rCoke,you WATER SYSTENVfREATING
become subject y the Workers h pro psmpensaton provisions al the Labor evoke,you must SOILS PI?E
� forthwith comply with such provisions or this permit shall he deemed revoked. WATI!R SERVICE
d
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.ET PAID
z;7
V Q Ihtmhy uffi'm that them isaconswmion lending agency for performance of Date Rol
the work for which this permit is issued(gee.3097,Civ.C.)
F' Lenders Nene TUT L:
O a Lender's Address 'OTARC
UII FEE /37
sally lhtlh doh' 1plt J 'll ihnh ab f IZ1 corn a g I ply undo ity J ty I : nI:ml l s Ig 'QTY. MECHANICAL 111iRMIT l : tyl trop llCIS ICI Hthou 1 l p cy pcY pup PHRMH'ISSUANCE(We)agreemsavu Idem hify and ku1 ales the City ofcapenum ago nst '1' NCCliahilhics,judgmm�¢,costs and expemas which may in any w.ay seems against sail C'nY AUIF.RORAUDTOMECH.in neyuence of the gramin,ofthis permit. GFEE X!3APPLICANT UNDERSTANDS AND WILL C `.Y WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM)SOURC610 4'I'IONS ::1 NICALI'EEAIR HANDLING UNIT(OVBR IILUMI CFM) UN 'fRUC'ION TAX
Signmuk ApplicanUCantua sr Dat EXHAUST HOOD(W/DUCT) ILO NO MITIGATION FEF,
HAZARDOUS MATERIALS DISC :URE
Will tire appliwnlor future buildbhg ce,aloul unmoor handle memos.unnatural HEATING UNIT(TO I W,000111'J)
or.all by the Cupertino Municipal Calc,Chapter 9.12.and the Health and Safely
Cale Sccliun 255321st" HI3Ar[NO UNIT(OVER 100,000 Is]Go
El Yet
VHN'i'ILAd ION FAN(SINGLE RES1U7 'NIU -
Datt Recciplp
WIII Ibc appllconl or I'uwre huilJing octup:uhl u.c alulpnmm or dcvicu which
oil hnemdousair am lamimorlk as defined hylic lis Ara,Air Quality Manager cut
BOILER-COMP(31111 OR aIf1.111N111'fUl
Y T(yl'Ah:
Dhslnur!❑Yes .Q__/wo MOILER-COMP(OVER 100.000111U)
y
' hc hamNous matenuls hryuimlhents under Chapmr 6.95 of the Cali AIR GUNUfI'IQNER
Ihavche:WtISSUANCE DATE
fomiu Health&Safely Cade.Sections 25505.25_ ns125534 1 un ".hand Bad rhe NEW RESIDENTIAL MECH. SQ.F f.
btildm acuwmlyha mnam,that" my . l"biln , MO the whop I
of the
,at tuns wh' of Can' an of Oce ncy _
�TAL. 15'<)
Own h auhhnnnJ agcn >me - .Y � ISSUED BY:
OFFICE