S 4398 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO,
BUILDING DIVISION APPIACATION/PERMIT PLUMBING-MECHANICAL S 4398
BUILDING PROJECT IDENTIFICATION
RU1LDINGADDRISS'. SANITARY NO. APPLICATION SUBM1'TI'A.DATE
io'i s c,- 7- 7- 9
O 'NER'S NAME: PHONE: N/C CONTROL
C��Lp'tN�T�R�ACfOR'S�{ME: LIC NO'.
Pitt: es ij M y JC /yI fJU IY 51
�ARCH]'I'ECI/HNGINEEW LIC NQ. )l I ESS: ❑
. , P14AM "Int-gAV
CONTACT., PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
�s r. �Nw, b 3 Erl- 9?--- � 21
LICENSED CONTRACT'OR'S DECLARATION Q'rY. ELECTRIC PERMIT FEE
I hereby alum that 1 out licensed under proviairnt.nr chapter 9(tt,mmemcing JOB DESCRIPTION
OAC with Section 7(M)of Division 3ofthe Businecsa d I'm fess ions Code.and my hecnre is PERMIT ISSUANCE RESIDENTIAL,
DENTIAL,
CWF in full force onddlell O _I Z �' I ❑SFDR'1, HEN RIiMODEL
QUrJ Lian.e Chis f� Lies I nPPL1ANCP_ti-RESIDENTIAL ❑ADDITION 0 PLUMBING R6PIPE
f-zW are Cammctor
m 6 677
ARCIII'T i s DF.CL RA 1 ❑MULTI-UNIT ❑STRUCTURAL
PANELS MODIFICATION
DZ—NZ lundecenmd my Plunv shall lauxedmpublicrm ds UP'T0200AMPS
OZ�O ❑IMP IOk ❑SWIMMING POOL
F�F-ad licensed Professional 201-1000AMPS IMPROVEMENT ❑SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER IOW AMPS ❑BATH REMODEUREPAIR ❑DEMOLITION
C C Q 1 hereby aRmr that I am eacmpt from the Contmctore License Law for the
3 U following reason.(Section 7031.5,Business and Professions Cale:Any city or county SIGNS ELECTRICAL EJ=Ell
which re,rince a penno,h.con,hrost.ido,nutprose,decouli,hp inne,th, y.t Bre
prior to r" leo 9 the Iplicu for oahp tt 11 grrvlvahcoci,nl SPECIAI.CIRCUIT/MISC.
$' }
,he,be,,liourrandpursuant t the prtoisicarsofffic,Counnuchre,L 1 (Ch Plur9
Wy�0 (commencing with Section AXX)of Division 3nrtheBuinessand ProfosonsCode)or TEMP.MITiRORPOLE INST. COMMERCIAL
a a e W Nm he is emmpt themblan and the basis for me alleged cacmptinn.My violation of El NEW BLDG/AUDITION ❑DEMOLITION
Section]OJLS by any applicant for aPermit subjects the applicant macivil pouchy of POWER DEVICES OTENANT ❑FOOD SERVICE
not mere than live hundred deflect($500). IMPROVEMENT
,zO ❑ 1,a,visceral the preapcit,orn,employee.with wagesaxthcirmle compensation. SWIMMING POOL ELECTRIC
tr. will do the work,and lhesnucurce is col intended or olloned foreulu(See 7(94,Busincss El OTHER
W 3 m and Professions Gde:The Contractor',License Law does not apply w an owner OUTLETS-SWITCHES-FIXTURES Q —' - �-
propen3 who builds or imprevm rherton,and who docs such work bimvelf or mmugh —_C' �-
his own employees,provided that web improvements um not intended or offered for NEW RESIDENTIAL LECTR SQ IT. LO
sale.If.howrver.the building or improvement is sold within one ymrofcompleoogthe t SQ. SFT- AR SO.FT.
r-ba ildar w11l he-the burden of proving that he did not bund or imrtove car per- L. - ..r
poeevfsde.), JUL 7 1999
❑ 1,as owner of the prapen,an,exulusivdY contracting with licenced comnaemc to TAI:
onsaucr he project(Sec.]BU.Rutinose and Profcxsion.c CWc:)'me Connacmr's I.i' �
reave Law docs not apply to an owner of property who builds or improves thereon,and QTY. VM7 G FEE
whotornrdmsfor such project,with a rontmetols)ficenud pe,tound 1.the Connuctm's
License Law. PERMIT ISSUANCE r 7 Y
1 am exempt under See. .B&1'C dim this.,,an
ALTER-DRAIN&VENT-WATER(EA) � VALUA'HON
Owner Dom
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE 4STO�Rll
O 1 and w clan under pewlly of oflug'arc of the following declaaWorki do o❑Ihvve and will forty eCion 37 m ofthe Lane Code,for the Waders Compem DRAINS-I .pOR.ROOIs.ABPA,COAD. TYPE CONM�ION
scion,us prvided for ci Section 3]00 of me LaMrz God[,!or the per(urmance of me
work lav which miaperme is isnucd, ` FIXTUREl-PER TRAP1 havefthe U will maintain he ourpe,f a Gompuwmien rkforwhi h o,perm by Scninn
3100 nfthu labor Cede.fvrlhc perfrmanceo[the work fm which thixpermit lsissued. GAS-EA.SYSTEM-I INC.40U'Il,ETS Q �s p��Z
My Wedeln Cnmpensction Insurance cancer and Policy number am: GAS-EA.SYTTEM-OVERJ(EA) s
Cameo Policy No.: 12
l.0 V
CERTIFICATE OF EXEMPTION MUNI WORKERS' GREASFANDUSTRL WASTE INTERCEPTORCOMPENSATION INSURANCE BUILDING DIVISION FEES
s 1'ILit xaalnn need our be ennpletcd ifthe'Hour is forme hundred dollar,(SI00) GREASETRAP
or less.) PLANCHIiCK FEB �
I certify that in me Performance of the ,,,it for which this pemriti.cissued,"shall SEWER-SANIFARY-S'IORM EA,200 FT.
notemplo.Ktny person in any mann m e due
Wakcrs'Compcn, ENERGY FE
,6 moon tawsit[CalH on a.Doc � 1—! a NATER HEATER WNENI'/ELECFR
zO Applicant A _ GRADING PF.F:
7NOTICE'11)Al t:L mak, g t is Cerehcam of Excmpuen,you should WATER SYSTEM TREATIN .
a 7 become suhjem a me orke' Gmrpensminn p,uv kiu. of the Lith nr Cale.You must SOILS FE
lonhwith cannily with such provisions or this perms shall be deemed revoked. WATER SERVICE
d' CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PI-MR. SQ.FT. PAID Receipts
Ll O 1 hereby affirm that performance of
hem is a construction lending agency for the per
1.6 ,ter the work for which this permit is issued(Sec.J(Fl].Civ.CJ
T(YI'AL.
Leeders Marne
lender's Addes
rr TO
r 6. I cent,ihut 1 have read this application and ,are Nat the aN,ve information is BUILDING 11[li
F" N cromc.I agree rocompfy with all city and cuanty ordinances and scute laws relating Ie QTY, MECHANICAL PERMIT FEF, SEISMIC FEE A. Q
' C_Iz huildingcondruaien.ani herthy amhooze rtpmscnmtives of this city tocntcrupon the
abovcmentioned properly fee inspection purpusec PERMIT ISSUANCE O ELECTRIC 'E
(We)agree to save,indcmmly and keep hamdca the City of Cupcnina against D
hatted Ries,bu,hrvnu,cors i I o,,cscs which may in:my way a,art, gaincwid LCity ALI fill OR ADD TO MUCH, PLUMBING FEE
in cr meya',, of'log nl lbic Mir.
APP .AlCr U'DERSTANDSA WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.1X18 CFM) MECHANICAL FEE O
SOUR iREGUL TIONS.
AIR HANDLING UNIT(OVER I0.000CFM) CONSTRUCTION TAX
Signature -A( Ilea r Our Date EXHAUST HOOD OVIDUCT) HOUSING MITIGATION PEU
ITA. DOOS MATERIALS DISCI..'SURE
Wi mr,plimI rlmmehuumngrccvmmlanreorhandlehaeadousmameial HEMINGUNIT(TOIS)OX)B'EU)
as defined the Cu mo Municipal Cale,CM1ap¢r 9.12,and the Iluhh and Safety
HEATING UNIT(OVER III(I,gMI B'IU)
Code.Section 25532(a)^-
❑Yee ❑No VENTILATION PAN(SINGLE RESID) PAID
e Ilam Recoiptp
Will he upplieea ur fuurrc building ammmnt use Waipment nr devices wbich BOILER-COMP(JIIP Olt IIXI,IXIII lT'I'U)
mit ba'ruNoux Mir Wnwnilnanrs rte Jdlnal by Rbc Buy Arca Alr Qnnlity Mawgonunt
Dome,?
El Yes ON. BOIL"?R-COMP(OVFR IIXLIXXI BTU)
I have read the hmardom materia@ myuinmonts under Chapter h95 of the Cali- AIR CONDITIONER ISSUANCE DATE
lomiu Hcuhh&Safety CW Sections 255115,"'''and 25533.1 understand thnt rf he NEW RESIDENTIAL MECH. SV.IT `��_ ^-
b Tding dace nut cum:ndyh ca tenant,the Livery respunsibil try In untidy the ae-Boul
oftmyuircm nc whichn 11 Poor
me pour to issuanccofa Cc ' 'ale al(kcupuncy.
Owners n ga t Date AL: ISSUED BY:
OFFICE