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31151 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO - BUILDING.ELECTRICAL PERM IT NO. BUILDING DIVISION APPLICK110,MPERMiT PLUMPING.MECHANICAL 81151 s BUILDING PROJECT IDENTIFICATION - v J.1 BUILDING Al)1)RIS: © �sO� '� SANIIAHY NO. APPLICA'f10N SO RM 119'AL DAfIi Awe PJ/l iT�e/ /e lOWNER'S ME I UNl:: CO ^ O'/ ?si/, 'J�/J LIv`.Cl , NIC CONI Rol,# A, -HITECfIENGlNCC LIC NO: ADDRESS: ❑ CON'I'AME PHOWi:a BUILDING PERMIT INFO // Lf��/�/ /la��/J�w. ❑ Consultant Fees Paid by Applicant(Initial) .pub IiLECI' PLUMB MliCx �% // 7/ T Leif-yrj ❑ • ❑ ❑ LICENSED CONTRACTOR'S DECLARKDON QTY ELECTRIC PERMIT FEE I hereby affiam Bd rm that I cen. ander provisnsioof chajiter 9(cammencing. JOB DESCRIPTION WOO with Section]WO)of Division Softhe Bminensand Pndcssions Code.and my license is RESIDENTIAL: W. in full tome end eff PERMIT.ISSUANCE ❑SFDWL ❑KITCHEN REMODEL aUU License Class l.ic.M APPLIANCES-RESIDENTIAL <Uu Dam " Cantracmr ❑ADDI'TION ❑PLUMBING RCPIPF. us , ARCHITECTS DECLA A ) PANELS [IMULTI-UNIT ❑STRUCTURAL. Z O,W Z 1 ualcnnnd my plans shall he axed as public records - MODIFICATION O Z- UPT0 2W AMP5' [=�F'W Licensed Profc,sinnal ❑INTERIOR CHIMNEY REPAIR 201-1000AMPS IMPROVEMENT Ya, OWNER-R scrota frDECLARATION ' OVER IWOAMPS C3 BATH RIiM0UE1/RBPNR ❑DEMOhI�'ON C C Q I hereby affirm that 1 L5 cumpt from the Cotnfac Cia Any r Law for the L U whichfollowing roams.(Sectionito construct, Businessandmpr fie.de o demolish, h,or:Any city nt cuumY SIGNS ELECTRICAL ❑OTHER 3 yG prim retains a permit to connmct,alar,improve,demolish.or repair any twcmrc OJ that he it,iomat ensedpalsoft to ntsthe Novisioso firrittethe Contractor License tried Law(Chapter SPECIALCIRCUITMISC. - f } tharheincingwit pSectionn the provisions of the Contvidess Liccnsclnol Coxhif Y RI�OO Iconmtencing with Sectiun]gp)nf Division 3nhhe Business nnJ ProfesaionsCWelar TEMP.METER OR POLE(NST. COMMERCIAL: a a c 1 that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION Section by any applicant for a parmit suhjccts the applicant la a civil Mostly of POWER DEVICES ly-y ` TENANT ❑FOOD SERVICE not more then five hundred dollars IS!W). F Z>' - IMP9gVF.MENT =< ❑Los cwork.thepropnatunco employeeswiN Bred fosthci(Solac .Busmen, SWIMMING POOL ELECTRIC '3 W F.O will Pr Ne oons ande: sh Cont is not s Licarve Law dJ s not apply to n Business R ,a 3 m and Professions Calc:The Coatroom's License law Jana not apply s if sora of OUTLETS-SWITCHES-FIXTURES V properly who builds or vided t s thereon,and who Jnea such work himself.r through his own ewever ,the profiling that such improvcold w arc not intended or ottani for' NEW RESIDENTIAL.ELECTR SQ FT. own r-huwer will have burdntpmvmnem is at h within one build (it comple forpan-the' SQ. .Ft R R EISA,FT. owner-builder will harc the burden of proving that he did not build ar improve for pan- Poo,of sale.). 1,us owner of the Proper,am exclusively coal...,a,with licensed coal...I to TOTAL: APR 28 onstrum the pmjeat(Sac.7(N4,Business and Professions Cod,)Ou Contrucuds Li. - ��- cucLuwNxsnutapplyo- tanuwncrofpmpanywhobuilAsurimprovesthem) d QTY, PLUMBING PERMIT FEE CITYUI' L who contracts for such projects with u eomomons)IiceneM mooamt t to the Contmeoe.s VY[T I I�t tlV License law. - - PERMIT ISSUANCE (] Ism exempt under,Sex. x.11&It C for this reason Owner AUER-DRAIN&VENT' WATER(BA) a/ 6� V ON _ - D' t WORKERS NSA'1'IO.DECLARATION BACK FLOW PRUI hCI IJHVICG' ' - (hereby alHrntutl P IIY fp 1 Y fol 1 II y I 1' t ❑lhavcuaJwJlma mtita(cnlsdctfC nvnn -:Jf nuref WnkeesG open- DRAINS FLOOR ROOF,AREA,COND. SIY)HIGS I'YPHCONSTRUCHON sation,as provided for by Section 3700 of the Lahnr Gale,for Na parl'onnmtcc of Nc - rkforwhichthispemul sissucd, ." FIXTURES-PER TRAP, 1 huve and will maimain Wnrker'e Cnt i,toallon Insurance,as myuimd by Section J ofthe labor Code,for the performance of the work lin which thisp it is issued. GAS-EA.SYSTEM-(INC.4 OUTLETS •OCC GROUP_ AVN M Worker'sp�s't9dM1�r�s titin Insurdncc carzicr and Ynlic o - - MyWo //Y FJ- Policy NtSY� GAS EA SYSTEM-OVER 4(EA) C12KI'I FICATE OP EXEMPTION FROM WORKERS' compE.NSADON INSURANC13 GREASFJINDUSTRL WASTE INTERCEPTOR - BUILDING DIVISION FEES (This section naJnot M+mtmpleteJ ifthe Memoir is for one hundrcJ dnllaas]8181) GREASG TRAP - - orlessJ PLANCHECK FEG I caddy that in the pafomnnce of Ne work for which this permit is issued,]shall SEWER-SANITARY-STORM EA.200 FT. not employ any peonsubject in any manner so as to become subjecn the Workers'Cmnpen. ENERGY FEE Z satin.laws of California.Data t WATER HEATER WNEIST/ELECTR Z Applicant • " GRADING FEE y NOTICE TO APPLICANT:IL after making this Ceniftcam of Exemption,you.Mould WATER SYSTEMG`REATING becume subject o the Worker's Compnution provisions of the Lbs.Cede,you must SOILS FEF. s ' W fonhwithcomply wiNsuch provisionsorthispvrain shall hedminedmvoked. WATER SERVICE DZ - CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL?LMB. SQ.IT. VA1D Data Reccip at V C) Ihereby affirm that them is a conswction lending agency for the perfottrmntt of Ne work for which this permit is issued(Sm.3097,Civ,C.) 0 F Lenders Frame iQ __ _ TOTAL: U Lenders Addrts—T - TOTAL: - �+ IL re BUILDING FEE I candy Nm I have thin application and enm Nnt the nbrvc information is F' h correct.l agree to comply with all city and county oninanees andante laws relating to QTY. MECHANICAL PERMIT FEL SEISMIC FEE U Z building eonamuation.and hereby amhotim repicarmatives of Nis city to enterupr,the IL above-mentioned pfoperrY for inspection purposes. + PERMIT IS.(We)agree m save,indemnify and keep harmless the City of Cupenino against ELECTRIC FEE liabilities,judgments,cons and expenses which may in any way accme against said City ALTER OR ADD TO MECH. - in consequence ofthe goading ofNisperil. s PLUMBING FEE APPLICANT UNDERSTANDS ANI IL COMPLY WITH AIJJJ...jJJ�JJ'ON-POINT AIR HANDLING UNIT(TO 10,000 CFM) MECHANICAL FEE SOURCER ONS. / AIR HANDLING UNIT(OVER In"CFM) CONSTRUCTION TAX Signatum of ApplicanUCommcmr Doc EXHAUST HOOD GVMUCD HOUSING MITIGATION FEF, HAZARDOUS MATERIALS DISCLOSURE Will theappliardorfuture building occupam,fore or handle hamrdousmurerml HEATING UNI'T(TO IfIB,g10 BTU) as defined by the CuMninn Municipal Cute.Chapter 9.12,and the Health and Safety Cafe.Section 25532(.)? { /' HEATING UNIT(OVER 100.000 BTU) _ s Y TR\N x - VENTILATION FAN IS RESIDI YAIU Dam Rc¢ptg , i-a Will theapplicant t buildia,',octpant'usn soup e i J 'as which t ma,sit inamounano,as defined by the Bay.Amt Air Quality M nage.cit BOILER-COMP(3HP OR I(XLgK BTU) District IOIAh: (]Yrs B(111.IiR-COMPIOVER IW.(If10 BTU) -I have read the hazardous materials mgtrtrcmb 6o cnunder Chapter 95 f the Cali- AIRCONDITIONER - ISSUANCE DATE f ria Hetlth Safety Cale.San 25505 25533 1255]4 1 t ndertt W that f the NEW RESIDENTIAL ME,CIL SQ.ET b 'Idlnrygd t Jy have I Y �p slbilityttm ffy�th}c�t euy'paut reds]Q��w��C/a� r cent( y - Owns ori uh toad.,an, - Uatc TOTAL: ISSUED BY: OFFICE _