S 2047 (2) APPLICANT-TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BOB DING-ELECTRICAL PITNO
BUILDING DIVISION APPLICATION/PF,RMIT rl.um ROG CT.IDENHIsie' 2047
NUILDIN(:PROJECT IDIrN'fIFIG'DON
BIRLDINGADDRIiSS: SANITARY NO. APPLICA'T'ION SUBMITI'AI.HATE
O NEH'S NAME:' PHONE: CONTRACTORS NAME: LIC NO.
N �. YG NIC CON TROL#
ARCHITECI'/F.NGINFER: LIC NO', DDR SS
� ' ❑
CONTACT: PHONE: (O BUILDING PERMIT INFO
a (o�O ❑ Consultant Fees Paid by Applicant(Initial) BLDG rLEC'I' PILIIMN MSCII
ld ❑ ❑ ❑
LICENSED CONTHAC OR'S DIiCLARATION QTY. ELI?CPRIC PERMIT -FEE
1 hereby anion but 1 no ucenad under provision,or chapter 9(canmenems JOB DESCRIPTION
WOOOZZ with Scction7000)nf Dlvlcho3 of tiro lLmmcuand Prufewinns Gde,nneDny licese,, RESIDENTIAL,
❑100 1'1711011'ISSUANCI?
C W F m full form ane effect. ❑spim. ❑KITCHEN REMODEL
aUU Liven. e- Lie # APPLIANCES-RESIDENTIAL ❑ADDITION [I PLUMBING BE PIPE
h z ii Ume m Commmor
FOy ARCHITI[CPS UECLAf:\PION PANELS ❑hlUhfl-UNIT ❑5'IBUCfURAI.
z O rn z I nndu+tand my plans shall he wad as puldie wcords MODIFICATION
Oz4-0 UP 10 AMPS ❑INTERIOR C1 CHIMNEY REPAIR
F��YI Livcmed l'rnfasinual 201.10N)AMPS IMPROVEMENT 0SWIMMING POOLS
OWNER BUILDER DECLARATION OVER HMAMI:S ❑BATH REMODEIIRITAIR ❑DEM01.1'I'ION
C C 6 1 hereby of rra that I am exempt from the Conat License Law far the
OUTU following rennin.(Section]0315,Business road Professions Carr.Any cit t ❑OTHER
y ar county SIGNS ELECTRICAL
a W y which its issuance,
a pans)re cvnnmmt nlma al fm o.demolish,or)repair nay,mmmrc
prtonaslivered. ....ae1.he the
....to so fa such...aor, Emco,Law(Chapter
SI'I?CIA(.CIRCUI'I'IMISC.
that he is liecnuJ punuummthe pmvisiore of me Cnnuacmh License Law(Chapter)
131 0 (commencing with Section 7000)of Division 3 of the Business and Professions Calc)or 'IENIP.MEIERORM)LE ST COMMERCIAL
Il q e W that he is exempt therefrom and the basis for the alleged exemption Any violation of [I NEW BLDG/ADDITION El DEMOLITION
iC t+: Section 7031.5 b,ary applicant for a wsu
Inm, hlects the npp arm In a civil penalty of POWER DEVICE.
W^In rnlnnre mm nuc hundred Jollara($5nu). ❑TIiNANT [I FOOD SERVICE>' 1MPROVHMEN'I
6pLo the work,the ptnpcuctremyal indeyces pracedfrtale(Se.i-sole 0,W.B ......, SWIMMING POO. .L'
l).,0
will do the work,and the structure is nil intenJW omOercdfor sale(See.]OW.Busincns 0fIIIiR
{may-mand Professions Code:'The Comracmr's Liecose Law dres not apply to ua owner of OUT LETS-SWITCti1S-Fl%Tl
property who builds or improves thereon,and who dues such work himself or through
his awn eamlo,o..pnwtred that each impmvemunla ore anionic J,J or offered for NHW RESIDENT'I Al,ELEC R Sfif
old.11.hnwever,the buildingnr in,pm.connt is wild w llhin oneyan at d....phrian,the SQ.FI',FLOOR AREA $/SQ.PI�
ovner-haildcr will have the human of proving that he did not build or improve for pur-
pose of sales
I,nserof the property,am exclusively contracting wiwithnm
licensed , mctom to TOTAL:
construct the project(Sec.71140,Business and Profusions Code:)Tic Contractor's U
arse Law does nm ulq,ly To onowncrol'pmper,who hard,or improve,mercan.aml QTY. PLUMBING PERMIT FET?
whocontracts for such pnjectswith a aomractor(s)licensed pun.unuo the Comnnctor'e
License law. PIiRMI f ISSUANCIi
❑ I mai acmpt under Sec. .B&P C forthis reason
ACT 17R-DRAIN&V17NT-WA'I'Ilk(EAI VALUATION
n
Ownu Duro / L O
WORKER'S COMPENSATION DECLARATION BACK FLOW FREE CCT.DEVICE
1 herebyillirmorder penalty airperjuryone of Iifallowingdedoretinns
❑on,as provided
faitnai Section 3700 of Comm toCossensare fen Wadersceofthe DRAINS-F10(IH.ROOF.AREA,CONT, STORIILS TYPE CONSTRUCTION
cation,as provided lin by Section 3]tp of the Labor Ctde,for me performance of the
work for which ,If Permit is issued, FIX'1'URIi$-PER'IAAI'
❑ 1have andwi- adc.far Workdr anceoftinw rkfor hi IIsmynln'cdby Smlivn
3]W of the Libor Ctdc.for the performance of the work forwhich This permit is issued. GAS-PA.SYS'rP.M-I INC.40U'fl.E'fs OCC,GROUP APN
My Worklex Compensation Insurance carrier and Policy number ore:
Cartier: Pol icy Nn.: GAS-F.A.SYSTEM OVER 4IRA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPFNSA'I ION INSURANCE GREASFJINDUS 1'121.WASTE ING iRCF.PTOR
(This section need nil he cmnplmed i0permit
he is fm
mne hundred Jnllar+fS 1110) - ---
ar len,.) GRIinSE TRAY Ruti.JllN,DIVISION FEIi$—
PLANCHECK FEE
I verify that in the performancenf the work forty ich this permit is issued,Is hall SEWER-SANITARY-STORM RA.2(0 14.
not employ any person in any ma m .ubjru m a e Workers'Competr, ENERGY FEE
Oz satinnl.nw ICI�i D Wn'I17R I EA1 FR W/VHNT/EJ.FCI It
7 2 APBllcnnl /'Xl.x.tx- - � �_� ,PCE
L7 NO'1'ICH'1'O A LICAM1 If,a0c naktng thi enllicme of Evanotplion,you should WA ,R SYSTESIMMATING
become subject to the Workers Cnmpcmation provisions of the Labor Cede,you must SO ' li
forthwith comply with such pueddr -s-this .it shall be deemed revoked. WATER SERVICE
Q' CONS'I'RUC'I'ION LENDING AGENCY NIiW I1ESIDIiN'I'IAl,('LMB. S r' 1
U O Ih...by attain mnnhere tan construction lading agency for The performnnec of IRmeisaf
The work for which this pmanit is issued(Sec.31197.Civ.C)
Lender's Name U TU'I'AL:
U lender's Addres, TOTAL: O
1 verify that 1 hove road this appllcatam Intl slam mut the above information Is BUILBIN P
fro coutImmeam 0...u,with.11 it,and a...nyordiumnees and emus lowsrelating to QTY. MECHANICAL PEI
U z handling construction.and hereby aulhorin reprecenmdven of this city to enter upon lire SEISMIC PE
aturve-mcntioned property for inepcction purposes. PERMIT ISSUANCE(We)agree to save,indemnify uad keep bmndes,the City of Cuperino against ELECTRIC&E
liabilities,judgments,costs and expenses which may in any way uccrueugviro said City ALI 3R OR ADD TO MECH.
Ina utdacnee of me granting of thh permit PLUMBING PEE
APPLICANT UNDERSTANDS ANO WILT.COMPLY WITH At.l,NON-POINTABR HANDLING UNIT(TO 10.000 CFM)
SOURCE REGUTATIONS. MECHANICAL FEE.
AIR HANDLING UNI'f(OVER Hing)CPM) CONSTRUCrION'IAX
5lgmtn caf Applicua1Coamwmr hate EXHAUST HOOD(W/DUCT) NOUS I NO M I'GGATION FEE
I I ALARDOUS MA'T'ERIALS 1)I SCLOSURR
Will the app)icant or future buil ding recupant.store or handle bwamous mamrial HEATING UNIT('I'O 100.00p B'I'U)
a+dcnned by the Cnpenino Municipal Cade.Chapter 9.32,and the I lcalth and Safety
Cede,Section 255321sT( HHAT'ING UNIT(OVER IFaddist(ITU)
❑Yea 7 N
V IN'I1 LATION AN ISI NO LH It HS I D) PAID -
Date Neceipt#
Will the applicant orfumre building recupmd usccyuipmenl airdevices which BOILER-COMI'IJHI'OR 100,00(d)BTU)
emit hlvamm
ous air nmma inanax defined by the Buy Arca Air Quality ManagementI:
District] BOILER-COMP(OVER 100,000 BTT])
❑Yes ❑No
Alli CONDIGON IR
I have read We Ino,wous materials tequirmncnu under Chapter 695 of the Cali- ISSUANCE DATE
foram health&Safdy Cede.Sections^3505.25533 and 25534.1 undemmud mat Ethic NEW RESIDENTIAL MECH. SQ.FI'.
building does not currently have. nam,that it nn
smy ra,,no ality mtify the cecupam ��
m
of the aceirements which must be met prim to issuance of a Certificre,of Occupancy,
Oscar,or authmited agent Dam TOTAL: ISSUED 13Y ,
OFFICE