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S 3844 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY C FPY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL S 3844 BUILDING PROJI!CT IDEYI'IFICATION ItUILDING ADDRESS: SANITARY NO. APPLICATIONSUUB/MITTTTTAALDAT r 7j? I OWNER'S NAh PHONE: COf"fRACIY)R'SN ME: LICIN'TO: S S / NIC CONTROL RCHITEC I'/IiNGINEER: LIC NO: ADDRESS. ,-� ❑ ONTACT: PHONE: y BUILDING PERh11T INFO '101 Cam) =P> ^(p01 ❑ Consultant Fees Paid by App.cant(Initial) LD G Ii1.liCT PLUMB EC LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT F88 � ❑ I hereby anion that 1 am licensed under provisions of chapter 9(reconnect ng JOB DESCRIPTION Z with Senian l(Xp)o(DivixionJolthe Business and Professions Code,and myliccn,e is I RE.SIDIRNTIAL . ' follferc and t PERMIT ISSUANCE m— ' FDWL O KITCHEN REMODEL aUU 1.icem� Lic.p APPLIANCES-RESIDENTIAL El ❑ ADDITION PLUMBING RIi.PIPE Naa I CnnVa i L`— F>vn ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT [DSTRUCTURAL viZ I understand my plan.shall M1e used as public records ` MODIFICATION ZOZ�O UP TO NIOAMPS N�,Ili RIOR ❑CHIMNE REPAIR W Licensed Prole,olnml 201-1000AMPS IMPROVEMENT C]SWIMMING POOLS =C Q 1 hereby aTrm that;ER'BWmDERom the CounaOoh license Law fur the OVER I(g10 AMPS ❑RATH REMODEL/REPAIR [I DEMOLITION L�aU tallow 6 .(S f 9031SB dI t Cd A '. aunty OTHER YJA1�C+•'• Lt.1li..ADtt7 xx Y Y SIGNS ELECTRICAL W3LLy wFch c4 e, 11 cowlalt 1 demolish, rear Y.. court .ff�Pae QLQd �j putt t ice al: req theapplicantf suchrapermit signed statement SPECIAL CIRCUI I'/MISC. T C �y} �a0pthat heul licensed pursuant 70the provisions ofthe ofte Burnes sLicenseta ICM1pter9 ��— 6'nnmsncing with Section 7000)nl'llivision3of.hC Business and Fntl'csxinns Codc)n, TEMP.METER OR POLE INST OhL�MFR�IAs Z.a e C .hat he is exempt therefrom and the basis for.he alleged cacmpiion.Any violation of ❑NEW BLDGIADIII'TION ❑DEMOLITION W:m Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of POWER DEVICES []TENANT ❑FOOD SERVICE not marc than five hundrnl dollars(5500). ASOQ Laxoe worwncrot the prospery,ornly employees with wage,as theirsole compensation, SWIMMING POOL ELECT C IMPROVEMENT F. will dothk.and theumearm is Pill intended oroOired l or sale(Sec.1613,Business ❑OTH17R ohiglitil W m anti Professions Calc:The Contractors License law does not apply to an owner of 7 OUTLIffS-SWITCHES- ' prapcny who builds or improves thenen,and who does such work himself m thmagh Ws own auno,ces,prnvidm that welt ill,.ovcmena am not intended or offered for NEW RESIDENTIAL ELECTR Q Fr. sale.ILhowcvm,the buildingorintprovement N,old within one year of nvnpinlon the SQ.PT.P ( RIiA IT owner Wilder will have the burden of proving that he did not Wild or improve for put- D D purse vital).). / n ❑ L as owner of the pngsrny,am exclusively contracting with licensed contractors to TO GN nnnmct The project(See.1114,Business and Porvs a s Ctde:)'I he Contractor's Li- JUL — 9 1999 cense Law does not apply to an owner of property who builds or improves Thm ar.and QTY. PLUMBING P I who contracts far such projeco with a comracmr(sl licensed purmanuo the Contmctuts License Law. PERMIT ISSUANCE I am exempt made,Sec. ,B&P C for do....a. s ALTER-DRAIN&VENT-WATER(EA) Owns Date WOR mund under PENSA'Iy[ON in DECLARATION PACK PLOW 1'R(YI'F.CT.DEVICE 'l Ihereby affirmunder penalty to perjuryenc ofthe in,mr,far decWorkers T ChJ Ihavc and will far by Se Certificate if he Ul000Code for the Workers Co.,.-CopRAINS-FLOOR,ROOF,AREA,COND. STORIES TYPO:CONSTRUCTION av provided fur by Section 3100 of.M1e Lvbor Code.tali the Ierformantt of.M1e for whish this peon!.is!,Lund. FIX'1'l1RF,5-PER TRAP have and will maintain Workers Compensation Insurance,as required by Steelton 3]W of the labor Cards.for prodmmnce of me work fgqor.rywhicr�h this permit is issuM. GAS-EA.SYSTEM-I INCA DUTL•' (KC.GROUP APN -nine, Compu salon insurance carnal ul icy Nv 1-' brl� GAS-EA.SYSTEM OVER 4(E ERT114'ATE OI'HXEMPDON FROM WORKERS' COMPENSATION INSURANCE GRFASPIINDUSTRL WAST M'F:RCEPI'OR BUILDING DIVISION IETES (This section need not W completed ifthe permit is for one hundred dollars(SIM) GREASE TRAP nr lass.) PLANCHECK FEE I unify Tho nine penbnnenva,idhe work fnrwhiehtno,scrout isolated.l shall SEWER-SAN)PA/-STORM EA.2W FT. flat employ any person in any manner so as to Wcome subject m the Worker!Compen- IiNERGY FEE � Z sation LawsofCulifomia.Dam WATER HEAT WNENI'/ELECM GRADING FEE Z O Applicata NCHCETO APPLICANT.If,after making this Cenilicam of Exemption,you should WATER S THM/1'RF,ATING F" N become euhjen to the Workers Compensmil a provisions of the Labor Code.You must SOILS FEEfonM1with c....,Y ss'itX such powixiaae of this permit shall W deemed revoked. WATT SERVICE: a. Q CONSTRUCT ION LENDING AGENCY I N RESIDENTIAL PLN It SQ.t1'. PAID U O I hereby affirm that there its a construction lending agency for the per(ennnnw of Bit# (-t the work far which this permit is!,sand(Scat 3097,Civ.C.) 17' lenders Nanta TOTAL: L) Lender's Address 'fOq'AL: y I ccnify Nm 1 have mail this application and state That the above orientation is BUILDING FEE AnZ .F. h correct.I agree to comply with all city and emmry ordinances.and slate lawxrelating m QTY. MECHANICAL PERMIT FEE ILO U Z buildingcmtstmction,and herebyaul oom representatives of this city to cn.erupon the SEISMIC 1:17F, above mentioned property for inspection purpnes. PERMIT ISSUANCE J' O (We)agree 70 save,indemnify and keep harmless the City of Cupertino against ELECTRIC FEE habil hies,judgments,costs and expenses which may In any way accrual against said City All ER OR ADD'POM ECH. PLUMBING FEE in ,sequence oftc ngranting of t this permi APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,00)CI'M) MECHANICAL FEB. SOURCE REGULATIONS. AIR HANDLING UNH'(OVER IgIXp CFM) CONSTRUCTION TAX Slgnata,cof Appllc.mrCommcan Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE ) Will the applicant or future Xnilding occupant store or handle httardous mammal HEATING ON['1'(TO 100.0011 BTU) �•p0 roc defined by.he Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532mG HEATING UNIT(OVER I00.00)BTU) yrs ❑Tics No PAID VENTILATION FAN(SINGLE RESID) Will thea Meant or fu um bulldni t axe c t or devices which Date eccipt p pp 8by the Area Qu BOILER-COMP(3GPOR IW,(XX)BTU) emit Xa>allous air contaminants as defined by tM Ray Arca Air Quality Managcmen. TATA istria^ BOILER-COME(OVER IW.000 BTU) ❑Ycx No I have read the haeardous materials requirements under Chapter 6.95 of the Cali AIR CONDITIONER ISSUANCE DATE fomia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the NEW RESIDENTIAL MECH. SO PIT, building doe,not curm..ly haven)nam,that It is my rcsp....mility to nerfy themeapm r, of the requirements which mus inn pnonoissuanc nl'a Cenilicum of Xeu a icy Own olio thorn agent Da TOTAL: . 49 ISSUED BY: OFFICE ,.. .. _.__ �� S 3� . . �, -� �-. ' • :. -• _ ' .:. :7 � .. �'�' .