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30990 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. 3 O 9 9 O CAL BUILDING DIVISION APPLICATIONIPERMIT PING,PROD CT IDENTIFICATION DENTIFIC ,. `lel VV`V.I BUILDING PROJECT IDF.NTIF'ICAI'ION BUILDING ADDRESS: SANITARY NO, APPLICATION SUBMITTAL DATE W N'S NAME: ` t PHONE (JONTRACT(jo'S NAME: LIC Np: `, `IFe TAJ NIC COM'N[ILp AR HITELTTNGINEER: LIC NO: ADRRISS: t _j ❑ S CONTACT: PHONE: _ Rl11LDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECTPLUMB MECH ❑ ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT ITE I hereby slfnn that 1 am la.awd under faiwWms of Chapmr 9(,marmot log JOB DESCRIPTION Qaf Division3ofthc B"ah"nal Prnl'e"oh"Coe nit Cd 05 with Section9WB) my license is RESIDENTIAL: �y00 ^ PERMIT ISSUANCE Fly.. in full force nn !e T7 ❑SFDWL ElKITCH17N REMODEL �UF Licenselass Llc.# ppPL1ANCES-RMIDEN9'LAl. ❑ADDITION ❑PLUMBING RE-PIPE �� me Cantmcmr A HI'I'IiCTI Of ❑MULTI-UNIT ❑STRUCTURAL F rn 1 nil dm shall he usoJ us puhlle records PANELS MODIFICATION OzO UI'T0200AMP5 ❑INTERIOR ❑CHIMNEY REPAIR FLlcPafahl Prrfessim7IT— 201d0110AMPS IMPROVEMENT C -a OWNER-BUILDER DECLARATION OVER Ip00AMPS ❑BATHREMODEL/REPAIR (]DEMOLITION C I hereby affirm that I am exempt from the Contractor's License Law for the O as U following roosan.(Section 7031.5,Business and PrnlF.asions GNe:Any city or county SIGNS ELECTRICAL (]OTHER I LL o I. L1 which requires a permit to consumer,alter,improve.demolish,or repair any structure ' ¢ trough its issuance,also requires the applicant for such permit I.Men signed statement SPECIAL CIRCUITIMISC. } that bets licensed pursuant to fie pmvisionsofrhe Commences License Low(Chaprer9 6C) (commencing with Section?000)of Dlvldou3 conic business and Profca.ihns Code)a, TEMP.MBTEIi QRPOLEINST.. COMMERCIAL tL Oo a that he is exempt(horror n a and rho basis fonho Nlcged exemption.Any violation of - ❑NEW BLDG/ADDITION ❑DEMOLI'f10N 4: Section 7031.5 byany applicant font permit,.bjens Neapplicanno a civil penalty of POWER DEVICES []TENANT Zm TENANT FOODSERVICE Zp- but marc than five hundred dollars(5500). IMPROVEMENT ^Q n Lus owner of Ne pmpeny,or my employees with wages as their sole compensation. SWIMMING POOL ELECTRIC will do the work.and the trunure is not immrdedorottered far sale(See.704M,But 4HER and PrafcWthas Cale:The Commcmr's License Luw data oat apply ro as owner of OUFLETS-SWITCHES-FIXTURES a' .a property who builds or improves thrown,and who dos such work himself or through his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECTR SQ FT. sale.If,however the building orimprovement is sold within one year ofcompletion,the I SQ.IT.FLOOR AREA $/SQ.FT, owner-builder will have the harden of proving that he did not build or improve for par- y pose of saleJ. - T`• N`ID I,as owner of the propany,am exclusively contracting with licensed co tuianrs m '1'(3'fAL: conswat the project(Sec.7044,Business and Professions Code.:)The Contractor's Li. current Law does not apply to an owner of property who builds or improves thereon,and QTY, PLUMBING PERMIT FEE TILT who conwms for such pmjecrs with a conrnemr(s)licensed pursumno the Conuacmrs _ 18 �0 License Law. • PERMIT ISSUANCE V. L3 am exempt under Sec. .B&1'C for this mason ` 1`(ev ALTER-DRAIN&VENT-WATER(EA) J Ur U ALUATION^ Owner Dam WORKER'S COMPENSATION DECLARATIONV„ Therebyaffiondcoach lty of perjury one nl the following declantinns: BACK FLOW PROTECT.DEVICE in �] I have and will maintain a Certificate of Conscnno self-insure for Worker's Compete DRAINS-FLUOR.ROOF,AREA,COND. Nation,as provided for by Section 3703 of the Labor Cade,for the Performance of the s STORIES TYPE CONSTRUCTION work fur which this pcnair is issued. FIXTURES-PER TRAP 1 have and will maintain Workers Compensation Insurance,as required by Section 37W ofthe labor Gale.for the perfonaunce ofthe work for which this permit is issued. GAS-EA.SYSTEM-1 INC.4 OUTLETS OCC,GROUP APN My WorkersCompenaniRynsu 'c curter and Policy numy� �^ Cartier M1'n� �Nko Policy No.: GAS-EA.SYSTCM-OVER 4(EA) CERTIFICATE.OF EXEMPTION MOM WORKERS' COMPENSATION INSURANCE GREASIVINDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FEES (This section need oat be complete ifthe permit in for one hundred it.]).($100) GREASETRAP or fern.) I'LANCHf?CK PEE I certify that in the performance ofthe work lin which this permit is issue,Ishall SEWER-SANITARY-STORM EA.2W IT. not employ any person in my manner so a m N to become subject e Workers ComPcn- ENERGY FEE sation Laws of Colifomiu.Dam WATER HEATER WNENTIELECTR 7O Applicant - GRADING FLIP. G y NO"DCE TO APPLICANT:IL a or narking this Cenlfcate of Exemption,you should WATER SYSTEMI'TREA'I'INC, a become subject tat the Workers Cmnpcnsutim pmvisians cf the Lubar Cade,you must SOILS FEC Forthwith comply with such provisions or this permit shall he deemed revoked. WATER SERVICE a � CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.FT PAID VQ L for whiffmv permit i ism ed(Seetionlendingagencylonhe perform.ncc n( me Be pt# . -F the work bor"Nrwhich this parrot Le ksucd(Sec.309],CIv.CJ - O U Lenders Name TOTAL: Lenders Address TOTAL: I certify that I have read this application and stare that the above infommminn is BUIL IN)1' laA cored,1 agree to comply with all city and county on inanees and store laws renting to QTY. MECHANICAL PERMIT ITE U,Z building construction,and hereby authorize mprewntmives ofthisclty to enmrupnn the SEISMICFEE above-mentioned pmpeny for inspection purposes. PERMIT ISSUANCE (We)agree Intact.indemnify and keep harmless the City of Cupenim against ELECTRIC FF. lieties,'udgmenu, ons and expenses which may in any wayu¢ncagaiastseid City ALTERORADDTOMECH. in or. uc ce oft gnntingof dispermia. PLUMBING IL Ap .ICA T U ERSTAND AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNl'1',(TO l0,0000IM) URCC tEG ATIONS. MECHANICAL ;E AIR HANDLING UNIT(OVER 10,001)CFM) CONSTRUCfIONTAX Sig t Ap b nn ter Dare 17XIIAUST HOOD(W/DUCT) HOUSING MITIGA ON FEE DOUS MATERIALS DISCLOSURE Will rheapplicant or future building mountain store or handle hazardous material 'HEATING UNIT(TO 100,000 BTU) as defined by the Cupcninm Municipal Code,Chapter 9.12,and the Health and Safety Code,Seems 25532(x)? HEATING UNIT(OVER HY.0101 BTU) ❑Yes No VENTILATION FAN(SINGLE RESID) PAID Uum Nweipt# Will applicant or building occupant use equipment or devices which BOILER COMP(3HP OR BTU) Incautious us air contaminantsnts a as defined - , ed by the Nay Arca Air Quality Management AL: DisrricC ❑Yes ❑No BOILER-COMP(OVER 1001,000 BTU) I have readthe hmmdomantbod.1s requirements under Chapter 6.95 of the Cali- AIRCONIIHIONER - ISSUANCE DATE fond.Health&Safety Cade,Stearns 25505,23533 and 25534.1..&.mmd that if the NEW RESIDENTIAL MECH. SQ.UL building docs tut currently have a tenant,that it is my responsibility to may do,mcupant of Ne"nimments which must be arch prim m issuance of is Cenificnm of Occorrim, Owner m authorized ugenr Date TOTAL: ISSUED BY: OFFICE