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00010166 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY ©OO) Q 1 6 (" CITY DI;CUPVISION BUILDING-ELECTRICAL rERM1TN BUILDING DIVISION APPI,ICATION/1'ERMI'P PLUMBING MECHANICAL IDENTIFICATION C BUILDING PROJECT IDFNTIFICATIUN J BUILDINGADDR SS 31-d '"1 / / SANITARY NO. APPLICATION SUBMITTAL DATI /0 95 Scenic VT/1- • Z_2-:-)aii-0 ERS NAh{!/ —1'110 ' C .TRACT H'. N Mki: LIC Nj1; / lrJ•�1#J� O-f1A/'l1 N/C CON'1'ROhp VP Mo 'CHITECDEN'1. :ER: .IC NO: A R' O El CONTACT: PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECTPLUMB MOH E:1 ID .W�/ LICENSED CONTRACTORS DECLARATION QTY ELECTRICPERMIT FEE 1 hereby affirm that 1 am licensed under provNnm.of chapter 9 mmm ocncing JOB DESCRIPTION OCZ with Section 7000)at Division3af the Rosiness and Vrofcs nnsCde,u my license is RESIDENTIAL: W O yy PERMIT ISSUANCE z�� in full force and cBan. � L ❑SFDWL [I KITCHEN REMODEL aUV Licenx Class Lica VV APPLIANCES-RESIDENTIAL. []ADDITION El PLUMBING RE-PIPE tF Q i Dale Contactor IITECTSDECLARATION ❑MULTI-UNIT ❑STRUCTURAL Z O w Z I understand my plans shall be used as public rca.Tds PANELS MODWICAT10N OZ=O UP TO 2fXInMPS ❑INTERIOR El CHIMNEY REPAIR H4t]W Licensed Profu..sad 201-1000AMPS IMPROVEMENT C]SWIMMING POOLS Y�J OWNER-13UII,D1?R IJECLAHA'I'ION OVER IIXHIAMI'S ❑BATH REMODI?IIREPAIR ❑DEMGLI'IIGN 6 I hereby allirm(hit 1 von exempl from the Common!',License Lnw for the K O W U following reason.(Section 7031.5,Business and Pndesoms Code:Any city or county SIGNS ELECTRICAL ❑OTHER W a y which requires a permit In construct,alae,impmve,deandish,or repair any structure 1_i Oil proom iHissuance.also requires forit,licam fo such Permian file i,ignd,batmcm SPECIAL CIRCUIT/MISC. E�} that he is licensed purmmenn the provisions of the Contractor's License law lChaprer9 +1 00 (commencing with Section7au)of Division 3 of the Business and Professions Cdelor TEMP.MITER OR POLE(NST. COMMERCIAL: 1 k a C that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION H Section 7031.5 by any applicant for a pemhit subjects the applicant In.civil pemlry of POWER DEVICES TENANT ❑FOOD SERVICE ,=Qunionists than five hundred dallao,($5IX). MP OVEMEN'I' Q Lns owner nl the prttpcny,nnny clnployeee with wages us thcirsole cninpenxmiuq SWIMMINGVOOLELECTRIC 4. will do the work.and thesmucwre is not intended muttered fm sale(Sec.904,Basin", ER W 3 m and Profcscon,Code: Me Contmi License Law does nut apply to an owner of OUTLETS-SWITCHES-FIXTURP_S Property who builds or improve,thereon,and who docs such work himself fir through his own employee,provided that such improvements am not intended ar oRmed for NEW RES]DENT IAL ELECfR SQ FT. sale.If.howevr.the building or impmm vecnt is sold within one year of completion.the SO.FT.FLOOR AREA S/SQ.FT. e ncr-builder will hone the burden of proving that he did not build or improve for pur- pose of sale). 1,as owner of the properly,met exclusively contracting with licensed connui to TOTAL: ououno the,onset(Sec 9144,Business and Prtucssiuns Codc'J to Contradnr'r L- ue Law dues at,,apply to unnwnefofpropeny who fund,ar improve,thereon.and QTY. PLUMBING PERMIT FEE whocontaeu forsuch projects wanuennmwlur )licensed pursmmd tome Contractor. License law. PERMIT ISSUANCE 1 am exemin under Sec. .B&P C for this reawn ALTER-DRAIN&VENT-WATER IRA) VALUATION r Date Ts-.� N'OHnder COMPENSATION DECLARATION BACK 41.041'ROTELT.DEVICE a-Yj /, Iherebyoffnaunder penvltyue per juryenc0fthefollowing dock,,'Co IJ�.J�/ ] Ibave nndwill lot S,Ii 37(X)uf fla,Lsttn sd0.,in,. ler Worbionacclhu DRAINS-II,UGH.ROOF.AREA.GOND' STORIES TYPE CONSIRl1CT10N tion,a,pnrvldcd for by 9awion 391X1 of We Leber Calc,fni the perfunnnncc nl Nc VWinfor which this,croup is issued FIKTCulls-1117R'I'RAP 1 have and will maintain Worker',Comcetrmlinn Cmace, tequircd by 5eaion 3710oIc work far hs OUTLETS OCC.GROUP AIN my Work Igancermanerdl'elicy � GAS-LA.SYST M"O ERfEA) � m anc5 702- �� CF.RTIPICATEOPESN FROM WORKERS' GREASMNDUSIRL WASTE INIrERCEPTOR COMPENSATIONTIONININSURANCE BUILDING DIVISION FEES ('mieseutionnecdnot be ....plidod if the,wenil is forone hundred dollars lS l m)) GREASETRAP or less) PLANCHECK GEL? I certify that in the performance of the work liter which this permit is issued,l Quill SEW(?R-SANITARY-STORM EA.2W FE not employ any person in any inum er so as to become subject to the Workers'Compen. ENERGY HE Z Qal ion lmw'c of Califnmia.Dam WATER HEATER W/VENDELECTR ZQ Applicant GRADING FEE N NOTICE TO APPLICANT:If,after making,hi,Cenifcae of Exemption,you should WATER SYSTENVTREATING f� ? become subject to the Worker's Compensation previsions of the Labor Code,you must SOILS FEE W fanhwith comply with such provisions or this Permit shall be deemed revoked, WATER SERVICE. d CUNST'RUCTION LENDING AGENCY NEW HIiSIUIiN'fIAL PLMH. SQ,FT PAID U O (hereby ldfnn lbin there ixnmmwctinn lending agency fm the padinmm¢c of Date Receipt# t+ rot work forwhich thism'rnhit IQ i.¢ud(Sec.31197,Civ.C) V Lender's Name TOTAL. r TOTAL: Lender's Address 6. 1 certify that 1 have rend flux application and.state that the above information isBUILDING FEE F' (A cortex.I agree to comply with all city and county ordinances and state laws relining to QTY, MECHANICAL PERMIT FEE V Z building ron,ordel intrad herchytolimi a representatives of this city to enter upon the SEISMIC FEE `+ uhrvementioned propcny for inspection purposes. - PERMIT ISSUANCE ELECTRIC FEE (Wc)agree no siva,indemnify and keep hani the City of Cupertino ngaina lubhutcjudgments.com,and expenses which may funny way acerae agaimt suit Chy ALTER OR ADDFO MECH. PLUMBING FEE nsnyucncc Bt dl'6"anRSTAng S A ptsmit. APPLICANT UN �iRS'IANUS AND OMPhY WITH ALI.NON-POINT AIR HANDLING UNII'(TO 10,000CFM) MECHANICALFEE SOURCE REG 11 F TIONS. Xy /q_qD AIR HANDLING UNIT(OVER Io,q%I CFM) CONSTRUCTION I'A% Sigmture ofA tic maractor Date EXHAUST I{(lOD(W/DUCf) HOUSING MITIGATION FEE1AZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant tore or handle hoeurdous material HEATING UNIT(TO 100.000 BTU) as defined by the Cupemno Municipal Calc.Chapter 9.12,and the Health and Safety Cede,Section 25532(a)'1 HEATING ON[I'(OVER 100,"00 BTU) C]Vic, )d N,) V I"N'FI LAI ION PAN(SINGLE RESIDI PAID Date Rcceipta Will the applicant or future building occupant u%c equipment or devices which BOILER-COMP(LHP OR 100.000 BTU) mit national air continua was defined M1y the Hey Amu Air Quality Munagen¢m TOTAL: _ D"mat] \yJ](�Y BOILER-COMP(OVER 100.000 BTU) [3 Yes No I have ail the nuardoes materials requirements under Chapter 6.95 of the Cali" AIR CONDITIONER ISSUANCE DATE Timid Health Safety Ctxle,Sectiotac 25505,25533 and 25534.1 understand that if the NI?W RESIDENTIAL MECH. SQ.FT. hullding does icurrently i.ou;i cnan,tum it lx my reapmsibility m nobly theuen,sna nl the req ' mtswl'- mat be nret riunu lMalunm ol'n Curilleme nfOcu uney. _I1 �^t Owner or gent oro` TOTAL: ISSUED BY: `l OFFICE