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S 4345 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. BUIIpING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL. S 4345 BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: �a FE il XJ n TlsTic �` �7�0 SANITARY NO. �LI^ATION��MITT�� NIiR'S A .. PHONE: CONTRA R'S NAME: LIC NO: 2 NIC CONTROL at e-I Its DIGITI I'ECI'/IiNGINEER: LIC NO'. AI DRESS: ❑ , rU IT Bw ITAC�I:y^ PHONE: BUILDING PERMIT INFO d ctiv 5'0 -3 yd li ❑ Consultant Fees;Paid by Applicant(Initial) BLDG ELECT PLUMB MECCH LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE 1 hereby affirm that I am licensed under provisions of Chapter 9(communing JOB DESCRIPTION WOOO WOO with Svvion7000)of Division 3 efthe Business and Professions Code,andmy license is PERMIT ISSUANCE `3 RESIDENTIAL F full force and effec CmF+ . —� a r El KITCHEN REMODEL QUU License Class Lic.N APPLIANC[.S-RESIDENTIAL H G i Da¢(� Cnmmc�LT � , Z O ❑ADDITION PLUMRING RE-PIPE �j Jz`�z_ RQj11TECTSDECLANATION ❑MULTI-UNIT ❑STRUCTURAL FHZ 3luldmtf Ill be used as public records BQ'1' PANELS MODIFICATION OZ=O UP TO 200 AMPS ❑INTERIOR ❑CHIMNEY REPAIR F`_'F-4: Licensed Professional 201-❑kg)AMPS IMPROVEMENT a ❑SWIMMING POOLS C�=�1 OWNER-BUILDER DECLARA'T'ION OVER IOIl0AMP5 ❑BATH REMODEU'REPAIR ❑DIiMOLITION yy Q I hereby affiml that I am exempt from the Comractors License Law for the pe G O following twson.(Section 913 t.5,Business and Prol...Code:Any city m county SIGNS ELECTRICAL ❑OTHER 3 a h which requires a permit to construct.aher,improve,demolish.or repair any nrocence _ �aon prionrits issuance,also requires the applicant for such permit file asigned statement SPECIAL CIRCUIT/MISC. O / E¢ glu N`. that he is licensed purmatm w the provisions of the Compwm/s Urease law(Chapmr9 /1 /�.� (com,ncocing on Section WAN)mf piston.,3 ofthc Bovines and Prefessions Code)or 'IT?MP.METER OR POL S COMMERCIAL- c.X c LL that he is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION Section?031.1 by any applicant torn Pnrit subjects the applicant to a civil voiof POWER DEVICES FZ> not more than rive hundred dollars($500). ❑TENANT ❑FOOD SERVICE ❑Las owneraf the property,nr my cmployccc with wages estheirsole compensednn, SWIMMING POLL ELECTRIC IMPROVEMENT F- will do the work,and thestrvcmre is not intended oroRered for Title(See70s Business ❑OTHER IIiIa m and Prnfmsions 00, TEN Cmareemr's Lintas law does not apply m an ownea of OUTLETS-SWITCHES-FIXTURES Z O Q Gt progeny,who builds or improves thereon,and who does such work hot or through Ly Y his own employees,provided that such improvements are not intended in offered for NEW RESIDENTIAL ELECTR SQ FT. sale.fl:however,the building or improvement is sold within ane year of completion.the ft. AR Q net molder will have the burden of proving that he did not build or improve for put- I , pit.0 vote p I,eta manse of ct Sec.70,1 .B enmdv ad Professions with )The cnruamo,s m p JUN 2 4 19 9 �nuroet the pm,len(see.9wa.Badness arta Professions code:)The commmms u. se law dies not apply to an owner of progenthem or,who builds or improves theon,and QTY PLUMBING PERMIT FEE who cnntrrdr fmouch ladvats whh aco,nracmrlsl licensed posmarn 1.the Cotnracon's License law. PERMIT ISSUANCE Q ❑Iamesem,modei-Sce. ,B&PCfm this realm, r (late ALTER-DRAIN&VENT-WATER(EA) VALUATION etc WORKER'S COMPENSATION pSATION DECLARATION PACK FLOW PR(TfELT.DEVICE I hereby will order pcnt,hy rf fCon ane mf the fnllrwing arker'iCo lJ ❑Ihave andwill maintainsCion 3700 of Ce Labor Code,for worker'sce of the DRAINS-Fl.00N,RWRARIiA.CONU. STORIE TYPE CONSTRUCTIOt saloon,as hick flus for by Station 3)W of the f.nhor Coda for the Konnancc of the N/ oak have and this Mmtai is issued. ! FIXTURES-PER TRAP I ha the I will maintain Wurko's Comp of me as lnsaraoee as he, by Section 3000 of the la , fm epofinma of the xnyrkYf�or,,'.weyh4ich]fCfhic permAit is i7zmN. GAS-T:A.SYSTEM-1 INCJOfITLETS Coca,Mys s ite un .corn cc YOG yo9o.-��asr GAS-FA.SYSTEM-OVER4 L,M � eeRIl-SOaUY ©� APN CERTIF .ATEOFEXEsIPTIONFROMWOR S' 3 D COMPENSATION INSURANCE GREASOINDUSTRL WASTE INTERCEPTOR (ccs.) Trois section aced nrn bernmpineJ iOloppeemit is for one hondreddelhos(S l0l GREASE TRAY IA BUILDING DSION FEES or PLANCHECK FEE lemony thatinthe gonfirmany ncersounce of the wokmewhich tt b)me Workers add],hallCooper- SEWER-SANITARY-STORM EA.2W FT cou employ any penon in any manner so as m become suhjem m tb<Workers'Compen- ENERGY FEE C) Z cation Laws of California.Date WATER HEATER WNF.NEMLECTR Z 2 AI'pl1Ltl"t GRADING FEE N NOTICE TO APPLICANT.If,after,making this Certificme of Exemption,you ebould WATER SYSTEMOREATING ? M:crme nuhjeclmthe Worker'sCompcncmim,pruvisiom of the Labor Cede,you.nett SOILS FEE forthwith comply with such polkions or this permit shall be deemed revoked WATER SERVICE aQ CONSTRUCTION LENDING AGENCY Z NF,N'RF_SIDGVI'IAL PLMR. SQ.FT. PAID I hereby affirm that is a construction lending agency for the performance of D Reeeipta the work for which this penon m issued(Sec.3099.Civ.C.) Lender's Name� � Isnder's Addrcsx T TOTAL: F-' G I certify that I have read this application and state that lbs abnvCmformvtion is BUILDING R3B 3 3 N correct.l agree m comply with all sty and county ordinances and slate laws reform,to QTY. MECHANICAL PERMIT FEE V Z building conmmnen,and hereby amthmdre representatives of this city to enter upon the SEISMIC FEE atone-mandoned property lis impeni m purposes. PERMIT ISSUANCE, //��a (We)a,.to sear.indetnnify and keep families,the City of Cupnnino against V.J ELECTRIC FI O liabilities,'udgmen 'cos¢and expenses which may in any way accme againslood City ALTER OR ADD TO MECH. I ,sect, ceof a mrtingefthis runt. PLUMBING IE' 9 (-1 PPLIC T ON IE STANDS A D WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 CFM) e G— C�l SOI RC,REGUL T SNS. MECHANICALFN AIR HANDLING UNIT(OVER IQOddi CONSTRUCTION TAX Sig ter r`Appli nl/C,den Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE HAZ US MATERIALS DISCLOSURE Will ofmapplicnnnr unvu buBAing nccupmn.etorc rr handle k¢aMuus mulcrial HEXIINGUNIT(TOIOO.aBOB'TU) as defined by the Cupertino Municipal Codc,Chapter 9.13,and the Health and Safety Code,Section 2553201)? HEATING UNI I(OVER 100.000 BTU) [3 Yes ❑Nn VENTILATION PAN(SINGLE RESID) PAID - Will the applicant rr force building exception use equipment or devices which a Date Receipt N mit blinders air communities as defined by the Bary Arca Air Quality Management BOILER-COMP dHP OR 1 00,000 BTU) District" AL: ❑Yes F1 No BOILER-COMP(OVF.R 100,000 BTU) I hav<ree t ehazuder, eenals mcuirement.c under Chaacr6.95ofthe Cali- AIR CONDITIONER Lt ISSUANCE DATE fort. s hh as.et•YC e.Se inns 25505.25533 cad 25534.1 understand that Bull NEW RESIDENTIAL MECH. SQ.Er h ing r not v al have tenant.the it is my responsibility to notify the wcupant / ^ rI, a yu rtt,tm is hich n,� use prinnnoce ens fie nifcalcof Occupancy. (/% L authorised a Doc T ISSUED BY: �� OFFICE 331 54 l I 18 3b 18 21 4 r 15 —34— 3� 3 36 i 21 v � ! 36 i ' 26 GFI I 851 33 I4k� -�- Zip% 1011 _�-I dt ons. . fir. Al � nd tt Ch�S 311 30 S\C\S 5e,�, , c.•ss-otr - 49d v � 281 the s a.�np,�.�,ae heal n nt haw � the \0� r. ``u\auo n1 5 ate \ SNp�\� a\�odYtOrd,nan� D:W_— -24-— —_36- nY i 1 REAR I GFI 21• 36 I vcT r \ 601 Y t, 30 36 C _ ` FI 24 841 ICROWAVE — — — - 12 - I 3 18 24 12 5 1NSPEOTION ERl1N0 owe'. O\ 0P OUP Dwg no. All dimensions&size designations This is an original design and must nndge2 Scale:ma>amum Design: 01127/99 given are subject to verification on Date : 06/08/99 9 1 not be released or copied unless job site and adjustment to ft job applicable fee has been paid orjob BARBARA RINDGE conditions. order placed. 1125 STAFFORD PL Designer CUPERTINO,CA ED BERTLOW