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29760 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALLPOINT PEN ONLY ' CITY OF CUPERTINO BUILDING-ELECTRICAL. PERMIT NO BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL 9 2 7 6 0 BUILDING PROJF.CI IDENTIFICATION T-V-• 4 BUI LNG ADDRESS:, - SANITARY NO. APPLICATION SUBMITTAL DATE NER' NAME: PHONE: CONTRACTOR'S NAME: LIC NO. g IS I L .e, 11jkv C•� N/C CON'1'ROLb R HITEC`UENGINEFR: 'LIC NO: ADDRESS: ^ ❑ CONTACT PTiONF.: BUILDING PERMIT INFO " ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT , PLUMB MECH /❑ ❑ ❑ ucehat I CONTRACTOR'S provisions of'I QTY. (ELECTRIC PERMIT FEE 1 hereby affirm that 1 am licensed under pmvisinus of Cha 9(commencing JOB DESCRIPTION 0WZ wiN Section]IXM)ofDivixion 3.fthe Husinexsn ons Cale,u mylicense is 00 to } PF.RMRISSUANCE RESIDENTIALr full fnree anA elfect. e 1 �U� ` - ❑SPDWI. 1:1 KITCHEN REMODEL. �aUU License Class Cone 4 Data Gmwmnr APPLIANCES-RLSIDLNTIAL ❑ADDITION' ,OPLHMBING RE-PIPE '• ARCHITECTS DECLARATION PANELS _ El MULTI-UNIT ❑STRUCfURAI. y p H Z 1 undersand my plans shall be used as puhhe meoNs MODIFICATION OZ�O I/PTO 300 AMPS El INTERIOR CHIMNEY REPAIR A.p{,fpp'41 LlccmW Professional is 201-1NIBAMPS IMPROVEMENT pp��2d 2,....11 has I..HUILDIIR DECLARATION O I"AMP5 g,,d'�6 1 hereby affirm that 1 am exempt Taus the Comncmr's Lic<nse Law for the ❑BATH kEMODEI/REPAIR El DEMOLITION W a LL U following reason.(Section 703 .5,Business and Professions Code:Any city or county .ECTRICAL [)OTHERLLl 4, which requires u permit to construct,alter,improve,demolish,or repair any sWemre ChSAI�LLO prion.its issuance,also requites the applicant untimely pemlino file a signed satemem S CUIT/MISC r y that he is licensed pursuant to the provisions offee Cnmmor's License Law lChapta') p0 (commencing with Section 7000)of Division 3 of the Business and Profeseituns Qwle)or TEM )R POLE INST. COMMERCIAL; Q. myy (hot he is exempt Beaman.and the basis for the alleged exemption.AnY vinlaitun tuf ms,µ Section]OJLS by any applicant fnral'erdit suhjecu the applicanunacivii penalty of POWER - ❑NEW BLDG/AUDITION ❑DEMOLITION I-„Z} notimre than five hundred dolly,($500), ❑TENANT ❑I'OOD$ERVICii p6 D Las.wnerofNe properly.or my employees with wages as their ale compensation, 'SWIMMING LECTRIC 'IMPROVEMENT �+O will do the work,and Instiumurc is not intended oroffced forsale(Sec.7004,Business ❑OTHER and Pmfessinns Cdde:'I he Cmamelm's License Law dues not apply toanowner nl' OUTLETS-S 'Cl�FIXTURES progeny who builds or improves thereon,and who does such work himself or through _ his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIA E SQ ET. sale.IL however,the no liing or iluprovenumt iss.ld'withinn feyewof complction;thc SQ.FT FLOOR ARI7A $/SQ.Fr owner-builder will have the burden of proving that he did not build or improve for par. U pose of mwni n )? ❑sus owner fiect(See 7 y,,B sines ad commuting with:)The l csaneum's i. TOTAL: „�.J 2 7 nserva the es not (Sec.]00Q Business and Professions Cale:)The Conlmmon,and cense law docs not apply a an owner M property cords who builds or improves Contra,or's TY. PLO n {r {n,/, 99 who con¢acu for such pmjecw with aconvocmr(s)Ilunscd pnrsuynnnthe Cnmmaa'y Q °e (SEE "�r(� 1"`a6 , License Law. I'ERMI'1'ISSUAN /, Guj 0 l am exempt under Sec. ,B&P C for this reason in M t1 GTI/ ALTER-DRAIN Owner Dare ° -WA':R IL ) VALUATION .s WORKER'S COMPENSA'TIONDECLARATION saaVIIIAM"VI NIL BACK FLOWPROT[CT.DEVICE . . U/0pf MceptCO,fYIp!ete II hereby affirm under penalty of perjury one of the following declarations d(have and will meinluin aCenificate of ConsenlmselLimure for Workers Cooper. DRAINS-FLOOI R A L ""f salon,as Pmvidcd for by Section 37M of the Labor Code,for the performance of the B STUMPS TYPE CONSTRUCTION work for which this permit is issued FIXTURES-PER I ' ❑1 haveand will maintain Worker's Cmnpemsmion Imsummce.as required by Section ' 37W ofthe lasur Code,for the performance ofthe work for whit t spennitisissueI. GAS-EA.SYST� OCC.GROUP APN M War ,vG�m�, t uranE�carticrunAPnlic , 1 J .4s e Combe\ cnxm )A1tU • Policy GAS-CA.SYST. - ( I pys CERTIFICATE OP EXEMPTION FROM WORKERS' COMPENSATION INSURANCE' GREASMNDUS TEI ERC. R (This section need not he eompletel iOhe permit is fora.hundred dollars(Slap BUILDING DIVISION fTF;S or lexsJ GREASIi TRA(' NCHF.CK FEE - I certify that in the pefform+mce of the work for which this permit is issued,I shad l not employ any person in any nanner so as to became subject to the Workers'Compen- SEWER-SAN I'T aZ cation Law:.f Coldomia.Date C C Applicant WATER HEATER WNENT/ELE Of ADING FEE NOTICE TO APPLICANT:IL seller making this Cmificmc n1'Exemption;you should WATER SYS,TLS� G a ; home subject o the Workers Compensation provisions of the Labor Code,you must - SOI FEE G1J forthwith comply with such provisions or this pennitshall be deemed revoked WATER SERVICE 1 Q CONSTRUCTION LENDING AGENCY .'7 NEW RESIDENTIAL P1.1,111. SQ.FT. PAID' U0 l for anther Nem issued(See.3nlending agency fonhe peRormunce of are Receipt W F the wmk for whlcM1 this permit is issued(Sat.309],Civ.C) U Lundcrs Name TOTAL: Lenders Addr<sn TOTAL: Iy 1 certify Lha 1 have reed this epplicmiorand state thin the above infnrinminn is BUILDING FEE E� ,V) correct l agree mutuality with all city add county ordinances and state liws relating o QTY. MECHANICAL PERMIT FEE V 7- building construction.and hereby authorize representatives ofthis city a emerupod the SEISMIC FEE above.memimad pmpeny for inapeminn purposes. PF.RMI'1'ISSUANCE (We)agree to save,indemnify and keep harmless the City of Cupertino against ELECTRIC FEE liabilities,judgments,costs and expenses which may in anyway scene against said City ALTER OR ADD TO MECH. in cor se,onme,of the goaling of this permit. PLUMBING EEE ev-ZLICANT U ERSTAN S AND Wild,COMPLY WITH ALL NON-POINT AIR HANDLING UNIT TIO IO.UIIfI CFM) OU REGUL TIONS. MECHANICAL FEE AIR HANDLING UNIT(OVER 10,000 CPM) - �-/✓ ry I CONSTRUCTION TAX SignatureofA,Iic.VCommnnr pmt- EXHAUST HOOD(WOUCf) HOUSING MITIGATION FEE HA7ARDOUS MATERIALS DISCLOSURE Will the applicaml or future building«cupam some or handle hazardous material HEATING ON]'1'(TO 100,000 BTU) ax defined by the Cupertino Municipal Crile,Chapter 9.12 and the Health and Safety Code,Section 25532(0)'1 I - _ HEAT]NO UNIT(OVER 100,000 BTU) FI yes ❑No VENTILATION FAN(SINGLE RE,SID) PAID Date Receipt Will the air contaminant, a defirng nccup:ntuseea Air enlnrdeviceswhich BOILER-COMP(3HP OR 1011,000 BTU) bet hazardous air cnnlyminants us JefinW by the Hoy Area Air Quality Managemcnl• strict? TOTAL: ❑Yes No BOILER-COME(OVER 100,000,BTU) , I have must(be hazardous materials AIR CONDITIONER "movements an 2513Chapterrstaof the if lull, mia Health n Safety Calc,e a teras t.that,25571 and 25571 I to notify the that if the NEW RESIDENTIAL MECH. SQ.FF.. building resPire mens rrentlywhich have be mon p that it is my responsibility fy Nc cccupam the requirenxna which mon be met prion.issuenre of a Certificate of Odvpamy. necmmohnimil agem Deo - TOTAL: ISSUED BY.- OFFICE, Y:OFFICE, Inspection Query for a Specfic Permit 4/7/97 1 M U$ $ TRE ro S<3fS 1 s UESI e o 1#1 9760 20301 STEVENS CRE LATH L.O. 4/25/95 9760 20301 STEVENS CRE FRAMEL.O. 4/19/96 4/19/96JB 2 N 9760 20301 STEVENS CRE SHEAR L.O. 4/19/96 4/19/96JB 2 N 9760 20301 STEVENS CRE ELECT 4/23/96 4/23/96JB 2 P 9760 20301 STEVENS CRE PLYWOOD 4/23/96 4/23/96 JB 2 P