29810 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY,OF CUPERTINO BUILDING.ELECTRICAL. PERMITIS0 L�4J lSJ(^�a ^ O
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL.
BUILDING PROJECT'IDENTIFICATION
BUILDING ADDRESS: SANITARYNO. APPLICATIONSUBMITTALDATT
o = VOPI
OVVISERS NAME: PHONE: CON'RACTOR'S NAME: _ LIC ND
13 „gv ut _ NIC _ CON'1'ROLp
A 11 'F.CT/IiNGINEI?R: LIC NO', AD I<1355: ❑ _/(fl�a./SJ /—_L/3
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CONTnCc . PHONE: BUILDING PERMIT INFO
a� E g ❑ Consultant Fees Paid by Applicant Uniting BLDG ELECT . PLUMB MUCH
� . ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT E
1 hereby affirm Nat I nn licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
DaR with Section 9lNX))of Divisionlnfthe Business omit Rofesxinns GNc.and my license is
�,�0 PERMIT ISSUANCE RESIDENTIAL:
0 in full force 0 SFDWL 0 KITCHEN REMODEL
�ULfC,�� License az Lic.p _ APPLIANCES-RESIDENTIAL OADDURON [I PLUMBING RE-PIPE
f-�on Ua,e !TS DECLARATION
As shall be
DECLARATION GMULTh UNIT' GMODIFI MODIFICATION RAL
Z p m Z I understand my plans shall be used as public record, PANUS MODIFICATION
pyla OTTO 201)AMPS ElINTERIOR OCHIMNEY REPAIR .
t:W Licensed Prolbsxionel 201-1000AMPS IMPROVEMENT
t+a$7 OWNER-BUILDER DECLARATION
yy I hereby affirm Nut 1 am exempt from the Contmcmr',License Law Law battle OVER]"AMPS ❑BATH REMODEUREPAIR 0 DEMOLITION
h63 L U following reason.(Section 7031.5,Business and Professions Code:Any city or county SIGNS CLECTRICAI. O C1 OTHER
44711 O wbich requites v permit it)convect,alms improve,demolish,or repair any swnum
Itl prions its issuanc<,alson micxlheapplanot for such pemtiuo filevsigned smtimeut SPECIAL CIRCUIT/MISC.
grn� that he is licensed pursuanno the prorminnx ofthe Contractor's License Law(Chapter 9
x (conpnencing with Satins 9fgl0 of Divinion3nf the Busines and Professions Code)or TEMP.METGR OR POLE IN. OMMFR IA
d`q o y that he is exempt therefrom unit the basis for the alleged exemption.Any viturrom of 0 NEW BI.DG/ADDITION 0 DEMOLITION
W..on Section]031.5 by any applicant fora permit subjects thenpplicanl In.civil penalty of POWER DEVICES OTENANT [IFOOD SERVICE
1F�..Z>• at marc Nun five hundred dollars P$50% IMPROVEMENT
CQ� Q I,as owner of Ne progeny,or my employees with wages as their sole compensation, SWIMMING POOL ELE 1 .
e� rffiiLL will do the work.and the xtrvcmrc isnml intended nrnfferul lice sale(Sec,9044,Busineex GOTHER
W 3 and Professions Code:The Contmcmr,License law does not apply m an owner of OUTLETS-SWITCHES-FIXTU S
property who builds or improves thereon,and who does such work himself or through
his own employees;provided that such impmvvocnts amour intended or onbred for NEW.RESIDENTIAL ELECfR S Irl'.
sale lf.however,Ne building orimprovnnem is mlJ within one y<.rofcompinion,the SQ,P.FLOOR AREA $/SQ.IT.
owner,builific will have,he burden of proving Na,he did not build or improve for par
or of sale.).
0 I,as owner of the Front am exclusively contracting with licemed convectors to
conestmet the project(See.704q Business and Pofirroiom Cade:)The Cmntracmr's Li� a y, Aj 17
ruse Law doer not apply to an owner of property who builds or improves thereon,and QTY, PLUMBING PERMIT FEE W
wimsmormrsforsuch p.jortswithacommrir(sHiccnseE pursuant to the Cnnlrocut's •®aPR n
License law. PERMITISSUANCE - /5
❑ I nm exempt under See. ,B&P C for this reason - R/ 19
I Owner Date
ALTER-DRAIN&VIiNT-WATER(CA) 1s1
1
I VAL ATIONm
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE �})�a )�� Q.:_
I hereby,whom under penalty of perjury one of the following dovlmations J C/
0 l have and will maintain a Cetificate of Conscnvo wif-insum fm Workers Comic.. DRAINS-FLOOR,ROOF,AREA,COND. STORIES TYPE CONSTRUCTION
,,tion,as provided for by Seati.n 39011 of the Labor Code,for the performance of the -
work lit which this permit is issued. FIX'1'I1RES-PER TRAP
0 1 have ad will maintain Workers Compensation Insurance,as myuired by Section
3400 of the Labor Code,for the performance of the work for which this permit is issued. GAS-EA.SYS1 EM-1 INC.4 OUTLETS ,
OCC GROUP APN
My WorYf(R�oVupe ion lox ace certicrand y'nlicyyniT
Gorier.rL Polic No.((r,l�ftGAS-EA.SYSTEM-OVBRi(Eq
CERTIFICTE OF EXEM PTION FROM WORKERS' LASPJINDl15TRL WASTE INI'GRCBPI'OR
COMPENSATION INSURANCE GRBUILDING DIVISION FEES
(Thissec,ion need nate completed ifthe penis is fur one hundreddollan($I00h GREASE TRAP
or less.) - PLANCHECK FEE
Icenii'y,M1atin Neperfommnce ofthe work forwhichlhispennitisko.sc lsha0 SEWER-SANITARY-STORM F.200 FT.
not employ any person in any manner some ��ttfdyyl1nn �yylIyy yy,o th Wy two.Co.,.- ENERGY FEE
z senior Laws of t Date _ '7Ly�'G
z 0 Applicant C4 Date y WATER HGTER WNGN ELEC R
�(� �{q GRADING 17EE
y NOTICE TO PPL1 T:If,vfmr mg Nis Cmtficxte of Esenupuon,you should WATER SYSTI?M?RIMTINC
f-' become subject no the Worker's Compensation provisions of the Latter Code,you most SOILS FEE
4a[I� fonhwiN comply with such provisions or this permit shall he devoted revoked. WATRRSERVICE
CONSTRUCTION LENDING AGENCY NEW RF.SIDENTIAI.PLAN. SQ,PT. PAID
p - I forby whichinnllm manFlI,."Ser.30 Ironing agenoy forthe perfortnvnce nl' Dem cip,p -
OF Lend week for which Nis permit is issued(Sec.3119].Civ.C.)
Uj Lenders Name TO L:
Lenders Add.... TOTAL
G1 ccnify Nat 1 have read this application and state that the show information is - BUILDING F
W7 comer,l some to comply with all city and county ordinances and state laws mlatmg n' QTY. MECHANICAL PERMIT FEE
VF7 building..mmun
.loo,lndherehyauthorize represvnmtivex of Nixcityto corer....the SEISMICFEE .
47
aMve-mentioned popery for inspection purposes. PERMIT ISSUANCE
(We).gree m save,indemnify and keep hamdces the City of Cupcnino.gains, ELECTRIC FEE
liabilities,judgments,casts and expenses which may in any way accrue against said City ALTER OR ADD TO MFCIL PLUMBING FEE
inecosequenceof Negmnting mfthis mrit.
APPLICANT UNDERSTANDS WILLCOMPI WITH ALL NON-POINT AIR HANDLING UNIT TO 10.00007M)SOU ,REGUfA'1'ION' MECHANICAL 4P
AIR HANDLING UNIT(OVER 10,000CFM) CONSTRUCTIO TAX
aegnetu o g(Ilca .c Ilalc EXHAUST HOOD(W/DUCT)
HAZARDOUS MATERIALS DISCLOSURE HOUSING MITI PEE
Will are applicant or future building occupant store or handle hazmdemi material HEATING UNIT CTO i 00.00,9 BTU)
as delinW by the Crisman,Municipal Gale,Chapter 9.12,and the Ilenhh and Safety
Cole,Section 255321a)'t HEATING UNIT(OVER 10000)BTU)
F7 Year E3 No VF.M'l1ATION PANS INGLE RESID) PAID
Dam IteceiPl
Will the applicvm sur furore building rccupunt use eyuipman or Jevicex which BOILER-COMP(3HP OR 100,000 BTU)
emir hazardous air mmamineme as defined by the Bay Arcu Air Quality Management TO' L
Dlsmn9 BOILER-COMP(OVER 100.000 BTU)
' L�a�t
? ❑No
nd the hazardous materials onmismar r under,Chapter 6.95 of the Coh- AIR CONDITIONER
9 p ISSUANCE D
Soony Code,Sections 25505,25533 and 25534.1 undermnd that it Ne NEW RESIDENTIAL al SQ.Irl'. /�
o currently have a tenant,Nat it is my res,im'Ibilit,to notify the occupant ``/ents which must he met prior to issnanee of a Cemiam of Occupancy.orized agent Dam TOTAL: ISSUED BY:
OFFICE