27350 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRI AI. PERMITNO,
APPLICATION/PERMIT PLUMBING,-MECHANICAL /)'7 C 0
BUILDING DIVISION p BUILDING PROJECT IDPINTIFICATION G I J
BUILDING ADDRESS:'/ -e I I ^ �� .y UNI'I'C'�o-r4"
g"CLOT# SANITARY NO. APPLICATION SUBMITTAL DATE
OWNERS NAME: IPJI I/�_ \u PIIONE: O'- CO RACTOR'SNAME: I LICNO:
_ I/ N/C CON'1'It01.M
RCI IITECfBiNGINT:I3R:� LIC NO: ADDRESS: ❑ '
CONTACT:-S' E. /' �/ LD
/ u�y(/N./1C SA.�PHON,Ls'-LaV6^y. r QTY. ELECTRIC PERMIT FEB BUILDING PERMITINFOBLDG ELECT PLUMB MECH
mar / d-r14! PERMITISSUANCE
LICIeNSED CONTRACTOR'S DECLARATIONAPPL NCES-RESIDENTIAL JOB DESCRIPTION 1 ` v
❑ca 7 I hereby affirm that 1 am licensed malerprnvisionsof Chapler9(commemingwith y
AJOLD Saturn 7001 Division 3 ofthe Busomisamd Professions Cole,and any license is in PANE
KU� WE LS
ll lune and effcet. F�
Fz,W License Class Lic.# Q 7. s UP70200 PS
.ndy Dote ConOumor Cr If! 201-1000 AM
Z`oyKARCHITECTS DECLARATION OVIiRIOWAMP. SQ.IT.FLOOR AREA $SQ.FT.
OZ 0 1 understandmy plans shall be Budur public records.
Fy ; SIGNS ELECTRICAL. -
sa Licensed Professional
OWNER BUILDER DECLARATION SPECIAL CIRC ISC.
I hereby affirm that 1 am exempt Town the Contractor's License Law for the
1+1�pm followimgrcaonm(Scction TUJLS,f3minessund Professions Code:Any cillmerunty IUMP.M OR POLE.IN
h which requires a peril to construct,alter,improve,demolish,or oputh any stm<mrc
'^TFm its isxuunce.also Tnuiresthea fieri Gnsm li tmfle a an Ike, arum POW- EVICES
gear I pp pw++d gee
� (comminuting,
comminuipro Division
ivisidie Gmoacmr's Licence Luw(Chapter SWI MI NO POOL ELECTRIC
C0.x otr, (eommecingwlb Seetinn7001Dlvixinn3nfthc Business and professions Code) VALUATION
WAN or that he is exempt herefrom and the bosis for heallegmd exemption.Any seam s of fLVr/z-
�ZQ Scaion TOI LS M1y any applicant forapemtit xuM1jtttsthe epplicam mucivilgcnalry of OUTLETS-SWITCHPS-FIXTURESI (f�af� 0Q �I��.u,
X20 not Mort thanfivehunJrcd dollars(SSW). NEW RESIDENTIALELECR _SQ.FT. ES LJ "IO
IYt� ❑do the
work,
an thastreny.ormyemployestorofwegesasale(Sec. 04,UBsiness STORIES l'YPIiCONSTRUCIION
per, and Professions
work,C d e:The Con is not s License
Lae doesed of apply to an,Business b
and property
mos Cnor The Cmnrmon, mocha Luw does not apply lf an owner of is
property w yces,pdx or i d shaves thereon,veil wh s itm n such work him Tic od hough hie
employees,prnvi or arprovehimprnvemwithinneyeromfoompletio J Teazels.If, - OCQ GNOUP RES.UNI'f5
solderhowevwNeave[lie burden orvementishat be didnoteyear ofimproeifor purpose of TOTAL:
builder bill have the burden of proving that he Aid not build or improve for purpose of
sale.).
❑ I.asownernfthepmp y.amexclusivelyconimciingwithlicanmdconrmorsto QTY. PLUMBING PERMIT FEE Ft000 ZO E AI'N
consumer the pmjcet(Sec.7014,Business and Professions Code:)The Contractor's
Liceme Law does not applyto an ownerofpropeny whobuildsorimpmves thereon.add PERMIT ISSUANCE -
whn contrasts for such projects with awntmclor(s)licensed pension toahe Cootmelor's
Licersm Law. AhTli -DRAIN&VIiNT-WATER(EA) 17E: QMMARY -
❑ 1 am exempt under Sec. ,B&I'C far this reason BACK FI-\W PROTECT.DEVICE UI'SIDE-FEES
SANITARY Y N
Owner Date RECEIPT#
-Fl. OR.ROOF.AREA.0D.
WORKMAN COMPENSATION DECLARATION DRAINS, SCHOOL X Y
❑ Ih'Comp Orthat nInsuance or ifeae,ofcomment pytheoself-im 3900,aceni&wcof
ch FIXTURES-PE TRAP' RECEIPT#
Wnrters'Compensmian Insurance oracenifeA ropy thereof(SeCc.JA00,LobCJ which PA FEE Y_LN
P�licy#IIemPlnytp E,yr�spciond a 11 Ce A N GAS-EA.SYSTE IINC OUTLETS RECEII'I(a
Company 11� (f I t flle's/Y�/ GAS-EA.SYSTGM iR4(EA) PLANCHEC
❑ Certified copy is hereby furnished.
0& CeNfied copy is fled with the city inspection division. GRFASE(INDUST .W STI:INTERCEPTOR GRADI
CER'1'IFlCATE OF EXEMPTION FROM WORKERS' GRIiASETRA IL
COMPENSATION INSURANCE
(This section meal not becomplered ifthe permit is(Drone hundred dollars(SIOB SEWER-S NITARY-STO EA.IWFT. EN E /
,it less.)
I certify that in the performance raffle work for which this permh is issued,I shall WATER EATF.RW/VENT'/EL CTR
not employ any person it any m sec as it)becomsubject to the Workers' PAID
Compensationl.awsef Culifrmis. Data WATER SYSTEM/1'REA1'ING Date Riani #
O O NOTICE TO APPLICANT:If,after makingthis Certificate of Exemption,
you,youshould
most NEW RESIDENTIAL PLMB.-SQ.PT TOTAL:
Fy becomes comply theWhites caums let this pravitkhafl feeonedbor eWlted. must
limhwith comply with nlich provisions or this peril shillhdeemed revoked. BUIL NG FEE
UJ
Z CONSTRUCTION LENDING AGENCY SEISMIC �E
1 hereby off rot Ihm there is a construction lending agency for the performance of
the work for which this .It is issued(Sec.3097,Civ.C.) TO'T'AL: ELECTRIC FEW
Lander',Name
r-' Landers Address QTY. MECHANICAL PERMIT' FEE PLUMBING FEE
C) I cenify that 1 have read this application and sure,that the above information is MECHANICAL PER
correct. l agree to comply with all city and county ordinances and slam laws relating to PERMIT ISSUANCE
,G building construction,and hereby authorize representatives ufthis city rr enter upon the CONSTRUCTION TAX
V alwve-mentioned progeny for inspection purposes. ALTER OR ADD TO MECII.
.(We)agree m sava,indemnify and keep harmless the Cly of Catania.against
Iiabdities,judgmem..,casts and expenses which may in anyway accrumtgainat said City AIRNDLING ON[I'll 010,01A1 'M)
incmamquen dthegrmamgofthis pe t
.` 4^ i,�c� AIRHA LINGUNIT(OVL' 8000 CPM)
Signature of App�cn�nt/Cntntnctor GY�d•'wt/Vn��s 71' Uatel EXHAUST ODD(W4) .
IT PAID
HAZARDOUS MATERIALS DISCLOSURE HEATINGUN IT 00,000BTU) Date Receipt Is
Wil l the applicant or future bui liting oc<npntnsmre or handle hazardous arachnid III?ATINOU VER 100,000 BTU)
as defined by the Cupeni
n inn Mucipal Cole,Chapter 9.12,and the I Iedtli and Safety
Code,smion 25532(u)'t
1:1 Yes ❑No VFNI'IL ONPAN INGLERESID)
BOI dR-COMP UIHP 100'"BTU) ISS#UaAf 9y ATE
Wultbe aexamernromb abuilding by the ay Are.Air
whichcmit r•a 1 L•�
hazardous air comuminams as defined by the Buy Area Air Quality Management B LER-COMP(OVER I 000 BTU)
Uismid1
❑Ya ❑No - NEW RESIDGNT'IAI.MECfI. SQ.Ell DEC, 71994
1 have read the hazardous materialsrequirements under Chapter 695 of the
Californif,heuil Health&Snlcy Code,Sections 25505at it
ynexpr3q. IunJernand that C b twrtt11�
if,he dcesn. hems yhave atenanL that it is myrespnceof a mnficat the C111 V
occupant of there 'emems which must be mot nor to issuance of a Certificate of
Occupancy. A
Ossamorauthemood est Date TOTAL: ISSUED BY:
OFFICE