99080004 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES,USE BALL POINT PEN ONLY �—Q '
CITY OF CUPERTINO IIUILDING-ELECTRICAL PERM]"
BUILDING DIVISION APPLICATIONIPERMIT ' . rLDMBING.MRt1HANIFIC S0001
IIUILDING PROJIiCT IDIiMPIF'IL`ATION. -
❑UILDIyN`GADDRESS: SANITARY NO. APPLICATION SUHMI'1'I'AL DATE
OW 10660 IHON 'RAC. DH'$ �j.•-�pQ����� N/C � C'ONI.R
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CHITECDENGINEER: LIC NO: A
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CONTACT': PHONE. , 'HUII,DING PliliMl'I'INFO.'
3,.rVX of(^5 f33 ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
c7 ..t. ❑ ❑ ❑ ❑
LICENSED CON TRACTOR S DECLARATION QTY. FLIiCTRIC PERMIT ' FEF
I hereby fl rat ltrl l licensed p of Chapter 9(commencing _ r JOB DESCRIPTION
Q9Z with SectionunuofD - n3 of Bus dP loons Cnlea.dny Bri c RESIDENTIAL
WoPERMI]ISSUANCE
(-,= 'n fill?force and affect. ❑SI-DWI. E]KI'I CI{EN REMODEL.
�UF�l Iicew .c Cla. I'm
- APPLIANCES-HF.SIDENI'I AL C1 ADDITION ❑PLUMBING RF.PIP17
F Z yj Dam Cnmr Ino
m60. "'�� UMDL11-UNIT ❑S'I'ItUCI URAL
ANCHITECFS DFCLARATI
Hyw Imadamemadan Inar,dult barred.,public records PANELS MODIFICA]ION
22 p
ZOmq , UPT0200AMPS E]INTERIOR El CHIMNEY R17PAIR
F 14.F..W LicenuJ Professional IDI-1010 AMPS - IMPN(IVIiMhiN'IE]SWIMMING POOLS
`59,= OWNER BUILDER DECLARATION OVER IIX AMT'S ❑HATH REMODEUREPAIR ❑DESFoUn
W6 1 hereby+tect Section n70 am exempr from the C,,ioro oil,An,c Law for the Afi bag 01,4111
YoS,
Call U fnllowlI mason.ffirra 91D L5,Iluam,f and he Co iuni GNU.Any city w many SIGNS I:hLC'HHCAL ❑OTHER
u+3
ato y whma
h gnims o earn r,,m ,alter,improve,denim ish,or repair any sometime su
'Juno its issuance.also requires the applicant for such permit m fleesignedsmmmenl SPECIAL CIRCUITIMISC. 1
g � that he ivlicensed paramountntire provisions itthe CmarearmsLicense Low Umpter9
eal 0 (eontmoncingwoh Section 7000)of Dlvisio.3afthe Busineasand Professions Ced0m TP.MP.METER OR POLE IN S'P. COMMERCIAL
Ih.,he is exempt otedmm wd the h ods for the alleged emotional.Any interloper ❑NEW BLDG/ADDITION ❑DEMOLITION
i< 4. Section 9113 IS hyany apiceir torn permlediens thennpliwmm a civil penalty of POWER DEVICES ❑TF.NAMP ❑FOODSFRVICH
Y1 not mone(ban five hundred dollars 185001. IMPROVEMENT'
zQ I,as owner of the Progeny,or my employees with wvgen uaheir sole a'mpensatinn, SWIMMING POOL HLECI RIC
L+ will do the work,and thearvcwro is not intended or offered forsale(See,70sFU Business (3OTHER
and Freetown,Codr:'[he C'ontractor's Licence Law does not apply Iran owner II GU'I'LE.I S-SWITCHES-VENTURE
a 3 property who builds or improves(here,.,and be does such week himulf e,through
his own employee%,provided that such improvements um not intended or offered for NEW RESIDENTIAL ELECTR SQ FT.
nate 11 1 tl h l log P l':sold 't1 o Y f pl i e ]th ^HAHI:A LSQ.FT.
owner—buildowner-builder witII the human fp owingthat h JJ rallbuilt)or impross,for Pr- I I
pose ( le). - TOTAL: I I I IA,1
I e rth P pent lycorrosion,with dContractors( ILII fI 11
coal I(h P .jou(S 91M4 B itProfession,C J )IM1 C t t 1' ., .,. v { .... y of
camel d t apply to fmopLnY h hill improves thereon and QTY I�PLUNIEUNC'PERMIT 'a „FEES. AUGp
who t wf rnuchpojects with acuad t licensed p tt the Contractor's 1 '- AUG 2 1999 I
License Law. I PLRMII ISSUANCE3� V U
Ej 1.,it exempt under Sec. - .B&P C for this raise.
Owner ALTER-DRAIN&VENT-WNTER(EA) ,VALUATION
Dnln J
WON KERS COM PENSA'I[ON DECLARATION BACK FLOW PROTECT'.DEVICH
I hereby affirm under penalty of Perjuryone of the following declomti,ns:
I have and will maintain aC...ifame of C....cut to self-ineme f,r Worker's C.mpen' DRAINS—FLOOR,ROOF AREA,COND. STORIES TVI'E CONS'rHI1Cfl06
(ion,to,provided for by Section 301X1.1 Om Labor Coda,for IIIc performance of Lha - '
ref r which this permit is issued. FIXED RES-PER TRAP
®1 haw and will maintain Workers Compensation Insurance,asrequire([by Section
CaniBeruT�n Code,lonho perfurmnn Policy o 65r�'X fICJ'["I(in Issued. GAS-EA.SYp'fEM-I INC.40UfLP,TS OCC GROUP APN
of the wit k far watch This pert t p
x nu i. ret JP 2C GAS-IIA.SYSTEM-OVER 4(-A)
I' I y N
CERTIFICATE OF FXEMPI'ION FROM WORKERS' GREASIIINDl1STRL WAS'I'F.IN]'IiRCEP10R
COMPENSATION INSURANCE - BUILDING DIVISION EKES
(Thissectiontacdootbecompleted ifna,murit isfnrone huadmddadaes(SIOIp GREASE THAI'
or less.) I'IANCIHiCK FEE
I coni fy lam in the performnncc of the work for wtd,b fir, mil is joined,I luedl SEWER-SANITARY-S'IDRM HA.200 FI'.
not employ any .on in any manner so as if)become subject m the Workers Cam scarENERGY FEE
Z ration Laws of California.[)are WATER HEAfER WNENT/ELEC R VO
z C) Applicant
1 - GRADING FEE
N NOTICE TO APPLICANT IL after making this Cenifica(e of Iblcmptinn,you should WATIiR SYS'I'HM/1'RES]INE
I•' become subject ret the Workers Compensation provlslmns of the Easier Code,you mutt SOILS FEE
forthwith cmnply with rich ur,joum;.,,his permit.hull bedeanted ravoRed. WATER SERVICE
Q
CONSTRUCTION LENDINGAGENCY NEW RESIDENTIAL PIl.10. tip.F1'. PAID
I hereb ffitm than Here iancnnnmmi.n landing for the dnnnance of Date ReceiptX
yu ,agency Ito _
the wink her wbich Otix pafmil is ismcd(Sea.30)9,Civ.C.) 'I(YI'N.:
O U Lardel,Name
W Lender's Add .. - - . TOTAL:
ilytltlfarcical thi,tppbwl nn and etvte lam tl h information _ BUILDING FEE
LF.I y correct Iag wcomply with allety and county ordinances anti..tate low raising QTY.' MECHANICAL PENMIT _t '.� FFE't„
U Z building consuumibn,and herebyaathisim represerna0vec oftMscity near and 0e SEISMIC FEh;
ahave.mcmmucal propcny foe inspection purposes. PERMI"P ISSUANCE
(We).gree to use,indemtdfy and keep Enables,the City of Catemou against ELECENIC FEE
liabilities,judgments,costs and expenses which tray in any wayacrear,mna said City ALTER OR At)[)TO MECH. PLUMBING FEE
megaence of the starting of this permit.
APPLICANT UNDERSTANDS AND WII.0 COMPLY WITH ALL NON-POINT AIR HANDLING UNIT fro 10,000 CFM) MECHANICAL,ITHE
SOURCE REGULATIONS.
AIR HANDLING UNIT(OVER 110,000 CFM) CONSTRUCIIONTAX
Signature.f Appllcaa/Con(mcmr Date E%IIAIJST HOOD(WIDIIC'O HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE' _
Will theuppliam nr future hindain oomr,are,breorhandR homal.usmmerlal HEATING UNI T(TO 100.000 BTU)
as defined by the Cmperllno Municipal Gale,Chapter 9.12,and the Healai and Safmy
Cala•Sedan 25532(0)'1 /- JESSE ING UNIT(OVER IIXLOt )RI'U)
❑Ver IFW�'t VENTILATION FAN(SINGLE RESID) PAID Dote Hcc ptp i
Will the applicant or future hatkit g occupad use equipmem er dm'ices which BOILCft—COMP(311P OR 100,111X1 BTU)
nit hv.mdmuc air mmmmmaats as defined by the It.,Area Air Quality Management 'I'OTA.:
1111cl'1 pOILER—CoMP(OVER loo.00011'1'U)
❑Yea Nn
I have mad the haraodws materials restatements under Chapter 6,95of the Cali AIR CONDITIONER ISSUANCE DATE
more Hallh de Safety Cale,Sections 255115,25533 and 25534,1 t drou nd that it IN NEW RESIDEN'HAL MIiCO SQ.Ep. �—
building nal current) ❑aveaenanl,dint it isnry msp,ncibiljty wnotify the recupant Cl
11 them hick um ha mm prion,issuance ofa CeNBeoi ,f�iflplJcl'.
Owner ramht s oagem Ilal[t/e y� 'ffYIAL. - ISSUED BY:
OFFICE