S0618 APP.LICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
Ir CITY OF CUPERTINO BUILDING-ELECIRICAL rFJ`yMIT No.
BUILDING DIVISION APPLICATIONrIPERMIT PING RLN(:-M IDENTICAL v 0618
BUILDING PROD F.CT IIIBNTIFICATION
IBUILDINGAUDRF,SS: SANITARY NO APPLICATION SUB 11'IAL DATIi
LOCKA.A00bmit I
OW" 'S ME: PHONE: 'I�ACTOR'S NAME: LIC NO:
' NIC CONTROLN
ARCHITE71.1:CENSEDLWS2
ADDRESS: ❑
CONTAC , BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
QTY. ELECTRIC PERMIT FEE
I hereby anion that 1 am licensed under provisions of Chapter 9(ennanci ting _ JOB DESCRIPTION
azz with station 7ap)r[Divisian3rf'he Busincrs and Profe,csio.Coda.and my lieenre is RESIDENTIAL
u10� In PERMIT ISSUANCE
�(yF full fo..eandc0ect. ❑SFDWL ❑KITCHEN REMODEL
aV License Class Lic.a APPLIANCES-RESIDENTIAL []ADDITIONE)PLUMBING RE,PIPI',
t- an, Conwemr
❑MULTI-UNIT El STRUCTURAL
ARCHITECT'S DECLARATION
PANELS MODIFICATION
OZ'N I understand mypla. I.shall beusulaspuhl,r rod,
14-0
UP T0211(IAMI'S
❑INTERIOR CHIMNEYEl REPAIR
1=°1~W Licensed Profcsslr..I - 201-1000AMM IMPROVEMENT C]SWIMMING 110015
OWNF,R-BUILDER DECLARATION OVER 10011AMI'S E3BATH REMODEIJREPAIR E3 DEMOLITION
5 C Q 1 hereby affirm that I am exemmpt frothe Conuocmr's License Law for the
X c.U following mason,(Section 7031.5.Raciness and Professions Code:Any city or county SIGNS ELECTRICAL [I OTHER
413 W y which requims a permit to cos.mcl.alma improve,demolish,or repair any Imm une
0st prix . . issuance,al q 'the ped tf h it II :s I:rmmcat SPECI AL CI RCU I IM ISC.
0 'hat he is I icenIed pursuant tthe provisions of the Contractors License 1' (Chapter9
(comrcenemg with Section 7")of Division 3 ofthe Burnes and Profession,Cale)or TEMP.MET ER OR POLE INS1'. COMMERCIAL:
a.M e K 0m he is esempt therefrom and the hacis for cite alleged e.car ion.Any violation of EI NEW BLDG/ADDITION ❑DEMOLITION
x�y Section 7031.5 by any applicant for a permit subjects the applicant ml a civil Penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
Cnot more than five hundred dollars(5500). IMPROVEMENT
5� ❑ I,os owncndthe propeity.or my employees with coag.us'hcir sale enmpensmion, SWIMMING POOL ELECTRIC
F will do the work.and the structure is not imm�dedoroll'end forsalel Sec.7W,kB smoss ❑OTHER
63m and Timm oca,Code:The Comaemr'c hicensc taw Jres not apply a1 an owner of OUTLETS-SWITCHES-PIX'I'URLS
propeny who builds or improves thereon,and who does such work himself or through
his own employees.provided do,such improvermot,are not intended in-Rexed for NEW RESIDENTIAL ELECfR SQ 19'.
sal If,however.thebuilding improvement . IJ lti y f plea an.the S :+Tf(Y.O�II�Mis
EA 95Q.14.
owner-builderalit v 'h h J fp 6'n.n JJ .b Id p cfrr par
p x f:l .). TOTAL A
b y I.
t c ly . . g n l 1 vacmrs m %� Ornate
aseLar tnc project(sec o a n,owner
of and Profession'Code:)ip e—mummor a Li NNN (I[y IYI
verse,tow does not apply wa.owner of property who builds orimprovc mercon.and QTY. PLUMBING PERMIT
who contracts for such projeen with a cremations)licenced pursuant the Co.uaemds EHTUVO
OF 4Ur
License Law, PERMIT ISSUANCE _.
ala B nthi
ALTER-DRAIN&VENT-WAI'IN IPA) VALUATION
•Oxer Date
WORKER'S CO .' T.SATION DECLARATION BACK FLOW PROTECDEVICE
I hereby affirm under penalty of perjury one of the following Worker declarations:
❑Ihavcand will maimainaCrniticatcnf Conscnun xlLinsure Workers rs Compcn- DRAINS-FLl)nR,ROOF.AREA,COND. STORIliS 'TYPE CONSTRUCTION
cation,as provided for by Section 37M of the labor Code,for the perfnromnce of the
work far which ahis pemnt is ix, cd FIXTURIiS-I'IiR'1'RAP
❑ 1 have and will maintain Worker's Compenssuoa Inennmce,as required by Section
377 of the l,ahor Code,for the perfornance of'he work for which thisiermit is issued. GAS-EA.SYS TFM-I INC.J OUTLEIN OCC GROUP APN
My Workers Compensation Insurance carrier and Policy number am:
Carrier Policy No.o GAS-EA.SYSTEM OVER n IBA)
CERTIFICATE:OF EXEMPTION FROM WORKERS' GREASI%INDUS'IAh WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(Thi ,ecdounesdno,heumtplemdi[the permit Le[or one hundmd Jolluw(51 W) CREASE"TRA('
or ko.) I'LANCIIF.CK I Ili
I ccnify that in the performance ofthe work lot which this permit is issued l shall SEWER-SANITARY-STORM HA.2W FT,
not employ any,creno in any manner so as to became.subject to the Worker'Compen- IiNF:RGY FEE
Z satire laws of C.lipm ia.Date WATER DEAHiR WNENT/ELECfR GRADING 1:121.7z O Applicant l
In NOTICE TO APPLICANT:IL sier making this CenlfiGne of Exent,im,you should WATER SYS'I FMCKEA'1'ING- 41AID
become subject to the Workers Compensation pnrvisiom of the LaborCnJo,you map.
� 7y forthwith comply with such provisions or this Permit shut be decined revoked. WA'IT'ER SERVICE
5Z CONSTRUCTION LENDING AGENCY NEW RESNIiNTIALPI.MB. SQ.FL I hereby afrm tht thre is aconswnion lending agency tonne perfrmtance ofciptp
G - 'he work for which this permit is issued(Sec.3097,Civ.C.) TOTAL:
� Lenders NamcLenders Address TOTN.'� aI ccnifytm 1 have read this applivo.ion and male that the above inform tion is QTY. MECHANICAL PERMIT FEE U Z building constraction.and hereby vuthome rpresenmtivesrftbn city toemer upon theabove-mentioned propeny for inspection purposes. PERMIT ISSUANCE
(We)agree m save,indemnify and keep harmless the City of Cupertino against
liabilities.judgments,costs and expenses which may in any way amme against said City ALTER OR ADD TO MECI 1, PLUMBING hili
- n,v,m ,cof rhe gmntin,ol this permit.
APPLICANT UND TANDS AN 'ILL COMPLY WITH A 1.NON-POINT AIR HANDLING ZING('10 Irma)CFM) M17C AANICAL I -
SOURC RF - TI 5,
AIR HANDLING UNIT(OVER 10.000CFM) CONSTRUCrIUNTAX
�.atureof Applic.mViscuroum Ilam EXHAUST HOOD(WNUCTI HOUSING MITIGATION ITE
HAZARDOUS MATER( SDISCLOSURE
Will Ile applicant of mune building rani,...tha'c ar handle larndnus omen it HEATING UNIT[TO IOO.fN10li'I V)
as defined by he Cupertino Municipal Code,Chapnx 912,and tle Health and Safety HEATING UNIT(OVER 100,00()BTU)
Code.See....a 25532(x)^ -
0Yes ❑No ('AID -
VENUILAT'[ON FAN(SINGLE RESID) Date Recci,#
Will the applicant or home building me-Pont are equipment or deices which BOILER-COMP(3HP OR 100,0 0 BTU)
mm
it hordnus air conmminnnts as defined by the Bay Area Air Quality Management TOIAL:
District^. BOILER-COMP(OVER IOBJNID BTU) _
Yes ❑No '
I have had the barardousmaterials requirements under Chapter 6.95 of'he Cali- AIRCONDI'11ONER ISSUANCE DAE
forma Health A Safety Cade.Satin.25505,25533 amt 25531.I umkrmnd'hm if the NEW RESIDENTIAL MEC1L SQ.ITT
building does not currently have a mnanL that it is my responsibility to notify the«cu,ant
of he mq,irenem,which mus,be nim prior tu I...an.of a Cenifieum of Occupancy
Owner or au.hnrimd agent Dae 'IOI'AI,; ISSUED BY:
OFFICE
6VAJ PMIS firISMAT11C S/�t�fGIfy'
1 C$ p 1 qvo
26 ga . GALV . STL FLASHING
AROUND SKYLIGHT WELL
C4ASSId� 2d MIN• CLEA 2 .
TYPICAL _ ROOFING DOUBL DOMED S,KY,. 3X3,
BLDG : PAPER (3ON roofing
felt) SHOWN DOTT 2 x It wood CURB @
INTWAVE W/
PER U . B .
►0�( '^6( STAINED WOOD :TR
As
sk
�__DBL . RAFTERS 6 HDRS ..
AROUND OPNG .
To AO p Sm BAz7
• lod— Neu INSULATION AROUND SKYEI',
FLLbIRE5�7 Gl�f�7' WELL
�I�G7C1 ReS �,
® SKYLIGHT WELL
,*7• 'ru )u w &F
2 x4 SKYLIGHT WELL
FRAMING
E pl pld&
V DBL . CLG . JOISTS,
U HEADERS @ OPNG .
GYP . BD . FINISH
EXts-FItjC7, ROOM .. BELOW4SKYLIGHT
! SKYLIGHT , CONSTRUCTION DETAIL