30366 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•.USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. ^
BUILDING DIVISION APPLICATION/PERNOT PLUMBING-,MECHANICAL 3 O
3l6J I6
BUILDING PROJRCp IDENTIFICATION
BUILDINGADDRESS: - SANITARY NO. APPLICATION SUBMITTAL DATE
ALLCo AtiK �tia IrJ� MTs 01 c� AI , �t�G
OWNER'S NAME: :VHONE: CON'I'RACI'OR'S NAME. 'LIC NO:
' ' Y NIC CONTROL#
LL A E " a Av lea ' N ❑ q ^.�
R III'TECT/ENGINF.F.R: LIC NO: ,DDRF.45: � Cl�tJl LVlJ
Kw I o Z O CoN OI C-
CO. ACT: PHONE: may' .. BUILDING PERMIT INFO
I` L�O Consultant Fees Paid by Applicant(Initial) BLDG ELECT LU MECH
-96 -3377 ❑ o o
LICENSED CONTRACTOR S DECLARAI ION QTY ELECTRIC PERMIT FEE
I hereby affirm that 1 Interned under p :of Chapter 9(commencing JOB DESCRIPTION
waZ wilh Semon 7(X10)of D' 1 fmc Basi dProfession,C I d ry license's RESIDENTIAL:
Hl= ;n full force and effect. TERM1'T ISSUANCE - OFO
SWL O KITCHEN REMODEL
�UQ License Class' Lie#mummoor APPLIANCES-RESIDENTIAL []ADDITION' OPLUMBING RE-PIPE
h<a Use C'S DELI
ARCHITECT'S DECLARATION ❑MULTI-UNIT ❑MODIFI STRUCTURAL
MODIFICATION'pa, PANELS .
Z Z v�Z I mnJersnind my plans shall be used as public months h10DIFICATION
OZ- UPTO 200 AMPS ❑INTERIOR El CHIMNEY REPAIR
W Licensed Profeaioead - 201-i"AMPS IMPROVEMENT
ION
IY C 4 1 hereby affrm Oa 1 um eam�L n frommeCnmiactor's License Law for the OVER I"AMPS ❑BATH REMODEUREPAIR 0 DEMOLITION
X0
E F following reason(Section 7031.5,Business and Professions Gude:Any city or county SIGNS ELECTRICAL 0 OTHER
.LLTOm which it e. allorm^t c rti ' cher: pro d mlish p .my swcmrc
mm6 ,air to t I: I thef hp t' f1signed.''mem SV IiCIACCIRCUIT/MISC.
'bar he is licensed pa the provisions of the Contractors License Law'(Chapter9
70 (coinmencing with Seco ]10(1) t Division3ofthe BusimussandP f Codc)or TEMP METER OR POLE.INST. COMMERCIAL:
a a ey Chet he ns exempt Iherefmm and the basis far the alleged exemption.Any violation of 0 NEW BLDG/AUDITION ❑DEMOLITION
X^LL Section 7031.5 by any applicant for a permit subjects the applicanto a civil penalty of POWER DEVICES
Wm,', [I TENANT 0FOOD SERVICE
[Sp :]ml more than five hundred dollars(4500} IMPROVNT
Sp
a owner of the property,or my employees with wages as their sole compensation. SWIMMING 'LECTRIC EM
f- will do the work,and the swaum is not intended or offered forsole(Sec.70Y1,Business ❑OTHER
W
3 m and Professions Code:The Contractor's License Law does not apply town owner of OUTLETS ITC - TURES
property who builds or improves thereon,and who does such work himself or through
- hi,own employees,provide phot such improvements ore not minded or offend for NEW RESIDENTIAL ELEC SQ FT.
xule.If,h^wever,the hrildingor improvement issold withmoneycarofcompletionahe F,FWORARIA 4/SQ.PV.
mer-builder will have the burden of pmving that he did not build or improve for put-
pro,
of raIt,), k/VU
01,es owaeO.f the property,..exchkively cormening with licensN contnnin"to TOTAL: !' V
onswctthe project(Sec.7(aa,Business and Professions Cade:)The Conuac'oes Li- '�Uh I✓(JNEk)I1`If„O
Li-
create law Jae^tit apply lm an uwnerof property who builds or improves theorem and QTY. PLUMBING PERMIT I FEE
wart convects for such projects with a commands)licensed pursuanuo the Contractors
License,Law. PERMIT ISSUANCE
0 1 am exempt under Sec. .11&P C for this reason
Owner [)are ALTER-DRAIN&VENT-WAFER IEA) VALUATION
WORKER S COMPENSATION DCCLARAI ION BACK FLOW PRO MCI DEVICH � OQ U� air
I hereby affirm under penalty tf per) ry one ofinelopt 'n6 dcly tions:
I have and will maintain Certificate ofComvni tosell-insum for Worker's Contpen- DRAINS-FLOOR.ROOF,AREA.COND.
ration,as provided for by Section 3700 of the Labor Code,for the performance of the STORIES TYPE CONSTRUCTION
work for which this permit is issued. FIXTURES-PER TRAP -
0 1 have and will maintain Workers Compensation Insurance,av requireal by Section
379)of the labor Castle.for the performance of the work for which this Permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS gMITIGAT11I
CC.GROUP APN
My Wer ns wen ins ranee carinrand Polio�9%�'�s -
Cwricc Policy N+T'-� ���z? GAS-EA.SYSTEM-OVER 4IRA) .
CERTIFICA Ii OF EXEMPTION FROM WORKERS'
COMPENSAI ION INSURANCE �R FA9El WASTE.INTE:RCB
fi UILD (VISION PLLS
(This sectimn nee nct Mnlmplcled il'hc penni'is fmm�c bnndl<d donnas($100) GIt EASE TRAP !�
or less.) HF,CK FEF.
lcenify that in the anynmrar,an the send,far which this the W isimc Comen- SEWER-SANITARY-STORM FA.200 FT
mit cmNlny any person in any manner,m rete bmame subject to the Workers Compen- Y FE
Z anion laws of Califomie.Dare WATI7R HEATER WNENT/ELE,CTR
kV
ZO Applicant NG E
rn NOTICE TO APPLICANT.If,afer making this Cenifcate of Exemption,you should WATER SYSTEATREATING
a ? became subject to the Wickens Compensation provisions of the Labor Cade,you must EE
G4I fnnhwilh comply with such provisions or this permi'sfiall be deemed revoked. WATER SERVICE
4 Q
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLA1H, SQ,FT
V O - Da t Receipt#
1 hereby affirm that there ix n eonxtiuction lending agency for the perl'omtmce oC _the work for which this permit is isxue(Sec.3097,Civ.CJLcndera Name • ' TOTAL:O LendersAddressI certiftam 1 have readphisii,dicaion and,ninepart the aboveinfomm'ion isNG FEF.T/1 correct,l agree to comply with all city and county lminances and slam lama relating'^ QTYMECHANICAL PERMIT FEE
V Z building conswction.and hereby authorize reprewimpoes of this city no enter upon the C-.above-memi^ned property for inspection Imirpr . PERMIT ISSUANCE
(We)agree t cram nJ keep Ie upenino againstliabilities. oris,costs undo ,wane any way acerae gain.saidCity ALTfiR OR ADD TO MECf{,e'ofihegami perI EEAP t.ICANTUNDER$ ND LL COMPLY WIT LL NON-POINT AIRFiANDLING UNI1'('1010.'WOCPM) NICA �I iURCEREGUL siAIR HANDLING UNIT(OVBR FLPO1CFM7 RUCTIG 1'A%Sig " re ApplicanUC ctor Dae EXHAUST HOOD(W/DUCT) GMITIGATI FEE
HA DOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material HEATING UNIT GO 101"BTU)
as dcfned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code.Section 255321.1? HEATING UNIT(OVER 100,000 BTU)
❑Y 7 1 No
VEPi*GL, ('ION FAN(SINGLE RE,SID) PAID
Will th ppl C' b 'IIt'ngecpm useequp r iteswhah Dam Raoip'# '
:nit hinumm,for comas nix ae detud by the Bay Area Air Quality Management, BOILER-COMP(3HP OR VVJXX)BT U) TOTAL: '
District! BOILER-COMP(OVER IOlk(XX)B'IU) -
0Ves F-1 No
I have rend the hazarker,materials requirement under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE
fomite Health&Safety Cale,Sections 25505.25533 and 2553x.I undmmad that it the NEµ•RESIDENTIAL MECH. SQ.ET.
building does not currently have.tenant,that it is my responsibility to county da,aeupren //r1
of the nopmo mens which most be met prier m issuance of a Eradicate of Occupancy.
Ow net otvmhorized agent Date TOTAL: ISSUED BY:' 1
OFFICE