S2038APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OP CUPERTINO - BUu.n1NG-ELF.CfRICAL 1117811 No. 2038 0 3 8
BUILUINO U1 VISION APPLICATION/PERMIT PLUaunar.-nn:Cu1-1- 11nNICAI. J
CIIMN+LS-1 RK 4a
AM:
Gtwvs 7 r
CONTACT: PHONE:
Ib 5299 I
❑ Consultant Fccs Paid by Applicant (Initial)
1 hereby aRnn that [an, licensed ander provisions of Chupmr 9 (enmmenamg
wird s«tion 7(Xlln nr Diniamn 3 none Burmess and Pmresainns ease. nae n,y Eanae is
in full have and effect.
Liana, Class L- 7--Thic.a
namy. o O . 9!k Count.. r
ARC11ED:C'TS DECLARAI'1015'
I undmtimd my plana shall he need as public reundv
Licensed Prole sslonoI
UW NPR -BUILDER DECLARATION
1 hereby affnm 1Wa I it vacon,o Ire..i the Commuters Cmense Law Tor Bra
following mason. (Section 7031.5, Bolin... and Professions Coda: Any eiry or e..my
which routine, u permit les convaucl, nlmr, oupona, demolish nr repair any xtroc me
prior In its issuance, aho requires the applicant for such permit to file a signed.vmtemem
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(con,mcncing with Section 71HXB ofDvision 3 of the Business and Professions Code) or
that he is rxemph groxforn and he basic to, The II g d d,omsh A) wilmion air
Section 7011 5 by any applicant for a prandat hl t: the ppl t to a civil P lty of
not mom than Five hundred l ll rsH5001
❑1 fth Pr pray y pIY Ih g: n,'.1 pc:(n.
will do the k. and the t t not it J J mothered! fI (Sec. 70,11 Business
and Professions Could. Ire Contnlctorx Lifense fan does not appH m an owner of
property who builds or improves thereon, and who mxu such work Turn— or mrough
his awn employees, provided that such improvements me not intended or offered for
sale. If, howmnr, the building or improvement is sold within one year of completion, the
ownerTtuilder will have the burden of proving that he did not bust or improve for pur-
po a of sale.).
❑ 1, as owner of the pmpeny, an, exclusively contracting with licensed contractors to
o.. met He poxi (See. 7043. 1tUsincxa and Profession, CMC) "Ire Contractor's Li-
ce Law does not apply to an owner of Progeny who builds or improves thereon, and QTV.
whit contracts for such En�jeels with a ennramor s) licensed pursuant to the Conaaetors
License law.
❑ I ten cxcmpt under Sec , B R P C far this reason
EI.EcrRIC PERMIT
PERMIT ISSUANCE
APPLIANCES - RESIDENTIAL
PANELS
UP TO 200 AMPS
OVER I(XX)AMPS
SIGNS ELECTRICAL
SPECIAL CIRCUI I'/MISC.
TEMP ME'I ER OR LEINS'1
MOWER DEVICE:
SWIMMING P(X) RIC
S�'
OUTLET.
NEW RESIDENTIAL FLECI'R
Owner Dole
WORKER S COMPENSATION NSATION DrCI ARATION
11 IYfli i p 'Icy Ipl) ry orthefollowing
� Ih J 'll n' C tl 'I t1 II Cod 1 W k : Compon
or th
.mint Is 1'. dell Iyseornt37Bu el ter lana Laee for mep Hrna,ee .r the
work ter whim ode pe'nu1 is issued.
❑ I tolerant will lnainlain Workers Cnmlmoemdn i Insurance, as rerouted by Suction
37W all the LuborCodc. Ibrthe Iwrfimnamv of the work rot which this permit is issued.
My Worker's Comper,cou n Invunmca carrim and Policy numMr am:
Canicr: Polley No
C17KI'I FIQSTI; 017 EX EM PTI(ON PROM WOR KERS'
COMPURA'N�CE
(Chisscaiounceenol Macemli no—lownNeddellm,(SIW)
nr Less.) �h/(`/
IcenifythrOntnapejytjnn�
mf, r hmntnixpennitis i...cd,lxhall
not employ any Pers anwbjea m the Workers' Cmnpen-
muinLawsofC Io. 1
C)
O AOPlieant ar
NOTICE TO APPLICANT: Tickler making this CeniBcme of Exemption, you should
?become subject to the Workers Compensation pros cion. of me Labor Code, you must
from. his comply with such pro rslons ar this rye— it shall he deemed revoked.
a z
CONSTRUCTION IerNDING AGENCY
U O I for whmrrm mm mem issued(S,etionlending agency for the perronnana of
F^ Be work far which his peanut i.v issued (Sec. 3097. Civ. C.)
O U Lenders Name
r u� 1..•neerI erfify
1 ttgree (hat I have 4th thiscity
and o warrant and sure mm the above information in
F.1 Z
correct. agree to comply with all eiry and evaes ntatives or and crate lawn mining
in'he QTY.
Uz but lding anxwaion, and M1uriuy umhurimrcprc cmmivcso(miscry ¢enter upon 'he
above-mentioned property furIaspe lion purposes.
(We) agree to save, iodate y and kV
x the City of Cupertino against
Iiuhlhirs.Pldf^unla, cosvn:uul vv whny way esu me agzi s,said City
1.11 TL tla.kruing d fs per aAPPLIC'IW.DCIS'I'ANI AND WIV WITH ALL NON-P(IINC
St UIt ' REGI .,,cd ON.S.
S nates ofApls?Iwcalffomrinnr Uam
HAZARDOUS MA:RIALS DISCLOSURE
Will the applicml or future building oc slpmt store or handle haze Nouv materia
as depned by the Cuponinn Municipal Cale. Chapter 9.12, and the Health and Safety
CocaSect n 25532(0)"
L] Yes
Will the applicant or future building n cupam use equipment or devices which
emit hazardous air contaminants us defined by the Bay Area Air Quality Management
District? /^
Ycs
ms We, Chapter 695 of The Ca1i-
anJ 25534. 1 undershoot mat if me
xxWn ibllihy to nand, The conga t
PLUMBING PERMIT
PERMIT ISSUANCE
ALTER - DRAIN R VENT - WATER (17N
BACK FLOWPBOI'ICI DpVICI:
DRAINS - FLOOR,ROOF AREA GOND.
FIX 'I'URLS-PER TRAP
GAS - PA. SYS THM- I INC. .4 OLU LE I S
GAS -EA. SYS'IENTOVER 4 (M)
G R EASUI NDUS'I'R L WASTE INT
GREASETRAP
SEWER - SANITARY - ST ORM EA. 2001 FE
WATER BEATER WNESTIELECIR
WATER SYSTFIBIREATING
WATER SERVICE
NEW RESIDENTIAL PLMII. SQ, FC.
MECHANICAL PERMIT
pE.RM I'll ISSU ANCE
ALIT IRf BAUD TU MUC II.
AI R I]AN DLINO USE (ID 10,010 CFM)
Alit HANDIAN) UNI'('( VER I0JXX)CRM)
EXHAUST 11OOD IW/UUC'I')
BEAT , USE I ('H) BXI,gP B U)
IICAIING UNIT (OVER Bp 0h) B Ila)
V ENTILAI ION PAN SINGLE RESID)
BOILER - CONIPOHl (R I0.00X BTU)
P( ILER-C(l l (OVER 100.00)BTU)
AIR CONDI'1'IONIIR
NEW RESIDENTIA1, MECH. SQ. ET.
(J
COMMERCIAL,
El NEW BLDG/ADDITION ❑DEMOLITION
El TENANT C1OUT) SERVICE.
IMPROVEMENT
_T . FT FLOOR AREA S .14.
AUG 2 0199
FEE l
I � �VN.UAl1U�
61'(IRIIiS 'I'YPI3 CONS"IRUC'IION
2 tr "Ceil 7
BUILDING DIVISION FEES
PLANCHIiCK FEE
ENERGY FEE
GRADING FEE
SOILS FEE
PAID
m Receipt a
BUILDING FEE
FEE SEISMIC FEE
ELECTRIC FEE
PLUMBING FEE
MECHANICAL, hili
C0NS11'KUC9 ON'TAX
I IOUSIFG MITIGATION LCE
ISSUED By,
HHAL:
DA'li
BLUG ELECT PLUMB Mal -K
❑ ❑ ❑
FEE
JOB DESCRIPTION
RESIDENTIAL;
❑SFDWI. ❑ ITL CHEN REMODEL
❑ADDITION ❑PLUMBING RE -PIPE
El MULTI ❑S"I'RUCTURAL
M IFICA'1'ION
❑INTERIOR •HIMNI?Y REPAIR
IMPROVEMLIN'I EJ SWIMMING POOLS
❑ FIAT H RP.MODE AREPAIR El DE CIA 'I'ION
[101 HER
COMMERCIAL,
El NEW BLDG/ADDITION ❑DEMOLITION
El TENANT C1OUT) SERVICE.
IMPROVEMENT
_T . FT FLOOR AREA S .14.
AUG 2 0199
FEE l
I � �VN.UAl1U�
61'(IRIIiS 'I'YPI3 CONS"IRUC'IION
2 tr "Ceil 7
BUILDING DIVISION FEES
PLANCHIiCK FEE
ENERGY FEE
GRADING FEE
SOILS FEE
PAID
m Receipt a
BUILDING FEE
FEE SEISMIC FEE
ELECTRIC FEE
PLUMBING FEE
MECHANICAL, hili
C0NS11'KUC9 ON'TAX
I IOUSIFG MITIGATION LCE
ISSUED By,
HHAL:
DA'li