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S1139 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERM IpNO. n BUILDING DIVISION APPLICATION/1'ERMIT PLUMBING'MECHANICAL S 11 K Q BUILDING PROJECT IDEYTIF'ICATEON v y v v BUILDING ADDR ESS: SANI'ARYNO. APPLICATION SUB MITTALIKU: Iii!,51Q LARRY 4J&'j, CvPER riA10 C'(T- 9s©IY ti­s\2 OWNER'S NAME: PHONE C I'RACIORAME: Wit su_� l -c NIC coNTROLw°Rn8L o LIC NO: ADDRESS: 13AR HITAG3v p In05I, i Llq 11A R CONTACT: HONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELF, PLUMB M H ❑ ❑ LICENSED CONTRACI OR S DECLARATION QTY ELECTRIC PERMIT - FLE JOB DESCRIPTION 1 hereby affnn hat 1 m licensed male,IF Won,of Chapter 9 loom tieing ❑ix, r Sof the B . dE fe,imm Coele.and my license is RESIDENTIAL wpwahsen on]IBIrn : PERMITISSUANCE. l�W= in full force and effect. ❑SFUWI. ❑KITCHEN REMODEL. aUU License Class Lich APPLIANCES-RESIDENTIAL. ❑ADDITION El PLUMBING RE-PIP17 F Z W Doc Contractor to ARCHITECTS DECLARATION ❑MULTI-0NIT ❑STRUCTURAL. I,,,D mPANELS MODIFICATION Z O to ZI undersm i my pbms,hull be used it,puhhe ncenfds v� UP 10200 AMPS ❑LN'IERIOR El Cl IIMNF.Y REPAIR ,--4— W Licensed Professional 2111-1000AMPS IMPROVEMENT [3SWIMMING POOLS OWNER-K ds' 1 hereby affirm that I a.exempt t BoER)m th the License Law for the OVER la0 AMPS ❑BATH RIiMODEVkGPAIR DIiMOLI'I'ION a v a U following reason.(Section]03)5.Business crit Professions Cade Any city or munry' SIGNS ELECTRICAL ❑OTHIiR 3 a H which requires a permit to contract altar,improve.demolish,or repair any structure 'A prior t t issuance, 1: q happlicantf suchpe t flsignedottement rECIAL CIRCUIVMISC. yi hath licensedpursuant t the provisions of the C I t L I (Chapter9 ��00 (cnmmem ng withSw un 9(X0)nf Dnvs n3tlthc l3usinu,and Pr<4::irn Cndc)war Tit ME ME 1 ER OR POLE INS,. COMMERCIAL; 0.d e C thus he i,c exempt therefrom and he basis for the alleged exemption.Any violation of ❑NEW BILDG/ADDITION ❑DEMOLITION X^y Section 703 L5 by any upplicanl for. knod,,objects the applicanno a civil penalty of POWER DEVICES ❑TENANT El TENANT t more than five hundred dollars($500). IMPROVEMENT SSD ❑Las owner of rhe propertYor my employees with waaesu Neirsolc annpenmtion, SWIMMING POOL ELECTRIC F.. will do he work.ond the,micwre iame inmodedonacrcd for wale(See.]Bpl.Business ❑OTHER Wim unit Panic,i.m,Code:The Contmchos License)Law does not apply to an owmef of OUTLETS-SWITCHES-FIXTUR Property h builds o mp .thereon. J h does:eM1 k himself through hisemployees,p d d that Inchimprovements not it J d ff red for NEW RESIDENTIAL EL17MR SQ sole If,however,thebuilding orimproverocal is sold aimint 1 f completion,he SQ.ET.PLO(WREA VSQ.)T. cov v builder will have the burden of pro ung hm he did rat build m'n pro e for put- W 4 I D quaofxd,), TOTAL: - ❑1,as owner of the property,ton exclusively contracting with licenced consimmrs in pA/ unshod the project(Sec.0044.Business and Professions Code:)The Conmerior's Li- off I(I c _law does not apply to an.,.a,of property who builds or improves thereon. ad QTY. PLUMBING PERMIT .FEE who contracts for such projects with a contract(,)licensed pursuant to he Contractors C/I'contractsGr License law, PERMIT ISSUANCE VVr ❑ I am exempt under Sve. .B&P C for his reason AlTHR-DRAIN&VENT'-WATEiR(EA) VALUATION • WORKER'S COMPENSATION OECLARAI'ION�rs BACK FLOW PROTECT.DEVICE I hereby affirm under penalty of perjury ono of he following declarations: ❑Ihave and will maintain a Certificate of Comenuo ulf-insure for Worker's Cromer- DRAINS-FLOOR.ROOF,AREA.COND. STORIES TY PECONSTRUCI'[ON sm cion.m For,ideal for by Scction 37W of the Lahr Cede.for the performance of the work for whichthis pc mail is issued. ' FIXTU BES-PER TRAP [:J1 have and will maintain Worker's Compensation Imran e,as required by Second 3700.1the Labra Calc,fortheperfomarom ofhc work bmuhicidn, mand is i.mof, GAS-PA.SYSTEM-1 INC.q OUTLETS OCC.GROUP APN My Worker's Cmmpvnsation Insurance sumer and Policy number are: Crider Palley No.: GAS-IIA.SYSTEM-OVER 4 WA) PER'I'IFICATE OF EXEMPTION FROM WORKERS' GREASIVIN DUSTRL WAS 117 IN U; COMPENSATION INSURANCE BUILDING DIVISION FEES (This action need not he completed ifhe poring is Grronc hundred dollars($1000 GREASETRAP m le".) PfANCI1ECK FEE I cenifYdiat inthe pemannance ofine work for which his permit is issued.I shall SEWER-SANITARY-STORM EA.200 FT not employ any person in any manner so as to become subject he W.rken.'Co ova - ENERGY Flat Z action Laws mf Califnmia.Data WKI ER HEATER W/VENT/ELECI'H C) C) Applies., i GRADING FEE NOTICE TO APPLICAN'1.If,orar making olds Cenlfiane of Exemption.You should WATER SYSTEM/TREATING h SOILS Il?I? become oubjeo in But Workuro Coops or thin provvoint stealons of he Labodeemed evoke,you must � fnnM1with comply with sucM1 provisions or permit shall he Deemed revoked. WAI'IiR SERVICE Z) CONSRUCTION LENDING AGENCY NEW RP_SIDLNTIAL PLMB. SQ.FE PATI TDate Recciq X L)❑ Ihembyuf.tha di iso construction lendtngage.ey far the performance.1' I. 6-' the work for which this permit is issued(See 3197.Co.C.) TOTAL'. C) 1-Craders,'Name w Lad .Add : TOl'AL: >s Iccertify that lh rad this application and state that b 1' tahmis BUILDING FEE .mss Tit coarct Iagfee nr mnply with all city and county ordinaries and sate laws reforms In QTY, MECHANICAL.PERMIT. FEE SEISMIC ITE V Z huildin.....traction,and hereby auhodee nepre,cmotivexofthil any rornmr-11.the above-dame ned Fropeny far inspection pugsrses. FHRMIT ISSUANCE ELECpRIC FEE (We)same to use,indemnify and keep harmless the Cry of Cupeninn against liabilities,judgments,casts and expenses which may imany was accrue agsinnuiol City' AIXERORADDTOMECH, PLUMBING FEE in .sequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT' AIR HANDLING UNIT(TO 10.000 CFM) MECHANICAL FEE SOURC REGULATIONS. AIRIIANDI.INGUNIT(OVER 10.00CFM) CONS')'RUCHONTAX sto - Signature of Appoctudou mmchr 1 Dmc EXHAUST HOOD(W/DUC'If HOUSING M I IGATION FEE HAYARDOUS MATERIALS DISCLOSURE Will theapplicaut or future buildingn,cupant smrc.rhanJ)c haemJnus manna) HEATING UNIT(TO 100.000 OTU) to dermal by the Cummins,Municipal Gde,Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 100.000 BTO) Section 25532m)? Dyes (D No VENTILATION FAN(SINGLE RESID) PAID Uute Recciptp - � Will the applicant or future building naeupnnt use equipment nr Acvicex which BOILER-COMP(3111'OR IIXI,IIIXI ITIH Cann drandous our ounuum ans tea'delinud by the Bay Arca Air Quality Ma rrivmom 'ITYIAI: District I BOILER-COMP(OVER 110,IXX)BTU) ❑Yes FIN. I have read hN e havucquire us secnd, u'nunder Chapter 6.95 of he Cali- AIR CONDITIONER ISSUANCE DATE forme Health&Safety Code.Sections 25505.25533 and 25511.I undersand that if the NEW RESIDENTIAL MI CH. SQ.ET. building does not currently have a tenant,that it is my responsibility to reify the.ccup at of the requirements which must he met prior m issuance of a Cenificate of Occupancy. Oxmeroraritu ri"l agcm Data TOI'A L: ISSUIiD 11 Y: OFFICE