C0413 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-U10 BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PE J'NO
BUILDING DIVISION APPLICATION/PERMIT PLDMBm' HANIEu.
IIUILUING PROJECT-MECHANICAL
S0001 04
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
1c L-o ®o R 4,M0 gg'lY 61--jIgti
OW E :SN S' PION CO CIOORP,
�I NAM : �
IMT•IrCFIf- NIC CON TROL#
\RCHITE 196NGINF.ER: LIC NO: ADDRESS: I ❑
CONTACT: PHONE: BUILDING.PERMITINFO
❑ Consultant Fees Paid by Applicant(Initial) BLUEELECT PLUMB MECH
El ❑ t ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
OT1Z th Section�00G)o(Divixion3ol a Biomass and Rnfe,mas Cale,an license is RESIDENTIAL:
WOO cal PERMI"1'ISSUANCE
F WI- in Utrial forceand cB (.( ❑$PDWi, ❑KITCHEN REMODEL
aVU hiccmc- hs.# APPI.IANCI',S-RESIDENTIAL. ❑ADDI'I ION 0PLUMBING RE-PIPF,
I-ZW Date Cont
mQa ❑MUI:1'1-UNI'[' ❑S'I'RUCI URAL
ARCHI'1'I:CES DECLARATION
F oo rn PANELS MODIFICATION
Z O'1'Z 1 undersand my plans shall he used as public records
OZ=� UP TO 200 nh1P5 f INTERIOR❑ [I CHIMNEY REPAIR
F�F'W LiccmN Professional IDI-UHH)AMPS IMPROVEMENT' L]SWIMMING MOM
w gg l j OWNER-BUILDER DECLARATION OVER 1000AMYS - ❑BATH REh10DE�fP R ❑DEMOL N
C Q 1 hereby.1 irm that I am exempt from the Connaeor's Liesme Law for rhe �Q
Xa :4FU- following reason,(Section 7031.5.Business and Professions Code:Any city or county SIGNS ELECTRICAL ❑OI Hl.k
r¢� which requires a permit m construct cher,"'Prost,demolish,a repair any mm�urc R
F'�OJ Priort t ce,also th applies tf act pemdra flsignala statement SPF,CIAI.GIRCDIT)h11$G. T�
S j thmh I' dpurzua tt m p -0s'on fthe Comeator' 1 c n tit (Ch Prot9
ata C, (aomn'oremg with Section 1000)ofDivlsioaSol"the Business unit l'mtcssiou Codelm TEMP.MIIPRORPOLF. NST. COMMERCIAL
EMthat ha is exempt Iherefmm unit the hurls for the alleged exnnptiom.Any vu l.Bon of ❑NEW BI.DGIADDITION FIT,IM(11,1'I'IOif
MN Section 7031.5 It,anyopplicam fare perm"'subjects the applicant to o civil penalty of POWER DEVICES ❑l HNANT ❑Fool)SERVICE
net more than rise hundred dollars(85{x)1. IMPROVEMENT
=Q Fl 1.as owner of the property.or my employees with wages as thei..ttilcvorri'mtinn, SWIMMINGPOOLELE IC
p.. will Jo the work.and the swetum is not intended or oRerel for sale(Sir 7(W.Business ❑OT'Hlik
u m and pm(essinns Code:The Contractor's License Law does not apply to an aware of OUTLL-I'S-SWITCHES-FlXTURFS
a 3— property who builds or improves theorem,and who does such work himself or through
his own employees.provided that such improvements are not intended m offered for NEW RESIDENTIAL ELEC R SQ PI'.
sale,If.however,the building or impmvement issold within one year ofcompletion.the SQ.fT.Fl.(�R AREA 5/SQ.FF
owner-builder will have[he burden of proving that he did not build or improve for pur-
p�u of sore.).
I,as owner of the pmy,pennot exclusively contracting with licensed coruaems to I(YIAL'
m%met the project(Sec.7044,Business and Professions Cod,)Cm Contrnctor's Li-
scLow does not apply it)an ewnerof property who builds or Improves thereon,and QTY, PLUMBING PERMIT FEE
whoennuactsforsuch projec'swith acammcmr(s)lie sed pursuon'mile Contractor's L
License Law, PERMIT ISSUANCE 7j .S0
❑1 nm exempt under Sec. ,B&P C for this reason
ALT[R-DRAIN&VENT-WATER(BA) VALUATION
Owner Dam
WORKER'S COMPENSATION
OhI E'EN Perjury
o DECLARATION BACK PLOW PROTF.CE DEVICE, / sq L_�
•'❑ have
and yethrm under Penalty
can,ofjoryonenfthe following r deskip'% ns: - (Q J
Ihave unit will maintain aCrniheme of Cnnzxnuo self for N'orkerx Cnmpcn- DRNNS-FLOOR,ROOF.AREA,GOND' STORIES 'fYPIS CONSTRUCTION
,liber,as provided for by Section 3700 of the Labor Cale,far the performance of the
work Nr which this Perrot is issued. FIXTURES-PER TRAP
❑ I have and will maintain Workers Compensation Insurance,as reg'ired by Seat iu i -
3700ot the Labor Cale,for[at ptrlimnanard the work for what,Hit lermil is'ssu CAS-EA SYSTEM-I INC.40UTLH'I:S OCCGROUP APN
Cerro:kc/E('/rm/{rgti{+ml �w+�rendyl,m gurshi ulpl/vf/1I DtA GAS-EA.SYSTF,M-OVBR 4(EA)
L LI'f1Cr (JAI Poh,l�lJk-IC 6/b�a V
CERTIFICATE OI;EXEMPTION FROM WORKIiRS' GREASFJINDUSTRh HASTE INTF.RCEYIT)R
COMPENSATION INSURANCE BUILDING DIVISION FEES
(This.sectionoeednot M cnntproad ifthe perm",Miami,humboddnllars r$Ig) GREASETRAP
PhANCIIECK PEI"
or less.)
I cannily that in Ne performance of the work for w hich this pemtit is issued."shall SEWER-SANITARY-STORM EA.200 PI'.
Z nLai ee Lo y�y person in any i anter so ym be a sub"t m the Worker"Compen- ENERGY PEE
r a fP Ot Y x \r WATER HEATER WIVENT/ELECI'N O. GRADING FEE
Z O Applicant al(taT 1 " 1 x GLr
Not CE TO APPLICANT:It,after ntaki ng this Certificate of Exempt p.you shmld WATIIR SYS I'FM)TREAT INC, $OILS THE
ph
bvlewith comply
y the Workers Con'penxohis provisions of the(learned
Calc,you Inuit
{R � limhwilh comply with such pnrvisinns or permit shall be Accord revoked N'A'I'IfR SIiRVICE I
Q
a CONSTRUCTION LENDING AGENCY NEW RIi.SIUIiN'TIAL PLMB. SQ.IT PAID pore Receipt#
C)0 I he vley alRrm that mere iso connmaion lending agency for'he performance of
IL.[., the work for which this permit is is..ad(Sat 3097.Civ.C.) TOTAL:
Lenders Name
BUILDING F
DJ Lenders Address TOTAL:
0. 1 cenify that I have read this application and smm mat the above information isFEE
.F.I lA coned l agreem comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE
UZ huilding eomsurome,and hereby authnrizo rcprescentro erofthis city memoupon the SEISMIC 1131?
above-mentioned prnpeny for inepeelnn purposes. PER%II'IASSIIANCE ELECTRIC PEI"
(We)agree to suvo,Imlenmlt,i I keep bro m.me City of Cupcniuo ligation
IleM1ili(iu,judgmcros,r zle to cxpcnsus which may in any way ucrmm'gaiost said CllY pIa'PR DR ADD 10 MECH.
PLUMBING FEE ~ ��
in vnxcyucnceofm granting of this Permit
APPLICANT U' DS AN .I,C PLY WITH ALL NON-POINT AIR HANDLING ONIT(TO 10.000 CFM) MECHANICAL FEE
SOURC A S
AIR HANDLING UNIT(OVER 10.000 CFM) CONSTRUCTION TAX
Sig ren Ap ne UCon Date EXHAUS'r HOOD(W/DUC) HOUSING MITIGATION FEF.
HAZARDOUS MATERIALS DISCLOSURE.
Will the applicant or future building averemnoreor handle hazardous material HEATING UNIT(TO 100,003 BTU)
;is defined by the Cupamno Municipal Calc,Chapter 9.12,and the Health and Safety HEATING UNIT[OVER Ia1,11C01i'i'11)
Code,Section 25532(a)" }
❑Yet Taj No VEN 1'ILA TION FAN(SI NOTE RESID) IU
uIC t
Will the applicant or fm arc he Edi ng occupant use equipment or devices wIncM1 BOILER—COMP(3HP OR 100,000 It r
'tit le,ardous air contaminams les Jefnel by the Bay Arco Air Quality Management ,
Gismo? LLyy BOILER-COMP(OVER IIkl000BTU)
❑Yes dL No
Ihave read' hmadou,maerialn oryuiremene under Chapter 6.95 of the Cali- AIR CONDITIONER ISSDANCE Ti
fomia IfeJm ffiSS ynCode.Sections 25505 255JJ aoW 255311 unJentvxl that if me NEW RESIDENTIAL MECH, SQ,PT. By
buildingdoesin rte amn�tJlo tism sponsibiliry m notify the axuponttism sponsibiliry to notify the occupant _
of1hrreq - now straw then� poi to' ertif�mof UcuPH to� enif�te
Owner rat d gent Da¢ TOTAL: ISSII
OFFICE