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S 0717 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES—USE BALL POINT PEN ONLY CITY OF CUPERTINO HIIILDING.ELECLRICAI. PERMIT M1'O. I,UII.DINGDIVINLON APIaLICATION/PERMIT PLUMBING-MECHANICAL Q 07'1.L BUILDING PROJECT IDENTIFICATION J SANITARY NO. APPLICATION SUBMITTAL[)At BUILDING ADDRESS: ' 1980 �alcn �! Gfi 102 - 8-47 OW ER'S NAME: - i'I,ONE: CO CTOR'S NAME LIC NO: NIC CONTRI n.a all %- 1G D ❑ ARCHITECDF 'INFER; - LIC NO: A)DRES Q 4. rr. luq r CONTACT: PHONE: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) HLDO 171 EC[ PLUFBt MECH r,tell 53-C)(•il g - ❑ ❑ �❑ " LICENSED CON'I'RACfOR'SDECLARATION EAPPLIANCES E FIcE JOB DESCRIPTION I hereby affirm that 1 um licensed under provisions of Chapter 9(commm�cing DccZ with Smdon 700(pofDu,bor 3 ofthe Busimcsmd pmfcssions Cde.md my license is RESIDENTIAL FOS in full force vnJ effect ❑SFOW'L ❑KITCHENRE ODEL QUU Larme Class Lic.a ❑ADDITION BPCQFTFlING Nii-PIPE;GDate ComracunARCHITECTS DECLARA,'ION MUId'hUNII' ❑MODIFICATION Z 1 undersm st my plansshall Wusedas publicrcords MODIFICATION PAIR O0.?g � � ❑INTERIOR ❑S IMMING I;OOLK4Lw Licesed l'ndmsional IMPROVEMIiN'I' EJ SWIMMING POOhS ap.YfJ OWNER-BUILDER DECLARATION OVER 1000AMPS ❑RATH REMODFUREPA1R ❑DEMOLIHON C W Q 1 hereby affirm that I am ceempt from the Conbacmrs License Law for the ❑OTHER iyqi55 d O lollowins reason'(Scetlnn701I I.S.10nincss and Prnfcaxinm CA,Any city nr county SIGNS ELECTRICAL w 3 W N which requires a parson to conancel,altar.improve,demolish.or repair any rlmmurc 1_'1=-fig prior to its'.. c I:o unions the ppb t for suchenson file a signed statement SPECIAL CIRCUIT/MISC. S y that he licensed pto the provisions ofth CrwdmctLicenseLa (Chapter9 COMMERCIAL' W a C) that be is exempt Section Mir and of iviF b 3 of the Business J P f +Calc)or TCM P.METER OR POLE INS'P. C d� son e p is lot the alleged exempunn.Any violation of ❑NEW ItIOGIAODIT1pN ❑DEMOLITION X m_fi Section 5031.5 by any applicant for a permit subjects the applicummvcivil pcnvlry of POWIiR DEVICES C1 TENANT ❑FOOD SERVICE not more than Eve hundred dollars($500). IMPROVEMENT ❑ Los owner of the prepcny,orany emidu,e,with waists as tncir anlcmomensanum. SWIMMING POOL ELECI RIC OTHER E- will do the work.and tbemructurela not imendedoroEered Rrwle(Set.70Hd Brourms Wim and Pmfecaimms Cale'Me Contracmrs License Law does not apply to an owner of OVI'LETS-SWDCf1ILS-PIX,11REti property who builds or improves thereon,and who Jots such work himself or through NEW RESIDENTIAL ELEC R SQ ET his own employees,provided that such Haprovencros are not itucnded or offered for NO.FT.FLOOR AREA SISQ.IT .sale.IL however.the building or impmvcmem is sold within one year of complcl Inn,the mer-builder will have the burden of proving that he did not build or improve for Pur- pteenfsal TOTAL: CEI D ❑I, f ownerte r of the Pmparty,min cxduaivdy conuucicun ting with lmd umm¢mm mr construct the project(See.70,14,nm%inecs and Prid cions Code,file Camranor's Li- s Law does not apply to an owner of pmpeny who builds or impraves tbereom,and QTY PLUMBING PERMIT FEE DEC 0 81 97 who contracts for such projects with a contractors)licensed pmmant aiCommunes too Comones License low. PERMIT ISSUANCE I am exempt under Sov. B ffi 1'C fanhis reaor ALTER-DRAIN&VENT-WATER(EA) BY. VALUA'l1ON Owner Data 1 WORKER'SCoMP17 SA'HONDECI.ARATION HACK IOW PROTEULDEVICE ' 1 hereby affinrt under pvnalry of perjury one of the following declarations: I leavened will ammuinaCrnifemmdC.rcol Ioself.me,for Workers Compcm- DRAINS-FLOOR.ROOF AREA,COND. STORIES TYPE.CONS I RUCIK svtion,as provided for by Section 3700 of the Labor Calc,for the Perfamtantt of the work lir which this permit is ixauod. FIXTURES-PHR'TRAP I have and will maintain Workers Compenamion In.aum ria, as rc9Wrcd by Sermon '' I INC.d OUTLETS 3](Xl of the hhor Crde.fur tM1e pcdormana of enc work fur which tM1is permit is issued. GAS-CA.SYS1LM- OCC.CROUP APN MyWor 'a Comlmnani lauran arunic,and Policy numbcTme;' Carrier: ry - Policy Na:J��tg-w! GAS-EA.SYSTEM-OVER 4(EA) CHRTIFIC_ATEOFE EMI410N FROM WORKERSGRFASEI1NDUSTRL WASTE INTERCEPTOR COMPEN"ATION INSURANCE, BUILDING DIVISION 1:171-5 (TaNwetion ncrinotlecoripletedifthependt isforonenundmddollan(SIM) GREASETRAP PLANCHECK 11317. airles.) " I certify main 0e my nrnanro the work us %Insubject lefia, orkeis rs Croatia- SIiW1iR-SANITARY-S'roRM IEA.213 FT. ENERGY PCE I not employ any person in any manner so an to become sunjea to Ne Workers Croatian- salion Laws of Cal impair.Date - WATER HEATER WNENTTLECI'R GRADING HE Z2 Applicant s y NOTICH TO APPLICANT:IL after making this Ccnifieam of Eaentptian,you should WATER SYSTEMUREAI'ING SOLI S FEE become smhject to the Worker's Compensation provisions of the Labor Code.You must � forthwith comply with such Ino,siomnithis Permit shit l be deemed revoked. WATER SERVICE 3 (J W Q a CONST RUCTION LENDING AGENCY NEW BESIDES]I IAL PLMB. SQ.IT. PAID U z Dict Receipt a U 0 (hereby affirm that there iwconstmnum lending agency for the peRomance of 6. 'he work It,,whi,fdr,permit is issued(See 3097,Civ.CJ O' Iti Lcadars Name 'RUA WLenders Address BUILDING FEE G 1 sonify that 1 have mad this application and ante that the above information is rFi IA correct.I agree to comply with all city and county ordinances and state laws relining to QTY. MECHANICAL PERMIT FEE SEISMIC HE U building eamuucdon,and hereby amnorize representatives of this city to enter upon the abuse-mentioned property for inspection purposes. PERMIT ISSUANCE ELECTRIC FBI. (We)agree at save,indemnify and keep harmless the City mf Cupertino against n labll'niea,judgments,costs and expenses which may In any way same against said City' ALTER OR ADDTO MECH. PLUMBING FEB tl in consequence or the granting of this pen 'qq APPLICANT UNDERSTA SAN LL OMPLY WITH ALL NON-POINT AIR HANDLING UNIT LTO 10,00007M) MECIIANICAGFEE SOURCE REGULATION p-/f AIR HANDLING UNIT(OVER[(1.000 CFM) CONS'I'RUCIION'rAX Si lmmru�r f6fpphc VContm Ume EXHAUST HOOD(WIDUCT) HOUSING MI'1'IGAI'ION FEE HAZARDOUS MATERIALS DISCLOSURE. WIIItheapplkant nr future buildingwcapod,untor handle haardnuc anterial HEATING UNIT(TO Hill."BTU) as definal by be Cupertino Municipal Code,Chapter 9.12,and the Hcallb and Set.', - BEq'[NO UNIT(OVER II%I,INMI BIG) Calc,Swims 255321d' PAID - C]yes 0 N VENTILATION FAN(SINGLE RF_SID) Dice Hmcipta Will the applicant or future building occupant not c'mi norm or devices which BOILER-COMP(31111 OR 100.000 BTU) emit hazardous air contaminants as defined by the Bay Area Air Quality Management 'I OTAL O E 0Ld(�,sma BOILER-COMP(OVER 100,000[ITU) _ F-1 No AIR CONDITIONER ISSUANCE D/VI'I? read the hmarJrms mmcrials mmummen S under Chapter 6.95 of the Cali ffi Safety Code.Sections 25505,33513 and 25331.1 undersand that if the NEW RESIUF.NTIAI.MECH. SQ.t'f nen currently have a tenant that h is my reN ommility to airily the oecvp:tnt l I entn which moa be met prior to issuance ofn Certificate of Obcuponcy.on,cdasem Data TOTAL: ISSUED BY: Il © • / 0 OFFICE