S 0430 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO - BundHNG.ELECTRICAL PeJIM'r NO. 0430
BUILDING DIVISION APPLICATION/PERMIT vING PROJECTW NT MECHANICAL
CV
- BUILDING PROJECT IUF.NTIFICATIDN ,
BUILDINGGAADD ESS: �� SANITARY NO. APPLICATION SUBMITTAL DATE
E N PH ' NTRACI'OR'S AME'. LIC NO:
N/C CONTROL
R'1 Tb GINf?CR: .ICN : ADDRESS'. El
CO T PHONE: BU ILDING PERMITINFO
�� ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
❑ ❑ ❑
LICBNSF.DCONTRACTOR', ECLARATION QTY 'ELECTRIC PERMIT FEE ^
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing , >, - JOB DESCRIPTION
1%u�Iaz with Section 7000)of Division 3 ofthe Businewmil Professions Code,and my license is RESIDENTIAL:
FWD fill force and effect, PERMIT ISSUANCE ❑SFDWL ❑KITCHEN REMODEL
TUU License Class Lich APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RF:-PIPE
P z I8 DareContractor'
wQq ❑MULTI-UNIT ❑STRUCTURAL.
ARCHITECTS DECLARATION
PANELS MODIFICATION
zprr�Z I understand my plans shall be usedas public beemds UP TO 21X1 AMPS
Oz.s, ❑INTERIOR ❑CHIMNEY REPAIR
Licensed Pmfeesioed - 201-1000AMPS IMPROVEMENT E]SWIMMING POOLS
OWNER-BUILDER DECLARATION
OVER I(IIH)AMPS ❑BATH REM III ❑DEMOLJTION
d 1 hereby affirm that I am exempt from the Comadorp License Lew for the ` �"'
(]OTHER
2,4� following reason.(Section 7031.5.Business and Profession,Code:Any city or county SIGNS ELECTRICAL
u+3 q F
which ophrims a permit tconstruct,alter, p demalid,or repairy sourclare
pri t L :. a I q m'Ih appl tf such Pem e fl 'g daacmenr SPECIAL CIRCUIT/MISC.
Ila, Ic dp pursuant th pr o fth Commerce,L' 1 (Chaptcr9
(vommencng will,Section 7000of Divismn 3 ofthe Blem.. and Professrns Ode)er TEMP METER OR POLE INSI COMMERCIAL'
d 4� that he Is exempt therefrom and the basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
Pro Stamen 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of POWER DEVICES ❑TENANT ❑FOOD SERVICE
no,mom Bron five hundred dollars($501p.
',�Y IMPROVEMENT
Qn ❑ 1,as owner,of Nc property,or my employees with wrvges as,heir sole compensaion, SWIMMING POOL ELECTRIC
W
will do the work,and,he suucme knot imarded oroffead for sale(Sea.904,Business ❑OTHER
W m and Professions Cale:The Courtrai License Law does not apply to an menet of OUTLETS-SWITCI I ES-FIXTURES
property who builds or improves thereon,and who dare such work himself or through
his own employees,provided that such improvements aro not intended fir offered for NEW RESIDEN'T'IAL ELECTR SQ PT.
sale.If,however,the building or improvement is sold within one year ofcompletiom the SQ.FT..bOygi qjt FNb 5/SQ.Irl:
h 'lilt, ill have theburden fpro ' gthtl did not build improve for put, M{1J�n
pired'ale'). ds 16
❑1 tithe property elu lycontracting with licensed tractors to s, TOP S�� _
constructth project(S 70,C Brines. ndProfession.,C de)TheC nstors].I - . P � �['O�
L d no,apply, ownerof, pe,y M1 build improves thereon and QTY. PLUMBING PERk11T, ! l� II[l!
who contrnds for ouch pmje Ts whh a eontn,cmrG)licensed purxmnnt to de Operations Cl�r
License law. PERMITISSUANCE Ur UUrtlri INC)
e=t,Sec ,D&PC I ,It
ALTER-DRAIN&VENT-WATER(EA) VALUATION
�ffowner Date
W PEN. TION CLARATIO BACK FLOW PROTECT_.DEVICE.
I M1weby affirm under penalty elperjury on of the following dedar n
n have and will notation a Cenlficate of Consent to self-insure for Worker's Crimper- DRAINS-FLOOR,ROOF,AREA,COND. STORIES TYPE CONS"I RUCHON
svtiun,as Provided for by Section 3900 of the Labor Ode,for the performanta of the
work for whrE ffids permit is issued FIXTURES-PER TRAP
1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 ofthe Labor Code,for the performance of the work for which this permit is issued. GAS-EA.SYSTEM-I INC.40UTLE'fS OCC.G P APN
My Workers Compensation insurance carrier and Policy fiords arc:
C..c,: Policy No.: GAS-BA.SYSTEM-OVER 4(BA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GRP.ASPJINDUSTRL WASTE INTERCEPTOR L G DMS N PENS
(This,erlimoeed nm becompleted ifls,permit is for oma hundred doll ars($100) GREASE'I'RAP -
mle_ss.) PLANCI FEE
leciify,hatintheperfermnneeofthework forwhiel,thispermi,is issued ldwll SEWER-SANITARY-STORM EA.200 FT.
OPAWnot employ any person m any manne...... become subject m the Workers'Com,xim ENE.
,t,7. saner law..f California.Date WATER HEA'T'ER WN9NT/F.LECTR
Q Applicant 1 - OR D G EF.
HNOTICE TO APPLICANT:If,after making this Certificao of Exemption,you should WATER SYSTEM/FREATING
become subject to the Worker's Compensation pmvismns of the Labor Cede,you mus, SOIL. >E?
Gn fonhwlth comply with such provisions or This permit shall be deemed meeker. WATER SERVICE
Q
rAaz
CONSTRUCTION Ltion lending agency
NEW RESIDENTIAL PLMB. SQ.FT. PAID Date ReceiptN
1 hereby affirm thvnhere is a construction lending agency for the performance
the work for which this Permit is issued(See.3197,Civ.CJ
W U Lenders Name _ 1(YfA1'
V Lenders Address TOTAL:
aI cenify the I have read this applicand,and slate It above nomination is - - BUILDI FEE '
h correct,lagreemcomply with all city and county nNinances and state laws rda,mg,o QTY. MECHANICAL PERMIT FEE
(,) s7�. building cnnsmuction,anJ hereby emhoriu represenmOvos eFlhis city mentor upnn,M10 � SEISMI X99
above-mentioned property for inspection purposes. PERMIT ISSUANCE
(We)agree to pave,indemnify and keep harmless the City of Cupertino against ELECTRIC LEE .
40
Iiarlltles,judgmere,costs and expenses which may in anyway accme mourst,wid City ALTER OR ADD TO MEOH.
in connequenoo of the granting of this permit, PLUMBING FEB
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR If ANDLING UNIT(TO 10,000 CFM)
SOURCE REGULATIONS. MF.CHANICAI.FF.F.
AIR HANDLING ON]TOVNR 10.11(X)CFM) CONSTRUCTION TAX
I
Signrvmre oFApplicrd/Contractor Dene EXHAUST HOOD OVIDUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or Farre building occupantsmre or handle hazardous material HEATING UNIT(TO 100,000 BTU)
as defines!by,he Cupertino Municipal Ctdo,Chapter 9,12,and(he Health and Safety
Code,Section 25532m)P I HEATING UNIT(OVER I ar,00B BTU)
Yes EJ Nn
VENTILATION PAN(SINGLE RGSID) PAID Date Receipt If
Will the applicant or future building occupant use equipment at,devices which
emit hazardous air conclusion as defined by the Bay Area Air Quality Management BOILER-COMP(7HP OR 100,000 BTU) - TOTAL.
Distrjc[9
❑Yes Fl No BOILER-COMP(OVER 100,100 B'FU)
I have read the hazardous materials requirements under Chapter 695 of the Call- AIR CONDITIONER ISSUANCE DATE
music Health&Safety Code,Sections 25505,25533 and 25534.1 understand that tithe NEW RESIDENTIAL SPLIT SQ.Fr,
building does not currently have a tender,that in a on,responsibility to notify the repiq an,
of,he mqulremanrs which must be met prier m issuance of a Certlficare of Occuper,
Owner or amhmired agent Dae I TOTAL.: IISSUFDBY.
OFFICE
00�1X�Z� r
1011 s T Nnr
itlVd
BUILDING INSPECTI011
DEPARTMENT
V6 II've
0An, �- _
LAN DEPTH y�
• � �BLDG. DEPT. r
o
OFFICE COPY �\
17
-- - C/e- �
• COMMUNITY MANAGEMENT
SERVICES,INCORPORATED
August 28, 1997
City of Cupertino Planning Commission
Re: Commons of Cupertino Homeowners Association
Spa installation-at 1008 Senate Way
Dear Sirs:
This is to serve notice that the resident residing at the above referenced address has fulfilled all the
Homeowners Association's requirements for a backyard spa installation.
If you have any questions, please do not hesitate to contact me.
• Sincerely,
Communit Management Services, Inc.
Bill Hubbard, Association nager
Commons of Cupertino Homeowners Association
BH/mr
cc: Board of Directors
•
727 University Avenue
Los Gatos, California 95030
Bus: 14081 395-9606