99080220 APPt,CANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY q `L) Q 2-
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING.MECHANICAL.
ap({di•e rz; :BUII,IILNG-PROJE(T,IDENTIFICATIONiil:j('$Uei'.Y(
BUILDING ADDRESS'. SANITARY NO. APPLICATION SUBMITTAL.DATE
OWNFIB'S NAME:Opp1/C'In� 1't1O � '�YJ 7. CQ _uVR.rV AIF-� D6 �y 1/ � ��� NIC CONTROLk
qqpC ITECT/F.NGMEER: LIC NO hjg(()1,$y. iC,.nr'1`R_•A 51 V'f SS V-1 ��- ❑
CON LACI: PHONE: 7 E.,d/H .1 } lP ?S t{i,;f ll/{iBUILDIN6iPERMIT
Y..V 1 `�f-OI 1 Orr I C� G?�,�C��/ / ❑ Consultant Fees Paid by Applicant(Initial) SCUD ELECT PLUMB MECH
LICENSED CONTRACTOR S DI CIARATI(1N QTY i. I tI/LLEC TRIC PERMITi' Illii { y¢ I#FEE ft`y
1 hereby rr,m th t 1 r d a p fChapter1)Enn l g a , irk - - z.1, .,. v# :., x, ns..., .tt,t .. i, ns s :I {. JOB DESCRIPTION
Elf CCZ with Seaton 9000)ofD "on 3 rfWe Fill s' nttl Pn fesF ons Code aW mY l'ce se's
00 �^ ZI- PERMIT ISSUANCE RESIDENTIAL
='U� License Clta Fill force deE Ci7W L., I ❑SFDWL ❑KITCHEN REMODEL
<ZU -� I APPLIANCES-RESIDENTIAL ]ADDITION [I PLUMBING RE-PIPE
F W Dntu� '� Conbacaa
mGy 'II�r / ARCHITECT'S DECI.ARATION ❑MULTI-UNIT []STRUCTURAL
Z Oto
y Z I understand my Plans-shall he used;s public records PANELS MODIFICATION
CZ-Q UP DO 200 AMPS ❑INTERIOR ❑CHIMNEY REPAIR
F��LLI
Licensed Pmfeselonal 201-100JAMPS IMPROVEMENT E]SWIMMING POOLS
Yy OWNER-BUILDER DFALARNTION OVER 1000 AMPS ❑BATH REMODEUREYAIR ❑DEMOLITION
CG W 1 hereby offimr Ihot I am exempt Com the Con,recwLr Lice-Law sur the
3 O L U following emsen.1Scetion 7031.5,Business and Pmf ions Cairn Any city Our county SIGNS ELECTRICAL. THER
u h whet,requires a permit to consincl-ifler,-improve, 1 -.1 or repairany co entre /
LLp
�y N;
pir it,issuance,ale-eptione,he applican,f hpe I flc a%affied,bummer, SPECIAL CIRCUIT/INISC.
UQ�'
hot here I it thSrvu II Ih p ':on' fid e I 't - I '(Chapter 9
(atm ith rag wScrimp 70(foiD'nsirn9t fthe lfusinuss.td Prefesi atsCode)or TEMP.METER OR POLE INST. M R I '
d X o p� Iha1 he is uxompt Nerefmm and the hasin far the alleged excmf firm Any violation of NP.W LDG/ADDITION ❑DEMOLITION
mW Section 9031,5 by tiny applicant for a permit subjects the appliennt to a civil penally of POWER DEVICES
W,z,' T NT ❑FOOD SERVICE
not thanf' h d d I II' 1$500.
'�� ❑ It P P t5 Y PI y 'th g." N pe:'I n. SWIMMINCPOOLEIECTRIC4 'U
GVEMFS)T
a P.o w'lld Ih k Ith t t t t d i ff df (S .]04411ass �OTHER
I11'�jm old P f Sion Code'. theC mmrtors Circuit,Law does no(apply In an owner of OUILL'r5-.SWITCHES-FIXTURES 407
GG��✓ property who builds nr impmvw thereof,and who does such work himself onhmngh
Or,awn employees provided Ihnl such intpfovcmcros am not mended ur offered for NEW RESIDENTIAL ELECfR SQ FT,
sale-fl:however thebuilding or improvement[sold wehiouneyear efatmplefon,the SQ.UP FLOOR AREA $/Md FT.
er-huillib will have the bardw of proving that he did not build or tutpreve for put-
post,of'ol'.),
ur-
p eofsale.).
❑ I,as owner of the property,am exclusively contrncling with licensed contmgnrs to TOTAL.
construct th larclect(S 70pl Inermsc andP Ess Code)The Connector,I
x Law dno(apply a fp pe,mv he b 'le p .m a QTY!-' PLOMBING PERMIT ` r " - 'PEE 3'
to curn acts for arch projects wLhvca yr tr(s)Iu.nsc0 pursuant it)(lie Contractor s
License Lax'. PERMIT ISSUANCE
❑ Ilan exempt under Sec. ,H&P C for this reason
Owner Dale ALTER-DRAIN&VENT'-WA'IHR TA) VALUATION
WORKER'S COMPENSATION DFCLARAI ION BACK FLOW PROIECTL DEVICE
I hereby affirm ander penalty of perjure mm of the fallowingw..ker in e
� Ihave and will main mi Section
3700 of the
Labor Codehrue far
how of the
DRAINS-PLOOIt,ROOF,AREA,GOND. STORIES TYPE CONSTRUCTION
cation,as all, his
for ul Sermon 3]00 of the Labor Cndu,Cur he performance til the
work iia which ihle pool issued, FIXTURES-PGR TRAP
have and will fountainsWorkcrn Compensation Insnrunec,as reynired by Section
3700 of the Labor Cade,for the performance oftbe work bur which this permit i,,,,.cd. GAS-EA,SYSTEM-I INC 40UTLF.TS OCC.GROUP APN
My Worker's C mpensatmn pxurancecnnirs and Policyr o, rine
Carrier: Policy ��� 1+ ��sI GAS-EA.SYSTBM-OVER4(BA)
CERTIFICATEOF :EMPI'IONFROMWORKERS' CFS
COMPENSATION INSURANCE GREASEINDUSTRL WASTE.INTERCEPTOR -
(Thi, l r uccd int tus,or,letfifffic,comaefisr otehutdreddellrs($100) .„{ ,",.a;BCIEDING EIIV1$I(JNFHL'8
ur Ie,,) GREASE TRAP PLANCHECK THE
I certify that in the performanceoflhework to which this permit is Issued,I dull SEWER-SANITARY-STORM EA.200 FT.
not employ any person in wry inamm so os 10 become subject m We Worker,Cannon- ENERGY FEE.
OZ. sabers lawn of California Date WATER HEATER W/VP.N'VELECTR
z Q Applicant GRADING FEF.
NOTICE TO APPLICANT.If,after makingthus Certifieme of Exemption,yonshould WATER SYS'I EMOTEATING
become subject to the Workers Cmnpensa,ion(,avis...;ofrhe Labor Code,you must SOILS FEE
W forthwith comply with such provision or this pemti,shall bedecmed mvokod. WATER SERVICE
Q
CONS them I..ION LENDING N(1 ACeNCY NEW RESIDENN'IAL PLMB. SQ,FT. PAID
Up lhereby affrm thinthereis Weed(Su.30lendingagency for the performanceof Dem ceiplp
W F [hewers for which this permit is ixued(Sec.31)9],Ge C.)
Q LcN, - TOTpL:
1 endmI A IJ
is
'TOTAL
' that ' e ' t .... ,tt.tIOTAL.
nY ildppf i I ,t.ih that M1 information
lrfiyi3 FBe}}
BUILDING FEE
t
color I y I vly With PH I l t dd so laws fa y 1Y f MECHANICALPEMyI tI ,QT "kZ building uwcbot ands rebyauthn-, repenmtves of this c y to enter upon the ' " 'PtII
#. [ r ,i$ tv SEISMIC FE,E
above-merlin fit property far mapmrnn Eumo—.
(WO agree to save,indemnify and keep harmless the City of Cupertino against PERMIT ISSUANCE ELECTRIC FEE
irahtics,tadgmenls,call'and expenses whiehnmyln any wary amrieagaimistid City ALTER OR ADD TO MECH.
in mnseyuence of the gmnbog nfOlis peO..L PLUMBING PPA
APPLICANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM)
SOI(�p�CE�REC�ATIONS. / MECHANICAL FEE
V yi/�— fit / /�G AIR I IANDLING UNIT(OVER 10,000 CFM) CONSTRUCTION TAX
Signatures ol'Applicae/Contraemr /�D[ EXHAUST HOOD(W/DL'CIT HOUSING MI'fICAT10N FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the nppl loon,or future building oecnecto some,Inndle hmaulam,ra dal HEATWG UNIT(0100,000 BTU)
as defined by the Cupenlnn Municipal Code,Chapter 412,and ihu Health and Safety
Code Section 25532(x)? HEATING UNIT(OVER 100.000 BTU)
E]yes [3 No VENTILATION FAN(SINGLE RESID) PAID
Dole RecomOr
Will the On'Pro m or furore noif..ed by he B yse e,Air equipment bleu wMob BOILEk-COMP(iHP OR Ifp,OpAI NTU)
tit haauNous air ,comamimnts as deFlnal by the Ray Area Air Qn;Jiry Manitgement TOTAL: � C
atricFl 7
E]Yes 0 N BOILER-COMP(OVER 100,0000CU)
AIR CONN I'ION17R
I Berlin
Safety
b t 25 y t d understand
n (J5 ftheGi'- ISSUANCE
farm H IIs&S fay ll I S t s 25505 5533 15594.1 1 t i that fihc NEW RESIDENTIAL MECH. SQ.Fp.
build,I t ufrunl}1 tet T�t I Y 1 1'Igi ffy th cupvm
o(ihclR�!! v]clhmi s,h.mu Pn'unr stat erfa(` Yf to Ocel y \������r/���
Owner or apWonred agem r � POTAL: ISSUED BY..�.y—A
OFFICE