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APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OE CUPERTINO BUILDING - ELECTRICAL
PERMIT NO. ^
BUILDING WIS1ON APPLICATION/PERMIT PLUMBING -MECHANICAL.
LUJ 2 5 2
29252
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS:
a✓gs eco.
SANITARY NO.
APPLICATION SUBMITTAL DATE
OWNER'S NA�ME:
w t PHONE:
A �v al D rI N M'/C.1 R �/,
CrTOR'gN E: • CNG:
F� ✓ GO �.�I S C.�C iT eIa%
N/C
❑
CONTROL p
RCHITECT/ENGINF.ER: LIC NO:
o..+ 2esI&W' cN c-a3vS
ADDRESS:
8101 U1.g�aZu� $.SIF
CONTACT.-- �ws PHONE:
BUILDING PERMIT INFO
&k&-46SAA tE L� D 3� _ S 440q
❑ Consultant Fees Paid by Applicant (Initial)
BL BLECT PLUMB MECH
❑ ❑ ❑
Lm OutIIICONnsedan R S,p DECLARATION
I hereby alarm Out I am licensed under provisions of 9 (commenchig
QTY. ELECTRIC PERMIT FEE
JOB DESCRIPTION
with Secfail tionDlvisi.n3 of the Business and Professions Cade, and mylicense is
s Code,
sal Week
LceneClan, effect. -
LicenseClass Condx
Dme Cnntracmr
RESIDENTIAL'
T
DSFDWL D KITCHEN REMODEL
❑ADDITION El PLUMBING RE -PIPE
ElMULTI-UNIT[]STRUCTURAL1
MODIFICATION
PERMITISSUANCE
-
APPLIANCES -RESIDENTIAL
ARCHITECTS DECLARATION
mantr a a my plans shall be mud m public records
PANELS
UPTO 2M AMPS
❑INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT
❑ BATH REMODEWREPAIR [I DEMOLITION
❑OTHER
Licensed Professional
ON
OWNER- exempt
RDECe Contractor
I hereby Affirm that 1 sen exempt from the RATION 6 License Law for the
following remain. (Section 7031.5, Business land Professions Cute: Any city or county
which requires a permit to construct. alis,, improve, demolish, or repair any suucmre
201.1000AMPS
OVER HXIIIAMPS
SIGNS ELECTRICAL
_
prior to its issuance. also requires the applicant for such permit o rile a signed statement
SPECIAL CIRCUITMISC.
OM he is licensed pursuant m the provisions of ile Conrmetu's License taw (Chapter 9
TEMP.METMORPOLEW..
COMMERCIAL'
(commencing with Section 700H of Division 3 ofine Business and P,afeninns Cnde) or
mat he is exempt therefrom and the basis for me alleged exemption. Any violation of
Section 7031.5 byanyapplicart fora permit xubjecta me applicant to a civil pcn.lt,.f
of more than five hundred dollars ($50E.
D1, as owner of the property, or my employees with wages as their sole compensation.
will dothe work, and the structure is not intendedoroRered for sale (Sec.?044, Business
NEW BLDGIADDITION [I DEMOLITION
❑TENANT DFOODSERVICE
p�.{T�
EIGHTIES'(Y1�+^/,, `` 11
POWER DEVICES
SWIMMING NL 131.961716COIMPROVE
and Professions Cod
Code: The Contractors License Law dues not apply to an owner of
-
OUTLETS-SWITC FINTU
property who builds ser improves thereon, and who does such work himself or through
his own employees, provided that such improvements ate not inandea or offered for
NEW RESIDENTIAL ELECT SQ FT.
SQ. FT. INDOORAREA
{,SQ. FT.
sale. If, lammer,the building., impnrvemem is sold wiOmome ye in foumpleti.n.the
owner-builderwill have the burden of proving that he did not build n, improve for put-
Pf [1 • p�
P A
pouof sale.).
AJ
TOTAL:
D 1, as owner of the property, am exclusively contracting with licensed contractors to
onswct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li.
reman Law does not apply to an owner of property who builds of improves thereon, and
EB 7 1996
QTY PLUMBING PERMIT FEE
who convects for such projects wise a contrucluds) licensed pursuant to the Contractor's
PERMIT ISSUANCE r
License Law'
D Ism exempt under Sec. ,B& i' C fonhin reason
r ser L.UrCn,,,
Owner Date
ALTER -DRAW & VENT- WATER (EA)
VALUATION
C
,S, V a...�}�''/� V
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
BACK FLOW PROTECT. DEVICE
DRAINS- FLOOR, ROOF, AREA. COND.
I have and will maintain a Certificate ofComentto self -insure for Workers Camper-
cation, as provided for by Section 32110 of the Labor Code, for the perhrmnan e, of the
STORIES
TYPO CONSTRUCTION
FIXTURES -PER TRAP
work for which this permit is issued.
D I have end will maintain Workers Compensation Insurance, as required by Section
37W.fthe labn,Ceds.forms perfxon.ofine work for which this permit is issued.
My Workei