99080063 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY qo 8 0 0 63
OWI
OF CUPERTINO BUILDING-ELECTRICAL. PERMIT NO.
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDENTIFICATION
NL111,DING ADDRESS: SANITARY NO. APPLI � DATE
OWN. 'SNAME: • P Oryy; CONTRA 'S A E N
4✓f NIC CON'fHOLp
Ion .CIITIECDENGINEF LIC NO A Ilj{ES" ❑
CONTACT. PHONE:: J✓-` BUILDING PERMIT INFO
❑ sultant ConFees Paid by Applicant(Initial) B❑LDG L� F.yT PdB IgeC�l
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I nenehy tiff than I um 1bewyr!under provisions of chapter 9(commencing JOB DESCRIPTION
CCz with Section 70)0)cfD,oioo3oflhe Rosiness and Profes.ionsCode.and mylieevice Ls RESID NTIA
I� 'mala(((ores and el t PERMII'ISSUANCE —4
W`- Cl AFD ADDITION
❑KITCHEN REMODEL
�UU hicen.eCss Lick AI'PhIANCF'_S-RESIDENTIAL. ❑ADDITION ❑i'LUMBING RE-PIPE
tF Dam L!tDEpr
A CHI'TIiCI'S DECLAR i ❑MULTI-UNIT El STRUCTURAL
ZC)OZ I undelsmnd my plansshall R used as public records IANCIS MODIFICATION
OZND UPTO 200AMPS ❑INTERIOR ❑CHIMNEY REPAIR
FL L Liucmcd Pmfealord 201-10(NIAMPS IMPROVEMENT F]SWIMMING POOLS
OWNER-BUILDER DECLARATION OVER I(XIOAMPS ❑BATH REMODEUREPAIR ❑DEMOLITION
z
Q 1 herehy affirm that 1 am eacmpl tornado,hContractors License Law for me
k 3 a.U following reason.(Sestion 7031.5,Business and Professions Axle:Any city or county SIGNS ELECTRICAL
❑OTHER
W U.y which requires a permit to construct.alma improve.demolish,or repair anY umcturc
��' prior m iu issuance.also requires the applicant for.such permiuo rile a signed statement SPEC1ALCIHCUITNISC.
that he is liccnsN purominin IM1e provisions of the Contractor's License Le,(Chapter 9
ua1�Go Icnnunencing with Section 7000paf Uivision J of the Business and ProtcaslunxCodc)m 'TtlMI'.METER OR POLP,INST. 5�4000` COMMERCIAL'
E.%o C Ihut he is cmmpl darnei'mm and me basis for the alleged exemprinn.Any violation of EW B DG/ADDITION 0 DEMOLITION
m Section 7131.5 by any applicant for a permit subjects the applicant m n civil pewlry of POWER UEVICE.S 7N T E3 FOOD SERVICE
noman
n arc thlive hundred did]an(S500). OVEMENT
=Q ❑La,ownerof the property,or my employees with wages as their sale compensation. SWIMMING POOL ELECTRIC is
WLI will Jo IM1e work.and the suctred
uum is not intended oroRefor aSir.ec.7014.Business OTHER
and Rofessions Code:The Contractor.,License Law does net apply to an owner of OUTLETS-SWITCHES-FIXTURES
property who builds or improves thereon,and who tlms such work himself Or through
his own employees,providN that such improvements are not intended or offered for NEW RESIDENTIAL ELECTH SQ ET.
nal..lf.however,the leaddiall improvement is sold within one year ofcomplecon.the SQ.F'ffrlc�)R AHF.A� SQ.FT.
owner-builderiHhave lM1 burden fp n' gthath old not bold p forpar- D L/JL1�\1 D
love 1- I )
I rth'pn 1 ly sit l)Contracting with l " 1contractors to 'I OPAL,
st mact,ly,p,,,jet,(Se70444Boone,,andPr f -.' .Gal )lbe Connector',Li- AUG 1 0 1999
axe Lo doe:not pplyi pr pony b bonds a p d t and QTY. PLUMBING PERMIT FE.E
who comrams for such projne5 wish a encomiums)licensed pursuant mine Contractors
Lure,law. PERMIT ISSUANCE
1 am exempt under Sce. .B&1'C for this mason
ALTER-DRAIN&VENUE-WATER(EA) VAtmdN3li
Dat` 3300 -
WORKER'S COMPENSATION DECLARATION RACK FLOW PROTECT DEVICE
I hand w affirm under Penalty of perjury,one of the following declarations:
Ihnve inavele for h, cCcni 3701of the 1-to,celdefor that
Worker'.Compen- DRAINS-BOOR.ROOF.ARE GDND. STORIES TYPE CONSTRUCTION
.mink,ac provided for by Scoots,issued.
J71NLa1 the Labor Code for fort the pcdirmunm or IM1e
w' rkfor and
Nis perms(ix ork.l, PIX'I'URIiS-VIiR TRAP
I have and will maintain he imri'.n C nec ofm o. ,it...far hi to re,his prcd by Sumton
(Nl nl the Labor Code,for IM1e perliammnce of the work for which this pemtil i.inweJ, GAS-IiA.SYSTEM-I INC.q OUTLETS OCC GROUP �fL
My Wor�ak's C;vp�eysetiryl urunce came P�lm PM yt{ulgtKr�3R3��>n GAS-EA.SYSTEM-OVER4(EA) ((�y
Carries �yWO -6 I
CERTIFICATE OPSATIONINN FROM WORKERS' GREASI%INDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(Thi section retainer he mmpleleJ if the pcmtit is forme handrtd Jollam(b IOD) GRFASETRAP
or IexsJ YW NCHECK FEE
I I verify that in the performance of IM1e work for which this permit is issued.(shall SEWER-SANITARY-STORM EA.200 I4.
opI employ an
any person In any mner sn as,,become s.b c,t m the Workers'Crnnpcn- ENERGY FEE
Qz lotion laws.1l
CalifCalifme.[)air WATER HEATER WNENT/ELL'C'IA GRADING FEE
Z O Appfieral
N
NUI ICE'10 APPLICANT:IL alter making this CeniOcale of 17—mo m.You should W'AI FR SYSTEMOREATING
a Mepnte subject In the Worker's Cnmpeacation pmvi...ns of the labor Coale,you all SOILS FEE
1mlhwim comply with .in provisions or this permit sha116c deemed revoked. WATER SERVICE,
Q
5 z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PEAR. SQ.FT PAID Date Receipt x
V O 1hemby affirm than them it.comwmion kerdingegens,for the performance of
D.
E-' the work for which this permit is issued(Sec.3097.Civ.C.)
Lenders Name TOTAL:
Lender.Address TOTAL:
I sonify that 1 have read mix application and a c lbw me aMwe mire rtimn is BUILDING FEE
correct,1 r,m.m....all,with all city road spumy ordinrneus and store wws rulaung to QTY. MECHANICAL PERMIT FEE
U z huilding con.tmcone.anA hereby nwhuriv.n rryercccmativc.ofmi.city wetter upon the SEISMIC FEE
a swe-narmioned property f-a-laeclian purpoves. PRRNILL ISSUANCE
(We)agree m save,indemnify and keep harm,,.IM1e City of Cupcnino ugalnst ELECTRIC FEE
Iiahilitie.s.judgmentx.costs and expenses which may in any way scene against said Cil)' ALTER OR ADD TO MECH.
consequence of germing of this pemtil. PLUMBING FEE
APPLICANT DF TANDS AND WILL COMPLY WITH A.L NON-POINT AIR HANDLING UNIT(TO IO,OIp CFM)
SOURCE iUL S. ` MECHANICAL
G AIR HANDLING UNIT(OVER 10,000 CFM111 CONSTRUCTIONTION TAX
3lgnnmru
HAZARDOUS
I'Appbtu0O0S MAI'F.RIALS DISCf.OSURIi Date EXHAIISTHOOD(W/DUCT) HOUSING MITIGATION FEE.
HA"l.AR
Wil by the Cupemorl mumbuiil Coe,Chapter
handleh eallh and Safety HEATING UNIT(TO IOfI,(KK)BTII)
ns de,Sed by the Cmpeninp Alunicipul Code,CM1npter Y.12,and tbt IlcalOt and Sufoty
Code,Section 25532(a)P HIiA'1'ING UNIT(OVER 100,000 OTU)
❑Yee kNo PAID
VENTILATION PAN(SINGLE RESID) Dam Rcceila
Will the applicant or future building occupant use equipment or devices which
.nil h nderdoas air conraminu us ac defined by the Bay Arca Air Quality Managc.cal BOILER-COMP(JHP OR 100,000 BTU) TOTA
Dlarlw^ BOILER-COMP(OVER 100.000 BTU)
❑Yes It No
AIR CONDITIONER
1 have rcwl me M1axardoae imao 2 5 5,25533 a.under 1 and 695 of me Carie ISSUANCEE
fomia Ilcullh&S fey IMe.Seaiom 255115.255JJ and 25534.1 understand that it me NEW RESIUF'JJ'TIAI.MECH. SQ.EI'.
huilding Joest ly huvcumnun6 Atm It i.my mspanxihilrym unify th.apam
ol'tha i ms rl ant he amt prior to svtrnce of a Cc�
O. ..red agent—/�C•� V Orrm ITOTAL: LSSUEDBY:
OFFICE