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99110065 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 10Z XK- C7-1-a- CITY OF CUPERTINO BUILDING-ELECTRICAL. PERMIT NO, RUILLMNG DIVISION APPLICATION/PERMIT PLUMBING-MECIIANICAL BUILDING PROJECT IDENri F'ICATION iWUILUING ADDRESS: SANITARY NO. AT LICAI'ION SUBMl'ITAL DATE ©t-b WN'ER:S NAM PHONE: CONTRACTOR'S NAME: LIC NO: � /,(j NICT CONTROL p 147-l ITiC ENGIN'P © LIC NO, ^�Y6 ADDRESS: ❑ CONTACT: PHONE: aV BUILDING PERMIT INFO /'�� ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT I.UMB ECH X S lig ❑ ❑ ❑ LICENSED CONT'RACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE 1 heeby affirm that lam licenwd under provisions of Chapter 9(commercial JOB CRIPTION O0Z with Sevtmn]axDof[hvismn 3 ofthe Business and Psofi stuns de.andmy license is RESIDENTIAL: WOO in PERMIT ISSUANCE FW.. full farce and eRaL � $� CSFDWL El KITCHEN REMODEL �UU Liccnse6LIc.N APPLIANCES-RFSIDIiN'1'IAL CAUflIT10N C1 PLUMBING RI:PIPE NQa Uat[ Ganlmclllt Fly AN IIITECI'S DECLARATION PANELS CMUI.TI-UNIT ❑STRUCTURAL Z p H Z 1 undcmmmd my plain shall be used os public records MODIFICATION OZ--0 UPT02MAMPS ❑INTERIOR [I CHIMNEY REPAIR F�CW Licensed Pmfcssirnrl 281-1000AMPS IMPROV .NT (SWIMMING POOLS OWNER-BUILDER UECLARNI'ION OVER IIxXI AMPS C B EMODEIIkF.PAIR El DEMOLITION C C Q 1 hereby aflinn that 1 am exempt from the Comfaaor's Liceme Law far IM1[ X 3 L U following reason.(Section](131.5.Business and Professions Code:Any city or county SIGNS ELECTRICAL OTHER W W ONQ which requires a permit to construct,alter,improve,demolish,or repair uny mmeture prior u)i is issuance,also requires the applicant for such permit it)flan signed statement SPECIAL CIRCUIT/MISC. �y Ihal he is li,atuodpnmtmntto the provisions of the Contractors License Law(Chapter 9 1 MC) (commenting with Section7000)mf Dlvlsion Sof the Business and Protections Cody, TEMP.ME'I'IR OR PULE INS'F. COMMERCIAL: a L o¢ that he is exempt thatcher)and the basis for the alleged exemption.Any violation Of C NEW BLDG/ADDITION C DEMOLITION X m N Section 7831.5 by any applicant',,,a pcnnit mbjcas the applir ono a civil penalty of POWER DEV ICES C TENANT C FOOD SERVICE FZYrnone than five hundred dollars 155(18). IMPROVEMENT < F1 I,as owner ofthe praps'ny.or my employees with wages aslhcifsale conspcasation, SWIMMING I.00L ELECTRIC will Jo lire work,and lh[smmmre on intended,coffered hu-la(Sec.]0.ta,Basins ❑OTHER W 3 w and Nofc,,ams Code:'l In,Con,...on,Licence Law Jots mol apply ,,an owner of OUTLETS-SWITCHES-FIX'I'OR prop,ny who huilda Or improves thereon,and who docs such work himself or through his own employers.provided that such improvements art not intended or offered for NEW RESIDENTIAL ELECTR S Full In sale.IL hnsioso.the buildingor int,omenmm is sold within one year of completion.the SO.FT,R AREA r-. SQ.IT. owner builder will have the hurden of proving that he did not build or improve for pur- pose Of solar 'T(YfAL' ❑ Las owner of the pepamy.am excla,,vely contracting with licensed councilors to NOV 12 1999 construct the project(See]1144.Business and Professions Casor e:)TM1e Comrac 's Li- nse,Law does not apply u+an owner ofpmpeny who builds or improves thereon,and QTY. PLUMBING PERMIT FEE who contracts for such projects with a contmcmrls)licensed pursuant to the contractor's License Law. PERM I'1'ISSUANCE ❑ Ian,exmrplOrder Sce. ,B&IsCfarthistct.ton By ALTER-DRAIN&VENT-WATER(FA) VAEUATICN Ua¢ WORKF:R;S COMPENSATION ofpamoDECLARATION BACK FLOW NROI'ECf.DEVICE I hereby affirm older penalty of perjury one of IM1e following Wo,kmr ions: Con,as and will main by eCion 37000 Con sent to Core,for the WOrkcrsn,rof h- DRAINS-I+LUOR.RfN)F.AREA,CONU. ST(IRIES TYPE CONSTRUCTION emir)+,rte provided for noSs i%su 3980 of the Lahnr Cute.for the pefom+amc of he our ti+r which this pennil is issued. IIXTUN1iS-PER TRAP ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3]011ofthe laMr Case,lot he ifonnon of the work for which this permit' - J. GAS-FA.SYSTEM-1 INC.J OUTLETS FICC.GROUP APN Workds C Ip rent( n h u ince a :and Policy nu \/ Crou NIZAn f Pulte,No.:- nt"�-i GAS-PA.Sys rEcl4 CA) CEIG MCA OF E%P.MI'I'ION FROM WORKERS' GREASI%INUUSTRL WAS'1'Ii1NI'ERCI?PIOR COMPENSATION INSURANCE BUILDING DIVISION FEES (ThissectionnmJ not becompleted iflmpcmlil nforonchumdre J011ars(b W GREASETRAP or less.) PLANCHECK FEE I ccnify that in the performance of the work for which this pe tisisw, roll SEWER-SANITARY-S"FORM EA.21x0 dal'. ploy any _ uny n he _ the uke roper- ENERGY FEE n+ �rvnni wore ann �su - m inn Luws o' WATER HEATER WNEN'1'l1iLItCTR Z Applicum o GRAVING FEE NOTICE TO APPLICAM':If,after making this Cenificate of Exemption,you should WATER SfSTENI TREATING F , became subject to the Workers Compensation provisions of the Labor Case,you must SOILS FEE ,s mchwahv ly with such provisions nr this permit nhall R Jeemedrevoked, WATER SERVICE a CONSem is acONLItNDINGAGENCY NEW NIiSI1lIiN1'IAL PLMB. SQ.FT PAID Z Dna Receipt M V l frw which this isaced(See construction lending agency for the performanre of f" the work for which this permit is issued(Sec.JfN].Civ.CJ IanJcr'n Name TOTAL: Lender's Address TOTAL: y I candy that 1 have read this application and stale that 0c shout Out'nrmrunn is BUILDING FEE Ftn corect.I agree a,comply with all city and county ordinuncas and.state laws relating to QTY. MECHANICAI.PERMIT FEE U IZ building constmnion,and hemby authove representatives of this city to enter upon the SEISMIC FEE oborcmcadmed property for in"clinn purposes. PERMIT ISSUANCE (We)agree On a" ind=71s,1.7 J keep ham+less t C'ay of Cupertino againu ELECTRIC FEE liuhdldas.judgmenls..nett uxpcnswhk inany way a,..again IvriJCay ALTER OR ADDTO MECH. saryencc of lheg ling of thi' PLUMBING FEE APPI ANT UNDE STANDS 11.1.COMPLY WI ALL NON-POINT AIR HANDLING UNIT(TO 1(I."CFM) MECHANICAL Rif; 5 CE REGULATI NS. Z- AIR HANDLING UNIT(OVER IB,000CPM) CONSTRUCTION TAX Signature,I App nalA..mmrmr hate EXHAUSTI iUOD1WIDUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building Occupant%mm or handle hazardous mmerial HEATING UNIT CFO 188.0X18 BTU) as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety Gds,Section 25532(a)'! HEATING UNIT(OVER 100.008 BTU) C Ycs VENTILATION FAN(SINGLE RESID) PAID Dam Receipt 8 Will the applicom or future building occupant use equipment or devices which emit hamrdems air contaminants as defined the Bay Area Air Quality Management BOILER-COMP(3HP ON 1(0,000 BTU) TOTAL ULsaw9 BOILER-COMP(OVER Instant BTU) C Yes I have rend nhamsda rials requiremenO under Chadvr6o5cl1hr C,ll- AIR CON DITI(INER ISSUANCE DAT. fomi lealth& fry Gal, tinny 8505.25533 and 25534.1 undemtamd that if Ne NEW RESIDENTIAL MECH. SQ.ET Jingdoesnm umntl catenant,thmitismyreS FoNlhymnmifylhcsrcu f Ne rophemak - he ssuanceofa Cenifiyn f( Owner or xmhoriecJ agim V Uwc TOTAL: ISSUED BY: OFFICE