29872 APPLIC;VNTTO,F:LL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. ^9 ^7
C
BUILDING DIVISION APPLICATION/PERMIT I•LUMBING-MECHANICAL L 4J VY
3LDINGAUURI.gg; BUILDING PROJECT
nW IDENTIFICATIO�ry
, SANITARY AY�ILIC�AION�SUBM�ITT
ALDATE
/ Qcto,J
1v
M
VERoiNASM a PHONE: CONTRACTOR'S NAME: LIC NO'.
Sl0 87-3812 — /C CON Ls
.HIZFCT Gf/�l'f��I Z I.IC NO: Al RES'64 RG El1
CONTACT: r, IC+ ,/ PHONE: 4'n110 n G�{yr EC-Ar "11,14 BUILDING PERMIT INFO
aV V IDH
Consultant Fees Paid by Applicant(Initial) BLDG EsrLF��,C�T' PLUMB MliCll
Imo- /��.
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE
I hereby affirm that I am licensed under previsions of Chapter 9(commencing JOB DESCRIPTION
W 0C)OZZ with
lforcoent7")off lDivision 3 ofthe Businsax and Professions Gde.and my license is WL C)KITCHEN REMODEL
WOOits PERMIT ISSUANCE
{eF�O7-�F Liccnsc Class�L10.N ��� ��
V�"Its Cnnuty APPLIANCES-RBSIUENTIA. ADDITION ❑PLUMBING RE.PI E
FW ARCHI'1I-CTS DECLARATION PANELS ❑MUDTb1.114I'1 ❑STRUCTURAL
Z p Z I understand my plans shall be mead as public records MODIFICATION
OZ—Q UPTO200AMPS C1 INTERIOR ❑CHIMNEY REPAIR
(-,y..f" 211
W Licensed Professional 201-i"AMPS IMPROVEMENT
a C < 1 hereby affirm OWNEm Bxemp EGomElh Coo DECLARATION
L icenxc 1�w far the OVER 1000 AMPS BATH 0.EMODEVREPAIR 4 D11
EMOLITION
S: 6 V hrllaw g (Section 7031.5,B d P f :Code:Any city or county SIGNS ELECTRICAL. OTHF:H -"
3N which requires .. t I h aitI ea socio �
priori Ix I: y ,r PPI, II hr n fl e:g Jsm¢memt SP[CIAI.CIHCIJII/M 15C. � -
�y (bar omen licensed p il th p Ise le t t i s n. Lv (ChapterY
W C G E (cat he is tog wnh Sccuourn and of basis n r t e ai ageBusinessland P Any Colon of 'IEMP.METER OR WLF.INST. COMMERCIAL'LFTT
a d o C that he is exempt thcrtfmm and Ne basis for the alleged exemption.Any violation of []NEW 61.DG/ADDITION•(Jr❑DfiMOLITION
,+y Section 7031.5 by any applicatfor a pemtitsubjects the applicant civil penalty of POWER DEVICES TENANT OFOODSERVICE
not mom than five handled dollars S500r IMPROVEMENT ��
F.^z.Q ❑Las owner of tM1e property,or my emPloycc..wish wages as their...le compensation, SWIMMING P(R)L ELECTRIC
will do the work,nnd the structure is not intended or offered for title(Sec.70,14,Business ❑OTHER
LdIand Professions Conic:The Conoaclor's Liccmc Law docs not apply lo un owner of OUTLETS-SWITCHES-FIXTURES last. 1115
d 3 propany who build.ler improves thereon,and who does such work himself nr through
his own employees,provided that such improvements am not intended or offered for NEW RESIDENTIAL ELECIR SQ FT.
sale.If.Im o,cclhe building or impmvement is sold within one yearo(completion.Ne SQ.PC ' REA VSQ.FI�
moviner-builder will have the burden of proving that he did not build or improve for put- ( O
pose of sale.).
0 1,as owner of the property,am exclusi say,contracting with licensed contractors to �O aa�
construct the project(Sec.) 4,Business and Professions Care)Fire Conlmetm's Lt. 1LTYT
came law doses nt apply to an ow net of property who build.or Improves thereon,and QTY. PLUMBING PERMIT FEE
who contracts for such pmjects with a cmuracto ls)licensed pursuant to the Contractor's
License law. PERMIT ISSUANCE,
1 am exempt under Sec. .B&P C for this mason
ALTER-DRAIN&VENT-WATER IG) VALUATION
Data ^ ^ r�/s
WORKERS COMPENSATION DECLARATION BACK FLOW PHOTT: D ICF. ` a``J `) `�I�
oar 1 hereby off rte under penalty of perjury one n[the 4rl lowing oledmminn
I have and will omintaim a Certificate ofConscm to)selor
l far Worker's Conrpen- DRAINS-Il.00R, ,COND' S'1'OR I EB TYPE CONS'I'RUCIION
smiom,as provided fnr by Section 3700 of the Labor Gale,fnr We pini rmance of We
rk for which this permit is issued. FIXTURES-PER TRAP
\
0 1 have and will maintain Worker's Compensation Insurance,as require)by Section
3200 of the Labor Gde,fnr the perfimmantt of the work for which Oris permit is ismd. GAS-EA.SYSTEM-] I'LL OCC.GROUP AVN
My Worker Comhrc�nr'�'mlins''f°na Cartier and Policy num be_ Lart: _ GAS-EA.SYSTEM-0 (EAI
Cnrticc 141iN No: \iC�r�IJlJP9
CIiHTIFICATE OF COMPHN EXEMPTION N FROM WORKERS' GREASFJINDUSTRL WASTE 'TO
' COMPENSATION INSURANCE BUILDING DIVISION IBES
(Thissecfionneednolhecompleled it the Permit is foram,handed dollars 010)) GREASETRAP
or less) PLANCHECK PER `
I ceadyna,imhe l¢rformance otthe walk far whiodabis permit is i.auad.Ishall SEWER-SANITARY-STORM FA.200 IT. �]
mol employ any Person in any manner sal as to become subjeG to the Workers'Compen- ENERGY fliii fN
,Z cation Laws of Califumia.Data WATER HEATER WNE,;T" CTR
z O GRADING FEE
Applicata
NOTICE TO APPLICANT:If,after rending this Certificate of Exemption,you should WATER SYSTEMG BEATING SOILS PEE
bonne subject In the Worker's Cnmpunsndon pmvisiuns of the Labor Code,you must
Q forthwith comply with such provisions or this permit shall be deemed revoked. WATER SERVICE
nx CONSTRUCTION LENDING AGENCY NEWRESIDENT1ALPLMB, SQ.P. PAID
V 1M1ereby affirm lost them is acunstmdian lending agency for We perforrwnsx of Data opts
H the work for which this permit is issued(Sea 3097,Civ.C)
QLender's Name TOTAL"'
{U Lender's Address T /_
y I anify lua I have mad this application and state that the above information r. BUILDING PEE
Ffq corral.I ugrccwcomrply with.11 city and county ordinances and.wale Ims,odming to QTY. M17CIIANICAL PERMIT' FEE
a 02
building cons0uni,n.and hereby authorize representatives of this city et enter upas the SEISMIC itlili
above-twmioned property for inspection Purposes. PERMIT ISSUANCE
(We)agree m save,indemnify and keep hatmlcss the City of Cupertino again.. ELECTRIC tiE
c1 Ilabilifies.judgmerm.coax and expenses which may in any way acerae against said City ALTER OR ADD TO MECH. PLUMBIN I E
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POIN' HANDLING UNIT(TO 10.0X)CFM) MECHANICAL IT,
SOL f tR[GULATI S./ / O
e HANDLI NO ON I'I'(OVER I B4O(d)CFM) CONSTRUC 1101TAX
of ppltire .mor Data EXHAUST HOOD(W/DUCT) HOUSING MITI,ATION FEE
HAlARDOUS MATERIALS DISCLOS RE
Will the applicant or future building occupant store or her hazallous material HEATING UNIT(TO 100.000 BTU)
a defined by the Cul art Municipal Cute,Chapter 9.12,and the Hea id and Safety
Coda,Section 25532m)'t HEATING UNIT(OVER 100,000 BTU)
❑Yes F-1 No VENTILATION FAN SINGLE RESID) PAID
WIII the applicant or future building oecupant use equipment lot devices which Dole Hca h p
.m foo s2oux air contaminants as defined by the Bay Arca Air Qualify Management BOILER-COMP QHP OR 100.000111 OF TOTAL.
le❑Yes []No BOILER-COMP(OVER 100.000 BTU)
I base madtbe haserdous materials requirements under Chapter 6,95 of the Cali AIR CONDITIONER ISSUANCE DA
'a
Imia Health&Safety C dc,Section,25505,25533 and 25534.I andr sernl ohm if the NEW RESIDENTIAL MECIL SQ.PT.
hadming does not tmr
emoral,have u anl,Ihut it N my rmpmsibility it)notify the,ecupica
of IM requirements which must be met prior to issuance of a Certificate of Occupancy.
Owner or auNodred agent Data T ISSUED OY:
OFFICE