99070038 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL P BUNT PEN ONE. LY
ICAI Y ,36
CZKMII No.'
ITY OF CUPERTINO rLUXnnnG +IE CI III L
BUILDING my1N1oN APPLICATION/PF.RMIT BUILDING pRoiNcl I>E,N'TIFICATION 50001
SANITARY NO. APPI.ICA'IION SUBMI'YIN.LAST
B UILDIRG ADDRESS.
A-4-t P GLT fl v - ERTEN O
OWNERS NAME: PHON: CONTRACIOR'S NAME: RC �•I NIC CONTROL#
O I L ❑
0IS HI'I'ECUFNGINEER: LIC No' AUDRIiti4. D �
CONTACC 1'IIOMi: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MITCH
LICENSED CONTRACTOR'S DECLARATv QTY F.LFCTRIC PERMIT FEL
1 hereby.athrm that l am licensed under provisions of Chapter 9(commencing JOB UESCRIP'1'ION
wooO Zwith Section 7000)of Divisionlaf the Bvsinexeand Profe.mnsCWc.a dmyhmnseis PERMIT ISSUANCE RESIDENTIAL'
F-,- n full forceand cRec 1 ElSFDWL ❑KITCHEN REMODEL
aUU License[In ie. Com- •LIANCF:S-RESIDIiNTIAL ❑AUDITION ❑SIRUC URAI' IPE
H66 Uam 7 Conuacmr ❑MULTI-UNIT' ❑til'RUCI'URAh
ARCHITECTS DECLARATION PANELS MODIFICATION
Z FO y Z I understand my plan.v shall be used as public retards UP TO 200AMPS
❑
OZ-� INFl 0CHL'.1NF:Y REPAIRFyF-ad Licensed professional 2UI-1000AMPS IMPROVEMENT E]SWIMMING PDOIS
j OWNER-BUILDER DECLARATION OVER 1000 AMPg ❑BATH REMODD`EIIREPAIR ❑DEMOLITION
C 6 I hereby afro that 1 am exempt fn a the Cammctarn License Law for dm ❑( ER CA..1 f•1"EFf+ /2
g a U ran°wil,g mnsan.rsemimt]al Ls,Badness amt rr°r«Llan.code:any city m amllltr SIGNS IiLEerRlcnl. �J 1 Lll1.r
yunite rcgabes a perms I° eanrweR.ager,impulse.denE..n.m repdm r aslmumre --# a
O prior m its issuances also requires the applicant for such Permit file a signed statement SPECIAL CIRCU[TIM ISC.
�.�} Rh t he is licensed pursuenuo the pre,ioice, f,hc Contra s License Law(Chapror 9 COMMERCIAL:
u1�00 l°ommencing with Section](NXII of Division 3afthe Business and Pndcisum,Code) 'TEMP.METER OR POLE INST.
C.%o that he is exempt thereliom and the basis for the alleged exemption.Any violation or NEW BLUG/ADUI'TION ❑UIiMOLITION
Sera 71131.5 by any applicant For a permil cdorela the rmhoual to o civil pcnuRy of POWER DEVICES ❑TENANT ❑1'0011 SERVICE
not more than live hundred dollars 18500. SWIMMING ff%11,I1LECIh1PROV EMENT
=o p L auwner of the property,or my employes with wages as their tole compmti ❑
enon. 'IRIC OTHER
F• will do the work,and the sometime is notintended isolated for sale(See J044.Business pIfILETS-SWITCI{t5-FIXTURES
a 3 m and Professions Code:To.Cammcmr's License Law does nm apply in an owner n!
pmpcny who builds or improves thereon.unit who does such work himself or through
his awn employees,provided that such improver ents are out intended or offered for NEW RESIDENTIAL HLEC R _Q 1'f.
[bowes'er,the budolingur im trees is sold withinere fcnm ichun.the FLOOR ARBA SISV.IrI'.
sale.lpmv ycuro p
wnepM1uildcr will have the burden of proving that he did not build or improve for pur-
p°.e of sett.). TOTAL:
1,as owner of the Property,am exclusively Contracting with licenmd contractors to
onsuoct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cones,Law does notapply ,,unownerof r,,,ny who builds or intpmves thereon,and QTY. PLUMBING PERMIT FEE
wpm annruuu for wch pinjccu with o wnvacmrtp IiecnscA pursuant m IM1e Comrucnds
License Law. PERMIT ISSUANCE
1 am exempt under Sec. .B k P C for this mama
ALTER-DRAIN k VENT-WATER(E A) VALUAI]ON
Data f1
�'
WORKER'S COMPENSATION DECLARN'ION HACK FLOW PROTECT.DEVICE �f
militia ma,, , nwy D
0ion.
as provideI touch,uer w,ed,ofp myoacof the rullinB declarationI havcond will maimainuCed,cmcof Conscmmalf-ho..lin Wnrkcr's Cmulpen- DRAINS-FLOOR,ROOH ARBA.CONS), S'I ORIESI Yri?CONSIRUCIION
d for by Section 37M of the Lubin Cade,for the Performance of dm
work for which Raiz pecom,is issued. Fl%TURFS-PER]'RAP
I M1ice and will maintain Warkers Compensation Insurance,as required by Sooner GAS-EA.SYSTEM- INC. OU`H.TN
3]00 to meLah aCurie.for the performance of the work for which this permit is issued. OCC GROUP AI'N
My WnrI I v cr nit Policy GAS-EA.SYS'T'EM UVI±R4fBA1
m
Moffitt ulicy Nn.:
CF.RTIFICCO PENSATI ION FROM WORKERS' GRIiA51%INDUST'RI.WASTE INTERCEI'IDR
COMPENSATION INSURANCC BUILDING DIVISION It6S
('fins mnion need not be completed ifthe pored,is foro:m handled dollen IS UKh GREASETRAP PLANCHECK ITUB
ar loo.)
Ic.nlfythnt inlhepedommtu,nimewark rorwnicM1thivpennit is issued,lbooll SEWER-SANITARY-STORM ISA.21X1 FL FNIIRGY FIE?
not employ any person in anynumtmsom Wbc,j esuhjeW:N11c Workers'Cnmpnt- .
Z satins law55��oI Calif ry'a.Dote ( d-O E 7 WATER HEATER WNENTELECI'R GRADING FCE
z O Applicant,JS.J, �•1 S
NOTICE TO APPLICANP:If,after making this Ccnmeme of Exemption,you should WATER SYSTEM(IREATING SOILS FEE
f-' become subject to the Worker's Compensation provisions of the Labor Crde,you mint
lonhwith comply with such provisions or this permit shall#+deemed revoked WATER SF.RVICIi
W Q
0.
CONSTRUCTION LENDING AGENCY Sol RESIDENTIAL FLASH, SQ.FT. INIiI
U Z Dam Receipt x
U work
wick thi Rh eomti is. for the performen¢o(
F" tenders bn which Olin permit is issued(Sm.309].Civ.CJ TOTAL:
Q U Lender's Name TOTAL:
W Lcndcl's Address BUILDING I'Eli
I ccniry Ihnl I Move Told Iiia application nnJ are that 0d move infm:winn Lv
:..: pJ correct.justice to comply with all city and county ordinance snnJ stmt rows mhnlnsm QTY. MECHANICAL PERMIT' FEE SEISMIC FURZ.
U Z building comwnion,and hcrcny..Ili ile rcprescnmtives of this city to emerurym the
abnvememiotmJ pmpcny for inspection parposes. PERMIT ISSUANCE EL[CfRIC PEC
(We)agree m save,indemnify and keep harmless the City of Cupertino against
llabilitics,jadgmems,call,and exPenms which may in any way aceme agamnssaid City ALPER OR ADD TO MECH. PLUMBING FEES
inmn o"lnceof thu a In, dthis Permit.
APPLICAN'I'UN ST r DWII1. IMPLY 1'I'HALLNON.I'(IIN'T AIR HANDLING UNl'I(TO 10,00I07M) MIiCIIANICAI,IPI!
ool�
SOURCES RP So f10
v _� AIR HANDLING IINi'T(OVER W.000 CFM) CON5TRUCTION'1'A%
Signa ApplicanUCnmmcmr Date EXHAUST HOOUIW/DUCIT HOUSING MITIGATION FEE
HAZARDOUS A URI#S DISCLOSURE.
W II I the applicant or finare bulldmg acO,ce,smm or hurdle by Nous material I117ATING UNIT(I'O 100.000 BTU)
as defined by tae Cupertino Municipal Code.Chapter 9.12,and the Ifealth and Solely BEATING UNIT(OVER 100,(10015 Wd
Coda Section 25512(.)^ �#,,ww�� PAID
❑Ye" Tu"O VENTILATION PAN(SINGLE BUSED) Date Receipt#
WIII the apda,oiao ur future building occupant use equipment or devims wbich BOILER-COMP 171IP OR I1X1,,dd HE'D)
it humnlous sir°onucontours ns detin d by the Bay Arco Air Quality Manug.ment TOTAL:
oolct'1 & X1BOILER-COMP(OVER I0L011'ITS)
Ycs
AIRCONDTHONER ISSUANCE DATE �y
I have m the hasmdnus mnmriuls myuircmcnm unokr Clupmr 695 of Rhe Culi- b 71
fomia Hc:Jth.@ rimy al• Setiom 255115.25517ffnJ 25574.1 undersmnJ that If the NEW RESNIiM'IAI.MECH. SQ.FL -7 — -2-
mem
_!,
nuilAngAxs Ica t culcnam!1 . '"iIMihililymnuli(y 0u¢<npmn
nnbe .a t pd I.eeyyeate or Pcenpa�� / /'
ow r mm�ndm sem
OC Dam TOTAL: ISSUED BY:
OFFICE