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99100111 AFFLIUANTTO FILL IN INFORMATION WITHIN RED LINES USE BALL POINT PEN ONLY CITY OF CUPERTINO IIUILDING-F.LP:CTRIG\h i M1ff N BUILDING DIVISION APPLICATIONA'F.RMI'P PLUMBING-MI?CIIANICAI. 11611.11 PROJECT IDENTIFICATION 5000 NUIL1 AOT r/H55: SANITARY ND. APPLICAT ION S URMI TITh DATI Ro Q e L6 zo 9 OWNERS NAME ONE: C NTk CI R'S NAME: LIC yx ` N/C. CUNTROhM H 113 /ENGINEE LIC NO: ADDRESS: 'Dell- PHONH '" BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT' PLIp1M0� MECII LICF,NSED CON R TORS DEC[ARADON - � E� c---I 1 hereby Cron that I dud p t (Chapter 9(commencingQTY. ELECTRIC PERhe iT FEE ' wm$ t pollrD" I nl Hvsi IP f;l'a Cade tndnyice,ae iJOB DESCRIP'T'ION tfolIl nd Ilea / ^� PERMIIFSSIIANCE RESIDENTIAL: QUV Lcen:e Clncs_ I'c.Or Ola Lf - ❑st,im, ❑KITCHEN REMODEL hQL Outc-_�..('�_'�� �Com for APPLIANCES-KLSIDEN'f1AL ❑AUDITION F{ ❑I'LIIMBING RI}PIPE p,D'n A tC TTI LT$DLCLARA'F1DN PANELS ❑MUI;I'1-UNIT' ❑S'TRUCTURAI. N O Z-N+Z 1 undemm�A my plans shall he ped as public rea,Ns O UPT0200AMPS MODIFICATIO F,I"'� LtcensedlrofenuonA _ ItIN'1'IiItIOR ❑CIIIMNI!V Klil'Allt 201-1000AMPS E3 SWIMMING POOLS OWNER-BUILDER DECLARATION IMPROVEMENT y 0 W Q 1 hereby affirm that 1 am exempt From the Centimeters License Law for the OVER I(Nq AMP'S ❑BATA RF,MOOEL RE'AIR ❑UI?MOI-1110N p(a following renes..(Section 7(p 1.5,llnsiaess and Prof..lin s Cndc.Any city or county SIGNS ELECTRICAL ❑OTUE F-LL O mQ which requires a permit e,construct,alter,improve,demolish,of repair any structure nh..l puerto its issuance,also requires the applicant for such permit no filevsigaedna¢ment SPECIALCIRCIAI'/MISC. ¢X that he is license:]pursuant rote prnvisinns of the amtmemrs Licanae Law lChapter9 Co (commencing with Section 7lNlf)al Divlsioa3 nfthe Business and Profenniann Ctde)nr 'TEMHMETERORPOLHFNST. •R L 6 n C that he ix exempt therefrom and the Iasis for the alleged exemption.Any violation of n Moe Section 91131.5 by any applirear for npermn subjects the epplicanno a civil penahy of POWERDLNICES ❑N. LD ADDITION ❑DEMOLI"LON F �, nt nu,rc than Bve hundred Jnllars($500). ❑ NA ❑FOOD SERVICE Ssc ❑Las owner ofthe properly,or my employee.with wages as their sole compensation. SWIMMINGPOO ELFiCIHIC PROVEN . II do the workmyr o ,and the stmce,is not intended RerW far .It(Sol.7044,Business 3 m and Pndensioa ns Clair:The CneareA Liceocs m nxa Law doat utility en owner of OUTLH'TTCHES-FS-SWIIX'T'URES OR properly who build.or improves thereon,and who does such work himself ar Though - hi.s awn employees,provided that,on Impnwemems are not intended or offered for NEW RESIDENTIAL ELECfR SQ FL sale.If,however,the building or improvement is sold within one year of emosetian,the owner-holder will have the burden W proving that he did not build or improve for par- SQ.FT FLUOR ARHA $/SQ.lel'. pose afxale.). _ ❑has owner of the properly,am exclusively contracting with licensed coporromts It, TOTAL construct the protect(Sou 7044 Businessman!Poll CralcOrilleCloulacholl].I. can-laces does lm.RAy bitancove,,cfropeny whohildeorp n es hopparmal UMBIN(' FEE I who PCRMIT� ', Licpor ame for such Projects with awmrect a(s)licenscd pursuanContractorsQTY. PL nnthe Cactols + Ltcensc Law ❑1 am exempt under Sec. ,B&I'C for this reason PI!RMI'I'ISSUANCE - Owner Dae ALTER-DRAIN&VENT-WATER(EA) VAI DATION WORKERS nallY of DECLARATION - BACK FLOW PkfyfF.CT.UF.VICIi �� tied © !1 Fhandca affirm1plantndcr Cenaayaf perjofConencofthconsurc or Worker's Ll ♦J Ihavc and will nwinwinaCenificap of Consent msdf-insure far Workers Cmnpen- DRAINS-FLOOR,ROOF,AREA:CIOND, ras ppvided far by Suction 3710 at the factor Cndc.for the performance of etc work for which this pertdt is issued. FIXTURES-PER TRAP STORIES 'TYPE CONS'I'RUC' ION ❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 al line Core,I..me scrfarntwmeof the work far wldch,likeennitit,lmel. GAS-17 SYS'D1M-IINCAOUTLErS My We Conipcns dun Uselaaee carrier and Polieynimberare: OCC. ROUP AVN Curriee Policy No.: OAS-F.A.SYS'IEAI-OVEHJ(EAI .a1 � Os t"CIF CATTi IBJ dMPTRN FROM WORKERS' •Y1f/. /✓1i U COMPENSATION INSURANCE GREASIYINDUSI'RLWAS'I'H INTERCEPTOR (This section need not M cnmp]enJ ifnhe permit is farone hundmd dollars($IMI BUILDING DIVISION IEE. nr less.) CREASE TRAP l anily that in theperfnnnancc of"The work forwbieh this pertnia ie inxtav],F shall PLANCHHCK FEE! not employany person in any mann orsnaetotecnmesabjeclo,thow ker"Co.,.- SEWER-SANEY 0 p z Ballon Laws of California.Dare ENERGY IIF APPllcum hGRADING FEE N(YI'ICIi TO APPLICANT:If,aflef making This Cenifrac of F:xennptionyet a � bcromesvbjea tonne Works,',Compensation provkiaroofsho Labor Cad,e. EATING W ardowiah comply with such provisions or this permit shall he deemed repokell SOILS FET! 6. (� ATER SER V ]z CONSTRUCT'ION[.ENDING AGENCY 5 S PAID U O Iherchy ufllm,thnuhcre isnconmm�ion lending agency Conte perli,nnunla of Dam NuoiptM W F Ific work far which his paper is issued(Sec.Pyr',Civ,C.) Q U Ispral Name Id.J Leaders Address a 1 caniry thut I have rad this applicainn:tot'clue flat We above ill a....ation is rt to mnrpea I ngroe In comply with all city and county ordinanres and state laws relatin 1311 1 I�G FEE U z building construction,and hereby authorize representatives of this city to enter upon •PERMIT FEE I O uhovo-memioneJ n linins SE Y.11 pn,pc y oily ad ksc,s me 11 ISSUANCE (We)agree a,casts ante xpere and keep ha in any w Clay on,against s again. FI. RIC THE in consequence jn ce of the cons end cxpenxs which they in any way acrnc againxt sail City in cnnsequcnca of the grunlin6 ul thin , ndL ALTER(IH ADD 10 MECII. I'I. INC Fl3E APPLICANT ULATrIOSTANDS AN,WILL COMPLY WITH AL1.NON-I'OI N'f AIR HANDLING UNIT(IT)Biggi CPM) NIL HANIBAFeFF' nQL InAIR HANDLING UNIT(OVER 10,00t)CPM) - CONSTRUCTION'fAX Signaller afnpplieun coal Dao EXHAUSTHOOD(W/DUCT) HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION FEE WILE the afericnnr or(more building owopttat splen handle lrauokux macriel HEATING UNITOO d(I,Bnll BID) us defined by ache Cohan ins Marm.p:d Code,Chapter 912,vad the Health and Safety , Cndc,Section 25532m)7 HEATING UNITIOVER 100.000 BTU) ❑Ycs Cl No VENTILATION RAN(SINGLE RESID) PAID _ Will'be applicantture building occupantuseea AirQuordo,ireswhich Dam keceiplp lit hevrdous air runmminvms us AefineA by the Bay Arca Air Quality Management BOILER-COMP(iHP OR IW.IXNI N'1'U) 'Fid? - - ' ❑Ycs L:jNn 1301LER-COMP(OVER IINI,IXIf 13'TU) _ I Ihaveteadthchaz>ndatta materials rcquir nunJar Ch;q,mr 495 of the Culi- AIR CONDITIONER famia Depth&Safey Cale,Scnians 25505, 5 11d 25534.1 understand Ina if thr. ISSUANCE DATE taildie snomuramly hvvee¢n Lthan renrymsihilityto nntifytheeccnpant NEW k15IDFN11A1.M[CII. SQIT. ndecoomro enswhich it cam lion onceof a Ccnifcal,of Occupancy. Ownernr prizeon- O Dane TOTAL: ISSUED BY: OFFICE 1