9909157APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY S
CITY OF CUPERTINO Bull - EI,ECrRICAL PERMIT NO,p��
x1ID.DINC, DIVISION APPLICATIONITIERMI'1' PLUMBING -ME...... lcAl. Q6LLll��
OFFICE
LA0 3 ST'EU4F)J_!t CaZUIC 9W10 C G
918-Q
NES NAME PHONE: CONTRACT OR'S NAME : LIC NO:
2YM/-)Or£ 5�
fC111TIiCf/EN
NIC
❑
CON(T`•/R/OLtt
IS
GINBER: PJC NO. ADURS:
( W f
YTA(.T: PHO E:
60116 Z101� ❑ Consultant Fees Paid by Applicant(Initial)
<oTo-2-Lz- 39 X
BUILUINC PERMIT INPO
BLD ELECT PLUMB MECH
Z— fir C3'
�Z
FCU
QUU
NQ 6
(_may
Z CZ � Z
O—�
F�F'LLI
C C Q
CUTU
m
F u'Oa
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W CO0
5. 6 C
wo
20
iS�
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t13..
LICENSED CONT'RACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I hereby from that 1 an Tressed ander provilier, of chapter 9 (commencing
with Sard 100)of Division 3ofthe Business and Prnfevvions Code, tool my license is
I'Ii12Ml'1' ISSUANCIi
in a force anal.
License Class _.�—LicaAPPLIANCES—RESIDENTIAL
bo, Contra, ^
JOB DESCRIPTION
RESIDENTIAL'
❑ SFDWL ❑KITCHEN REMODEL
[]ADDITION❑PLUMBING RE -PIPE
❑ MULTI UNIT ❑STRUCTURAL
MODIFICATION
❑INTERIOR [I CHIMNEY REPAIR
IMPROVEMENT C]SWIMMING POOLS
❑ BATH REMODEUREPAIR [I DEMOLITION
ARCHITECTS DECLARATION`�- pANf71S
1 understood neon plans shall he uWin records
UP 10 2g) AMPS
L¢cnseJ Professional 201-1000AMPS
OWNER-RUILDER DECLARATION OVER 1000AMP5
I hereby afro Thal I am exempt from the Connector's License law for the
following mason. (Section 1031.5. Business and Professions Cade: Any city or county SIGNS ELECTRICAL❑OTHER
which nquim, u pcnnil to conclmcl, inter, improve, dcmolisb, or repair any simulate
panorm its issuance, also requires the applicant fnrsuch lnrmit In file a signed nammenlSI'IiCIAI.CIRCUIT/MISC.
mal he is licensed pursuant it) the provisions of the Comecmr's License Law (Chapter 9
of Division 3 of the Business and Proions Cma)or TEMP METER OR POLE INST.
(commencing with Sea 70010 fess
that he is exempt therefrmn and the basis for the alleged exemption. Any violation of
Section 703 1.5 by unY applicant fora pcnnil, subjects the applicant mocivil penalty of POWER DEVICES
not more. man five hunted dollars 1)50X).
❑ I, as owner of me progeny. or mY anpinyces with wages as Meir tole compensation. SWIMMING POOL T:LE RIC
will Jo the work, and the smeture is not intended ororteed for sale (Sec. Bush...
and Pmfessme, Cod,: The Contractors License Law does not apply to an owner of OUf1.ET5—SwITCft[S—FlX'fUHI!
who builds or improves themen, and who does such work himselfor through
COMMERCIAL:
�NF;yG.RLDG/ADDITION ❑ DEMOLITION
/
NANT ❑ FOOD SERVICE
IMPROVEMENT
DTHER
property
his own enployccc, p000red mal such intprovcum,, ore not intended or afford for NEW RESIDER IAL ELECTR
sale .11;hisses, IM1e building. improvemmelo urld wahmeary—of completion. the
SQ. FT. FLOOR AREA
$/SQ. PP.
err -builder will have the burden of proving that he did nal build or improve for put "
,pose of ale.).
t3,6 -war, of the am a contacting with licensedTTC correct, to TOTAL:
the
/ /} y O
i
Sec. 704,
,norm( the pnsawt (Sec. oar Business and Py who hu Code:) She Connaccors Li
r p irmssv and
ee Lnw Atm not apply Iran owneral pral'eny who Fuilds.. thncan.oml QTY. PLU EIiMIT PP.E
//
one,a) the
wM1u enmecla for such projects wim u rnnnunor(,c) limnmd pursuum m the Cnnaaetor'x
License law. PERMIT ISSUANCE
EJ I um exempt under Sce. . B & P C for his reams
VALUATION
ALTER — DRAIN&VENT — WATERT A)
Date
WORKERSCOMPENSATIONDECLARATION BACK hLON'PH61'IiCT DEVICE
on
hereby afOms under pcnahy n, ofCon one of the fallowing doclaWorket Coo
have and will maintaina Cenihca0 of Ce Labor Ced, for the Workers Compcn- DRAINS—FLOOR. R(wF. AREA. GOND.
workas provided for by Section PINI of the Labor Ctde, for the performance of IM1e
It,, which this permit is issued. FIX TURFS —PER TRAP
gTQ S
'TYPE CONSTRUCTION
I Ilam to d will nmintoin Winkel, Contpcnsatlon Insurance ux rcynin•J by Section
Our o1 the labor Cale, lot The perfom+ant, of me work for which this pknon is issued. GAS—EA. SYSTEM -I INCA DOMETS
OCC. GROUP
APN
My Workers Compensation Brarence carrier and Policy number arc:
Camey. Policy No.: GAS — EA. SYSTEM OVER 4 (EA)
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE%INDUSTHf. WASTE IN'I'IiRCIiPI'OR
COMPENSAfI(lN INSl1RANCE
BUILDING DIVISION FRES
(I his section need not be completed lithe pennh is lis one hundred dollars 611X) GREASETRAP
or Icss.l
PLANCHIiCK FEE
0Z,
z C)
=
>Tonne
Q
Oz
U 0
F-'
0 U
}
y
�rncorrect.
U,Z,
I cenify lcac imhe performancesf the work for which This permit is issued, Isha11 SEWER—SANITARY—STORM EA. 201 FT.
not employ any person in any manner sat as nr become subject to the Workers' Campeau
station Laws of Californlu Date WATER BEATER W/VEN'VELFCTR
Applicant
ENERGY FEE
GRADING FEE
NDDCE TO APPLICANT': If, utter making Ibis Cenilic:ne of Exemption. You .should WATER S1'STENVI'BEATING
subject to the Workers Compensation provisions of she LaMn Core. you must
fonhwich comply with such previsions or this pcnnil shall be deemed revoked. WATER SERVICE
CONSTRUC'T'ION
ection [i AGENCY NEW HIiSIDENI'IALI'LMN. SQ Ell
thereby oflirm thanhere is ueonawninn landing agency for the perfiirmonee nl
the work for which this Mrmit is issued (Sm. 3091, Civ. C.) I
Lendef,Name
SOILS PEE:
..
til to � p
PAIDIl Dam �—'Receiptp n
j I I
/ I„
;.1
Lender's Adireo TOTAL:
B DING FEE
I certify that I hall, mail this appliralion and state that he shove informaunn is
I agree to canPly with an chynnil «ncryonrmraces and sum Inw, rdadng w QTY. MECHANICAL PERMIT FEE
is city toenter upon e
baildingcousaucdon, and hereby mahorim representatives ofthh
aMvonmmiottW pmpeny for im,rl a Purposes. PERMIT' ISSUANCE
(We) agree m save, indemnify, and keep harmless the City of Cupcnirm against
S ISMIC PEE
_
PLUMBING PEE
liabilities ,judgments.mats and espunacs which may i puny way accuse against said City ALI17R OR ADDI0 MECH.
in r,equcnce of Ora granting ofthis lannut.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT AIR HANDLING LINECIO 10,000 CFM)
MECHANICAL FEE
SOURCE REGULIU IONS.
CONSTRUCTION TAX
AIR HANDLING UNIT (OVER I it" CFM)
'ane nrApplicunt/Conteear Date EXIIAUSTHOOD(W/i
HOUSING MITIGATION PEE
HAZARDOUS MAIERIALS DISCLOSURE
8511 the applirae «(umre building «rupml one or handle harardous material IIEAI ING UNIT (10 1(0.10X1 BE U)
as defined by the Capenino Municipal Code. Chapter 9.12, and the Hwlth and Safety
Cole. Section 255320d? — HEATING UNIT'(OVF,R 100.000 B' TO)
❑Yes ❑Nu VENTILATION PAN (SINGLE RISID)
PAID Datc Receipts
Will the applicant or future building «sopor um equiploa t or devices which
riders air mnemalso,, as defined by the Bay Arca Air Quality Management BOILER —COME' (3HP OR 100,000 BTU)
TOTAL:
^+
t
I BOILER — COMP (OVER 100.010 TITLE
t Yes ❑ 'No
I lam rend he hamdous eternal, re is under Chu ncr 0,95 of the Cali- AIN CONDITI(INITN
forma M533; 8534. I remmrh that if the NEW RIiSIDEMIAI, h11iCH. SQ. PT.
Seciinns 25505, ,toy
rr Safra
ou
ISSUANCE DATE
—
8undindisei l It in. to
buildingoin, urentlyh nuns. mac it ism.
1-2-o0
ce If. entytonotifylhaoccy.
of cite rc9uirc ca whi ton 'nnuissunnce olaCenificam of(kcup:I«y.
ISSUED BY:
\C or uuthaneNag� Date TOTAL:
OFFICE
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY S
CITY OF CUPERTINO Bull - EI,ECrRICAL PERMIT NO,p��
x1ID.DINC, DIVISION APPLICATIONITIERMI'1' PLUMBING -ME...... lcAl. Q6LLll��
OFFICE
LA0 3 ST'EU4F)J_!t CaZUIC 9W10 C G
918-Q
NES NAME PHONE: CONTRACT OR'S NAME : LIC NO:
2YM/-)Or£ 5�
fC111TIiCf/EN
NIC
❑
CON(T`•/R/OLtt
IS
GINBER: PJC NO. ADURS:
( W f
YTA(.T: PHO E:
60116 Z101� ❑ Consultant Fees Paid by Applicant(Initial)
<oTo-2-Lz- 39 X
BUILUINC PERMIT INPO
BLD ELECT PLUMB MECH
Z— fir C3'
xZ
�
QUU
NQ 6
(_may
Z CZ � Z
O—�
F�F'LLI
C C Q
CUTU
m
F u'Oa
��}•]
W CO0
5. 6 C
wo
20
iS�
F
W— w
t13..
LICENSED CONT'RACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I hereby from that 1 an Tressed ander provilier, of chapter 9 (commencing
with Sard 1)of Division 3ofthe Business and Prnfevvions Code, tool my license is
I'Ii12Ml'1' ISISSUANCEFU00
infullanal.
License Class _.�—Lica APPLIANCES—RESIDENTIAL
bo, Contra, ^
JOB DESCRIPTION
RESIDENTIAL'
❑SFDWL ❑KITCHEN REMODEL
[]ADDITION❑PLUMBING RE -PIPE
❑ MULTI UNIT ❑STRUCTURAL
MODIFICATION
❑INTERIOR [I CHIMNEY REPAIR
IMPROVEMENT C]SWIMMING POOLS
❑ BATH REMODEUREPAIR [I DEMOLITION
ARCHITECTS DECLARATION`�- pANf71S
1 understood neon plans shall he uWin records
UP 10 2g) AMPS
L¢cnseJ Professional 201-1000AMPS
OWNER-RUILDER DECLARATION OVER 1000AMP5
I hereby afro Thal I am exempt from the Connector's License law for the
following mason. (Section 1031.5. Business and Professions Cade: Any city or county SIGNS ELECTRICAL❑OTHER
which nquim, u pcnnil to conclmcl, inter, improve, dcmolisb, or repair any simulate
panorm its issuance, also requires the applicant fnrsuch lnrmit In file a signed nammenlSI'IiCIAI.CIRCUIT/MISC.
mal he is licensed pursuant it) the provisions of the Comecmr's License Law (Chapter 9
of Division 3 of the Business and Proions Cma)or TEMP METER OR POLE INST.
(commencing with Sea 70010 fess
that he is exempt therefrmn and the basis for the alleged exemption. Any violation of
Section 703 1.5 by unY applicant fora pcnnil, subjects the applicant mocivil penalty of POWER DEVICES
not more. man five hunted dollars 1)50X).
❑ I, as owner of me progeny. or mY anpinyces with wages as Meir tole compensation. SWIMMING POOL T:LE RIC
will Jo the work, and the smeture is not intended ororteed for sale (Sec. Bush...
and Pmfessme, Cod,: The Contractors License Law does not apply to an owner of OUf1.ET5—SwITCft[S—FlX'fUHI!
who builds or improves themen, and who does such work himselfor through
COMMERCIAL:
�NF;yG.RLDG/ADDITION ❑ DEMOLITION
/
NANT ❑ FOOD SERVICE
IMPROVEMENT
DTHER
property
his own enployccc, p000red mal such intprovcum,, ore not intended or afford for NEW RESIDER IAL ELECTR
sale .11;hisses, IM1e building. improvemmelo urld wahmeary—of completion. the
SQ. FT. FLOOR AREA
$/SQ. PP.
err -builder will have the burden of proving that he did nal build or improve for put "
,pose of ale.).
t3,6 -war, of the am a contacting with licensedTTC correct, to TOTAL:
the
/ /} y O
i
Sec. 704,
,norm( the pnsawt (Sec. oar Business and Py who hu Code:) She Connaccors Li
r p irmssv and
ee Lnw Atm not apply Iran owneral pral'eny who Fuilds.. thncan.oml QTY. PLU EIiMIT PP.E
//
one,a) the
wM1u enmecla for such projects wim u rnnnunor(,c) limnmd pursuum m the Cnnaaetor'x
License law. PERMIT ISSUANCE
EJ I um exempt under Sce. . B & P C for his reams
VALUATION
ALTER — DRAIN&VENT — WATERT A)
Date
WORKERSCOMPENSATIONDECLARATION BACK hLON'PH61'IiCT DEVICE
on
hereby afOms under pcnahy n, ofCon one of the fallowing doclaWorket Coo
have and will maintaina Cenihca0 of Ce Labor Ced, for the Workers Compcn- DRAINS—FLOOR. R(wF. AREA. GOND.
workas provided for by Section PINI of the Labor Ctde, for the performance of IM1e
It,, which this permit is issued. FIX TURFS —PER TRAP
gTQ S
'TYPE CONSTRUCTION
I Ilam to d will nmintoin Winkel, Contpcnsatlon Insurance ux rcynin•J by Section
Our o1 the labor Cale, lot The perfom+ant, of me work for which this pknon is issued. GAS—EA. SYSTEM -I INCA DOMETS
OCC. GROUP
APN
My Workers Compensation Brarence carrier and Policy number arc:
Camey. Policy No.: GAS — EA. SYSTEM OVER 4 (EA)
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE%INDUSTHf. WASTE IN'I'IiRCIiPI'OR
COMPENSAfI(lN INSl1RANCE
BUILDING DIVISION FRES
(I his section need not be completed lithe pennh is lis one hundred dollars 611X) GREASETRAP
or Icss.l
PLANCHIiCK FEE
0Z,
z C)
=
>Tonne
Q
Oz
U 0
F-'
0 U
}
y
�rncorrect.
U,Z,
I cenify lcac imhe performancesf the work for which This permit is issued, Isha11 SEWER—SANITARY—STORM EA. 201 FT.
not employ any person in any manner sat as nr become subject to the Workers' Campeau
station Laws of Californlu Date WATER BEATER W/VEN'VELFCTR
Applicant
ENERGY FEE
GRADING FEE
NDDCE TO APPLICANT': If, utter making Ibis Cenilic:ne of Exemption. You .should WATER S1'STENVI'BEATING
subject to the Workers Compensation provisions of she LaMn Core. you must
fonhwich comply with such previsions or this pcnnil shall be deemed revoked. WATER SERVICE
CONSTRUC'T'ION
ection [i AGENCY NEW HIiSIDENI'IALI'LMN. SQ Ell
thereby oflirm thanhere is ueonawninn landing agency for the perfiirmonee nl
the work for which this Mrmit is issued (Sm. 3091, Civ. C.) I
Lendef,Name
SOILS PEE:
..
til to � p
PAIDIl Dam �—'Receiptp n
j I I
/ I„
;.1
Lender's Adireo TOTAL:
B DING FEE
I certify that I hall, mail this appliralion and state that he shove informaunn is
I agree to canPly with an chynnil «ncryonrmraces and sum Inw, rdadng w QTY. MECHANICAL PERMIT FEE
is city toenter upon e
baildingcousaucdon, and hereby mahorim representatives ofthh
aMvonmmiottW pmpeny for im,rl a Purposes. PERMIT' ISSUANCE
(We) agree m save, indemnify, and keep harmless the City of Cupcnirm against
S ISMIC PEE
_
PLUMBING PEE
liabilities ,judgments.mats and espunacs which may i puny way accuse against said City ALI17R OR ADDI0 MECH.
in r,equcnce of Ora granting ofthis lannut.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT AIR HANDLING LINECIO 10,000 CFM)
MECHANICAL FEE
SOURCE REGULIU IONS.
CONSTRUCTION TAX
AIR HANDLING UNIT (OVER I it" CFM)
'ane nrApplicunt/Conteear Date EXIIAUSTHOOD(W/i
HOUSING MITIGATION PEE
HAZARDOUS MAIERIALS DISCLOSURE
8511 the applirae «(umre building «rupml one or handle harardous material IIEAI ING UNIT (10 1(0.10X1 BE U)
as defined by the Capenino Municipal Code. Chapter 9.12, and the Hwlth and Safety
Cole. Section 255320d? — HEATING UNIT'(OVF,R 100.000 B' TO)
❑Yes ❑Nu VENTILATION PAN (SINGLE RISID)
PAID Datc Receipt if
Will the applicant or future building «sopor um equiploa t or devices which
riders air mnemalso,, as defined by the Bay Arca Air Quality Management BOILER —COME' (3HP OR 100,000 BTU)
TOTAL:
^+
t
I BOILER — COMP (OVER 100.010 TITLE
t Yes ❑ 'No
I lam rend he hamdous eternal, re is under Chu ncr 0,95 of the Cali- AIN CONDITI(INITN
forma M533; 8534. I remmrh that if the NEW RIiSIDEMIAI, h11iCH. SQ. PT.
Seciinns 25505, ,toy
rr Safra
ou
ISSUANCE DATE
—
8undindisei l It in. to
buildingoin, urentlyh nuns. mac it ism.
1-2-o0
ce If. entytonotifylhaoccy.
of cite rc9uirc ca whi ton 'nnuissunnce olaCenificam of(kcup:I«y.
ISSUED BY:
\C or uuthaneNag� Date TOTAL:
OFFICE