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S3988 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPESRTINO BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATION/PFRMIT PLUMBING-MECHANICAL. S 3988 Q .BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: Q -3 (� LT� _- SANITARY NO. APPLICATIONE.. AT/ SUBMITTAL DAT /V c-A I s"Y�! Cs� /J-Qf ' / CORATOLIC NO:M NIC CONTROLNL-.F--t rAT{_«a1e Lr AW0_ ARCHITECT/ENGINEER: LICNO: ADDRESS: r gLV ❑ c'L T O CONTACT: PHONE: BUILDING PERMIT INFO', ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH LICENSED CONTRACTORS DECLARATION ❑ ❑ ❑ I hewh farm that 1 I rued t. J n s : (chapter 9(comma QTY. ELECTRIC PERMIT EEE y aeis - JOB DESCRIPTION LLOZO with Section ndefec Di -onJ,UM1C Business and Professions Code-and my license is PERMIT ISSUANCE RESIDENTIAL: F� L enserto, effect. USEDWL [I KITCHEN REMODEL U F License Clasn Lic.# 6 V - gPl'hIANCES-RLSIDENI'IAL - ❑ADDITION L1 PLUMBING RE-PIPE unG i Dae ARCHITECTS Tton S DDEECLARATION ❑MULTI-UNIT ❑STRUCTURAL O Z Z I unders,nnd my plans shall be uvcJ us public records PANELS MODIFICATION UP TO 200 AMPS OINTERIOR ❑CHIMNEY REPAIR F W Licensed Profeaioaal 201.1000AMPS IMPROVEMENT O SWIM NII NG POOLS CYC; OWNER BUILDER DECLARA'I"ION OVER I(gIlAMPS UBATH REMODEUR AIP j UhiMOLI'1'[ON a a¢ 1 hereby all,.that 1 am exempt from the Contractor's License I.aw(or the Wx :W U Initialing reason.(Section 7031 S.Bovines,and Profe,,ani,Cade:Any city or county SIGNS ELECTRICAL ol 00THER LLp y which requires a pemtit to construct,xtotr impeve,dent mlim,nT repair any straclare 17 Q] prionit)t vanc<al',requiresNe applicant fh permit tofile a signedslammem sPEC1Al.CIRCUIT/MISC. } Nath licensedp a u Ih p s of the C t i r'sLicense Law(Chap.,9 ay.Q� Rmthennng with Section 7M))efD'v':on30 the Ba.'nena and lrol'.:'mz Coda)or TEMP.METER OR POLE DIST. COMMERCIAL: u _a0 a a c a, that he is exempt therefrom and the basis for the alleged exemption.Any violation ofEW BLDG/ADDITION 0 DEMOLITION m Section 9031.5 by any.,heirm for.penal suhlcas the applica ,to a civil penally of POWER DEVICFS TENANT 0 FOOD SERVICE I ore than live hundred dollars(S500). F_Z} OTHER Eh1EN'1' Sa Lothe work,thepe oractor myemntendedwiNered fosale(Se.compensiness SWIMMING POOL ELECTRIC to will dothewmk,and thehe Comlznori License Law dos notapply town Business 00THER tail-w and I'mfecsion..Code:The Commmor'z License Law Jncs ria apply m an owner of OUTLETS-SWITCIIES-FlXTURIiS 13_ propcny who builds or imprmct thereon,and who does such work himself or through his awn employee,S provided that tach improvements are not intended nn offered far NEW RESIDENTIAL ELECTR SQ FT. sale.If,however the building in ins,owemmrt k mId withinmu,.,ofemopletm.,the SQ.FI'.FLOOR AREA 5/SQ.FT owner-builder will have the burden of placing that he did not build or impmve for pur- puceot',ulc.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to DUAL: construct be pence,(Sec.7814.Business and Pmfessiom Codc:)The Contractors Li- ,c law does not apply to an owner of property who builds or improves cocoon,and QTY. PLUMBING PERMITFEF. uh,enntracts for such Project with a mmri ctar(s)licensed pursuant o be Contractor s License law. PERMIT ISSUANCE r ❑ lam ex ,pt .R&PCfor thin •axon ALTER-DRAIN k VENT-WATER(EA) VALUATION at f. Date WORK :S COMPI?NSATION DECI,ARATION BACK FLOW PROTECT.DEVICE e I hereby affirm under Penalty of perjury one of the following declarations • 01M1arc onJ will maimain aCanifica,e of ConsemmsdGinsure for Workers Compen- DRAINS-FLOOR,ROOF.AREA.GOND. STORIES TYPECONSTRUCTION sailor,as invaded to,by Section 3700of the IahorCn It,for me perboneor,of Nc work for which this Permit Isis.cued. FIX'1"ORES-PHR'IBAP 0 1 has,and will indam n Workers Compensaion lion ran..as recleaned by Section 4/11 ILS 0 3700411he LnhorGale,bnmeperformace oflhe work l'orwhich this prom„,issued. GAS-EA.SYSTEM-1 INC.4 OUTLETS OCG.GROUP APE My Worker',Compensation insurance,arcaand Policyn... mao, Cartier: Policy No.: GAS-EA.SYSTEM OVER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASEANDUSTRI,WASTE INTERCEPTOR BUILDING DIVISION PEES (This action need not be completed ifthe permit is(alone handled dollars(S 100) GREASETRAP or Ie.cv,) PLANCHECK FE I certify that inthe poforinane,offie work far which this permit is issued,I shall y� 0 not employ any person in any manner so alto become suhjecno,M1e Workers'Cnmpn- SEWER-SANITARY-STORM EA. FT. ENERGY FEE O Z action Law,of California.Date WATER HEATER W/VENT/ELECTR © (� Z O Applicant GRADING PIai H NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SYSTEMORGTING a , ballme ti b co e the Worker,Comltennanon p iliki.mv,of,he Lvlwr Cures you must SOILS FEE fcnhwiihcomplywith wch pr..Won,in this lvarstshrill be deensedrevokcd. W'A'FER S17RVICE 0. A CONRIROCTI(INLENDING AGENCY NEW RESIDENTIAL PLMII. SQ.FT PAID rel Z Uum Reaip,M U O 1 for which the,mere is sued(Sec,ion Ie-„dons xgencY for the performance of HNework for whirA Nis peed,is issued(Sec,3097.civ.C.) Lender,Numc DO TOTALLLI Lender's Address I certify Na 1 have read mis application and sem bribe above information is BUILDING FEE A correct.I agree m comply wib illi cil,and county ordinances and state laws relating to QTY MECHANICAL PERMIT PEE 1..) Z building cun.uruetion.and hereby aumori.<repne¢nulivec of tris eity,o anerupmthe SEISMI tE' above-mentioned property for inspection purposes. PIiRMIT ISSUANCE, (We)agree to save,indemnify and keep hnrmlees the Coy of Coma o against ELECTRI Iiabililicx,juJgments.costs dna expenses which may in any way accrue against saiJCiry' ALTER OR ADD'TO MECH. D0 inconseyurncc ofth ami gofthi,prmu, PLUMBI FEE APPL1 \NT RS' DS AND WIL DMPLY WITH ALL NON-POINT AIR IIANIl1.ING 11NIT(TO IgfN1t1 CPM) MF,CII CALFEE SOU 'RF 'jAT} �Q AIR HANDLING UNIT(OVER 10,000CFM) CONSTRU ION TAX Signature al Applwam/ door Ef a EXHAUST HOOD(W DUCU HOUSING MITIGATION FEE HA RI US MATERIALS DISCLOSURE Willthe appli,ear nr teen buildingoccupento c handle locations materiel HEATING UNIT U 0100.(100 BTU) as defined by the Cupnino Municipal Code,Chapter 9.12,and the Henbh and Safety Code.Section 25532(x)^ HEATING UNIT(OVER 100.000 BTU) ❑Yes C3 No V EN'I'ILA'DONFAN(SINGLBRF,SID) PAID - applicant or fuwm building t or devices which Date- Raeip,# Will he a pp g oceopayser.Ail en BOILER-COME QHP OR 100.000 BTU) emit M1mnrdnuz air cnnmm;nunts as JeBnW 6y be Hay Arev Ail Quvlity ManagementTOTAL: District, BOILER-COMP(OVER 100.”BTU) OYc, UNo AIR CONDI I'ION lilt I have read the Code, u,memdul5 5.25533 a under Ckapmr,6.95 of Ne-Ceti- ISSUANCE DATE ,r fomia Health&Safety Code,smions 25505.25533 dna 25531 I uWcrs,aW Nat Kill, NEW RFSIUF.NTIAL MECH. SQ.FT. fia11JIn• t no, ur ally cntenumyylhxt I my yxsnzibillrymnoify the rccup nt o arm , w ' abeme,pnbnoixv chfu Cenifiev,e oro ypy�� (d/ Lo—ed agent Dute Tarn1: ISSUED BY: OFFICE