S 0562 APPLICANTTOWILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL. PERMIT NO,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL S 0562
- BUII,DINO I'ROJE(,'P ii)FN,rIEICATION
BUILDING ADDRESS: SANITARY NO APPLICATION SUBMI"ITAL DATE
065 A-my-Ie-d
HRS
,'S NAME.: PHONE.: CO kAC'fOk'S N)M., I ^LIC NOU
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'733 7 9 8 ^� d.lc(� L 9 NIC CONTROI.p
ARCHITECT/ENGINEER; LIC NO: ADDR.Q / S• LMN-Ani �� . ❑
L
' CONTACT: PHONE. ILDING PERMIT INFO
❑ Consultant Pres Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
❑ ❑ K_ ❑
LICENSED CONT'RACTOR'S DECLARATION QTY. ELECTRIC P17RMIT FEE
I hereby affirm tat i,mmmd
rI am licensed order IF of chapter 9(eoenn, .JOB DESCRIPTION
al'Z whh Sembm]PMpaf Divi,l.n3mffw lhninessmm rmfeas;.ns Gale,snots Atli lleenso is RESfDP,NTIAI:
00 in full Onto antl effect, PHRMITISSUANCE
=�UF License Class Lit.N CSFDWL CKITCHIiN REMODEL
bIZ Dale Contractor APPLIANCES—RESIDENTIAL. ❑ADDITION BPT MBING RF.-PIPE
ARCHITF.CI'S DECLARATION ❑MULTI-UNIT CSTRUC'1URAL
Ir O y PANELS
Z b V` I undin,mad my plans shall he used as public records MODIFICATION
OZ4O UP 10200 AMPS ❑INTERIOR (2 CHIMNEY REPAIR
Licensed l4nfcssinnal 201-1050AMPS IMPROVEMENT E]SWISIMING POOLS
OWNER-BUILDER DECLARATION OVER)"AMPS C BATH REMODEIIREPAIR CDEMOLITION
C Q I hereby affirm that 1 am interrupt from the Cnnlmcml.c Licence Law for the
O y U following reason.(See ion 7031.5,Ensues,and Professor.,Code:Any city or county SIGNS ELECTRICAL C OTHER
which reunions a permit to construct,alter,improve,demolish,or repair any stuactnrc
N..1 prior to its issuance,also requires the applicant for such Permit to file a signed statement SPECIAL CIRCIRTIMISC.
that he is licensed pursuant o to provisions of the Connector's License Law(Chapter 9
fcnmmendng wit Section]1100)of Division 3 f,he Business and Pmfessi...Cnde)m TIMI'.MISTER OR POLE INS'll COMMERCIAL:
a e W
that he is exempt therefrom and the Insis for the alleged exception.Any vinletion of NI3W BLDG/ADDITION DIiMOLI'I'ION
W Section]031.5 by Any applicant it suhjecl,the applicant n civil penally of POWER DEVICES
roN C'IIiNANT FOOD SERVICE
F�Q>> not more than Eva hundred dollars 1 'ROVEMENT
Cl,mownerof the pnoPeny,lir my employees wit wages as thcirsole compensation, SWIMMING PO(II.ELECTRIC
O will drlhework,and thestecnre isnot intendedocofferedforsale lSec.]PFLIm%iness THEE
W end Pnofcssions Crede:The Conlenm's Licemc Law does not apply to an nwncr,of OUTLETS—SWI'T'CHES—FIX'I'ORES
property who builds or intpmvcs therein,and who does such work himself or through
his own employees,provided that such improvements are not mended or offered far N17W RESIDEN'I']AL ELECT R Sp FI'.
sale.If,however the building or inaproventent is sold within one year ofcomplenion.the SQ.Fr.FLOOR AREA $ISQ.IT.
owneo-huilder will have the burden of Proving that he did nm hai)d aro improve for pur-
pat,of sole.).
C 1,us owner of the propertY,am exclusively connecting with licensed contractors m TOTAL:
onawa the project(Sea.70144,Business end Professions C.dc)'Me Contractor's Li. - i
cense Low does not apply no an owner ofpmNny who builds or improves thereon,and QTY, PI,UMBINGPERMIT FEE
Who contracts for such pmjeets with a atmeamD)Licensed personal u the Commcmr's
License law. PERMIT ISSUANCE A
C lean exempt under Sec. ,B&1'C for this mama
Owner Dam - AUITR—DRAIN&VENT—WATER(EA) �.ygLUAI'ION
WOR KER'S COMPENSATION DECLARATION RACK FLOW PROTECT.DEVICE {//V///�I/awl►��
I hereby anion under penalty.f ry perjuone ofthe f.11mving declarations:
❑I have and will maintain a Cinificale of Consenno self-insrre for Worker's Camper- DRAINS—II.00R.ROOF,ARIIA,COND. ST >,�/),. S RUC'T'ION
.sation,as provided for by Section 3]1X1 of the Lakin Colo,for the perforate,of the `
work lin which this permit is issued. FIXTURES—PIER TRAP `UH Y
C 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 ofthe Labor Cale,for are performance ofthe work for which this pcmdl is issued. GAS—EA.SYS TEM-L INC.4 OUTLETS OCC.CROUP AVIS
MYW4 's en.calon �Vamtteeca fintnyNt.rpO[�'92S ens_.
EA.SY$'I'EM-OVER 4(13A)
CERTIFICATEOPEXI. PTION FROM WORKERS'
COMPENSATION INSURANCE GREASEANDUST'RL WASTE INTERCEPTOR
II1111.DING DIVISION FEES
('ITissstion Aced not be completed ifthe pcmoin is for one hundrtJd.11ars(SltMl) GRIiASE TRAP
or less) PLANCHECK Id'eli
I.y any tnlln@e saymaancenfdle 111.become
for subjech ct(11
perthe nt is WokersCl.Ishall SHWFR—SANITARY—STORMHA.2(10 PC.
nm employ any person in unY manner.cn use Mecntne suhiectan the Wurkcn'Cnrnpcm - ENERGY FEE
zz sation Laws of California Date WATER HEATER WNENT/F.I.ECTR
O Applicam a GRADING FEE
lin NOTICE TO APPLICANT:If,after making this Certificate of Enemption,You should WASTER SYSTEM/1 BEATING
abecame atect to the Workers Compensation pnwisinm of to Labor Code.Yon moil SOILS FEE
{>a forthwith comply with such provisions or this pencil shall he devoted revoked. WAIFR SERVICE
Q
5zCONSTRUCTION LENDINGAGENCY NEW RESIDEMI'IAL PLMB, SQ.Ff. PAID
C.)O winds
which tmtha0here is.constructionlen ding agency for the performance of Dam kes 'pN
Hthe Underrk for which this.permin is issued(Sec.309],Civ.CJ
Q Leadin,Nnme '(1'1'A L:
W IenJar'I Address T(YTnI.:
I certify the I have read this application and tome ohm the about inf.rmurion is BUILDING :I
N correct.l agree to comply with all city and county ordinances andaic laws Iran,to QTY MECHANICAL PERMIT FRE
L) z Inildinge...auction.and hetebyaufhorize represen,mives ofthis city,.w,', u,,,,, SEISMIC
ahnvt.memioncd peps"for inpec,ion purposes. PERMIT ISSUANCE(We)agree m save,indenmify and keep hnrndcs the City nl Cupertino against Iil,liC'1'
Rif
P
IiaM1ilities,judgments,costs and espen<ve which may in any way acrnc�g�inst wiA City AurERORADDT'OMECH.
M oscri yucnceofthe gemingofthis Pc tit. PLUMBING-4i
APPLICANT UNDERS 5ND5 A ' IL OM WITH ALL.NON-POINT AIR HANDLING UNIT(TO 10,1X0 CITI) MIiCIIANICAL iC
URCE RE ATI 5.
B !((� AIR I IANDLING UNI'P(OVHR 10.000 CFMI CONS'I'RUCTI N'I'AX
Signa ppli nUContecmr ` 77 Dam EXHAUST HOOD(WIDUC) HOUSING htITIG, ON tEB
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant Gore or handle hazardous material HEATING UNIT'('rO 1ahoon BTU)
;is defined by the Cupertino Municipal Code,Chapter 0.12,and the Ilculnh and Safety
Code,Section 25532m)? 1 EATING UNIT(OVER 100,000 BTU)
CYu Fl No VENTILATION PAN SINGLE RISID) PAID
Doc R tip N
Will the applicant.ream,a building occupant areea Airantnrdeviceswhich BOILER—COMP(3HP OR 100,000 RTU)
mit iha ce? nus air nmmminams us AdinW by the 13oy Area Air Quality Managctn°nth 'I'01'AL:
DimddP
C yes Fl No NOILER—COMP(OVER 100.1X0 BTU)
I have read rhe Innate,materials fix fic:mmm under Chapter 6.95ofthc Cali- AIR CONDITIONER ISSUANCE DATE
foein Health&Safety Code,Sections 25505,25533 and 25534.1 undeamnd that if the N 11 RESIDEN'I'IN,MECI T. SQ.FI'.
building dor,not currently have a event,that it is my re,prnsibil try In and ly(lie.txui and
of the requirements which must be met prior to issuance of a Cenlficam of Occupancy.
Owner or authorized agent Data I I TO'T'AL: ISSUED BY:
OFFICE