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S 1736
AP%LICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING.-ELECTRICAL PEIS{\iyI r NO BUIMi)ING DIW510N APPLICATIONWERMIT TING PRojFcT n MECHANICAL V 1736 BUILDING 1'RO,IECT IDISNI'IN'ICATION BUILDING ADDRESS: SANITARY NO, APPLICATION SUBMI'I.1'AL DA'I'li 1AM0 96W# X k4t.4 0440e / OWNER'S NAME - L, .�PHUNE: CONTRACTOR'S NAME: LCNL. CONTR 11,# \R HI"fECT/E GINP 2: LIC NO: ADDRESS: ❑ �© a- VVa CO TACT ♦♦♦ PHONE: „r,/�.� BUILDING PERMIT INFO Wj /d 1:1A. 5'1. ace�altd��y Applicant motel) IT ELECT �PLUMB MIiCH Er LICENSED CONTRACTOR'S DECLARAIM QTY ELECTRIC PERMIT FEE 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION DMZ with Section 7000)of Division 3 offleBusiness and Professions and my license is RESIDENTIAL; 41 O O PERMIT ISSUANCE. F in full fofce and e L ❑SFDWI. ❑KITCHEN REMODEL �U� icon Cls Lic.# 3�2�I� AI'PLIANCIiS-RESIDI?NTIAI. ❑ADDITION [IPLUMBING Bit PIPE rF oroContractor OLad irmDaS) ❑MULTI-UNIT ❑STRUCTURAL. t•O ARCHI'ECTS DECLARATION S MODIFICATION I understand my plans.chill be used as public renxdx - OZ-0 P'DO 2,011%, El INTERIOR ❑CHIMNEY REPAIR �,�1qq"'Iy Licensed Professional I> 201-100X1 PS IMPROVEMENT E]SWIMMING POOLS OWNF. . UILDERD All se (101y� MPS ❑BATH REMODF,UREPAIR El DEMOLITION C 6 a ' 1 hereby affirm that 1 ai x ram t atom �'O G U following reason.(Section]1131. and cion oy ci w mY IGNS EI. RIC ❑OTHCN x 413 LL rn which requires a permit to cons L ahef,simp , smolt mr repair s mm �yI 0< prior to its issuance,also requires ,applicant re sfileasign amt ent ppalE MISC. W}`a that he is licensed pursuant to f Cant were La hop er9 �p0 (commencing with Section 70N)) rvtston3 nftbe BusinCrofessions Cod,)nr E PMRTERO O,. ,NST. a q m ohm he is exempt therefrom and the basis for the alleged n.Any vi tat n of HW BLDG DDITIO ❑UIiMOLITION X Section]031.5 by any applicum fmapennit suhjeceuheeicil pe ed P ❑TENANT ❑FOODSERVICE,not more than five hundred dollars($SW). /S/ IMPROVEMENT ❑I,asownerofthepmpeny,ormy employees with wagetiun, SWIMMING POOLE . NICwill dothe wo,k,.nd,hc saunure is nmoimendeJ nr Mercd Sea74M.Business 11 OTHER W end Professions Code:The Commctors License Law does nen apply to an owner of OUTLETS-SWITCHES-FIXTURES D p' property who builds or Improves thereon,and who does wch work himself ur through his own mnployee..providN that such improvements am not mended or offered for NEW REST AL ELECfR SQ Mr sale.If,however,the building or improvement is sold within one year ofcnmplimnn,the SO FI'.ITOOR AREA $/SQ.FI'. awmer-builder will have the burden of proving that he did not build nr improve for par- /O��(Z pose of.s.E.). Ql'A (� I,as owner of the pmpemy,am exclusively contracting with licensed common s to onse La the es note ISec.]Zino owner of and ry who builds Contractor's and ase Lew does not apply to an owner of property who builds mr improves Hereon,anJ QTY. PLUMB IN MIT FEE who contracts for such pmjecu with a contractors)licensed pursuant to the Contractors Licensreason e Law. PERMIT ISSUANCE el am exempt under See. .B&P C for this ALTER-DRAIN&VIM-WATER(BA) VALUATION Owner Date WORKER'S COMPENSATION DECLARATION BACK FLOW I'NOTF,CT.DEVICE D I hereby ill mai under penalty of perjury one of the following owing declarations: I have and will maintdnaCrnificae of Concemmself-Insure for Workers Camper- ! DRAINS-Fl. R,ROUE AREA,GOND. STORIES '1'YEE CON IIIIIIIII'satmn.as fansided for by Section 37110 of the LaNar Code,for the performance of the 4w k fur which this permit is issued. FIXTU -P VR TRAP I have and will maintain Worker's Compensation Insurance,an required by Section r 3 W ofthe Luber Code,forthe performanw ofthc work for which His permit is issued. GAS 'A.S INC.O OUTLETS OCC.-GROUP APN My Wmk,,rp Coyip .xba I urafeeartie dal cy No R Iva GAS-G.SYS -O :R .A) X Carricr.U�It7Yua �1UC��• CERTIFICATE OF EXEMPTION MOM WORKERS' GREASMISDUSTRLWAS E :MR COMPENSATION INSURANCE BU II.D,NG UI'IS )N IgIIS or lent flus section need not be completed ifthe permit is for one hundred dollars I$INE GREASETRAP -, PLANCHIiCK PEE I certify that in the performance ofthe work forwhich this permit is issued,l shall SEWER-SANITARY-STORM EA.200 FT. nm employ any pcnnn in any manner so as m bunme subjecn0 Ne Workers'Compen- ENERGY PET: OZ cation Lawsof Calilomia.Date WATISR HEATER W/VENMELECfR GRADING FEE Z Applicant NOTICE TO APPLICANT:If,after making this C,rdicam of Exemption,you should WATER SYSTENIGREATING �rrfy......' me subject to the Workers Compcnsatin l provisions of the Labor Code,you mus SOUS PEE forthwith comply with such provslons.,,his permit nbull he deemed revoked. WATER SERVICE Q n' CONSem is ac0NLENDINGAGENCY NEW RESIOCNTIAI.PLMB. SQ PI', PAID Dme Receiptp O khereby which that there isaced(See construction lendingagency for the performance of (~ the work for wNch this permit is issued(Sec.3691,Co.iv.CJ O L7 Lenders Name WA TO'TAL: ULeaches Address OI rectify that 1 have fend thisapp,iaedn andm¢Nat Neabove information isBUILDING FRCcorrect.l agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT,Z, building emonomion,and herebyauthodze reprcsenmtNes of this cirym.mer upon the SCISMIC DiEabove-mentioned property fur inspection purposes. PERMIT ISSUANCE'(We)agree to save,indemnify and keep harmless the City of Cupeninn against 4 40 GLIiLTI21C FF..Iiabilities,judgmentc,costs and expenses which may in any wayammeagainasaid City ALTER OR ADD TO MECH. PLUMBING :F.inconscqueneeofNcgmntingofthispetmit. I APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINTRIA ' NDLING UNITcI'O Io,dgClM) MECHANICAL PE SOURCE REGULATIONS. NDLING UNIT(OVER 1111X10 CIM) CONSIRUCI'IO TAX SignatumcdApplient/Combecter Dae STHOOD(W/DUCI} HOUSING MITIGA NIn: HAZARDOUS MATERIALS U,SCLOSURE Willtheapplicanmr future building necapnm memo,baotele hmnNnus materialG UNIT(TO IIXLIXX)[]TO) n JefinM by the Cupertino Municipal Code,Chapter 9.12,and he Health nM Safety Code.Section 25532mci If EATINGG UNIT(OVER I(I0,(NXI BTUI ❑Yes Ili LATION PAN(SINGLE RESID) PAID Dae Receipt# Wilhite applicant firmre building occupant use equipment or devices whichR-COMP(3His OR 1110,000BTU)emit huallous air conmmimants s defined by the Bay Area Air Quality Management 1(YEAL Disritt"❑Yhx /J�°,(�Nn R-C'MP(OV[R I(MI,fXp BTU) !7:7- 1 have read the haaSdnus navoLds requirements anter Chapterfi95 of the Cali- NDITIONER /I ISSU NCE DATE.fomia Health&Safety Cade,Section 25505,25533 and 8530.I undersmn l tits if NeESIDENTIAL MECH. SQ.FE buildin docs not currently have a mount,that it is my responsibility to notify the occupant `' o(o ment�hlls mus npriormis vartcc ora Cenif ate of my. ! V I//�IIJi adzed agent Date TOT ISSUEDRY: OFFICE N O CN N . Ln d, V a X :LL: y A a a a a a LL a a a a a a LL LL LL a a a a a a a a a N N NN V N �- �" M N N N M M N N D w U U In y C/) fA U In In mU U U DU U U U U U W U S 0 0 U U D U O O U U U < U - U U U U aL CO 0o CO 0 o CO CO 00 00 00 CO CO ro o 0 00 rn rn rn rn rn 0 0 rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn o 0 r M M M V M M OD � O . . . N Q N N N ` N M N N N N N N m ___ .....__.._....___....__._ ..... 0 W aocoaocoaocoao0oaumooromOocOmrnrnrnrnrno rn rn rn rn rn rn rn rn rn rn rn m rn rn C3) Q rn rn rn rn rn o 0 t 3 M h �_ W O V m M w R ? 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