30543 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL. PERML'T NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL. 3� J/{C A
BUILDING PROJECT IDFNTIFICATIOS
BUILDINGADDRPSS: SANITARY NO. APPLICATION SUBMITTAL DATE
8 Vi 1 -2-96
OW' ER'S NA 1E: PHONE: l ACTOR' NAME: LIC N6 N� CO
U w, Vee I�1 tau /j-- 6267
AXCIi IDECT4iNGINEER: IJC NO: A R S: ❑
covrACT: PxonH: BUILDING PERMR INFO
❑ Consultant Fees Paid by Applicant(Initial) I F PWM MFs
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
I hereby.(firm Nat I am licensed under pmvisiov of Chapter 9(eomnxrcing 7 DESCRIPTION
X00 IhSrafor70ffE.fDC
Bmirex+red Pmfaui ns Coale.and myl'xrnsc in RFSIDENTIAL'
�O O PHRMR ISSUANCE
mill roused coat. (yS�J -7�]
a U V Licm Lk.N L V Vp [J ❑ADDITI SEOWL ❑KITCHEN REh10DEL
��W ale•—ef� APPLIANCES-RFSBJENIIAL ❑ADDRION ❑PLUMBINGRE-PIPITOo,t CTS DP. TION ❑MULTI-UNIT ❑STRUCNRAL
Z O I mdermand my plain shall he usd as put lk scads PANELS MODIFICATION
OZ-'� UP DO 2"y1 AMPS 'El INTERIOR ❑CHIMNEYREPAIR
F.F'W Liamted Pmfesimal 201.10WAMPS PROVFMFNT
�y E,j OWNER-BUILDER DECLARATION Y OVER,1000A PROVEMREMODEVRFPAIR ❑DEMOLITION
0.'9 Q I hereby uffmh that I am exempt fmen the Contractors License Law for the r
O6U following reosan.Sermon 1031.5.Buineas aid Profevsionn Code:Any city or coumy SEINS FJ.ECI IC - '1 ❑OTHER
W a LL NF' which m4mrem a permit m sono et,altar,intpmve,hnndish,or repair any sm¢mre a
HLLOa prior to ids iotance.•darn tea lusm fmsuch
y rcquim pp permntofkaaigxdswemcm SPECIAL CIR R
f'�y that Mis licvtad pmauant tomk pmviaiarn oftle CauractNsticcmc l�w(Cluper9
W�'CD (rnmmercingwithS ion 7")of Division 3 Nthc Butinesa and l'mfwims Codelar TEMP MEI L I14 I COMMERCIAL'
6 e C ohm he is exempt marefrmn end he hr N for the alle9a ecmption.Any violation of t ❑NEW BLDG/ADDITION ❑DEh10L TION
ip5. 4• Section 7031S by any applicant for o parnelaubjeets dr applicant to a civil penalty of ( POWIiR'1;EV1C
I++�ln !- ❑TFNAnT ❑FOOD SERVICE
FZ} not I-nowen fivehural ad)PietY lan(SSW). I.MPROVEAlEN1'
f=0 ❑ L.as owner oftx ryvpeny.eemy cmpWym with wageutheir umle ctmprnaetion. SWIMMING POLL Fl Fl."TR I
sy will do the wank,enJ mhcawcmrc is not intrndN oroRaeJ fnreWc(Sn.111W,Bunmu ❑OTHER
W aril Penresions Ctxk:The Cmtmetoh Lice.Law m-not apply to an owner of UUTLE6-SWITCHES-gXTIIRES
�'.. Property who builds or improves thereon,aid wM dm such work hirrexlf or through
his own employees, ro,med that ouch Lmpmvemerus aeenot iy=a offvd for NEW RESIDENTIAL ELECIR SQ FT.
vale.If,however,Ne building or irnpovernent is and within orey�ofompldin .1 SQ.FT FLOOR AREA ssQ.PT.
owner will have the huNcn of proving that he did as build or improve forput-
pose of talc.). a
p 1,as owner of tx prelpeny,am exclusively contracting•'ith licemd conuacuea to TOTAL: -'
cmamxt the,panel(Sec.1144,Rosiness and Profcsvons Ct.J Tlx Cmttxtars D. -cr •
certam owlxny w
e law dnot apply to an reecf prolmo builmason.
ds or improves and QTY. PLUMBING PERMIT FEE �
P 19
whuconttan.for_weM1 P,jactx with a omm n (s)Ilcen til puemhnt m NC Cmtrvcur'n
Li.law. PERMIT ISSUANCE _f r t 96
❑1 am exempt miler Sec. .B&P C for this renwrn r
'amu.
Ow rmu Due ALTER-DRAIN&VENT-WATER(IA) "IIVALUAION
WORKER'S COMPENSA'ION DECLARATION BACK FLOW PROTECT.DEVICE
1 hereby M.untkr prnaBy of perjury one of to following decNratoos:
❑IMve era ll mairmuna Ccnif teofCmaeru to.self-inaac far W'tNera Corryem DRAINS-FLOOR.RDOE AREA,CONT).
amon,as provided for by Section 3100 of the Iahwr Code,for he pafonmancc of the STORIES TYPE.CONSTRUCTION
pork for which this permit k issued. FIXTURES-E'ER TRAP
I-)I have end will maimain W..kern Compansatim Lnwuame,m aynind by Section NA R
3100ofthe,Lxbai for the prfanrureen(tx work(or which Nix peanut u i.d. GAS-FA.SYSTEM-I INC.4 OUTLET
My work'J'mCL71T6 iepr l_^fie gpreiv and Policy number are: OCC.GROUP APN
Cenie FUk'IYJ
Policy No.: GAS-EA.SYSTEMOVER 4(EA)
CERHFICATE OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASFILNDU.STRL WASTE INTERCEPTOR
Ciba rection ted not be cmopWd iftx permit m fame hanAN doi(SIM) BUILDING DIVISION FEES
or leas) GREASE TRAP PLANCHECK FEE
I cenifybminthe perLmwrreafthe work far whkh this permits k.d,10.11 SEWER-SANITARY-STORM EA.2W IT.
int mnploy any pervtm in any manner an ax to nemore aubject to the tankers C.,.-- ENERGY HE
O Z sauna Laws of California Done WATER HEATER WNENDELECTR
Z O Applicant GRADING FEE
y NOTICE.TO APPLICANT.If,after making Nis Ceffmcele ofF empion,you should WATER SYSTIWMTREATINO
a became a Nacl to the Worke't Compemetam pmvieians of the Labor Cole,yaa no SOBS FEL'
forthwith comply with xuch pmvisiom or Nis permit WWI be herd revoked. WATER SERVICE
n.
CONSTRUCTION LENDING AGFNCY NEW RESIDENTIAL PLMH. SQ,FT. PAID
U 0 Ihcrtby efErm that Ebert i,.cmninruetiox lending egrncY for toe prrftxmnrec of Date ReaipN
V. r+ the work for which thin permit is irved(See.3(147,Civ.C.)
C) U Ixdrn's Name TOTAL:
Lari Address AL.
yI certify that I vee"read thla application and seats that the above information it BUB-DIN
V) correct.I agree to conwly with.II eddy ed cmmty ordinance.rend nus lawn relating to QTY, MECHANICAL PERMIT FEE
U7y bmldingcutmrmam.it hemhyamlmn-oToc.mmiveof Wrcitym enter upon the SEISMIC
ebuve-trcntoned progeny fa im r,e p,e,et.
(We)agree to neve indemnify anal keep hamha tk City of Cupeam agama PERMIT ISSUANCE ELECTRIC
lialmilitieajdgmenu.emu and epcnaer which my in anywayacena,a thea said City ALTER ORADDTOMECII.
n conac4ucace of te,'naming of Nis pmmit. PLUMHING F
L V
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT TO UL"CFM)
MECHANI AL FLE
AIR HANDLING UNR(OVER 10,000 CFM) CONSTRI ONTAX
Sig of AppliWcanVCont Tor�l�F/FN/((//VV/, [date EXHAUST HOOD(WMUCI) HOUSIN iMR10AT10N FEE
IWARDOUS MATERIALS DISCLOSURE
Wil the applicant orfmme building occupw store or Made,hazudwa material HEATING UNIT(TO IW.000 BN)
as defmnd by be Culxnino Municipal Cade,Chapter 9.12,and ole Health and Safal -
Code.Sect.2SS320P - HEATING UNI'T(OVER IW,(Xk BTU)
I:]Yes [-1 No
VENTILATION PAN(SINGLE RFSID) l PAID
WJI to appliceN a fume building menlalI
emithvardma aircmmremimms en tkfrcd by the or devices xhich Deme
lacyAraAi,QuelityMnngmnl Rn e
BOILER-COMP(3HP OR IgI,(p0 BTU)
DisWCW TOTAL:
❑Ye C1 No BOILI?R-COMP[OVER IIq,UW BTU7
I Mac real the hav m,mea'da AIR CONDITIONER
regai 533 am aide Chapter rata of m e Cali- ISSUANCE DATE
farms Healthes&t orre Cu M,a.,e 25N15.25531 mal 255;U.1 andmtad Not If the NI;W RESIDENTIAL MLCH. SV.PT
I( buildineemmrmwhich Mvebar matpracrtit ixmy resp»sibllitymagitytr usulvm
of IFe re¢miretRlW which tin V b[iM prKK IU ISW WnY Uf p CFnIfKNe Uf(MLpYCy. '
Owner m aaNaiad ag<m Dom 1 ISSUED BY:
OFFICE