S 0644 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-EI.BCI'RIGM, Pl! N ITNO. 0644
BUILDING DIVISION APPLICATION/PERMIT 1'LOMBING-MECHANICAL l`J
BUILDING PROJECT IDEN'I'IF'IC-A'1'ION
BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
/0s0 924pineIg eft, g-aS- 97
OW B'S NAMI PHONE: CO 'TRAC'ITjR'S N LIC NO.
o L C f L -7%60737 p.l I YV l I NIC CON'1'ROLp
ARCHI'rECrIENGINUR: LIC NO, NU SS: ❑
CONTACT: PHONE r0,Anu � Seung A qS BUILDING PERMI'I'IMO
❑ Cunsultanl Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MUCH
❑ ID Ea
W ❑
LICENSED CONI RACI'OR'S DECLARATION Q'TY 17LECIRIC PERMIT FEE
1 hereby M.that 1 am licensed under moviduns of Chapter 9(commencing JOB DESCRIPTION
O a'Z Ih Sermon)IXXII of Divisinn3of the Business and Pndmsions Cade.and mylicemeis RESIDENTIAL:
WOO WI i PI7RMIT ISSUANC12
FW. ,full lorecand ell 1. 1LkSI ❑SFDWh [I KITCHEN REMODIiI.
�U~ License Class s--�� Lisp
Q U APPLIANCES-RESIDENTIAL ❑AUDITION ❑PLUMBIURAL'PIPE
NQ6 Dam�y��Conlruclnr
-1 -r ' ❑hf ULTI-UNIT ❑STRUCNRAL
ARCIIITIiCr:S DIiCL 'PION
~HZ IunJemmnd mY Plum shallRuud ns PuM1hc records PANELS MODIFICATION
ZOO
UP ID 200 AMPS
❑INTIiRIOk ❑CHIMNIiY REPAIR
W I.icensed Professional 201.1(XX)AMPS IMPROVFMF.NT 0SWIMMING POOLS
OWNER-BUILDER DECLARATION OVIiR 1000AMPS ❑BATH REMO)HV EPAIR ❑)IiMQLI"f10
C Q 1 he¢by elf rte that I am exempt from the Conlmamrs License law for the A �,wy.`
7�('O,U billowing reason.(Section 9031.5,Business and Professions Gavle:Any city or county SIGNS ELECTRICAL. �0TH
1+1'3 a NG which requires a permit to comm".alter,improve,demolish,or repair any sho con,
1' 00 prior m its issuance,atm requires the applicant for such permit to file a signs Kda men, SPECIAL CIRCUI'LIMISC.
�d a�
that htttizLeensJpu uamevhcDnrvision,noneConaunars "ensclaw(Chaithe COMMER �l
(commencing with Section 7lNX)lot Divisinn3nf,he❑nsineseund Proftrssium Grle)or TEMP MITI'HK OR POLE INS'r.
a a e C Nat heisexempt thummen and,he basis for the alleged exemption.Any violation of ❑NEW SLUG/ADDITION ❑DEMOI,I'I'[ON
"' Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of POWER UIiVICES v TENANT ❑FOOD SERVICE
not more than five hundred dollars($500) r IMPROVEMENT
ESD ❑ I,mownerol'im propcny.m my employees with wages as their sole compensminn. SWIMMINGPOOLELECIRIC
p. will Jn the work,and theammure is solmmadcdormBeredforsale(Sce.7 .Husinas OTHER
{�il�w
and profession,Code:'@c Contractors License Law does not apply to an owner of OUTLETS-SWITCHES-Fl%TURF_S
a3 property who builds or improves Ihemon,and who docs such work himself or through
his own employees.provided that such improvements am not intended nit offered for NEW RESIDENTIAL.ELECT SQ EL
,ale.I L however the mildm,or impmvemsen is sold within one year of completion,the SQ.FT.FLOOR AREA &SQ.PI'.
osancr.hudder will have the burden of prmv heir Nut he did not bund ter improv,Iia Lam-
Lou of vlc.). TOTAL'
I,us owner of the propert,am cadh sfvely contracting with licensed cmican a,to
contact,he pores,(Set.7014,Baines,and Profcs,iuns Ca,rJ)na Commeor's Li-
cerise law does nut apply minmwnerof progeny who build or lntpors,daremn.and QTY. PLUMBING PERMIT FEE
who contracts for such projects with a contracmr(s)licensed parsaanrto Ne Canmctoh
License I.e.. PERMIT ISSUANCE O
❑ I am exempt under See .B&P C for this mason
ALTER-DRAIN&VENT-WATER TAO VALUATION
Ow v, Umc
• WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
1 hereby affirm under penalty of perjury one of be following deelamtions
I have and will maintain a Ceni,icateofCbmcn,to self-insure for Workers Comped- DRAINS-FLUOR.ROOF.AREA,GOND' ESTO]R TYPE CONSTRUCTION
satins,as provided for by Section 3700 of the labor Calc,for the pMoormalr of he
work for which this permit is issued. FIXTURES-PER'IRAP
❑1 have and will maintain Worker's Compensation Insurumce,as rtyuircJ by Section
971X1 of the LuMr Coda for Ne perbrmuncc of the work for which lM1is permit is lssu.it GAS-PA.SYSTIiM-1 INC.d OUTLETS p APN
My Wanw, pv two�n issue cu ' dPolicy number dm
Came: Policy No.:fax We GAS GAS-GASYSTEAt-OVEKi(EA7
CGRI'IPI'ATE 00717%EMI7ION FROM WORKERSGREASIYINDUSI'RL WASTE IN'I HkCEP`FOR
COMPENSATION INSURANCE BUILDING DIVISION ITIES
(This section need not he complete)ifum pemat is for one hundrtddollacs DIM) CREASE'IRAP
ter lass) !PAID
FYai
I"may that in Neperformanceofthe work lir which this psm+it is dewed.i shall SEWER-SANI'T'ARY-STORM EA.21X1 FI'.
not employ any Person in any manner so as to become subject in the Worker+'Comped- ENERGY
Z ration Laws mf Cul if In.Date WATER HHATER WNENTELECI'R E
Z0 Applicant t
N NOTICE TO APPLICANT':If,after making this Cmilicate of 1!xemption,you.should WATER SYST£MIfRFATING
I•-' become subject to he Workers Compensation provisions of the Labor Cade,yon mus,
IY15 forthwith comply with such pmvlaions or this px n,,JWII be Ja7ncd revoked. WAFER SERVICI?
0 Q
0.
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.EL ax' I hereby iffrm NUOhere is a emrtm"lion lending agency for the perfonnunw of vm pT
�- the work for which this permit is issued(See.3097.Civ"C.)
0 Lenders Name TOTAL'
U Lend ds Addre„ TAL
[yam a 1 cenily that I have read this application and atam thus the aMna infor admn is BUILDING FEE
correct.l agree to comply with all city and county aNimenves mal state laws relating u' QTY. MECHANICAL PERMIT FEE SEISMIC FEE
U Z building construction,and hereby authorize reprco,undives oflhisci,y to enterepon the
above-mentioned progeny for inspection Imposes. PERM[L ISSUANCE IiL1iC 1'kIC PEIi
(We)agree m,aro,indemnify and keep harmless the City of Cupertino again,,
Iiabiliics.judgnsen,s.costs and expenses which may in any way wane against said City ALTER OR ADD TO MECIL PLUMBING FF.E
nxqucncc of tiro granting of this I mal. I
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING ON IT(TO 10.000 CFM) MECHANICAL 1'1117.
SOURCE REGULATIONS.
AIR HANDLING UNI T(OVER 10,00()CFM)
CUNSTIt11CfION'ITX
�
ama pPh"ard/Cmdowbr Date EXHAUST HOOD(WIDUCT) HOUSING MITIGATION 191E
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant orfuture Wilding oc'eupsntmenor handle humaRtwmzNrial HEATING UNI'I'(10100,000 BTU)
as Jefned by the Cupertino Municipal Code.Chapter of 2,and,h,Health and Safe.,
Cn le.Section 25532(a) HEATING UNIT(OVER 101.000 BTU)
❑Yes ON. VENTILATION FAN(SINGLE RIEMIH PAID
Dec Hcceipt N
Will the applicant or future building Occupant use equipment nit devices which BOILER-COMP OHP OH 100,000 RTU)
emit Wmixious air conmminantr as detincd by the Bay Area Air Quality Management 'LOCAL:
L
I{UILER-COMP IOVEk 1(U.000 BTU)
s ❑Nm read Nc nvuNons materials requirements under Chi695o(the Cali- AIK CONDITIONHR ISSUA CE DAr,&Safety Code Sections 25505,25533 am1255:4f.1 understandtat if the NEW RISIDF.NTIAL M17.CH, SQ.Ff.not cumntly haven cold.Nw it is myne") ihilitym notifyNeoccupuntnem,wmeh marl h<mel primr,m „aan"e ter a eertifeate m a"alaney.thorimd agent Date TOTAL: ISSUED IF Y K
D
OFFICE