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99120152APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 619 CITY OF CUPERTINO BUILDING - ELECTRICAL. PERM1tI'f NO. BUILDING DIVISION APPLICATION/PERMITu....1.MCar NG M rCHA AC .ry n r ICaltos OFFICE J BUILDING PERMIT INFO IBLDG [I,' , PEU l MEC/T JOB DESCRIPTION VO S-C� SAI ��d010 ❑ Consultant Pees Paid by Applicant (initial) LICENSED ONTRACTOR'S DECLARATION affum that I am licensed under powisier s of Chupmr, 9 or, mocndng with Section 701Xpof Diviemin Sol'the Busion.itad Professions Code,andnly luensu is 1�tf�/}� li<cmfall e Clucorce en Lie.M Datc'acmr•�� ITEC PS We" RATION I underamnd my plans mall Mnscsl as puMie rcutds QTY. ELECTRIC PERMIT FEE azzhereby W O p ,5, �UF Q U �•�W� p� Z^ Z pi] 1'IeRA11T ISSUANCE APPLIANCES -RESIDENTIAL UP'f02(XIAMI'S .-I O d V LLO y Licensed Rofesaional OWNER BUILDER DECLARATION I hereby affirm that 1 am exmnpt from the Contractor's Liconsc Law for the following noon. (Section 70315, Basics, and Profes.xims Cods: Any city or county which requires a permit to consumer, alleq improve, demolish, or repair any structure prionons issuance alsarequirexlhe applicant for such pc.it o fileasigned smtnmcm 201-101MAM1'S OVER 1000 AMPS SIGNS ELEC'T'RICAL SPECIAL CIRCUIT/MISC. ',HMP. MITf1i11 OR DOLE I NS' I'. LL po that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000).1 Dlvision 3 of the Business and Prof r,,mrs Code)o, that he is exempt therefrom and the basis for the Idlcgcd exanption. Any vlolnilon of Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of POWER DEVICES m C nal marc than fee hundred dollars (S500). El Las owner of the propcny, or my employees with wages as their sole compcnsmiml. will Jo Bre work, and the structure is not intended (it offined for sale (Sm. 7044, HarnessW SWIMMING POOL ELECTRIC corm Ingcromennpdy will, all city and county ordinances ant sone laws rclufingm building construction, and hereby andumae representatives cflhisclly memerupname �m and Profceslons Code The Co oncoses 1 iccnsc Law does not apply totan owner el OUTLETS - SWITCHES - FIX'I'GRES O .. pN3 rnpcny who builds or improves thereon, and who does such work himself or f cough his own employees, pravisland that such improvements are not intended or offered for NEW RESIDENTIAL ELECT R S IiabTlities,ludgments, cases and expenses which may in any way acerae against said City sale, If, however, the building or impmvemcnt is sold within one year of completion, the vsgarace of Be gntiong n' Penni,. AIR HANDLING UNITUn B,"PECEM) ter -builder will have the burden of proving that he did not build or improve for pvr- APPLICANT UNDP A 1)WILL CO 'If ALL NON -POINT ry,m of ate.). ❑ 1, as owner ofthe propany, am exclusively contracting with licensed contractors In 'TOTAL construct the project (Sm. 7014. Business and 1'mfcssions Gale) The Contractor's Li- EXHAUSTHOOD(W/DUCD muselawdoesnotapplytoanownerofpropenywhobuildsorinrprovesthereon,and QTY. PLUMBING PERMIT whn urmracts for such projects with a conaactnr(s) licensed Partition to the Contractor's PERMIT ISSUANCE Lima, Law. D I and enompt under Sec B & PC fonhi..eason AErHR-DRAIN & VENT- WATER (EA) V 17NTILA'I'ION PAN (SINGLE RESIDE ner DareBACK Will the apph"m or fuwrc building occupam use equipmem nr devices which mit hmadons nit camm�inanrs es Jefned by the flay Area Air Quality Manegemenu BOILER-GBM11P DEE OR 100,00) BTU) BOILER - COMP (OVER 1(X1.0100 BTU) PLOW PROI'EC6 DEVICEE1I AIR CONDI'T'IONER hov1j DIiA1N5-I4.00R,ROOT',ARBA,CON[] 1..,., t nsorkfnFlJ(TURIS - I'IiR TkAf 1hlufGA5-EA.SYSTHM-1 INC.40UTLIHS yWorrrin: IL/Il/r OMN PnIicy Nn.: GAS- EA. SY STEM OVEIt 4 U:A) OFFICE J BUILDING PERMIT INFO IBLDG [I,' , PEU l MEC/T JOB DESCRIPTION -- ----- COMPHNSATION INSURANCEGRF.ASPIINDUSTRL WASTE INTERCHVIOR ❑RCASE'I'kAl' D KIT CI BEN REMODEL. (this section need nor be umlPlmad if thepcnnit is for one hundred dollars (El(XI) :r1usJ SEWER -SANITARY- S'IORM EA. 21X1 IM 11MULTI41Nl'F I mist, that in the performance ofthe wad for which this permit is issued, Ishall not employ anypendn in any manner sn m to became subject the Workers' Camper - WATER HEATER W/VENIELECTR Z 0C1 sation laws of California. Date Applicant 1 a ; �" LUkI NUI CE TO APPLICANT If, claw, making this Cenitime, Of Ise'aliun, "no 'I Id become object io the Worker's Cnnlpensalion Prov Simi of the labor Code, you most forthwith comply wirh such provisions or this permit shall he deemed revoked. CONSTe i, a cION nsumb iINGAGENCY T far which 11c, .it I ix:sued Es . 30lending agency litmhe perfomuumc of 'he conk for which this permlr is issued (Sea JfFA, Civ. CJ WATER SYSI GvIUJUAI'INC, WATER SERVICE NEW RESIDENTIAL PLMIi. SQ. FT D OTHER Lenders Name I<nderAddress TOTAL certify that I have real this application and araC thm the those information is rad U Z corm Ingcromennpdy will, all city and county ordinances ant sone laws rclufingm building construction, and hereby andumae representatives cflhisclly memerupname QTY. MECHANICALPERMI'P PERMIT ISSUANCE above-memioned property for inspection purpose, (We) agree m save, indemnify and keep h rnmess the City of Cupertino against AUT ER OR ADD TO MECII. IiabTlities,ludgments, cases and expenses which may in any way acerae against said City vsgarace of Be gntiong n' Penni,. AIR HANDLING UNITUn B,"PECEM) APPLICANT UNDP A 1)WILL CO 'If ALL NON -POINT SOURCE AIR HANDLING UNIT (OVER I0,fI(%1 CPnO Signaunc afA plinmp ntracnnallhue EXHAUSTHOOD(W/DUCD HAZARDOUS MATERIALS DISCLOSURE Will due applicam mfrome tooldingoccupamame orhandll huterduus achrml HEATING UNIT(TO ifa,o00 BOB as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Sermon 25532m)1 E] Yes i'o HEATING UNIT (OVER IIMOM BTU) V 17NTILA'I'ION PAN (SINGLE RESIDE Will the apph"m or fuwrc building occupam use equipmem nr devices which mit hmadons nit camm�inanrs es Jefned by the flay Area Air Quality Manegemenu BOILER-GBM11P DEE OR 100,00) BTU) BOILER - COMP (OVER 1(X1.0100 BTU) []Tories! ❑Yes AIR CONDI'T'IONER I havereaJ uhc heard -nus mu\ivnols reyuimmenks undo Chspmrfi95 of the Cali- NEW RESIDENTIAL MtiCll. SQ. FT. fomes Ilcahh & Safny Code. Stereos 25505. 25533 unJ ZSSJJ. 1 uMcrsmnd thin if the buildingdre, nae cn,ca,JJyy haven mount dnayyttis yresponsibilitymnolify the <ropam oftncommueraraWerllydtaeRehmd» to isaurR6 ofsLeniliam nf/)ccununcv. OFFICE J BUILDING PERMIT INFO IBLDG [I,' , PEU l MEC/T JOB DESCRIPTION RESIDENTIAL: DSFOWL D KIT CI BEN REMODEL. ❑ADDITION ❑PLUMBING RE -PIPE 11MULTI41Nl'F DS'I'RUCTURAL MODIFICATION ❑INTERIOR D CIIIMN17Y REPAIR IMPROVEMENT []SWIMMING POOLS D BATH REMODELfRE'AIR []DEMOLITION D OTHER COMMERCIAL, D BLDG/ADDITION DDHMGIA 1'ION KA []FOOD S17RVICE IMPROVEMENT D OTHER SQ IT. FLOOR AREA S/SQ. FT. 1( Di VALUATION flo0 STORIES TYPE CONSTRUCTION OCC. CROUP APN� BUILDING DIVISION IT S PLANCHIiCK FIFE ENERGY FEE GRADING 1'1717. SOILS FEL' PAID Dom Remilo# BUILDING 1'17.17. W:E SL'ISMICITH ELECTRIC PEE PLUMBING THE MECHANICAL THE CONSTRUCTION TAX HOUSING MITIGATION PBE PAID -- unto keaiplH ISSUANCE DATE 2-(C(- Z® -'DQ