S 0722 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUD DING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLwfIUNG MECHANICAL S 0722
11 11.DINC PROJECT IUEN'1'IFICA'TION
-
SANITARY NO. APPLICATION SUBMITTAL DA'll
BUILDING ADDRESS:
R'S ANE H ' C AUTO 'S N
CON'fMOL p
A II +C'f 1 of N( ACDW ' ❑
CONTACT. PH I. BUILDING PERMI'TINFO
❑ Consult at Fens Paid by AppliCanl(Initial) ULD ELECT PLUMB MUCH
I. EED Co - ACTORS DECLA ATIha QTY ELECTRIC PERMIT FEE
' I hereby atfi that I am licensed under provisions of chapter 9(rnmnrncing JOB DESCRIPTION
CCZ with Scdinn]II00)of Division3ol the
came", Prafwsirns Code.mA mylicense is RESIDENTIAL:
W p C PERMIT ISSUANCE
FBF in ful#d?tand
L Q4�'j _ ❑SFDWL ❑KITCI PLUM INHEMODEL
�U . ►ip�-'g'r/=(`�.(�� APPLIANCIiS-NF:SIDENTIAh ❑ADDITION �PLUMIIING HE-PIPE
Commctnryd0. ❑MHLFIUNIT ❑STI2UCTURAI.CIII'fIiCTS DI!CLAATIONPANELS MODIFICATION
my plans shall he used as public records
Oz , UP10200AMPS
❑INTERIOR [I CHIMNEY REPAIRr4l'- Licensed Professional 201.1000AMPS IMPNOVEMENT [:]SWIMMING POOIS
�Y f
4 OWNER-BUILDER DECLARATIONOVF.k 1(xM)AMI'B El RAI REMODEUREPAIR ElDEMOLITION
C w Q 1 hereby afftrn Thal 1 am exempt fru.the Contrnmor'e License Law for the
X�Q. following reasoo.(Section 703 LS.Easiness and Professions Code:Any city or county SIGNS ELECTRICAL ❑(rf1113R
3
as which regmres a permit to con.ame,.plot,improve,demolish,or repair any mmcwre
1"'u'�� print to its issuance,also requires the applicant for such Permit to fileosignedmitu mem SPECIAL CIRCUIT/MISC.
yLha he is licensed pursuant the provisions of the Contractor's License Law(Chapter 9 COMMERCIAL:
W apO (commencing with Section Division 3 of the Business and Profess is Code) TEM H MIS'I'EN OR MULE I NST. ,/�
tY y m c
that he Is exempt Resubmit and the has!,nor the alleged exemption.Any vinbalon of ❑NEW BLDG/ADDITION Y�tDL3M01.)'1']ON
.�
Section]B31S by any applicant for a porion xulvects the applicannm a civil penally mf POWI!H DEVICES ❑'1'I!NAN'f SL-J•I' OU 513NVICf!
N amore him hundred dollars($500).FZQ Oan five1.as owner rfthe property,or my employees with wages m their sole compen.saioo, SWIMMING POOL ELECTRIC IMPROVEMENT
will do the work,tied the simcmrc is not intended ruminated for sale(Sec,](H4.Business ❑O'I'HI!R
and Pmfexsions Code:The Cnmrecmr's License Law does not ripply to un owner of OUTLE S-SWI]'CHES-FIXTURES
C. property who builds or improves thereon,and who docs such work himself or through
his own employees,provided that such improvements one,not intended or oRcred for NEW RESIDENTIAL ELECTR SQ 1T.
sole.IL however,the building or improvement is sold within one year of cnmpldinn,the //.�/�yk tT.FLOOR S/SQ.FT
r.builder will have the burden of proving that he did not huilJ or intpmvc fur pure �/ A
49
I,as manor of the property,am exclusively contracting with IicnrseA umt.dnrs to eI�-tsw
construct the project(Sec.]M4.Business and Professions Cndep'Ute COntrastor'.s Li-
c sel.ow ones not apply to on owner of property who builds or improves thereon,and QTY. PLUMBINQ PERMIT
who cnnrxts for such projects with uennoaemr(s)limnacd ptmnnm mthu Cnnvucvds - C x�
License law. IT RMIT ISSUANCE //'•�
C]I atm exempt order So .B&PC for this Teas'
ALTER-DRAIN&VF.YT- AT' DiAI VALUATION
Owner Date /� V
WORKER'S Gomm,of NATION DECLARATION RACK PLOW I'ROI'ECI'. IJ+ OoO g e
1 hereby affirm under penally to perjury use of the following W Worker's
Co:
❑Ihave and will maintain etion 37M ofComent to
Labor
Code,
for Wrlkrs Comp the DRNN$-IlOOH,R 'AREA, S'1'ORIFS TYPECONSTRUCTIOt
sainn,as provided for by Section 7]W of the labor Cede,fm the pcdormonce mf the
work for which this permit is issued I'IXTURES-PER TRAP
❑ I have and will maintain Workers Compensation Insurance,as required by Section
3]1X1 oftho tabor Code.fnnhe pertonnnncem the wrrk�fpoyryw'hic}h/t/hi�s perp it is Issued. GAS-I!A.SYSTIiM-I INC.40 ,TS OCC GROUP ANN
Cmr: bc
cy No.yu `r' GAS-I!A.SYS'll!M-OVER4(F:A)
CERTI CATS( EXEMPTION FROM WORKERS' GREASIIINDIISTRL WASTE INTERCEPIVIN
COMP eNSATION INSURANCE BUILDING DIVISION FEES
(This section need not be completed if the permit is for one hundred dollms($100) GRF.ASL'TRAP
or less.) PLANCIIIiCK FEE
I certify that in the perfammnce ofthe work for which this permit lsissued,l shall SEWER-SANITARY-STORM FA.21X1 FL'.
not employ any person in any manner sec as to become subject o the Wisdoms'Conifer. ENERGY IT-F.
Z smirn Laws rf C.Iifmpi.,Data WAI ER HEATER WNENT/ELECI'R
0 I GRADING PI?[?
NOTICE.TOAPPLICANT
1. he ANT:If.Co prinking this provisions
isio cam of Exemption,Code,you should Wq'TIiR SYS'1'IiM/fREA'fING SOILS FEE
F "N" kathavi0i Concur the Wxh tao Cmnpemmian ermiisimall be de Laborsuite you must
W � farthwidt comply with such provisions nr this permit shall M:Deemed rcvokal. WATER SERVICE
Q
p" CONSTRUCTION LENDING INGAGENCY NIiW ItIitiID1!N'IIAL r1.MU. SQ.FT. PAID Date eipt#
V O I far which rat thaturrol i is.construction lending agency dim the pedirnnance of
tr the work for which NLa permit is ismeA(Sec.3U97,Civ,CJ
Oh Lender's Name 'IY)TAL: TOTAL:
}� Lcndcr's Address
0. L certify that 1 have read this application and nam that the above information isWI BUILDING FEE
i.. U1 correct.l agree to comply with all city and county ordinances and state laws refuting to QTY M ECHAN[CAL PER M IT FEES
V Z building Conduction,and hereby authorize mpresentativesofthiscity toctiorupon the SEISMIC FEF
`+ uMme-mentioned property fur inspection purposes. PERMIT ISSUANCE
(We)agree m save,indmnnify..it keep hornless do,City of Cupeninn against ELECT FIishil'nies,judgmems.costs rand expenses which may in any way accrue againN said City AIJER OR AUDIO MECH.
in uuegaanee of the groat rf thio PCrndt PLUMHING PI?H
APPLICANT UNDERSTA DS AND WILL COMPLY WITH ALL NON�POINT p112 HANDLING UNIT(TO 1(1,(X)11 CPM)
C L( LLAT MECHANICALFEENo
AIR HANDLING ON]f(OVER 1(UNNUCFM) CONSTRUGI]ON TAX
S namreof ApplicanVCr nr Datc EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FE
HA N)(1S MATERIALS DISCLOSURE
Will theapplicant or Rome,building occupantsrreor handle haz.Nmns martial HEAPING UNIT('1'010).000 BTU)
as defined by the Cupeninn Municip:ml 5'yde,Chaprr 9.12,and the Health and Suety
as dq Section he Ca er .1Ys//' HEATING UNIT(OVER I W.(XIO BTU)
❑Yes VENTILATION PAN(SINGLE RESIG) PAID Dam Recnipl#
Will the applicant or future building occupant use equipment of devices which
m
mit hazardous air nmnrnu.sas define by the Bayzardous dernc by the Bay Area Air Q.dity Manageniet BOILI!R-COM11(3HP OR 100,000 DTII)
TOI'N.:
District" BOILER-Com P(OVER Ioo'c 113 rut
❑Yes m
I have read the hvnNous.ardols regairements under Chapter E95 of the Cali- AIR CONDI'I'JONES ISSUANCE DNYE
❑mmia Health&Safety Code,Seniors 2550.''5533 and 25534.1 undcmand that n the NEW RESIDENI'IAI.MECH. SQ.FT.
No]it nem hevca ant t t my responsibility to notify the occupant
on regain a swhi t v once ofa f
Owner r tndzed agent ^)me TOTAL: ISSUED Hy.
OFFICE