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31081 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY - CITYOFCUPERTINO - BUILDING-Eu?CTRICAL t PERMITNO. 31081. BUILDING DIVISION APPLICATION/PERMIT PI,UN1BING-MIcCHANICAL BUILDING PROJF,CT IDBNTIFICA'1'ION BUILDINGADDRESS. SANITARYNO. APPLICATION SUBMITTAL DATE OWNER'S NAME: PHONF,:. CfOR'S NAME: LIC NO: ' - NIC CONTROhp nRCHII'ECTIENGINEER'. AC NO: - RF.SS:a� CONTACT. PHONE: - - BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initlal) B��LLDyDG.� ELECT' PLUMB MECH LA ❑ ❑ ❑ LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMITPEE 1 herehy affirm that I am liceu...I under to+.'..ions of chatter 9(commencing JOB DESCRIPTION WOO with Section 700(fi Division 3 of the Businessond lkofessions Codgandmy license is RESIDENTIAL: FEW in tall force and affect. - PERMIT ISSUANCE ❑SFDWI. KITCHEN RF:hIODF.L Q ZUZU Liccnu Class Li APPLIANCES—RESIDENTIAL C1 ADDITION ❑PLUMBINGRE-PIPE NQW Date Contractor ARCHITECTS DECLARATION:"'. - ❑MULTI-UNIT ❑STRUCTURAL zOma I understand my plans shall W used as public records PANELS MODIFICATION' N 'r UPTO200AMPS j oz—, . . ❑INT PRIOR ❑CHIMNEY REPAIR FEW Licensed l'mfessionnl 201-IfxNIAMPS IMPROVEMENT OWNER-BUILDER DECLARATION CouniON 'OVER 1000AMPS ❑BATH REMODEIJREPAIR�Lf1iMOLITION O< 1 cousin: :(firm that 1 L exempt from the Contra,m'sCod License Law for the ippiS5,aOyV following rear m.(Section'co3Lr t,aiter,imdne, entoli Cnoe:Anycily.r county SIGNS[LECTRICAh - ❑OTHER u+3 W~ which requires o perms t constrict, ¢ immune,do fish repair any structure �1410 prior to its issuance u1smocappres the applicant liar such permit ale asigreadtatenent SPECIAL CIRCUIT'/MIS! that he is licensed connotations,provisions ofah Comoscanex Licemo,La (Ctrma9 (commencing with Section 700(l),I'Divtslon 3of the Baines.:td Pmt cos:ms Codc)or TEMP.MEIIiR 011 .IN. COMMERCIAL: 00 that he is exempt therefrin and the busis for due alleged exemption.Any violation of g [I NEW BLDG/AUDITION ❑DEMOLITION 4q Seclion 0831.5 by any applicant for a jronnit subjects the applicantm n civil penally of POWER DEVICES ul=y ❑ FOOD SERVICE •gip, not room than fivehundred dollan($StIMPRop. - IMPROVEMI3NT � O I]Lasownerk,the the structure r myotatoployac.sintended or offered wages ,sale,Sola 0n 1.B siren, SWIbIMING POOL ELGCfRIC will do the work,nod the s o Con<a sots License Lwit..not a(Sec.t Diu.Business ❑OTHIiR and Profwhons Colo:The Contra,.'.License Low tines not apply himself am ownemN OUTLETS—SWITCHES—FIX'1'UNES progeny who builds or improves thsuch i and who rices such work uadOror through his own employeese provided that m such mens isemann are sol intended or offered for NEW RESIDENTIAL CI.ECTR SQ FT. owneL uildor ill h ve building orprovinl ia3old within ant b ild or improve the - 'SQ.FT.I LOOR AREA $/SQ.Ef. owner-builder will have burden ofPmving that he did not huild or improve for par- PAID D pose os own. - r ►i ❑ I,rr weer of the progeny,ran sines and Cnnasains with licensed contract i- - TOTAL: _ constmn the project(Sec.'/Bid,Boniness and Professions Cale)The Contracmr's Li- - , cense Law d.O,,,.apilit)an owner of property who bmilds or improv es thereon,and QTY. PLUMBING PERMIT NEE MAR 19 RECD who contracts for such projects with a commends)licensedu pursuano the Contractor - ' License Law. PERMIT IS, ,C 'r]I am exempt under Sec. .B&P C far this casco CITY Ur Owner Dote ALTER—DRAIN& '—WA �R(HA) VALUATION � - ' - ' WORKER'S COMPENSAi'ION DECLARATION BACK PLOW PROTECT.DC: I hereby anion under penalty of Perjury one ofthe following declarations 6606--' , ❑ Ihave and will maintain aCeniticae of Cousentcoself-inter,for Worker's Compem DRAINS—FLOOR,BOOK iA.0 STORIES. TYPE CONSTRUCTION silica,as provided for by,Section 37W of the Lalx)r Code,for the performance of the _ work for which this permit is issued. FIXTURES—PER TRAP - 1 have and will maintain Worker's Cnmpeneaion Insurance,as required by Section 3700 of the Labor Code,for the serformance(if the work for which this Internal,is issued. GAS—EA.SYSTEM-I INC.4 OUTLETS (ICC.GROUP APN MyWoder's Compcnsationlnsuranceca erandl'nlicynumher Lv Cartier: Policy No: - GAS—FA.SYSTEM-OVER 4(EA) ,. CERTIFICATE OF EX17MM]ON FROM WORKERS'. - COMPENSATION INSURANCE GREASF/INDUSTRL WASTE INTERCEPTOR BUILDING DIVISION FE!S (This section conduct be completed ifthe permit is for one hundred dollen($101) or less.) GREASETRAP PLANCIIECK FEE I codify that in the Performance ofthc work forwhich this permit is issued,Ishan ^ SI:WEN—SANI'T'ARY—STORM F.A.21X1 FT. -- net employ any pernm er any manner m as to became mlocat m the Workers'Comped- - ENERGY FEC Z an..lows of California.Data WATERHEATERW/VPNI'/ELECIR 0 Applicmnt _ _ GRADING FEE y NOTICE TO APPLICANT:Jr.alter making this Cenificme of Exwnptinn,yon should WATER SYS I'E IGREA'1'ING f~ become subject to the Workers Compensation previsions of the Labor Cale,you must SOI I:S I;rr •ti forthwith comply with such provisions or arts permit shall be daemei revoked. WATER SHBVICE„ aZ CONSTRUCTION LENDING AGENCY NEWRESIDENTIALPLMB. SQ.IT. PAID U O l hereby affirm that is a construction lending agency for the performance of Date ItemiptX Or thew kl h' bd P 1(Sa ,909". C' C) ULender Name - TOTAL: Isnde:AJdbmi, I AL: I versify that I have card this application and state that bove inficurrionionis - BUILDING FEE W) entree I agree tow.idy whh.all city and ourany ordinaticasand state laws relating in ,QTY. MECHANICAL PERMIT FEET U X� building comuuction.and hembyamhodxrepreunutivesnfthls city to crona,.the SEISMIC FET: nhova-(War agree ro save for indemnify an keep harmless agree to save.indemnify end keep hvmaless the City of Cupertino againq I'ERMI'1'ISSUANCE ELECTRIC FEE - liabil'ities,judgments,costs anti expenses which may in any wayaceme against said City ALTER OR ADD'10 ill - ronseyuenceo( a gmming of this pemtit PLUMBING PER A1, s DS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,M)CFM) , )URC -' ONS.. MECHANICAL PER S js AIR HANDLING UNR(OVER ItI"C_FM) CONSTRUCf10NTAX ". plicunt/Cnmmcmr J /Do,. EXHAUSTHOOD(W/DUCT) - t HAZARDOUS MATERIA.S DISCLOSURE 'r HOUSING MITIGATION FEE Will the mplicame,into,¢building occupant more or handle hdzadous material HEATING UNIT(TO I0)(1,000 BTU) as defined by the Colonic.Municipal Calc,Chapter 9.12,uad the Health and Safety Coca,Section 2553266? HEATING UNIT(OVER 100,000 BTU) ❑Yes '.QNo - - VENTILATION PAN(SINGLE RF_SID) PAID a Dae Receipt X Will the applicant or antra building occupant use ea Air a or devices which BOILF,R—COMP LRIP OR 100.0011 BTU7 ' _t hazardous air atmnminams as JefinM by the Bay Area Air Quality Management TOTAL: DlsmetP1. r ❑Yes ❑No BOILER—COMP(OVER 110.000 BTU) .1 have card the ha<rdous materials requirements under Chapter 6.95 of the Cali- AIR CONDITIONER ISSUANCE DATE t forms health&Safety Code,Sections 25505,25533 and 25534.1 undenmad tam,if the NF.W RESIDENT JAL MECH. SQ. .IIF buildingrtlwa Tly haveutenant Nm iii.myrespamsihility.tocaffy theaccuparm I ar duo s, Is winch must he mm rimce prom is OV Cenli",ol/kcnpuncy. J )f / 1 I I t t Own u or aJ agent Dom TOTA1-: ISSUED BY: OFFICE