30715APPLICANTTO FILL IN INFORMATION WITHIN RED LINES -'USE BALL POINT PEN ONLY
CITY,OF CUPERTINO - 'BUILDING
-ELEC'I'RIgAh .PERMIT NO�
• BUILmNG DIVISION APPLICATION/PERMIT '= rl.uMBLNr.ML:cnnNLcnl.';30715 O •% 5
,. In In I1 TN(: PROII-V I IDEN l ll•IVA PION 1
FE_
CONTACT'. PHONE:
, ' -
BUILDING PERMIT IP'PU
❑ Consultant Fees Paid by Applicant (Initial)
BLDG ELECT PLUMB MECH
'El El
LICENSED CONTRACTORS DECLARATIONQTY.
1 hereby affirm thin I am licensed under provisions of Chapter 9 (commencing
700Oof Divlsinn 3ofmc lar,inewinl Professions Code,andmy license is
in full force ante
Lieense Cla �Vjf��(��—Lic'N
Uate l s -- Cann,,
ARCHITE.CI'S DECLARATION
" )understand my plmd,mll bensWas puhlic rccnNs
ELECTRIC PERMIT FEE
'
WOO OZvitalSection
II- W
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P z a
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py��
WLicensedP
�aW ay
iGSI O a U
'JOB DESCRIPTION
RESIDENTIAL,
`
❑SFDWL ❑ KITCHEN REMODEL
E:1 ADDITION `, . ❑ PLUMBING Rfl-PIPE
❑MULTI -UNIT. [I STRUCTURAL
MODIFICATION
El INTERIOR ❑CHIMNEY REPAIR
IMPROVEMENT
❑ BATH REMODF:UREPAIII El DEMOLITION
El Up]
-
PERMIT ISSUANCE
ppPL1ANCIS-RISIIl1iNTIAL�
PANELS
UPT0200 AMPS.
f 1
OWNI R BUIL DI.R III CLARAI[ON -
Ih M1y ff not I exemptl theC t t License'L for the
following g (S f 7011 .5, B I I 1. Code A y Ty ounty
20M000AMPS
OVER IfI(IOAMPS
SIGNS HLhCTItICAI. s
x.10
which y p 1 t t ll , I I T h p y ut cion
prion t .. m a1. fileapplicantul 11 a filesigned star nt
_
t
SPECIAL CIRCUIT/MISC.•" -
_
...]]]
that h I' I p n tl I theC ntr t r I s L (CI pt r 9
_
- IEMI M EI'HR OR POIII I NIST ° p°'
- - -
COMMERCIAL:
, ❑ NEW BLDG/ADDITION "El DHMOLITION
❑TENANT - '.-OFOODSERVICE•
IMPROVEMENT _
OT
QO
a o a
4•
q�ca
d2
• a�m
(c)m g thSe1 9(X)11) IU' r f, B c, 11 e sC d),,,'
that be v exe dp( there) d h o- malleged pt A Yviolated of
Seci on'IOI IS by any applicant I I I hl L'th ppl u I pe Ity of
not more dint five hundred d II 0500). - r
❑1dothewcr Pl the pct p ty y pl y o ed :th I pe sines.
wild th k and the t t I. t intended ff-df I (S 9044E i
and Pr f:i "Cde Th C rtm . LicenseL n t apply t n ownerofOUTLETS,
properly h 6 11. p th h J h w k h .elf thiough
I, -
POWER DF.VICPS'
-
..-�
.SWIMMING POOL ELECTRIC
SWITCHES CIXTURES
s ,
r s
his own employees provided that such mpn vements are not intended or offered for
sale. If. however. the building in improvement is add within one ydm.fcnmpletiA. the
ower -builder will have the burden of proving that he did not build or improve for pur-
NEW RESIDENTIAL ELF,GTR SQ Ff.
SQ.Ff.FLOOR AREA
PIw' .
A
SSQ. IT.
-
.
of sal
El 1, as owner of the property, on exclusively contracting with licensed contractors to
nstrucuhe project (See. 7004, Rminow and Professions Code:) the Convenor's Li-
d
,
FED
TOTAL:
'
cense law does out apply Rs anowner of property win build„,,improve, thereon.and
who convects for such Emil with •a cournmemds) licensed pursuant to Contmnm's
License law.
1 ..exempt under Seca , B & P C for this reason
QTY. PLUMBING PERMIT' FEE
.
.2
Ul• (,(�Y
PERMITISSUANCE
Owner hate
- ALTER- DRAIN &VENT" -WATER BEA)
- .TION
WORKERS COMPENSATION DECLARATION
BACK FLOW PROTECT. DEVICE
”
1 herehy u1Rtm under penalty of perjury ane of the following Je<larati,,ns:
DRAINS- FLOOR. ROOF AREA, GOND.
❑Ihave enAwill muimainvCertificvlc of Conserv mselGi...reftw WorkelOCompcn{
s tion, as raviIcd for by Section 3900 of the Labor Calc, for due performance of the
STORIES
TYPECONSTRUCTION
o rk which this permit is issued. ' .
FI%TURFS - PER TRAP
have vad will mainmin Workers Contp... upon Insurance, as required by Section
'
•
3700 of the Labor Code, for Ore ped'onnance of the work for whichthis pernitisissued.
GAS -EA.SYSTEM-) INC. 4 OU'I LEETS
DEC. GROUP
APN
-
My Wor�y� tsip�yIg� Ipp nce rand l'nlicY � her egg'
Car,ier.<FeI_I_L'tula tris Policy NnzlK�^g� ����
_
GAS -F.A. SYSTEMOVEit 41EA7
-
• CERTIFICA'I B OIs EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
I(Thi,weirn need bmorphed Pihe perm it is for one handled dr in IS 11101
edeas.) fluids "' , •
'
GREASUINDUSTRL WASTE INTERCEFIY)It
BUILDING DIVISION PEES
r -
CREAST TRAP
PLANCHIiCK FEE
Icenlfythat infiepcl'limntnnccol'ILowork forwhlduhis permit lsissued, Isbell
not et pl y any l .... i y Is t s hj t l the W k, C mpcn-
SEWER -SANITARY- STORM P.A. 200 Irl'.
-
ENE.RCY FEE •.
WATER HEATER WIVIiNT/hLL(.TIt T "
%.
r
z0
.
amino l m f Col f u U tc
-
A
GRADING FEF' '• '
pplcoa
NOTICE HD APPI ICAN I If Itc A n6 th e C t II tt f I nptioq you should
become subject tthe WorkConitionsafion I n s of the Labor Code you must
WATER SYSTEM/TREATING
L.I I
SOILS FBI.
W
�' I'•''
0 L)
�" G
iFi to
U Z
f,,rthw th t ply idt s 1 p n r r (h' p i t sh II M1 Deemed revoked.
GONSTROC TIONLENDING ACI NCV-
"• Thereby ufHlm that there( ac naw inn lent ng agency forth¢ performance of
me work for which this pornit is issued (Sec. 3097, Civ. C.)
Lender's Name
WATER SERVICE
PAID'
Data ceiptN
NEW RESIDENT AL YLMH. SQ.IT'.
-
OTAL:
leach's Address
TOTAL:
- -
-
BUILDING FEE
I certify that I have read this application divisions that the above Infortnmind is
correct. i agate to comply with all city and county ordinances and state Laws relating m
boilJingconstruction, and hereby authorise reple,¢motives ofmiseiymemerupontbe
QTY, MECHANICAL PERMIT FI7L
,
SEISMICFEE
PERMIT ISSUANCE
- - -
FF.FALtERORADDTOMECH.in
aMsve-mentioned tont for inspection InaT scs.
(We) agree la save, indemnify and keep handless the City of Cupertino against
emaeyuncc ofthe grating of this Permit.
UMBING FEEAPPLICANT
AIR HANDLING ONI'I'(TO 10.000 CFM)
CIIANICALE
NDE; TANG. ND VILL COMPLY WITH ALLNON-POINT
$$
SOURCE RF ,UL NS"I!,
AIR HANDLING UNIT(OVER IU,000 CFM)
[ELECTRIC
NSTRUCTIONSigna
e3lJ
HOOD (W/DUCT)
USING MITIGATIO FEE
urea( Applican mmetor pateF.%HAUST
_ HAZARDOUS NIXTERIAI S DISCLOSURIS
HEATING UNIT CFO 1000000 RTU)
Willtharrpdicam in future huildingtxcupummore in handle hvaallous material
as defined by the Culart Municipal Code, Chapter 9.12, and the Health and Safety
Code. Section 25532(a)T i
HEATING UNIT (OVER 100,000 RTU)
a
❑Yes []NO 11 -
Will tic epplinrrl ,,r future wilding mccapam use equip rem ,,r devices which
-mit hararm us air contmninnon us defined by the Bay Area Air Quality Maintained,
Disvict/ '• 1.
❑Yeas' ONo
PAID -
Date RecelplM
VENTILATION BAN (SINGER RESID)
BOILERR-COMP (3HP OR 100.000 111 U) s
TOTAL:
BOILER - COME (OVF,R 100,000 BTU)
- .. P
• AIR CON IN NON ER
"
I hali, onaltheh 1 `t I, repai rousul, oder Carl 695 of file Call-
ISSLANCEI ATE
NEW, RP,SIUEN'HIM. MIECIL SQ. irl'.
fnmi 11 Ith&Sf(y'Crvlo, hu's (x255.525533 125fl4. I understand that if the
'buildfiritchiesnotearoul, haven intnt that tknynxpnns'b'Ihy to notify thaoecitpvm
�y ��
'oftherequiremens, wluch nitlsI he lttctlni lxoe canfa CeriticaucoI Occupancy
_
F
TOTAL:
-
ISSUED BY:
Owner or authadzeJ agent. Dare'
„)r OFFICE