S 1425APPI IrAMTTn gB 1 IN INEnRMATInit WITHIN RED LINES • USE BALL POINT PEN ONLY
CITY OF CUPERTINO
OFFICE
BUILDING - ELECTRICAL L
1•LIIDIRING-M1IECIIANICAI.
PIiIl�IT No, 1425
BUILDING DIVISION APPLICATIONIPF,RMIT
BUILDING PROJECT IDRNTIFICATION
.
S4N/
APPLICATION SUBMITTAL DATE
BUILDING ADDRESS:
O NEifS NAMI?: PHONE
�• �ySrj
Q) " ACIOR" NAME: LIC NO:
CON 'I'ItO1.M
`S•�`
A1O ,VI�
AR�CI(IR�F:C�f/ENGINIiER: LIC NO: P_ti�x
�'f
CONTACT: PHONE.:
BUILDING PERMIT INFO
PRN
H+'T l
11 WAI M ^�,. - vcn-ozw
UCL,UAA)'ION W
❑ Consultant Fees Paid by Applicant (Initial)
BLDG / aI':(T, PLUMB i MrByC�H
CONTRACTOR S S
LICBNSIiID O`,D
QTY Ii1.ECTRIC PERMIT'
FEE
1 hereby ::firm that 1 am licensed under provisions of chapter 9 aommcaiIng
JOB DESCRIPTION
with Section 700(b.f Division 34ine Business and Profes,iom Cnde uadmylicenseisn lull force and elfin
�gy-is /
PERMIT ISSUANCB
r
O
RESIDENTIAL:
❑SFDWL [I KITCHEN REMODEL
Licca Ltc'g
APPLIANCES -RESIDENTIAL
[]ADDITION [I PLUMBING RE-PIPI?
Du1C Cmn NCln!
UCTURAL
❑MUl:fl-UNIT' ❑MODIFICATIO
{ ARCHITECTS DECLARATION
I murfromnd my plans shall be uncal., public accordv
PANES
MODIFICATION
UP'I'02pIAMPS
❑INTIiR10R El CHIMNEY REPAIR
j Licensed Professional
2014000AMPS
IMPIFM1:SET CSWIMMING POOLS
OWNER -BUILDER DECLARATIONOVER
IIMIOAMPS
❑ BATH RIiMODEUREPAIR 0DEMOLITION
1 hereby duos that I an exempt from the Contracmrs License law lin the
C OTHER
following reason. (Section 7031.5, Business and Professions Cute: Any city or county
SIGNS ELECTRICAL.
j which requires a permit m construct. alter, improve, demolish, or repair any ameturc
' prior In it. Lnwance, non requires the applicant for wch pennluofileamEnedsmtemeut SPECL\L CIRCUIT/MISC
that he is licensed punuanna the provisions of the Contractors License Law (Cooper 9
(commencing with Sua'wn 101Ngnf Oivisinu3 nnhe Businuresand Pnreal I, Coca)or
TEMP. METER OR POLE INSI
COMMERCIAL'
that he is exempt therefrom and the sets Coshes alleged exemption. Any violation of
0� NEW BLDGIADDI'I'ION 0 DEMOLITION
• Section 7031.5 by any appllcanlfnrapermit subject, the vpIflant n, a civil pen:dry of
POWER DEVICES
�
WTtnANT El FOOD SERVICE;
not more than live hundred dollars(S500).
IMPROVEMENT
f ❑ I. as owner of the property, ora In een with wages as their sole cont peau tion,
ycmp y g
Sal M MI NO V001. ELECTRIC
❑Ol'IIF:R
will do the and the oot intended Business
offered for rvlepply
The Curn
In
i and Nofesxions Code: The CanOunor's License Ww docs not apply m nn owner of
n,Licarve
OUT'LE'TS-SWITCHIi$-PI%TI1RE5
propcny who builds or improves thereon, and who does such work himself or through
his own employees, provided that such improvements am not intended or named Int
NEW RESIDHNT'IAL ELECTR SQ FT.
SQ.I'LRP.ItD
SISQ. FT.
sale.IL hawavcq the building Crimpnrvcnmmissold within one year of ernnpktion,the
ser -builder will have the bntJcn of proving that he did nm build or improve tar put-
pose or anle.l.
❑ 1. 4s owner of the property. am exclusively contracting with licensed contractors to
construct the protect (Sec. 7044. Business and Poll—in Is Calc:) The Cmoracm'n I,i-
,AAA
Nj(,R 3 0 ANS -0
museLawdoesnotapplytoanownerofpropenywhobuildsorimprovexlhereon.and
QTY PLUMBING PERMIT
FEE
whoammL,fmsu,h protean with rmmmcmr(s) licensed p.,.art Into, Cmbecluns
CITY Vf
License Law.
PERMIT ISSUANCE
VVi CfI I BVV
❑ 1 am exempt ander Sec. . If & 1' C lin this m r.ann
ALTER - DRAIN & VENT- WATER (EA)
VALUATION
Owner Uote
WOR DECLARATION BACK PLOW PROTF.CI'. DEVICE
I hereby al
affirm under penalty of perjury one the following dedkent's
Clhave and i inection3Mficaac of Ce ll sd6inome for or
th-
DRAINS - FLOOR, RM)RARG,COND.
STORIES
TYPE. CONSTRUCTION
Labor fortheefformsce of
sainn, as provided for by Section 3100 of the Lahr CMe, for the pertonnance of the
polviddfor b
work fns which this penult in issued,
FIXTURES - PER TRAP
El I have and will m oxides] by Section
Wnrkefs Compream
ols he w rk lot whiae,ch
PWof the Labor Crbe.lisr the perfinmmme nllhe work tui which this la�mrit is issnW.
Code
GAS - EA. SYS1'HM-I INCA OUTLETS
OCC. GROUP
APN
My W'oH.els Compensation Insurance canner and Polhyy number am:
Cameo Policy No:
GAS -I?A. SYSTI7M OVER 4 (EA)
CERTIFICATE HE EXF.MFI'ION PROM WORKERS'
GREASfYINIIDS'1'RL WASTE INTERCEPTOR
aulitili OIV'ION FI?F.S
COMPENSATION INSURANCE
('Ihi,waion need not bewmpleted iffeEmor, ixfarnne hundrdddm11am($100)
GREASETRAP
m les)
PLANCHI?CK FEE �.
I Wily that nth, pufnrmanceol the wo rnwhicpthispeyrtl[)a.n Qishall
SEWER -SANITARY -STORM f?A. 2fq FT.
IiNER(IY Elis
not employ n morin an ry so as men( enc ISe /rkers'Compen-
• sainn latws California .te
WATER HEATER WIVFN`1MLECfR
GRADING I:EE
Applicant
NOTICETOAPPI.ICAN'.11',u ermaking Thi'die,molExempt in I, you should
WATER SYSTF.M/1REATING
SOILS FEEi
became subject to the Worker's Compensation p vision, oFlhe Labor Code. In. must
fonhwith comply with such provisions or this permit that be deemed rcvnked,
WATERSEIIVICH
I
CONSTRUCTION LENDING AGENCY
NEW RESIUF.N'1'IAL PI -MIL SQ, IT.
PAID
Dal/kuciptM
I hereby afOrnt that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3091. Civ. C.)
Lender's Name
TOTAL:
Lendc(n Address
TOTAL.BUILDING
F/ I.
1 sanity that 1 have read this appllcon m� and state that the above info dmilon is
court. l agree to comply with all city and county ordinances and suite laws relating m QTY. MECHANICAL PERMIT
PEE
buildag emm0Inner uction, and hereby unihoriae mpreunmtives of this shy car ,pun the
SEISMIC F
ELECTRIC :EE
shove -mentioned properly for inspection purpose. PERMIT ISSUANCE
(We) agree m save, indemnity stud keep harmless the City of Cupertino against
to
dahilitius,judgments, costs andexpemes which mayin any way ammeagaimt said City ALTER OR ADD TO MECH.
in I ce Is the granting of us permit
MECHANICAL FEB
AP LICAN UNDFRSTAN DS AN LI. IMPLY 11 AL1. NON -POINT AIR HANDLING UNIT(TO 10.000CFM)
SO CI: :C.UI O'
CONSTRUCTION TAX
AIR HANDLING UNIT (OVER 10.00(1 CPM)
A 4111,11
Si marc of Aimmunl/Cnnuumor Date
EXHAUSTHOOD(WIDUCq
HOUSING MITIGATION FEE
HAlARDOUS MAT RIALS DISCLOSURE
Will the appllcam or I mane buildingoccopanlranom handle hmnrdoua tourist HEATING UNIT (10 10(1,0!10 BTU)
as defined by the Cupcnino Municipal Cafe, Chapter 9.12, and the health and Safety
Coale, Section 25532(4)!
HEATING UN[T' (OVER 1(0,00(1 B'DD
0Ycs E] No
VP,NTELATION FAN (SINGLIiBESIDE
PAID -
])—am RcceipM
Will the applicant or future building occupant use equipment or devices which
BOILER- COMP(3HP OR 1(X1,00(1 BTU)
emit hazardous air contaminants as defined by the Bay Area Air Qualily'Managcmen(
'I'OTAI.
Dinricrt
BOILER - COME' (OVER 100,000 BTI)
E] 'fix CNn
quirt
I have read the baeardous na¢rialsis under Chapter 0.95 of the Cali
AIR CON fit HONER
ISSUANCE DATE
fomie & Safery Cute, 2559) and 25534. I undcrsy tom if Ne
NEW RESIDEN'I'IAI. MBCH. SQ. F1'.
gdohs
th
buildinggiodoes not currently have atenantthatit ismyrespf arnotifytheoccupant
aaSection, that i
a Clati
of the requirements which must is met pdor ¢r issuance of a Ceniticme nl Occupancy.Ise-
1A.r " r ` A �--.
I SUED BY: •Q 1✓ /
Owner or submitted agent Date TOTAL:
OFFICE