S 2277 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO till II DING-ELECTRICAL 11128111'NO.
BUILDING DIVISION APPLICATION/PERMIT r1,I1MlHNO-NIECIIANICAL 2277
BUILDING PROJECT IDh;N'I F1cviTON
BUILDING ADDRESS: SANITARY N0. APPLICATION SUPMI'1'PAI.DATE
0 101 WOLA,— OBD W114 7
O 'NI3H'$NAMG: I'IIONE: C>'TNAC'UH:�NAMIi: LIC NO:
NIC CON'RRIM,p
•IARCIIII'IiCT ENGINEIiN: LIC NO AI >RtSSL1:_ �. ,�- I�
CoT/A�C�T` Iy^r,L PHONE l/4. 13UILDING PGRMITINI'O
`�•^'r �� "�"� 303 Caa,mhan3 Fecs Paid by Applicant(Initial) BLDG LECF PLUMB MUCH
AAc Ad S-!tf' hQ.CH 232 0 ❑ ❑ ❑
LICHNSEU CONTRACH I35 DECLARATION Q'rY. ELECTRIC PERMIT' FEE
I hereby off an and I ten Iicened ander,uwi.dm+.v of chapter v(immnaeng JOB DESCRIPTION
o�z m Section 7lxool Di,Alm 3m the Bm1mw.nmu'mfexsionv Cnde.nndn+y license i, RESIDENTIAL:
W p PERAII T'ISSUANCE
�U� n lull force and effect O ❑SFDWL ❑KITCHEN RIiMODFa.
QUU Liccnm&':''�iLr<-# APPLIANCES-RESIDEM1TIAL ❑ADDITION PLUMBING RIiI'IPE
FZm Ua1e Contractor
rn Qct ARCHITECTS ULCI, RA' o ❑MULTI-UNIT ❑STRUCTURAL
~yZ 1understLord my plan shall be used as public rcmrdx PANELS MIIMN17A'I9UN
OZ�� � UP TO 200 AMPS ❑INTERIOR ❑CHIMNHYREPAIR
OL
W I.Iccnad Irrol iunill 201-1SXIAMPS IMPROVEMHNT (]SWIMh11NG POOLS
OWNER-BUILDER DHCLARA'IION`1a� OVER IIXXIAMIS ❑BATH REMODEIJREPAIR ❑DEA101A I[ON
tie'' Q 1 hemhy ofarm that 1 um exempt from the Cnlnra,ha,License Law for the ❑OTHF:
X p 6 U fallowing reason.(Smion]1131.5,Business and Prnfewinm CWe:AnY city nr county SIONS ELECTRICAL r
❑:3 C)
�y which requires a permit to construct,alterimprove,demolish,or repair any structure
prior to its issuance,also requires the applicant for such perms to rite a signed staumcnt SPECIAL CIRCUIT/M PIC.
ag that he is liccdx pursuant o the pmvismm of Contractor's license Law(Chapter 4
I+3=C0 (commencing with SectionWXNp of UivisinnlnfthcBminmv and Professions Code)ar TEME mriEl OR POLE INST. COMMERCIAL:
a C ea that he is exempt therefrom sad the basis for the lexen+ption.Any violation of [I NH G/AUDITION El DEMOLI'1'IUN
X m LL $ecllnn](1315 by any r,pli-al halt permit mhieetx the applicont m a civil pcmilty of POWER DEVICES PKFNAN'1' ❑FOOD SERVICE
(
hnn
NomN..^ our Inol'u @un five Jretl Jollun $51111).
C=< Las owner,oI be n SWIMMING 1'(101,HLECI'RIC GFFIER EMIiN'I'
2d O pmpu Y�unnYcn+pluycas wllh wages us their snlccnmlwnuminn, ❑IMpRO
P.. will do lhenork.and the--ammmmix not intended or offered forsde(See 744.Bnlnesv
C n 3 m and ProfessioCode The Contractor's License Law doe%not apply to an owner of OUTh1!I:S-SW I'CHES-FIXTURH$
pmpeny who builds or improves thereon,and who des wch work himself or through
his ox's cmployeec provided that such imprmen
ovets um not intended or offered for NE-\V RESIDE WE LAL ELECTR SQ FT.
%de.If.hmvmer,the building or imprn'ement is sold within one Year ofcompletiou.the SQ.FT.FL(K)R AREA 5/SQ.D .
oonser-trailder will hove the burden of proving that he did not build or improve for pur-
p+n••ol'xalcJ. TOTAL:
1,n owner of the propert%an+exclusively cnntrmang wall licensed"Loosiom a+
:nnrua Ne,pmjecl(Sea 7(014.Bowness and 1'mtussion,Codef The Conleeha,Li-
eLaw does nal apply met owner ofpropony who brikkor improves lheren...and QTY. HINGjF '1' FEE
who contracts for such pmjats with a cnntracmr(x)licensed pnmuanuo the Contractor's /
ase Law. PERMIT'ISSUANC
l am exempt under Sas .B&PC for this mason
ALTER-DRAIN&V6 (EA) VALUATION
Owner Dam
WORKEEVS COMPENSATION DECLARATION BACK FLOW PRO] .
1 hereby affirmunder penally of pe Juryone of the Edlowing decItrom I,:
Iha,cmd will mointnina Ceniti,alc of Comcnno self-noun,ha Worker's Compcn- DRAINS-FLOOR,ROOF,AREA.0 NO STORIES '1'YI'E CONS I It UCI'ION
work,zliou,t r Wuvidml for by Seen ]71X1 ul the Lubar lode,till perfonnanee of Chu
work base
tills pantaill crier' FIXTUNBS-1'I!N'IJtAP
❑ hove and will maintain Workers Compensation Insurance.as required by Section 'C.
J](MlnDhe LaborCNc,fonhe perfimmonee of the work finxhich this permit is issued GAS-EA.SYti'TEM.I INC,JOUTI,EI:S APN
sWo - r.candoInvmnc rand Pnhcy y��n�Wl"K td 'nlicyGAS-EA.SYSTEM-OVERJ(IiA)CLRI'LgCA lifll'8Xh1PI'IUNHGRf3ASIlINUUS'181,WASTEINIIiRC1ePIT)kCOM193NSATION INSURANC17 ES
(Ibi-ocrienncal nut becomplemdd he permit is fur one hundred dlhas D l0f6GREASIi'TNAI' Lillsr Ices.)catifythotialbcperlb co.ofthcw... lin wbichtbis pnmit lx LancJ.l xlnrll SEWER-SANf1ARY-STORMRA.2B017T.employ any pemnn in any mann n bcao le 1 rbjcetmtheWurkerdCon+pcn-O 'nn Wwsa.
fnrnia.yy�a+tc • \VAfER IIEAIIiR W/VENT/ELECIR le
zNOTICmt�NLbe,comE TO PLheWork If,xhcr testing Lpr let am of Exemption,youshould WATER Sl'STIiM/fkEATINGBalite,su comply the workers Compenstuionpmsixionsofthe Labor Codayounun
U r lonhwith comply with web pnrvimms or this penninhall he deemed revoked. WATGR SERVICE
p PAID
CONS1RUCI,,is.sat"
LENDING AGENCY NEW RES DE PLh1B. SQ. Dwe Receipt#
U O Thor hir,h mnhunhcm iv,oed((See
l7, xgmmy rte the perh:nnancu til
d+e work for wmd+sax perrtin Ts ixxaw[sae.3u9],C.O.cin.e 7 ro1'nl.:
. O U header,plume 'I OPAL:
r D.1Lender's Addeo
CL 1 certify that I have mud thim
s application and state that the above information is
BUILDING FEE; Q7
,F. N c nect.I agree to comply with all city and county nNinali and lima laws reducing to QTY. MECHANICAL PERMIT FF.E SRISMIC IEP,
U Z building conswcoun.and hereby andmiu mpmxntmives ofthis city to enter upon the
sfo c,d cntinncd progeny for in,pemion pc,,,Ix. PERMIT ISSUANCE ELECTRIC IEE
(We)agree Nr lav,Indenmify and keep harmlcts the City of Cupcninu against
liabilities,judgna7ns,...somal expend whid Indy in any way oceme against said City ALT CR OR ADO'10 MECIL PLUMBING FEE
rscqucncc of the Sit ming of lhiv pcmilt. s
APPLICANT UNDBRS'I'ANDS AND WILL COMPLY WITH ALI,NON-110IN'I' AIR HANDLING ONI'I'('1010,00OCIFM) MECHANICALTEE
SOURCE:REGULATIONS.
AIR HANDLING UNIT(OVER 10.000 CPM) CONS'TRUCT10N l'A
Signature of ApplicantlCommctor Use EXHAUST HOOD(\WDUCT) BOUSINGNH
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant...home building occupamnnre nr handle a... snm¢rial HEATING UNII'(TO 100.000 BTU)
as dirmed by the Cupertino Muna.pal Code,Chalet 1)12,and the Wallin and Solely
Ctalc,S,,rm 255320)^ I IEA'TINC,UNIT(OVER I(fl,0m)If I U)
UYcs ❑Nn PAID
YEN'I'lLA'I'ION FAN(SINGLE kCSIU) I,nc Rcreipt#
a Will the applicant nr future building Necupant use equipment or devlcm which BOILCN-COMP(3HPOR Idd.dpp HTU) r^, I�l
mit hvawk us air conurmnunts as defined by the Bay Area Air Quality htanagemem TOTAL: W-`-�NJ
Diouf'] BOILER-COVIP(OVER 100.0011'IU)
❑Y: ❑N
Ih' IJ l I I -I 9 t. 1 ClIu 695 ftl CtI. AIH CONDI'ILONER ISSUANCE DAI'fi
Intm.11Th&Safety C. l Section,25505 5533 I d2553d 1 J .I I II'I it the NEW RESIDES'I AL MUCH, SQ.PC
Full 6J t tlyl tchat t 1 '.I I'llyt 111111Y Ill Ito
of me rcpt mmunbwa sb +ml M. act Pnorb vu taut Cs tf 'tete nl'(Yu P'rsY. •/� /'� r
Owner or authnrie,d agent Date, rLFAL: ISSUED BIF_ rC /���s.�/WCCa
OFFICE