S 0241 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY _
CITYOF CUPERTINO BUILDING-ELECTRICAL _ PIIRMI'I'NO
IJUII,1-VG DIVISION APPLICATIONIPERMIT PLIISIIIINO-]IRCIIANICAI. �1 094t,
.BUILDING PR(3JECT IDENTIFICATION' J
�IDILDING4UDRESS: SAN)'FARY NO APPIJCAI'ISI .
IDWNGY,*A7- d"G/Q� / (�{N�,2-I1 1 COM'1SkACT,%e NAME LIC NO.
//j=��JJ L /\ ^^C. NIC ON'l ltOhp
ARCHI'I'ECTIIINGINEER: - LIC NO: ADDRESS O`
rho/ OC4h5Q B/v�
GDNT CT w [//f 1. PHONE I ' BUILDINGPERNIIT',INFO
6(' Kr% x`601' (41s)y/-7• r837C ❑ Consultant Fees Paid by Applicant(Initial) I RLDO ELECT PLUMB MFCH
LICENSE.)CON RACTORS UIiChARA'I'ION QTY "' "ELECTRIC PERMIT'• 11 FEE"
1 hereby affirm mad 1 am 11een.J under pmvlwons of chapter 9 molamenrng I . . •' � . "''• - JOB DESCRIPTION
I
wOZ wnh Secuon]111gl of D,vnwn Sol the +meta unJ Pwlccnnns CnJC,and my Ucensc„ PERMIT ISSUANCE � RESIDENTIAL:
FWS mfullfor a anddrect. _ ❑SFDWh ❑KITCHEN REMODEL
aUV License a Lich APPLIANCIiS-RIiSIDLNTIAI. ❑ADDITION ❑PLUMIING RE-PIPIT
NQq Dule 'rm or
A IT[ 'SD LAR 'ION I ❑MGI.T[-UNH ❑S'IRUC'1'URAL
p-D I PANELS MODIFICATION
Z O nta J p plan shall he +. +pub m cumJs
OZ� UP TO 100 AMPS ❑IN'TERIOR ❑CHIMNHYRERAIR
Fy IrJ Laeme P Iro 201-I000AMPS IMPROVEMENT E]SWIMMING POOLS
•.1 OW NE -IiU WRWC < 1'1 N m t e Commcdors Llcen¢Law for the DVlik I(NI AMPS ❑BATH kEM(1Di?URlil'Alk DI3NIU1.1'1'ION
WWh achy affirm thaltan cxm he 3 G U blow g reaa (Se,ntoo]IUI 5,i IeIand i'neseuns Cute Any uty nr roomy SIGNS ELIiCTRICAL ❑(FFfIF.R
which require a prmlll m e s almprove,delnollcl,,or repair any someone
at poor con,.rsa Ines,olio rnpures cuppbwnn lnr Inca perms mBkaslgncA stdminml SPECIAL CIRCUI I'IMISC.
�). that he Ntee plrmcrat tV,p �ums of the COnoi,am's License law(Chapter9
14 tcommencing with Section 70,10)of Dlvmon 3 oflhe Business and Franc— oCmle)ar TEMP MET 17K OR POLE INS r COMM RCIAL
a LL e rG mad he m e,empt thenfio nl and the has,,lea the alleged e,enspmon Any violation of ❑NEW BLDG/ADDITION ❑DEMOIATION
ern Section 7031.5 by unyapplicand tarn Mnnn whJerts the eppnearal to a civil penally of POWER DEVICES El TENANT El FOOD SERVICE
'I more than hit lmndreJ dollas D5)(d. IMPROVEMENT
6 01,es owner of the property,or my employees xnh wages es them sole a,mpensation, SWIMMING POOL ELECTRIC
p=.,O wdl do the work,and not the structure In nontended or catered for sale(Sm.7044,Business ❑GTHI:R
w 3 m and Pndesaom Carr The Convector's Laenw Law does not apply to an owner of OUI LUIS_SW ITCHES-FIXTURES
property who builds or m,pmves Ihcrmm.and who Jrcs such work himself or through
his own employees,pnrvWed Ihad such uoprovcmenh are not Intended or offered for NEW RESIDENTIAL ELECTR SQ PT
sale IC however.the buildogonmpmventenussold within nneynu ofemopleunn,the SO IT ILOOk A`RIiA $ISQ FI'.
eel.noddrl will hove the handrail pnrvnxthm he.ad nth nuJd onmprnec roc par-
Note olmle.) wqy� — fir\ 1`\T1,J
El I,a owner of me property,,Business s and contracting with.)TIhe Contractor's to 1
sense alhepmlot applc]IW, fpr.,'ywho build,orrafhe c,lhorar.and I ,)
case Luw Aocsnol apply to an ownendpropcnywhn nmlJsorlmpravestherenn,end lQTY;''!' rr /`r PLUMBING PF,RNIIT• ' , FFF„',° to
who contracts for Inch Pmetls with a cwnraclor(s)accused punuanl to the Conti sou'+ '
License Law. PIiRM1III'ISSUANCE
❑ Iamesemptundrl Sts. ' IN&1'C fart his rcmon
Owns-
ALI ER-TRAIN&VENT-WA A) VALUATION
tII.
WORKERS COM1IPENSATIUNDECLARAFION BACK FLOW PROFE61' Out I �� t �^
I Starchy union ands penally of pcpuryonc of the following deciaarnme, _ (•
I] Iinunandx dI andena Cmti Ileum of Consent to+clf-mwmtor Workers Conifer- DRAINS-FLUOR,R(E)F,A R HA,COND STORIES ' '1't'PE('ONS3 RUCTION
,Inc..as destine far by Scene.37(X1 of the labor Code,for the performance of the
work for which this permit is issued FIX'NRES-PER TRAI' a
1j I have and will maintain Woder's Compensation Insurance,as required by Seeuon I— I •PI A
17W arthe Labor Code,for the wrouraa e,nfthe work for which this permit is issued GAS-EA.SYSTEM-I INC.4 OUTLET'S r �r /�l i OCC GROUP MIN
My W,nrker s Compensation Insurance earner and Policy nwnhcr me. Ili' L/
/s
Cal Policy N,, GAS-F.A.SYSTEM-OVERJIEAJ OCT
1/
CERTIFICATE OP E%IiM1IP If3N FROM WORKERS OkEASPIiNDUSIRI,WASII?INlliitCHl'IOR GC� b
COMPENSATION INSURANCIi rI BUILUINO IIIVI, ills
(Th,,wnum need urn ocmmplmnl ernwls fan,ehunJred dollars l8l W) - - -
orlew,3 GRBASEBRAP PLANCHIiC I�rr Laur�HU r
Icenif Ihatmthe perfnrmnnc ofnhe Orka rwhmh npermlt issucd,Isball SEWER-SANITARY-STORM1f EA.200 F1'.
nolempiny pear ro airy m:mn s,as his ,.,at, .Oni l•WI Ws Inpen- EN ERGY FIT, �r
Q Z cation law oc ma Date WAHER HEATER WNENTRILEM R - -
y,f� Ap hCa r GRADING FEE
N 1'O P LI makm ho rte �E a non,n null Wp'FIiR Sl'S'fF.M/TREATING
heconm soh d n d n rvan f�Hn Cr ,you mow SOILS Plea:
{[I founwimeo plyw hweh pm vivo+or dh It sl eJeen,eJ re Ud W'AI ER SERVICE
Q
7 Z CONSTkUC3'1 .ENDING AGENCY NEW'RLSIIIEN'I'IAh i'LM1IH. SQ FR (PAID �I{I-,-
UC Thereby afhrm teal inert isaconwrvcuon lending agency for the permmlunm of /,1'y Nor Ip
me for whlnh inn I h lua,ed lSec.LN],Gv.C.I r a
penal
C'U lender's dens Name - • IfI I'AL.
Lender's AJArca q 1Z�
Ly..I 1 1 certify Thal 1 have real nhro application and stem Thal the above,monnnaon n RUILI G �
is y correct.l agree to comply with all city and county oolmanees and wade laws relating to QTY. � I •' NIECHANICALPERMIT' � FEE III
F
V Z bnddmgmmaucuon,ond hereby uufhmirerepreununvesol this city contact,p,on ph, - SEI$h11C
above-menunn agree to fonrrpecunn pulXS So PlikhllT ISSUANCE •%�•��
(We I agree m sour,mdemmf hnnnle the CiIY of 'upenma oeuinn _ ELECT
aandmes.JuJgmena,cosrc andm nueswhm ayln ny xay etc agaimtaid0ly AIIFERORADUTOMF.CH
me r the grams n Ihs pc II. PLI1M01 GF ! �^
-'O NT k
AP L .A or L DERSTA 'AND IL CO 'LY W TIi L NON I I AIR IIANULING UNI1'1'10 In,OW CPNH MH CHANT
C C LIKE
NI :EI GL IONS OL
A I R I IANDLING UN I F DVHR 10,1X10 CFM) IGUNS'FRU TA Trill
� Sign turn FA pheanUCia ac Date EXHAUST HOOD(W/DUCT) (HOUSING MERGA NFF.E
HAZARD)US h A RIALS DISCLO. R
Willi apphcanlmfuu ebu dI ecopam store or ha le harandms madamd HEATING UNIT(TO 100,001 BTU)
as Jclined h the Cupertino Mu v1 L c,Chapter 9 12,and the Health and Safety
Cale.Sevin 25532(x)1 HEATING UNI'1'I OVER ImL1100 B 1U)
F1 es ❑No VENTILATION PAN SINGLE RESIDI PAID pine k¢tpn q
WD, Will rand the applicant ont contaminants a hudmng oucupand use equipment Quality or Mara which
',', hamrdnue an co at one defired riding ny the Bay Area ip Quality devices which R(IIhHR-COMP 13HP OR IINI INN(BTU) 31
DnlnoI
( ❑Ycs ❑Nn BOILER-COMPIOVIiR IIXI,fIfXI BTU(
AIR CONilll'1(IN[R
1 have read the hwndnm malrnuk mpllremmaN under Ca.Ipan 695 oa the CnU. I ISSUANCE 11ATfi
�omia Health&Safety Code,Sectlam 8505,M533 and 25530.I understand that If the NEW RE-SIDENTIAL MECII SQ PF
omlJing does interment,have a amen,domora my ner,mwbmry to nnufy me aaupan•
of the regmremenls which muss he met prior to Issuance of u Cemficaa 01 Herepancy
Owner or announced agent Date 'y' L ISSUEDBY
OFFICE !�