B 0156 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE®ALL POINT PEN ONLY
CITY OF CUPERTINO • . BUILDING-ELECTRICAL - PHRMI N0. 015 6.
BUILDING DIVISION APPLICATIONIFERMIT PLUMBING-MECHANICAL, OO 1 'I�/r'�
Lf •"aCk:rt,BU1LDING PROJECTIDENTIFIC`ATION y.t ' ;pr,".� J���I y,J •
BUILDINDADDRESS SANITARY NO APPLICATION UBMITPAL LAIF' NAME
[ ARCFCr/NEN(i1NFER`r\`— ` LIC N��� ICUS 10R 61111'nlDr\iv ai \\14\\1V N/C CONTROI.N
° Al m."\ / PIAkI C\ Al-Th `1`130 '
CONTACT PHONE I -t!: fl BUILDING PERMIT INFO',j`.7
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB�MrE�c
LICENSED CON'TRACTOR'S DECLARATION r •a lit-:{,+,PEEL`rr{"+
-!"'s, J(' "x+ ELECTRICPERMIT i
I nerebv aramj mmiam licensed anger pmvivmn,of enapmr9 r„ammeamng .,}, ,,. , _? . .�.,,I ; LtJ.�" .r,rf-� 706 DESCRIPTION
❑az wnn socuon POln)oroi�itian3rl ha BJtrae„and rrom,nna,code,nhd my licensee, _
Er'O PERMIT ISSUANCE RESIDENTIAL'
II U U facer ace anJ off -� --�rA
V _�� ❑SFDWL _ ❑KITCHEN REMODEL.
VO Date o Inns Uc.M _ ❑AUDITION ❑PLUMBING RE-PIPIT
y�Y] Date\�� ^, Csatmemrl .`� l _ APPLIANCES-RESIDENTIAL - t
0.0. Ax ITEC'r'S DECLARATION I ❑MUITFUNIT El STRUCTURAL
zo-f _ lundomaund myplans shill he used vepuhlsremrde UPT02 MODIFICATION
oz-,- UP TO 2(O AMPS
er aol^ Llecnsed Yndesjonnl + E:1 INTERIOR ❑CHIMNHYREPAIL
CS, 801-IroN)AMPS I IMPROVEMENT �SWIMMINU POOLS
OWNEom ove LDER DECLARATION,
�C I hereby affiliation,I via exempt Entrant,Commcmr's License Lew far the OVER IdW AMPS ❑BATH RP.MODF1Ix L'PAIR [I DEMOLITION
0P.U following reason(Seclmn]0315,Business and Professions Cade Any city orrummy SIGNS ELECTRICAL ❑OTHER
w I++rjj which politics v pour m construct,tiller,Improve,demolish,of repmr ony slocwm
�', �� pnnrtwts issuance,also rurylms the tippbcant for such pcmmiofileau"irdstarcmem SPECIALCIRCUIT/MISC L�h'��oc
y that he is licensed pursuant it)[In,previsions of the Contractors Lieense,Law(Chapter 9 -
CA� Icommennng wnM1Sechon7IX0)of❑rvnien3ef theBminess and l'mfvseimns Gde)or TEMP METER OR POLE INST. OMMER IA
W y o that he Is exempl d erefmm and the basis tar the alleged exemption Any violation of ❑NBW BLDGIADDITION DEMOLITION
• �� Section 90915 by any appliance for a permit subjects the applicant to a civil opoltyof POWER DEVICES ❑TENANT ❑FWOIATIO CE
not Inure than five Mona,dollars($500)
A ❑ 1,as owner of We property,or toy employees with wages as their sale compensation, SWIMM I al POOL ELECTRIC IMPROVEMENT
p,Fa wJl du lM1C work,nnJ lM1Cmm�nrcja noumended or offered formic(Su.�lld4.
Brume„ OTHER
[i] m and Professions Cole.The Contactors License Low doe,not apply In an owner nl OUTLETS-SWITCHES-FIXTURES
6i pmpnny who hard,on mtprnvev thereon,and who doe,total,work hlmvclt or 11
his awn emphryees,provided that such improvements are rat intended or offered for I NEW RESIDEN I'IAL ELECTR SQ PP
Nola.It,howevee the budding arlmprovemmns sold wnha one yorref Oreadal n' he SQ FT.FLOOR AREA $/SQ PT
-hwlder will have We bmNen nl proving that he did nor hard or improve for par-
paseeofsale) 'TOTAL
❑ I,as owner of the property,our exclusively contractmg with hcenscd amuachas an -
construct No project(See.9W4,Business and ProfeVank C,dep The Counselor's W= �, iii. - v Is, n .y - _ !( t, I
tense Law does not apply to an owner ofpmperry who builds or improves thertnq and �.Q7rY.-'. 'PLUMBINGPERMIT.e •!}}c',•' FEE 1,
who wnuocts for such projects with a conuactont)licensed pursuant the Contractors _ -°'i=+`' ' ` 1=-, ' f'/" �� r c +tf .e,1
License Law. 111{{{ /'//'.� ``
so
ALTMkT G,R'A" &UMN'I AY ER(EyJ •” 1
❑Lam exempl uric,Sec ,B&P C retail,reason
Owner Data - 11 - VALUATION
WORKER'S COMPENSATION DECLARATION BACKP ObJ,I'ROPECr DP.VIC
I M1amby eMrm under peunit,of pe,c,one arms,following dedaations 11 7q�
�,l have and will mainmm vCttufimm of Consenuo sdf-insure for Workers COmpen- DxAINSGL00 ,R .A HA. O - STORIES TYPI?CONSq xUCT10D
n wurr,as provded for by Section 3700 of the Label Code,for the performance of the !!))
work
which his peons issued PIXTUx PERTRAP
r ❑I have and will maintain Workers Cor,columa Insurance,as required by Secmn
3700ofthe Lahrr Cock,Tar tlwperfor nee of the work for wh¢b hrsperrnnisjssued I GAS-E SVHTEM-I INC 40urfddiTS
My VV 'rs�Cn_mpc n o 1 u Q er and Peal, y _ OCC GROUP APN
'• Corner Ali'AAA_11i a` n Palley No��k ��� GAS-8A SYSTEM-OVER 4(EA7~J`
CERj'IFICATE OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASFNDUS'fRl.WASTE INIRCEOR
(This section need not be comprwed if hepernuns for one hundred dollars($I W) BUILDING DIVISION FELLS
err less) GREASE TRAP
PLANCHECK FEE
1aunty that inthe perfnrmaneenl the work for which this permit is issued.Ishall SEWER-SANI IARY-STORM EA 2WFT
nal employ ail,person m any more er so as to M1ceame subject to the Workers'Grmpom nNPRGY FEE
.C) Apple Laws of Cahfennv Dam (GRADING FEE
Z O Applicant I WAIF.R HEATER W/VENT/GLEETk
rn NOTICE TO APPLICANT If,after making this Certifier,of Exemption,you should WATER SYSTEM/TREATING
F? hecomc subject m he Worker,Compensvuon D"w"Eve,co jhe Laden Gidc,you man ' SOILS PEI?
Wfonhwhh comply with such pmmsiom on has permit,Mall be deemed revoked WATER SGRVICP. _
� z CONSTRUCTION LENDING AGENCY .I NEW RESIDENTIAL PLMB Sp TE PAID Unro 'Roc t ho 1 herebyal nrm that thereiva mmma coon Iendmg agency forhepertrmer,, f
w 0 the work for which this partial is issued(See 3097,Civ C.) -
Lenekrs Nom- �L;i (YTAL
�•I W Leadia,Addre, TOTAL
I eerily that I have rod this application and state Not ail,have mfnnnmi°n is } • ' 't';
,LI f•L i n+ IBUILDING PIiE f�
to aortae ivgrecmuimply with all aryvnd wunryeNmances via smrelaw,relvnngbe QTY. nI MECHANICAL.PERMITit it •"FEEit r,
budding conanucuon,and hereby authorize representatives of lmis city to enter upon the +•• TT,%1SEISMICPSH
aberve-mention,d property forinspection purposes I PERMIT ISSUANCE 7%9 Jvf
(WE)ugrooiosave,mdemnlfy end keep hvnnleas the Crty of Crpettmn agvmsl . �ELECTRIC FEE / 1
hvhdldes,lydgments,costs and expenses which may in any way inane against said City ALTER OR ADDTO MUCH PLUMBING PEES /
in cans,trum,oI the gro
nung of this permit.
REGULATIONS AND WILL COMPLY W[Tii ALL NON POINT AIR HANDLfNG UNIT CfOIO,IXId CFM7
SOURCE I MECHANICAL FEED
AIR HAN DUNG UNIT'(OVER 10,000 CFM) ICON TAX
Signvlme of Apphcant/Convacmr Dote EXHAutor IOOD(WIDIICT) 1 LOUSING MITIGATION P.P.
.HAZARDOUS MATERIALS DISCLOSURE -
Wlllthmipp hoau or Boom building mcupam store or handle Manna...,internal HEAL INC,UNIT TO Polaroid IT U) �� 4 a If
as deYned by life CaNnmo Munmipol Code,Chapter 9 12,and the Health and Safety
Code,Seaton 25532(a)1 HEAPING UNIT(OVER 1(0,001)H'I'U)
❑Yes "Sq.
VENTILATION FAN(SINGLE RESID) (PAID bit Rcceipl#
WI II the applicant err future braiding occupant use equipment or devices which (�n �(
eon hozvNnue mil oonmmmams o,defined by the Bvy Area Am Quudty Management I BOILER-COMP DDP OR I W,(1013TU)
District' I A I a,
(tea' r
E3 Ye, -pyvo BOILER-COMP(OVER 100,000 BTU)
I have mad he hmArdau;malenalvm requirements under Chamil 695 of the Call- AIRCONDITIONER
82553 p ISSUANCE DATE
famla Health
esac Solely Code,
eaterear, 505,is my and 25534,I understand
notify the that lithe NEW RESIDENTIAL MUCH SQ.FT 9— Q �Q
of[lie which must net Pilot to ismyceOTo Carrimnkoffythenccupum r(
of aierequiremems which mull bit mw prmrlo lsmvmc nfa Cenifiwl fOCC icy, - •
p�atin� ?r^„s,��0 I�-�4vg _
Owner d.gen Dole TOTAL ISSUEDBY • _�
OFFICE