S 1191 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO _ -- - _-_ — HUn.DINC.•
' u o ' I VI ITNO
MECHANICA
1191
1
"�9rV BUILDING U.inISioN APPIIC AFIO N/16RMIT LY]NT��NAMMLI T - rMLI:U nun- nr-EC
A3U(I1NADDRESS RUILDING PROJICT IERN--ri F ICATION• SANITARY NO. A�PPLICA�TIO�NN�SUSUj'B MIff(L1\N1 h�/,I/tA
l
ALDCAIL P11 12-0 } LAP� / LICND"ONE.
LAMS Ii
NC CON'I'RO(.M
t
ARC1"113LT/HNGINEE LIC NO ADDRESS
�_ `S a 1474
CONTACT PuONii' I :BUILDING.PERMIT INFO
���Q' P �_
'1 LUHIR NIECO
S ❑ Consvltan[Fees Paid 6y Applicant(Initial)
LICENSED COM RAC'I'OR'E DECIARIf Ch'N f
1 harehy affirm ihal 1 con of the B licensed under and Prod nr charymr 9(etmmenai,g I QTY'. t ELECTRIC PERhil9'• JOB DESCRIPTION
{O d'Z web Satin,)INgpdUmiann3 oRhe❑urines.onJ Prolcwnn+Cale,and my l ic...... l ,I PERMIT ISSUANCE {�.� RESIDENTIAL,
F O O III force end e1Lxl.
aVU License Cross Loup _ _ - �WI. ❑KIICHf:N RI?MODEL
y�>>WM Dute Comracros APPLIANCES-NFSIUENTIAL APION ❑PLUMBING REI-PIFE
ZO q AROJEFECFS DECLARATION PANIiLS MULTI-UNIT ❑STRDCTDRAL
undeommi my plans.hall be used as puhttc record+ MOD CJ IJR'ION
O� , Licensed Pronn.cut l]PT02nn AMPS ❑INTF,RI(lk ❑CIUMNEYREPAIR
Q ..1 201.6009AMPS IMPEOV lis,pp..
OWN13R-BUILDER DECLARATION Vfoss El SWIMMING TOOLS
E C Q I hereby affirm that I sent exempt from the Commanr',License Lew for Ili^ — OVER HALO AMPS ❑BNPI REMODEUREPAIR ❑ IiMOLITi0N
X3 fallowing race+nn Radon 70315,Husmns send Profe,wmo Cwlq My any of unll'iy SIGNS ELECT KICAI. ❑OTHER ���+
4F O which reopen'u perms set mmWCn alter Improve,chromboh,or region any tmcturt
N
prior hh Issuance,alsoruquireetc-11dunl for such pernm ro life.s:gnedum¢ntent SPFCIAL CIRCUI"I'(MISC, A
GfIlia(he is licensed pursuant to the provisions ofthe Contmne/s Lrecn+e lrxlChapmr 9 !
ty (enmmvmmugwith Secunn](XNI)tfUmann3nl the l{uanc.+und 1'rolmmemGuluLnl TEMP MEl P.I1 OR POLE INS'1'. F VUrGI<
a y y that he i+exmnpt therefrom and the huts for the ellc6cJ exemption Any vmlaum of
uX7 W Se"am7Nl 5 by tiny upphcanl for a in nuI.....11ieu Iraacorn ❑NI?V3, GADUI"ri(IN ❑D13M(Iur,(IN
W pp mint lweahy of POWER DEVICES
not mom than file hundred dollars lS500) oIG `1 NA NT ❑FOOD SERVICE
=Q❑ ❑1..+nwn.rof the propcny.or my employee,with wugv+Iry lhernnlu cnn:p,loa I, I SWIMMING I'(IOL ELECTRIC 1� PROVFMENT
will do the work,and the oimemre n not Intended oroRend forsale(See.70,14 Ruslnes. ` ❑OTHER _
and Prolevion,Code I he Contmmor'+License Law thaw nal amply In as owner of OtT LEI'S-SWITCI IES-FIX FURES
,..Way who her Its or outputs es thereon,and xho units such walk himself onhrough _
his own cmpfoyeew pnmubd that ouch nolor em"an not Inrcnded or... Inn NEW RESIDENTIAL.ELEC`TR� SQ Pr.
,ale IL Bice, oll Inee 11mgmmolImennanldwnbm nn cyearnfcompleuon the SQ IT FLOOR AHF.A EISQ IT
mrbuddcr will hove the M1urJen nl pnrvmg thni he AIJ ern hudA or unprovc for per- ,p�j
ry' of+ale) _ ey/ I -412. A"-s,
- •r of die See,7ty,am Business and cenvachng with j Theed contr.aom to T[ 1' 111 JJJ---
n s 1.atheprote ct(Sec.9014.Ruanee+ropr(nwhaons Gsorii The Commnor+Lr I
sense L.w Uocv nm apply m nn owner of pmpeny who huddwr iinprnvu ibercon,and I QQQTI'. 1' 'tp1,UM I NO PERMIT' I PEE i,, ` �O
who rommem fonu<h pngaiswnhaco rvcmof)I¢en od pursuant to the Contrdetorc \' \•"a rr+' t'
Iatemc Law. I ` PF.NMII'ISSUANCI' \/
❑gym axe unde Scc RGPCmr0a,,om+mt+ _
ALI ER-DRNN& - ATIiRA) VALUATION
der U.nc
reby Mo.under penally ofpvrpay nnc ofla follawmg declamnnns, I RACK PLOW PROTECT UN
Ili: anA wJl mmrnumaCUrufcme of Cnnwnuo,ell-Insurvlm Worker',Cemlrem DRAINS-FLOOR,NOOF.AREA,
icamor as pmvW ed For by Saxon J)Wof An J,bec 11,broke,perlolmawe nl the \ STORIES J '1 YPP.CONSTRUCTION
--- work lot which lluo perms.tolo+oeJ I PIXTURIS-PER TRAP '
I have and will mmmmn Wallace,Contemn".Insurvnce.as required by Section
3]W of the labor Codc,Ireff"'Jorm"weefihewnrk""wbmb Nn pvmurt.ismvd I GAS-IS.SYSTEM-I INC.4 OITI.LT.S l OCGROUP My Wnrkefs Compensatitb Inomnce earner and Public,number arc qpN
Cartier, Pettey No (GAS-13A SYSTEM OVER 4(13A)
CERTIFICATEOF EXEMPTION FROM WORKERS' I f
COMPENSATION INSUNANCIi GRPASWINDUS)RLWASTE INTERCEPTOR
(Thasaunn neW nm be nsmplettth(me pnamis Inr one handled duffers(S100) I RUILDJaV('1li Vi ON FIJff
or)es) II GREASIi THAI' �HANCHIiCK IE /V\I 1
Ioymay maothe any orntnnceof the work Inr which thanperms reissued. shall
naboul,oy hnypmoonmaDa mmmvr se u.m hcwme wblecunihe WnrkvK Compete 513WER-SANITARY-STORM RA.2fX1 PP "NIiRGY FEE
Z A,ph,aaws of Cahfnmm Dale I WA'1'F.k l{EATER WIV13M/131.IiC'I'R —
z Appla'unt t ^RARING FIi�;
ti NOTICE TO APPLICAINT.IL after making(his Certificate of Exemption,you should wAT131t SVS'113M11'kEAI'ING !
a x�r Mvnnte suhµ'ct nt ilia WOrkcrk(-ksinpetA+aaon pmvisions u(ibe laMx CtMe,'en mast COILS FI /
CiI fanhwnh comply with+ach pmsn+inn.of this perms,hall M:deemed revoked. I WATER SERVIC13
Q
� 7. CONSTRUCTION LENUINO AGENCY NI3W kIi.S1bI:ML1L PhbIR SQ,FT (IPAID
V p Ihcrchy nlhim❑tuvhcre wacnngmcunn lending ogency for the performance o[ — _l Um Ramptp
U. F the work for which this permit is nomij(See 3097,Clv,CJ
lend!.. ir
'.Na .
O U CLT Lender's AJdru
Cy I certify that I have read this application and state that the active information is
F - BUILDING 1Ii
I/} builder lagreemro,and wvmy ntynmf m.ntymdmaneeannd smrc laws Mmmgui I'Q'fY. MECHANICAL PERMIT' `5
L) �y bmldmgumand pm,end foravipectionpr presematves ofthw mty menmruptm the _ F E ,SEISMICF 13 2v
alive-mentioned property Inr imany an purpnsa 1
(WC)agttm mnnve,indenimf Jkec handless me Clt tCu g I'ERMII ISSUANCN
yon p yt pmmta coon _ ±LEL'I'N! f9i13
habJn¢s.ludgmenm,costs and expenses which may in anyway aceme againsumd City ALTERORAUDTOMECH.
onsoaOncet the granting of Ihis l twit. �P1. MIi IC IF7
in APPLICANT I DERSTSNOS AND WILL MPLY WITH ALL NO POINT I AIR HANDLING UNIT(TO 10,oW CFM]
SOURCE kEO ,gTlO �CONSA1 CA '1414
AB IIANDhING UNII'IOVIiR❑I IXNI CI;MI �C(IN.S'I'It IlCl1ON'I
r
Signotureo( Ilcanf omrect�I Ialc ` EXHAUST I IWD(W/DUCT) —
HAZARDO SMA ALS DISCLOSURE �HDDSING MITICATIO AEI!
Wdt appisam or future buJdm wcupent nom or handle humrou'l mnterwl I I WAY ING UNTrfTO(07.(MB HTU) f '
as defined the Cupenmo Municipal Cede,Chapter 9.12,and the Hcldth and Safety 1
Cale,ScOnal 25532(a)+ HEIII ING UNIT(OVER 100,000 II'1'U)
❑Ye+ ❑Ne
V EMfILA'1'IfIN PAN(SINGLE RHSID) (PAID
Wdlthco Imdntorfumm b idtlm 1 Ome RaeipM
pP grcaryem use equipmem or Devices which HOIfAR-COMI'(JHE OR IIp,IXM)B7 U) J ■� I
snit fmvlJtm av ammminunin its JelineJ by the(fay Arw Air Quuttry Manngcmenl
Uiermtl �r`l{yll
❑YCS ❑Nn HDILIiN-COMI'(OVCR IBILIX111 RTU) \\'Y
I have read the larallouontamnale re9mreemd,under Clutpter 695 of the cah. AIR CONDITIONER ISSUANCE DATI>
foam Hwlth&Safety Cale.Saxons 25505,M513 and 25534.1 understand that if the NIiW R&SIDENTIAL MF.CiI SG.FL J
building does al s currently have a noon!,that n ra my m ponsrhrhsy le nobly the tacupanl
of the requirements which must be met pfm to issuance of a Centfeam of Occupancy.
Ownertr.uthaomd,,t,m Date I TO
ISSDI:O EY
OFFICE