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S 2237- APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY CITY OF CUPF.RTINO BUILDING - ELEC,'TRICAL BUILDING DIVISION APPIACATIONAJERMIT PLUMBING - MBCIIANICAL HIALDINO PROJECT IIIICN'1'IFICATION Ii NO 2237 BUILDING ADDRESS: �i / SANITARY NO AITLICA'I'IONSUBMI'1'1'AI, DATE 2-K •15" OWNER'S NAME: PHONE: Rs" 1 K R NT P(A T E L CONr RACE OH :S NAME: LIC NU: Nrc ❑ a)Nrkol,x o O ��/ � A CII'1'HC]'IIiNGIN Iiki_ N u'✓I x ,�A ADDRESS: CONIC �` yyLRtt �� AIp " MOO AKT • I • 'Y/� Q �W /l ❑ Consultant Fees Paid by Applicant (Initial) ,' fIUILDINC PERMIT INFO HI.DG ELECT PLUMB MECII ❑ El 17 LICENSED CON] RACmR SD ARn I hereby amm, but Into fi . 1 d p : f Ginnie, 9 d,onannealin, with Semfon]INp)af Ui is it n3nffhL Bu .. IPn fcssinns G,dc, and my ECen: i+ ou lClass ys �r 3� s z .melee Class ` -- Lim. ate Cermacta QTY ELECTRIC P17R Nil T .; _ - FEE " ��ZO ti a_u Ha ZO°1Z OZ `0 L Ot�i1V x W�LL�y JOB DESCRIPTION ❑ RESIDENTIAL, El KITCHEN RIiA1(1DIiL ❑ADDITION ❑ PLUMBING RE PIPE ❑MUL11 UNIT ❑STRUCT WAI, h10UIPICATION ❑IMPROVE ❑SW CHIMNEY IMPItOViiMI ?N'I' SWIMMING I'OOIS MINRFOC ❑ BATH RIiMODIi1JI2 F.PAlR � UY :MOLL "PION 171 OLDER MO PERMIT ISSUANCE Sf APPLIANCES - RESIDENTIAL � ARCHI'GiCI'S DECLARATION I undemmed myplan,,h.11 heuccd aopuMlc records PANF.IS UPT0200AMP$ IaccmeJ Professional OWNFR-BUILDER 1 hereby aff rm that I am exempt Irnm tM1e Comnemr'a I,iccaw Law for the ateflor he Codm,cN co Intl 6 .IS t 703L5. B IP 1 Cod AY ume II hp Il II g Lrlenem fo ] t, l permit .t I If p d rl p.,rany .Iruncou pr e 'I 1 the 201- LINM1ANfI'S r3VL' -R Iqq AMPS SIGNS rl.i'CI'k[CAI. - SFI CIALCIHCUIT /MING. %%%` ��� M L es O that he I lip tt th p n rs offle he l d License LHOW t (Chicane 9 ,iho com Bent nwim Secon ]pM)o(]vsmf3 tthc Hu +inundP (a+dn ..CodeOr that be ix exempt tnerc(mur and the basis for the alleged exemption. Any vinletion of 1'CMP. Mhrflt OR l'OLC INS'['. � COMMF,RCIAI: ❑ NIIW BLDG /AUDITION ❑ DEiM0iJT[ON Xm lal�m Q 51.0.0 6 3 m Scion, 71131.5 by any.p,llfanl tin a pmmivahfrclo the applicant to n Gill penalty of a' m'ban live bundleddellms( 500) ❑I, ms ownfraf the pn'pfrty nnnY CmPlnycea with wager natheirxnle enmpasminn. will do the wnd.and the urucom inmm imendedmoffhed fnr nde(See 70dJ, Beside.+ and Prolcsrium Code the Comeacmr's Uccle, Law Aax net apply m ua owma' property wan builds or impecve, tooled. and who does men work himself nr favor h POWER DEVICES ❑'lLNANT ❑FOOD SERVICE , - IMPROVIiM itN! ❑OTIIh:R SWIMMING I'OUL ELIiCI'RIG 3 )UI'LI.7S - SW'I'IC116S -FI 1 his own employees, powided line such imprnvemcnls all not intended m uffmcd tor sale. IL hearser, the building nr ia.provlocal -old w l thine myeurefenmplcl Eon, lire NEW RESIDENTIAL. ELECTR SQ rL SQ. Fr, FLOOR AREA F /SQ. IT, fr-buildcr will hall the banded of proving fan he did nnl hould or improve ka pm- pv e "Oral.). , ❑Lax nwnendlhe property. vie excimively amrnlming with acemed cnmmasnrs to T[f AI. r msenect the prnicct(Sec]IHd, Business and Professinm Cca J' G, Contractor Li- - cen+eLdwdoesallappl yon.., owner ofprnpcny wbe Tilde or improves thereon, and QTY, LUMHINGPERMIT FEE,.' who a,mraca for amen Eh B,N with a,nn nc,hsh,) licensed pursmon eu the Cnn lot ..or's mE u cE License Law. ❑lam exempt under Sec. ,HAPCInr this reason AITIR - DRAIN WATER WA) Owner [)are VALUATION D.V W'ORKER'S COMPENSNTION DIICLARAI'ION I hereby affirm under penally of perjury one of the I deep BAC .( 1'R F.CT. L , �'�lbeel �� CJ 0757 DRAINS -F O IDP RIiA. COND :md will maintain aCenificafenf G,msennoslf.ined.fg GO.. afar the erfor aCamped- amino, to pnrvmvA tin by Section J]Ixl of ehe Labor Cale, fur the perfonnnnce of h work forwhich thi,er it is issued. 1 have Imd will mninmin Wnrkerx C.... mrwtion Imamnce, m rcynlreA by Seem STORIES ^ _G 1YPECONSTR000ON SF� IX'ORPS -PERTR z oyk 3711fmom Labor Glide, for Im,rfommneenf the lark for which a bisperafil is i.vnat GAS— HA.SVS'TEM -I INC UTLEI'S OCCCROUP APN MY Worker's Compeneainn In.wmnce earner anJ Policy number art: C,m ier: Pnllcr Nn.: %� GAS -EA. SYSTE -Ni OVER J (IiA) CER'I IFICALE OF EX BM PTION FROM WORKERS' COMPENSATION INSURANCE / (� GRHASIUINDUSI RL WASTE IN DIRCEFIOR BUILDING DIVISION FEES flhixscnion need not he mnhplemAlf lhepcmtit lief rune handrcd dollar .+151(1111 t or urd GRLASIiTRAP - -- -' - -'- PLANCI IECK PEI: / " - V o^ z,7, Icend,floalinthepe , nurnenfido— kfnrwhichouspem..16 isucd,IShill not emp+1, emne to hecnmexuhject to the Workers' Cangwm .mien lthee[ s�� Amd,h ^y _ SEWBR -SANI "TART- S'IOkM 1i IXl 1'1��. -• \VKITlR IIEATIiR WNP.NI'dILHI L!s ' PRE O? OR At GI NOT IC NT: If, abcr making his Cenificam of Iixcmpemh, yon .should M1ecnme W'nrkcr's Comenmlion pmvisians of the lahnr Colic, you mu,q Inrthwasuch provlsbnts orlbis permit shrll be deemnl evoked. CONSTRUCTION LENDING AGENCY 1 hcrebynffirmthanhcre is a conrnntion lending lgnmy lo, the perb :mnncenl' Lae work for which Ibic permit is homed (Sec. 31190, Ci, CJ WATER SYSTEM /TREATING WATER SERVICE I,W' u7 a^' � '� V 2 PA / -Iz� C17rl NE \V RF_SIpEMf[AL PLMB. SQ. p,, Recoils QU CSI F" h U ,Z Lender's' Namc TOTAL: _ Lender', Andres, G 47 _ f I emi Ctrlll al Ile, i,mi,,ama a icao, the, th b '1 coon t.I gre t ply 'th l 'ry d ly I' 1a l l W(yl build' gconnmcl, n, nd hereb}authom pfsenmt vex of thacly toe nvlpofehe QT'Y ' MECHANICACFERMI I, FEE SI:ISMI P li t d PER'MI'T ISSUANCE �ffix S :J V i!LIiC' I pit "Z usrvu- manlianf,l propunY for in >peetion Purprsc. (WC) agree to save, indefnnily and keep hnmlms the City of Cupertino against ALTER OR ADD to MIiCH. 'LUMPING PII Iinbdities.judgmcams, costs and expenses which only many waymmrue againm,md nnse(luenceofthegemtingofthisper ,nit, AIR HANDLING UNIT(TO I0.001)CPM) MIiCHA [CAI. FEE / 0 APPLICANT IINUP.HS'IANIlS AND WILL COMPLY WITH AIJ. NON -POI, SOURCE REGULATIONS. AIR HANDLING UNIT(OVIR I1,Ix)0CFM) CONSE'RU TIGN TAX Signomrenf Applic :me/Cn tracer Date HAZARDOUS MATERIALS DISCL(ISIIRE EXHAUST GOOD(W /DUCT) HOUSING MI'RGA'f[ON ITIH I[EATING UNIT(To 1(IgINx) II'TU) Will lhenpplicam ormore building occupier store or handle baanrdonx malt as defined by the Cupertino Municipal Cade. Chapter 9.12, and fire Health and Saint Gx]c, Section 25532(a)'P fIEATING UNIT (OVER I011,gX) B'rU) . es ❑ No e mil hum Wrildl otuhs e air plicaanmt oinr ants a x hJucnftnicnd g by the Bay Area Air Quali ty lnir t y d Mana gement Dixac(! El Yes [-I No VENTIEATIGsJFANOlNGI.ERF_tiID) PAID pate ItecciplN BOILER - COMI(lll'OR Iq.[XI P'iU) 2- ©)I ILOIhEIi- COMP fOVER I(XI,IN)B III U) AIR CONDITIONER [ have viced the Case, Section, 2 1.5 5. 25533 had under . 1 mul fi rral the Gdi- builmodec,aW, exutaCWaco .detit2Ony,,souldloy talent, mi hal net eawhlih ClBfy m nnlfOh there] for ISSUANCE DATE NEW RIiS1ULNTIAf. MEET 1. SQ. Ft. of ire Toust a ow,lp m mf fefpdremema wmnn,ml ne met pdmmirrrana macemEcmf. nrctfapdncr. It issuance ce of. up'ney. ,/1 -r SSUEDBY:v0e /JAS? ,3A�UCCt T I'Al,. a �F Owner or untboriecd agent Dale OFFICE r