S 2032 .'� APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
IIUILDIN(i-h11.ECTRIC I. PE 1'r NO.
CITY OF CUPIsRTINO PLUrvnrING-MECHANICAL 2032
a "ani nIVI4TON APPLtCATION/1'ERMPr nTi DING PRO.bCF HJENrn'ICABTUN .
IIUILDINGADDRESS: SANITARY NO. AI'1'LICN'ION SIIRMII'I? DATT:
OWNER'S NAM d IN '(1NfR rOR'SN MG 1'IC No: NIC CON]'HOLp
t \RCHI'I'ECT/HiNGINEEW LIC NO AUDI :SS ❑
CONTACT: PHONE: BU ILDINGPE,R MIT INFO
�/_ �� ❑ Consultant Foes Paid by Applicant(Initial) IlO ELI❑'�.CIPLUMB MECI
LICENSED CONTRACTOR'S DIiC1.ARN'ION QTY IibECTRIC PERMIT 1PIie JOB DHSCRIP'r10N
CZZhereby afloat that I ant licensed under previsions oe Chapter 9(counmeneing
,c0 'N Social 7")of 3onhe Dusmesmad Profession.ClAc.nnd my hcmreis RESIDENTIAL
L— wl I'ERMI'1'ISSIJANCIi
1 ��U in full force unJ effut. / � � ❑SPDWI. ❑KI'UMBINRIiMODHI.
ed.zuV1 Dutc�Cm —E�SQ--Cnntrvemr �T—_ APPIJANCEti—I<&SIDENI'IAI. ❑ADDI'r10N E;PLUMBING RE-PIPE
tn6a ❑MULTI-UNI T ❑S'L'RUCS'URAL
NtCHI=S DECLARATION MODIPICATION
1)D m PANELS
OZ UP IundersmnJ my plans shall Mused ax puhbc records UP'1021X1 AMPS
[3 INTERIOR El CHIMNEY REPAIR
I�4E ,aj Licensed professional 201-Rall AMPS IMPROVEMENT ❑SWIMMING POOLS
<.�2; OWNER-BUILDER DECLARATION OVER 1000AMPS ❑BATIJ REMODEIJREPAIR ❑DEMOLITION
G'6W Q I herchy utfvm mal I ant exempt from the Comrminr'x L icon¢Lax for the
O O'fH1iR
y U following reason.(Section 7031,5,Business and Precessions Code:Any say'a county SIGNS L'LL'C'DUCAL ❑
3 W 1— such trip,...a ,.it m cnnarse,lifer,improve,demnlielt,or retail.toy sn fume / -
F.^O� primrm its issuance,alsure,out the applicant l asuch permit o then signed sanction, SPECIAL CIRCI11TIMISC.
µ�Y Nat he is licensed pmsmanl u)the previsions"Rise Cuntructnd Lmense Law(Chupmc9
N
ao fcommeneingwiN Scdimn]qXl)ufDivixinn3 prom Business and Pndenxinns Catheter 'TEMP MITFI!R OR POLE INS'1; COMMERCIAL,
m 6pC Jr.,he Is exempt throatim am Ibe hasis fur c alleged esemptlon.Any violation of ❑NI7W BLDG
/ADDITION E]DI3MOLITION
Xlm Section7031.5 by my upplieam for u permit adjcee he applicant m a civil penury til POWER DEVICES ❑TENANT E)FOOD SERVICE
of more than f ve hundred dollars(5500). IMPROVEMENT
y� 0Lus ownaudthe pmpeny.mrmycmployvexwilhwugvx avtheirwlemu-pntxaEoo, SWIMMINGPOOLELECfRic
F willdo thcuock.nndthe,rui is not intended mrl)pure70
OIL mOule(Sol, lq inures, ❑OTHI?R
W3 m end Professions Cade The Cnnaummr'x I.ieense Law docs not apply ut an owner of OIJTLIi I:ti—SWITCIJY.S—FIXTURES
fI' properly will)M1ulds or improves thereon,and who does such work himalf nr through
his own employees,provided Ihat such improvements are nal intended or oftered for NEW RESIDENTIAL EITM R SQ 1.7,sale.If,however,Oe buildingmf imm
proveem is sold within enar c yeul'compinion,the Sp.1°I'.PIAON ARBA $/SQ.Fr.
er-builder will hove Lha burden of proving Ila,he dill not build or imprrve for pun-
so so TOTAL:
❑1 f One Frulselall,exclusively contracting wi h licensed enmmaors m
reel 'IIIt,proper,(S ](44 B .'n.- dProfessor'Csle)'Ihe 111ntmloa—e -
st,Lawdoos net apply to n owner of progeny wh)huildxorimpmvesthercon.cid QTY - PLUMBING PERMIT, FEIr
who wmrans far such projcas wiN v conwemr(q licunvcJ pursuum m Ne Cnnnosan"s
�. License lsw. jPIRMI'1'1SSUANCE tlT�❑ I tot exnnpt under Set. .If&P C for this rwson
LTER—DRAIN&VENT—WAFER U!A) VALUATION
Owner Date
RKER'S COpIPENSATION DECLARATION LACK FLOW PROTECT.DEVICE
horchy afbnn un der penaty ml pe Jury nuc efrhv folll)wi'decla'ationx:nsemmeelf-insure for Workers Cmmpen- RAINS—FLOOR,BLUE AREA,GOND, 53Y)RIEg 'TVI'ECONSTRUCTION
satin.,as pmvlded for by Swllan 2700 of The Labor Cal,for the performance of he
work for which rhlxlemtit is issued, hIXr,BZLi.S-1'I-1 GZAP
1 have-red will mutnamm Wonkeei COlnpeasminn Insuranceav required hY Section
3700ofthe Lmbur Cede,for the lieffontmneeol'the work for whichmivpernal is issued. GAS—HA,SYSTEM.]INC.4 OUTIJRS ( GRO1 AVN
hfy Workers Compensation Lowrance currier and Policy nunthr tire.
Canis: Policy No.: GAS—IA.SYSTEM-OVER 4(EA)
CERTIFICATE 01;EXEMPT ION FROM WORKERS' (1RI!AM!/INDl15TR1,WAST"E INTEkCFarfOR
COMPENSATION INSURANCE UID ;DIVISION IT
('Reis soclion food not be completed dohs permit in formic hundred dollars(S100) GREASE 9RAP
or IessJ 1'LANCI IECK ITT
I codify thus troll.pethaparecu off he work for which Nie gmmtirN issued.Ixhall SEWER—SANITARY—STOR M P.A.2011 FF.
not employ any to...arm my ntnn--cr sn us m hcmnte subject m the Workers'Cnmgvn- ENERGY PEE
.�{ sena 1' fCt )'t WATER HEATER WNEN'1/CI.EC'IR
�y bee
[� NO FOAP A If bd ntc c pt ymi should WAIERSYSILINF1'NEATING
y SOILS I'lili
bee t bj the W k ",.;;5'au p ratio I Labor Code you ousel
frrmill comply wnb web nen rd Lenoir'1all het I ked. WAFER SERVICE
4I
c DCONSB'ROM ION LENDING AGENCY NEW RESIDEN'I'LAI.PI.MB. SQ.FI'. PAID
L) O Ihereh firm that in a construction lending agency I...the gerli-rmanm of —Due ceiptp
{L I"' the work for whicM1 Ni.petmn rs issued(Sec.J(19].Cis.CJ
OU Lender's Name TOIAL.
H.1 Lender's Address TGrn
W I certify Dal 1 her—real this application and state Nm the aMtve inlinmeioa is - ,. - BUILDING ILC
wF.t V7] wrrcctl ugreu Incomply with allcity and county ndintmns and state laws rclalingw QTY. MECHANICAL PERMIT rFEE g1!ISMICPIiE
V G building ennstmeinn,and hereby ambnrize rcprcsenutivn of this city reenter upon the -
chase
-mentioned progeny for inspection putpnves. PERMIT ISSUANCE ELECTRIC Illi
(We)agree to save,indnnnily and ksep harmless the City of Cupenmu against
Iinbilitiex,juJgmenu,nntxundenpm-ties 11
which-nay in any-,yaccme against still City ACIT:R OR ADD To MECIL PLUMBING PEE I 0
in xcqucnm M the gmndng of this permit .
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT' AIR HANDLING UNI'TUO 10,00of CFM) MECHANICAL rpE
SOURCE REGULATIONS.
AIR HANDLING ON1'f(GVCR 10,(X10 CENT) CONST RUCTION TA
Signature al Appream/Contractor Date EXHAUST HOOD(WIDUC'1') I IOUSING NO TOM ION FRE
IIA%ARDOUS MATERIALS DISCLOSURE
Wi11 the applicant or future building occupant store or handle hazurdrms manorial II HATING IJND'I'10 1(10,IXN1 BTU)
as]dined by the CoNtainm Municipal Code.Chapter 9.12,and the Health and Setefy
B'I
Cade,Scrum,2 532(ap! If BATING UNI f(OVER IIXkIXNI U)
❑Yes ❑N. VFNTILA'rION PAN(SINGLE REST[)) PAID Dec Receipt To
Will rise upplimvnt or future huildnal,eZupunt can egmigmomur devices x]rich BOILER—COMP(311P OR 100,IXNI B'I'U)
mil htmnlrnls air amtmmnwu on,defined by the Hay Arca Air Qual'ny Managcmem 'fOFA L:
DisaimP BOILER—COMP(OVER 1011,(1)0 BTIJ)
El yea ❑Nm
I buve read the buoudmrx ntawoulx re a ander Chapter 6.95 of NC Cali- AIR CONDITIONER ISSUAN E 4QTI3
y 21111a p �p LO,(
fails lush&Safety d,La Sectionsrou 25505,is toy and pubillI understand the
Nat Ic Nc NEW RCSIUENTIAI.MI!C11. gQ.I'1'.
orderreduns mmtcurrently base arenot m itis ua responsibilitynrnotify's necupum
order rtquircmams which must be met prior m issuance of u CerlEare of occupancy.
Owner or authorized agent Date T(YI'AL. ISSUED BY: A
OFFICE