S 2787 --APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. -
BUILDING DIVISION APPLICATION/PERMIT PING FROG-MTIDENTIFIC C - 2787 2 7 8 7
BUILDING PRO.IIICT'IDEN'1'IF'ICA1'ION J v
BUILDING ADDRESS: _ Cn.l r 6.11yr`� ;3 SANITARY NO. APPLICATION SUBMITTAL DA'1'F:
5-90 As-+e_+- e f).41 3 31 y
OW 1?RI NAME: IC n P�-1� CONTRAC'10 NAME, LIC NO: N/CCONTROLp
(I yn71
,ICIIITEC'1'/ENGINEER'. of LIC NO:: ADDRP.SS: _ E]
� Wl.lrhea kr 61151_
CONTACT. P{IONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECTPLUMB MECH
LICENSED CONTRACTOR S DFCLARAI'ION QTY. ELECTRIGPERMT, FEE
I beach,errrn r I licensed a p ns fCh pt 9 oma thg
JOB DESCRIPTION
wzCode,main,fi,ell RESIDENTIAL,
with Section rf
PERMIT ISSUANCE
�{ in full force and effect. USFDWL ❑KITCHEN REMODEL
6UULiccmc Class _ Li,.# APPLIANCES-RFSIDENTIAI. ❑ADDITION El PLUMBING RIiPIPE
Fzw Dote Contractor
mQq ❑MUI:CI-UNIT El STRUCTURAL
ARCHITECTS DECLARATION
F'r z I malle,tand my plans shall be used as public reatds PANELS MODIFICATION
=zoo UP 200AMI5 ❑INTERIOR El CHIMNEY REPAIR
,,� W LicarvAl Pedia,"snal 201-1000AMP$ IMPROVEMENT E]SWIMMING POOLS
OWNER-BUILDER DECLARATION
OVP.R III(1(IAMPS ❑BATH RF.MODF,L/REPAIR El DEMOLITION
Q I barmy.(Scene.
e.(fi1 1. exempt from Wa Cmnrn,Co A.,I Law far me
JqqJ55 0.V following mmum.(Section 9031.5,r,aleenx and Pro&e o li h,Code Any any or couaLy SIGNS HLIICTRICAL ❑OTHER
w�OF' which1, Capit .t I II p' demolish, p; Y Ir cure
pt I I q Ih ppl tl 'h pe n file .6 Ltaemmt SPF-GIDE CIRCUI'I'IMISC.
math dI tt thl Ith C f l L L (cnnnter9 COMMERCIAL:
(coimec gw'Ih Sector 90ftoofOsinn 3 of the Ensure Jl of doro Codc)or TF,MP METER OR POL9
do that he is exempt theafrom and the busis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
W.. Section]0315 by any appllca d for a permit subjects the app, In a civil penalty al POWER DEVICES ❑TENANT ❑FOOD SERVICE
not more than five hundred dollars($500). IMPROVEMENT
I,as owner of the property.nr my employees with wages av theirsole compencalicam SWIMMING OLELF.
F. will do the work,and the structure ie m intended or offered for sale(Sec. Bm'incss ❑O'TIIER
and Professisns Gare:The Cmtracmh License law does not apply to an owner of OU'I'LF.� -SWI S RES
q'3^ ianpeny who huildc nr improves morose,and who does each work himself or Ihmagn
his own employees',provmul mm such bnptwemea,,are not unsealed m offered oar NEW RESIDENT EL 'R
snle.lf,However,the miming arimprovementivs�ld within dna rearof romplehommeSQ.Fr.FLOOR AREA $/SQ.PP.
own
el builder will have the burden or proving that he did not build or improve for par-
VrmdeJ.
as owner ofmc property,con exclusively contracting with licensed eo praetors m AL''
a the project(Sae.7IM4,Business and Professions Code.)'I he Conwdor.U
coxa Law Jne,rolapply m maownerofopmenoy who bu dsorimmprovesthereot.and QTY. PLUMBING PERMIT. 'FEE
who oantmed fmsuch project,with atoonvacials)Iicensulpurxuaatm the Contractors 11
License Use. PERMIT ISSUANCE
❑ tum,xem funder Sac. .B&PCfor thisre et
ALI FIR DRAIN&VENT-WATER EA) VALUATION
n. P O
WORKER'S COMPENSA'DON DECLARATION HACK'FLOW PROTECT DEVICESO0•�lO
I hereby arhrn under penvhy of perjuryone of Jur following deehtutions:
❑ I haveomd will maiatmain Cenificamof Consentm self-insma for Workers Compno DRAINS-FLOOR,RODE AREA,COND, TOF.S TYPE CONSTRUCTION
snook,os provided for by Sector Amo of the Labor code.for We petlarmvnec of the
work fur which lhixpeiate is issued. FIXTURES-PER TRAP
❑ 1 haveendL will nodi,oir Workers anneofthe n work
force,as requirer by Section 1 / Au
3?Otl of the Labor Cade,Tenho performance of work rarwhich this permit is issued. GAS-IiA.SYS'fP.M-I INC OU'PLGCS OCC.GROUP P?'
My Worker's Compensation Insurance camor and Policy number am::
Gorier:- Put,No.: GAS-EA.SYSI'EA ER4(EA)
CEWil'I IICATF.OF EXEMPTION FROM WORKERS' CRIiASF%IND .TRL WASTE IN'T'ERCEPTOR V
COMPENSATION INSURANCE BUILDING DIVISION FBI>$_
(This teoliconeadnatbecomplehd iflhepemtit is fomes madraWnlhm(SI 00) GREA CRAY
err les") PLANCHECK PI?5
I certify that in the performance often work farwhlch this pernitls issued,I shill SiWIR-.SANITARY-STORM EA.200 FT.
I ,employ any person in any manner eo oc m become xobjeo n,the Warfalls Compton- ENERGY FEE
Z Neva Lawsof California.Date - WATER HEATER W/VENT/F.LECTR
O ( GRADING FEE
7 O NOTIAl,pliCE
G y become able,,
APPLICANT 10 after making this Certificate or LiEnptio d you mould Wq'fEI1 SV$TEMITREATING
hcunne suM1 est m the Workers Compensation f the Labor Gale,you Hwa 5011.5 PP.P.
j pmvit hall
W A forhwith comply with such pmvisionxmthis permit shall be deemed revoked. WATER SERVICE `n
� Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL,FLAIR SQ.FEJPE
PAID pate Reccipl❑#
1 hereby off rm that there is a conshuatiun lending agency for the pedarmance of
U 0 the work for which this permit is ismaeJ(Sec.3097.Civ.C.)
0U Lerderx Address 'I'O'IAL: n yuI�
I oerifr that I has,mod this sppllemion and state that the stars,refonmadon is ) - BUI11Dl U E rV
.�. (A concel Iagree to comply with all cityand century ordinances and state hwc relating ta -QTY. MECHANICAL PERMIT
U Z buildingcnnmmalogand hereby amhorizereprowerstiv.sel the Illym enter upon 1111 SEES PEG 5 SO
shove-menlinned ponety for inspection purpose., PERMIT ISSUANCE
(Wer)agree to save,itmeni Ty and keep harmless the Cay of Cucallum against F.LII f IC FEE
hubilitles.judgmams,costs and expenses whrUmay irony way away ogri tenacity ALTERORADDIOMFAH.
in consequence of the granling'of this permit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10 II CFM)
SOURCEREGULATIONS MECHANICALI'13F:
0Ach wo. - -�� I/ AIR HANDLING UNIT( P.R 10,000CFM) CONSTRUC'TION'fAX
SignamrasfAppliaant ����J Dom EXHAUS'I'HOOD /DUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE '
Will thesapplleant or from building occoment stare or handle hazardous tnmtodal HEATING UN' 00100,000 BTU)
as defined by the Cupenim Municipal Code,Chapter 9.12,and the Hathh and Safely
Code Section 25532(o)? HEM IN 1NIT(OVER 11111.004 B'TU)
Yes )I(o V a ELATION FAN(SINGLE RESID) PAID
Date Receipt#
Will the opph,ant nr future building seaapom me e0uimuent or devices which pO1LERCOMP(?HP OR 100,11(10 BTU)
:mit hamrlous air conmminoms as defined by the Bay Area Air Quality Manogem -
n
m TOTAL: r��
Dishier? BOILER-COMP(OVER 100,000 BTU)
❑Yen Nn
I have read the hmardousmaterialsmyuiremonts under Chapter695of the Cali AIR CONDI'1'IONBR ISSUANCE DATE
fo H o Ith&Safety G de Sinama,25505 25513 and 25534 1 understand that-P0c NEW RESIDENTIAL MECH. SQ.FF.
nn'Iti g 1 a re dv199 I 11th 1 t rree msn'rtyt tirym,a,tonva,t 9�9
of th tx hat R II. h I nc faCd1 t ,the 4�
c ix y6L ��k..�;&Wl , 3��1� 9 .�Je AM�n vc� .
Owner or authorized agent Doe 7 TOTAL: - - ISSUED BY.
OFFICE