99120106 1 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY _� E�q ap
fr1 FB�LBLDIN
CUPERTINO BUILDING-ELECTRICAL rrun4rr No.
G DIVISION APPLICATION/PERMIT PLUI%IING-MECHANICAL
... IIUILDING PROJECLIDENI'IFICATI(IN
DDRESS: 1 NITARY NO. APPLICATION SUBBMI PEAL DA'II
B0.rh'wr+ QVO.. C v p,r�l 110ej Rr y09P�(ISE2�L�y78I CONTRACTOR'S NAMIi: I.ICNO.
NIC CONFROLa
RCIII'I'P.C'I'/ENGI NHEk: LIC NO: ADORE55. ❑
CONTACT. punrvE: ,BUILDING PERMIT INFO i
❑
Consultant Fees Paid By Applicant(India)) RLDC .LECI' 4�C
'LICENSED CONTRACTOR S DECLARATION I ( ,
I hereby affirm that licensed J p (chapter n momma ng QTY ELECTRIC PERMIT / �•', FEF.' JOB D:SCRIPT N
tADOZ with Sec1on 710(Bod'D "e of 9 ofthe Bus : WPndwsinu Cbde unJ nYl'ev . -
�w. in full force and effect. PERMIT ISSUANCE RESIDENTIAL'
,UL License Class Lick ❑SFDWL KITCHEN REMODIF,
F WDatc C'omramur APPLIANCES-RESIDENTIAL
y y ❑ADDI'f10N ❑PLUMBING RE-PIP B
ARCHITECIPS DECLARATION
ZON� I undenland my plansshvll be.+ed a, ,,hit,records PANELS ❑NIULTI-UNIT ❑STRUCTURAL
91
O Z O UP TO 210 AMPS MODIFICATION
F-11 ELLE Licensed Romast...I El IN rURIOR ❑CH IMNEY kF.PA IS
kG�,',j OWNER-BUILDER DECLARATION 20E-10DOANIPS IMPkOVEMENT E]SWIMMING POOLS.
1 hereby affirm that 1 an exempt fmm the Comracuds License Law for the OVER 1000AMPS ❑BAIII REMODH1lRHPAIR ❑DEMOLITION
L 06 U following reason.(Section 7031.5.Business and 14ofexxiom Gale:Any Cil.or county I]OTHER
t
U. which MENS Ii1.ECIHICAI.
^=o quires a permit to ennxwm.alter.Improve,demolish,br repair any structure
Poor to itsis Ise restuires the pplle II - hpenal lifleso,nodomentern SPECIAL CIRCUIT/MIS(].
yE��6�, Nall 1
pursuant d p ons fib C t Io'%L 1 (Cooper9
YI�.lCO barn -g uh Section71(X8 fD' sin l Uh Business IP f: :CnJelov II:MP.METER OR POLI?INS']'. COMMERCIAI:
L d
xM. ,ha,by rs exempt,herclinm and the Fn,is for 0C alleged exemption.Any violmlon of ❑NEW BLDG/ADDITION ❑DEMOLITION
,^„4. Sechn 0315 by anyapplicam for a permit ailcresdcapplmum ma civil penalty of POWER DEVICES
not ae than five hundaJ dnllnta 15500). ❑TENANT
OF O ERVICE
ESC Lotownerk,the pe ady,caust remyot Ifu funded
with wages rsale(Sec.s their 044,Bsmlbn. SWIMMING 11001,ELECTRIC OTHER F will do the work,and the he Contatoomenerue offered wonesnsaleppec.](44,Business ❑OTHER
a3 dna Probes inns cove:The commemrx a«n e Law dues not apply ret an owner of GUTIAITS—SWI ICHES—FIXTURES
pro,.,who builds nT improv..thereon,and who does such ,,,it himself or,hough
his own employees,provided that such improvements arc not intended or offend for NEW RESIDENTIAL ELECTS, SQ FI'.
sole.IL however,the huilJing nrimprnvcment isn'nld withinbncycmbfnnnpleli(3n.the SQ.FT.FLOOR ARIA b/SQ.FT.
crvbuilder will have the burden of proving that he did not build remittance pve for pur-
po a of R.). -
I,us owner of the property,ant exclusively controlling with licensml enmrucfns in 'TOTAL:
construct the fai l(Sec.7044.Business and Pmfessiun.Cale:)The Conpamm'.+Li- i .
rens Law does not apply) ro
of progeny who build:(it tnproveunemon d QTY, t FLUMBINGPERMIT FEE
wnoemto-aata rm.'G poi r "tr bn,ra t (HI xd par+ In In me Cbntrtenrs r.l . :( .
License Law. I I'IiRMI'T ISSUANCE
❑ I p—tm c.
S ,I{ffi PCfar this rwson
La
ne,SL 40 -ji"� ALTEIE-DRAIN Ml V1iNT-WA'I'IiR(FA) VALUATIONC W.kKER'SCOMPENSATIONDECI.ARATION LACK FLOW PROI-i DEVICE! O/ 000
1 hereby alBrnt mNer Pcnalty M perjury one of tiro following decluruebns:
Ihave andwill maimainaCrnificae of Consent In self-insure for Wbrket.Compem DRAINS-FLOOR.STOP.AREA.GOND,
sation,as provided for by Section 3700 of the Labor Crate,for the performance of the STORIES TYPE CONS"I'RUCTION
work lin which this permit is issued. FIXTURES-PER IRA)'
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3701 of the Labra Code,for the performance brine work for which this pemtit is Issued. GAS-P.A.SYSTEM-1 INC.4 OUT
My Worker's Companmtion lmumnce carrier and Policy number me OCC.GROUP APN
Carrier: Policy No.: GAS-IIA.SYS'I EM-OVER 4(IIA)
CERTIFICATE OF EXEMPTION FROM WOR K ERS'
COMPENSATION INSURANCE, GIRHASHflNDIIS'I'RL WASTE IN I'HRCIiFI'OR
or lexs.l
(This section need not M+completed if the Permit is for one hundred dollop GREASE'I RAY
(S1Pan BUILDING DIVISION FEES
Toy any that in the any trimmer bOhe work for subjec n l.kaO,Can.hull I'LANCfIIiCK PI?I3
nadatLay any Person in any mannenn u.+m become subject mthe Workers Contpen- SEWER-SANITARY-SIORA11iA.21011'.
O z svtion Laws rel Cuhfnrniu.Dole ENERGY IIiE
z Ap,fician WATER DEAI ER W/VHN'OELEC'I'li
GRATING PEE
` NOTICE TO subject
to the ANTWork If,ager making this Cedl set of[aemptinn,you should Wgl'F.N SYSTEM?REAPING
a ' beesaneh cran,y son aitch no,wisub nit lemon
ba hthe Labor Codi Tom nmol sons FIHi
0. Q forthwith comply with such pmvisiom nr This permit shall he deemed revoked.
WATER$1iHYIGhi _
9�. z CONSHl1CT10N LENDING AGENCY NEWRESIDENTIAI.PLMB. SQ, PAID
U O I hereby a1Eno ihauhere i�a comweeon lending agency lerrbe Ivrfnmancc bf Q =)emmr.--Hemp,a
f4. F (he work for which this permit i.+i.xeed(See.3097.Cm.C.)
Tender'sNom
`"� ;r/iNV 1 )TAI,
Lend
r {U ; AJJ : TOTAL: ` '
y 1 reality that I h d h' application anstale that the aboveinformation is
(~ d1. -1
FEE
h emrbu [.agree to comply with III city 1counlynofirounce,and film : I f gto •QTY: a MECHANICAI'P13RM it II .FEE
U Zbuilding construcion and hereby amhorze representative.+of the city to enter upon the f SIT MECPE
above mentioned properly for insp;mion puryoses.
(We)agree in sloe,n"anni fy and keep funnies,the Cit ICS,senin,again', PERMIT ISSUANCE
Y o b 13LIi RIC PP,S
Iiacoisequnce of ts,m+mand ft his ps which may inany way acerae again.,said City ALTER ORADD TOMECH, II
in consequence of the granting of pcmdt. PhUNaH Gh'EE
:Code,
NT U DERSTAND5 AND WILL COMPLY WI'I II ALL NON POINT AIR HANDLING UNIT PL,XXf CFM] t
.1 ATIONS. MEiCHANICA�LAIR HANDLING UNIT(OVER I(BBECPM) CONSTRUCTIONTAX
ofApplicanOCnmmclor Dam,�l EXHAUST HOOD IW/DUCT)
HAZARDOUS MATERIALS DISCLOSURE HOUSING MITIGATION PEE
ll,hu npplicum...future huilJing ooeua(smrcor handle hmurdous molcal1113A1'ING UNIT QI'G Ig1.(1110 BTM bythe Cupenino Municipal Cade,Chapter 9.12,and the Health and Safety
tion 25532(a)! HEATING UNIT'(OVERIW,O( HTO)
YenNoVENTILA I'ION PAN(SINGLE RESIT) PAID
ll theapplicant or haute buildingoccnnam use equipment or devices which Dam Receipt a
don%eir contaminants m defined by the Bay Area Air Quality Management EOILER-COMP(3UP OR 10B,WII BTU)
TOTAL:
❑Yes BOILER-COMPIOcTR IIp,0001ITU)
I have read the hvaawme,contend.m,piaments under Chafer 695ef Ih;Cali- AIR CONDITIONER ISSUA EDATE
)arm,I lulW
Sol ions 2.5505,25533 z 125534.1 andenunA ohm It,he
h gJbe tenon,,that it ism bilis In motif the ocw , NEW I11iSIDLMI'IN,MECH. SQ.PI'.
y r..rymst Y Y Pan
fthtreymhicame bami.svanre fa Cenifcm .f0eyps.
Own rnapate TOTAL: ISSUED BY:
OFFICE