99120094APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY <
Y OF CUPERTINO nun.DlrvG. ELECTRICAL
ILDING' SI(JN APPLICA'I70N/PERMIT vLurvlmrvc- MEcnnNICAE
BUILDING PROJECT IDENH'1F'ICATION
IIayITND.
IN/
mw dmo
UING ADDRESS:
FIT
SANT "GARY NO.
A PVI.ICATION M Ji;MT 11'AL DATE
1�I847 BEEK,MAN PI -RCE
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RSC14A EL MAUI \ p��%76-751
CDNTRA19 I C�I'OR'$ 1: LIC NO
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Nrc
❑
cnNTRDLw
CHIFECT/HNCINEER: LIC NO.
ADDRESS'.
CON'IAC'1': ,�,, PHONE:
//
HONE l',"S% "M-752 pp
woAk 8)980-3833
❑ Consultant Pecs Paid by Applicant (Initial)
UUII,DING PERMIT INFO
BLDGELECT PLUMB Mmol
C� ❑ ❑ ❑
LICENSED CONI RA(TOR S DECLARA I ION
I1anch, off Ilell alp reused and,, p ns of Chapter 9 pluon ing
LTTY ELEC' I'RIC PERMIT FEE
JOB DESCRIPTION
PEIiMI'1'ISSUANCB
away
�tyy On
,ZU
rr G
Fly
O vi'ZZ,
z ,!`❑❑++I�����;;Q
w'ul S 78101 rD"- l of the Bus dP tellinls Codc toll nylic a
pull force nna nlf t.
Liccnnc Class Lia#
Dalc Commemr
RESIQENTIAL:
❑SPDWL ❑KI'I'CIHEN I2EMODEI.
❑ADDHION CJ PLUMBING RE -PIPE
]MUhI'I-0NI'I' ❑STRUCTURAL
MGDIIsIGATIGN
71 INTERIOR ❑CHIMNEY REPAIR
APPLIANCES - RESIDENTIAL
ARCHITECT'S DECLARATION
1 understood my plans shall he u.ed us public records
PANELS
UP TO 200 AMPS
O y V
I�0
yy�
IGS
a ty'
so
Warn
F Z P
�d
O
L 3 ..
OWNER-HIIILDER DECLARA'I ION
fnlloxh 6heresemlaffirre dial IJain rxenipt reel he ouninectC Low fnhe
edeIL,, cut 1 Ay'lyaum l>
uri.j to pc 'u I I'hh I tlisl 1 ysmJt re
pool t , '1 y , Illi tf ', p not II 'y ,sol no, tt
Got 1 e p t t In p ':'n n1 C L Ino 1 l [cb,ptar9
don nonC ywOSection7000) I Orvia 3 ftl Entities, II f ..lr,Ctde)nr
Thnt he , exempt Ihcrdioln and the basis fm the allaged exemption. Any vlolnion of
Section 7031S Lyn,opplieontforopermii sub_lecls the upplicanl on civil Tenuity of
not nor, rive hundred dollars (S501).
I,mowncr of the pmpcny, lir my eniploycca with wngcs as Wcir sole compw:satin 1,
will du the work, and theNmctun c,not imended or oltomd Elastic(See7044, Easiness
and Profnvotu' Code'. The Cnnlmdors LicmrSe Las, dire, not apply To nn mane, lir
Tmpery who build, o' hnpmvas Thereon, and who does such wink himself or Btmugh
his own aoployees, provided that such Impmvereents aro Bol intanded or effeed for
sale lf,however, the huilAing orimprovenlam is told within one ycnnd'mnplotlon, the
2111-1 OIIIIAMPS
ISEI'ItOVEMIDE 0SNMMMII I POOLS
❑HATH KE' o'1LIREPAIR ❑DEMG1.1'1gGN
❑OTHER
OVER IIIOIIAMI'S
SIGNS ELECTRICAL
SPI CIALCIRCUIT/MI$C.
'TEMP. METER Olt POLE INS'C
COMMP.RCIAL:
❑ N13W BLDOADDITION ❑ DEMOLITION
TENANT ❑PGODsrhoo Ii
ROV EMEN'I
THlilt
POWER DEVICES
SWI MM ING POOL 1;LEC'I'RIC
OU'TIALS SWI rC1113$-FI%'IY1RH5
NEW RIS(DENUAI. ELECTI2 SQ Iaf.
SQ.FLPLOORAREA
S/S'QFI'.
',builder will hove the burden or proving khat he aid not build or Impmvc for lar-
PUmMIsplc.7c
srcornetin, with licensed mnlredors In
�� nf The property, ton exclusivelynl
'I (YIAI.
coniarecl the project (Sec. 7044, Business olid Professions Code) The Conlmcou, LI-
nwLawdoesnolapplymonownerofpmpenywhoholdsorimprovesthereon.and
QTY. PLUMBING PERMIT FEE
who eonvmu forsnch pmjec¢ with e eonnanor(n) IirenseA punu,nl m the Cnmmnm's
PENMI'I' ISSUANCE
License law'.
I] I oto exempt undo,' See. .B&PCI did, oon
!Y T—'
ALTER URAIN&VENT WATEIINIAI
Dole
VALUA'T'ION
JA ll
a
WORK(RS COMPS N DECLARATION
1 herebyalFrel OnLrpenoltyofpel Y one of thefcll "g l done
BACK FI.OW PROTEGE DEVIL
�] IIno,cand will nni I'" C I me ofC n If -ins ref rW k sCn open"
nation, as provided for by Section 3700 of the LA, Code, for the p,,lonmmce o1'the
p
Dot PI.00R, ROOK. AREA COND.
STORIES
TYPE. CONSTRUCTION
work for which this permit Is issued.
171X I URE - PIIR'I'RAI'
❑ I Lave and will peaundo We kO's Cnmpemution Inwmn'e, os required by Section
3710of The Lord, Col, frn the odbintance of the work for which this tis issued.
1 permi
My Worked Gnnpensmion Insurance cartieroPolicy number or:
Cvrricr'. —Policy Nn.:
CERTIFICATE OP HXHMP'HON FROM WORKERS'
COMPENSATION INSURANCE.
GAS-IIA.SYS'WM-I INC.401ITLE'r5
OCC. GROUP/
APS
/
GAS -[?A. SYS'TI3M-OVHH 4 (17AI
GREASFANDUSTRLWAS'I'E IsUIRCIJ?OR
IIUILDING ❑I VISION PEES
the Intone rnrnhundred dol lars IS 100)
('nhaacnlnn neral not n,: emtymnee ifinT
lir lc,,,)1'LANCI
GREASE 'n<nr
IIiCK FY.B
SEWER -SANITARY- STORM 17A. 200 ITT.
%a
zI;R
0
q r%
z
w
I'lmlytlwtintheperformonce oflhe work furwhich Wis permit is insnM.I xhall
otonnploy any pension innnymannenoasmbecome subject mT he Workers' Cnmpve
ion Las or Col i Da. Date
smwani
Appllrant s
Esti GYPEE
WATLE
HEATER W/VENT/ECTR
GRADING PEE
NOTICE TO APPLICANT: 11; vEn making this CeniOanc of llxamptimy you shmdA
heroine suh,lm'l In the Workers Cmnpeesation provisions of The lahnrCode, you must
bul lh mnlply with such provisions (it l prem shall be disputed revoked.
CONS'T'RUCTION LENDING AGENCY
(hereby affiri tom tine l sa consmelion lending agcucy forthe perfnnnance of
the work fur which this pcnnh is Ixsural (Sea 3(197, Civ. CJ
Lenders Nome
WAIT;R SYSTENVIREAL INC,
SOILS FEIZ
WA'TEIt SERVICE
%' \Ilnlc I I Recup,
-
I'- AT,
NEW RESIURNTIN. PLMB. IQ 11
f'1
� ��I
L.
Lenders Addmo
IOIAL
H. 1 NI F
�
I'unify That I have read this application and state that the above infornaLon is
w~ Z)
U 7.
correct. I agree m mmply with nE shy ane eoumy ordinances nnA snnn law-. mruling m
huild'o,co tmmlon, and hcrchynuthorire mprtcmutivcs ntdEN,lty to cnmr upon the
QTY MECIIANICAL PERMIT F P
f
SEISMIC PCI:
PIIRMI'I' ISSUANCE
above-mcnhnne+l pmpcny for inspection pinholes.
We to save, inderrid 1 keep hama,ss the Ch fCu Wino agent,
( )agree y nm T y o pe gthns
Iinhilitics,Judgmcnts,cas¢and expemca which may in any wry nccruavguinssnid City
in r. tmequcnw ofthc gmming of Ibis pemtlT.
ELECTRIC FTI7
ALTER ORADD TO MEGA.-a�
-�
—_
PLUMIiINC Plili -____
AIR HANDLING UNIT (TO 10,000 CPM)
MECHANICAL PEP.
APPLICANT UNDERSTANDS AND WILL -I MPLY WITH ALL NON -POINT
SOURCE RHOULA'I'TONS.
AIIt IIANDLINC UNIT (OVER 10,000CFMl
CONSTRUCTION' TAX
ZA4 (��
SignnmrenfApTlicvntlContmcto )ate
I IAZARDOUS MATERIALS DISCLOSURE
EST AIIS'I' HOOD t1V/DUCT)
HOUSING MI"rICATION PEE
THEM ING UNIT' CIV) 100,000 IITIJI
Will The uppGCunt or W,aa building occupant slam lir headle harminus material
s defined by The Cupcnino Mun'mipal Cook, Chapter 9.12, o I the IIndTTt and $ul'ety
Colic, Section 25532(a)?
1IEA UNG UNIT (OVER 100,0011 nrU)
I-] Ye, El No
PAID
Dom Receipt#
WNq'lhA'fION PAN (SINGER REST D)
BOILER -COMP (311P OR I110,1111013N)
W,ll The s icma lir final, building ascendant use equipment or dcviws which
not hazardous air comalmnants us defined by the Ray Area Air Quality Manogenmal
DiNdct7
(]Yes ED No
T(YI'Ah 4
BOILER -COMP (OVER 100,000[i
AIR CONDITIONER
I hove read the hnzardous materials requit incnts tinder Chapter 6.95 of the Cali-
ISSUANCE DATE
NEW RESIDENT IAL MECIL SQ. PI.
Iernin health & Safety Code, Sections 255(1.5, 0 3 and 255311 understand Tend the
hu11da6draa notnor hoveacrol I, �jl ilpy.fy msrymsihilily In n�tiO deo"o'diel
oftheregropw. hanyTwmet ofie ((ssian'e nfa Cn,iyn qf� ect9 y.
42
Yi/J!—Oc_
may--
1SSDED BY: 1
TOTAL
8ldhn lir nom... zed agurl
OFFICE