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S 2393
APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING.ELECTRICAL PERMIT NO. BUI .DING DIVISION APPLICATIONIPERMIT PLUMBING.MECHANICAL S 2393 BUILDING PROJ6CPIDENTIFICAT'ION B011-DIN )DRESS: � A{ SANITARY NO. APPLICATION SUBMITTAL HATE OWNER NAM PHONE N �ACiLIC NO'. 3-� N ' �y /�f� ,/p�•� /� IEC CIINTROL0 • ARC]1:111 EMIENGINEER: `i /O�OLIC NO � ADDRI:tiS:�M�S S/G�LJxrSC/�c�yC �/ ❑ - �� NTnCf lP'HONE: K/ 6ULDING PERMIT'INFO J�.i/��g �l ©�qO ❑ Consultant Fees Paid by Applicant(Initial) BI-nc e1,ECr PLUMBFZ . MECN, !///'11T,ICAC(N/SIiDFCON'IkACI'ORf.11ViCl/.ARA'I'IIOYN / (1TY. BLEC'IR[C PIiRMIT FEE �/ 1 hereby affirm that 1 am licensed under pmt s of Chapter 9(commencing JOB D8SCR11'•iION �n'z with Section of Division 3 nnbe Business and Paras on.Code.andmybceh.cis RESIDENTIAL: W P I'IikMIT ISSUANCE �U, infullvaLClass LLffec Licq ❑SFDWI. ❑KITGHIiNRF.MODF.I. y<L Contractor APPLIANCES-R1iSIUFN'I']AL ❑ADD]T]ON El PLUMBING RE-PIPE ARCHITHCTS DECLARATION I'ANHLS ❑MUE.T[-UNIT ❑STRUCTURAL z p v,Z I to desu rd my Plans shall he used av public records MODIFICATION OZE, UI'TO2WAMPS ❑INTERIOR El CHIMNEY REPAIR 1= ; Licensed PpecoI,,nal 201-10(IOAMPS IMPROVEMENT (]SWIMMING POOH C6 OWNER BUILDER DECLARATION C Q I hearty affirm Nm I ern exempt from the Cnnnacmr's License Ln Rm the OV13R 101NIAMPS El BATH REMODI?LIRePAIR (]DI:MOLI'I'ION a a U fallowing..an.(Section 703 L5,Rashness and Prnfeseimm CMe:Any city o, umy SIGNS ELECTRICAL ❑OTHE W O y which requires a pemhil tr1 ttmMnml,oiler,itnpmvc,dcm,,llxh,nr repair any svuv i E+.. prion,its issuance..[air acquires the applicant Earlier permit to file asigncdxtmmne SPECIAL CIRCUIT'/MISC. E�'T Na he is licensed pursuant m the pmvisions,fthe Cnnlracmr's License Law(Chapters, SAO (commcncingwllb Section]IXI(1)of Divixlnn3nfNC Buvinuxs nnJ Profcsvionx Crvlc)ar 'fIiMPMETER OR POLE INET. CIAL E.L ey Nat he is exempt Therefrom and the facial fur the alleged exemption.Any violation of ❑NEW BLUG/ADDITION ❑I31iMOLl'I'ION x Section]031.5 by any applicant fora psmtit subjectvlhe applicamm.civil Penally of 4' 1'OWiik DIiV ICIS not nmre than live hundmd dollars($5W). ❑TENANT ❑FOOD SERVICE 0 ❑ 1,muwnendthe pn;pcTry,onnycmployceswllhwugesu.xlheir.olecnmpen.Minn, IMMINCIPOOI.1?LEMItIC IMPROVEMENT L. will do the work.and the.structure is not Warned or oficnd for sale(Sce,AW,Business ❑OTHEIt Wand Profession..,Cede:'1 he Contractor's license Law does not apply in an owner of OU IS-SWI'I'CUES-PERTURBS properly who anilds car improves themtm,and who arcs such work introit or Ihmugh his own employees,Provided that such improvements are nn;intended or offered for 7114"E. UENTIAI,EL5Pj I '. safe.If,h.wever,the building or improvement is sold within one year nfalmplelion,the ` SU.F�_g-OORAREA $ISQ.FI'. c,builds will have tire burdetud pawing thin fatal urn build,.improve fur pury poveof s.leJ. TOTAL: 1,as owner of the no,cm,am exclusively contraGinmn m g with licensed comra construct the project(Sec.7044,liudnevs and Pmressions C.JC)The Contractors Li- stshawJhmnnrnapplynh an owner of prnpany who builds nr im�rovesNmenn,and QTY. 71 G PEPM FEE who contracts for arch projects with a conmaaor(s)licensed Pronoun it)the Contractors License Law. PIR ITIS NC ❑ I ant exempt under Sec. ,If&1'C for this reason Owner Data Al1FER-DRAIN&VENT- TER FA) VALUATION . WORKHR'S COMPENSATION UECLAkA'I'ION PACFi.(r PIF EC.U' CL' 1 hereby ri inn under penally of perjury one of the f,lluwing declarations: ❑I have and will maintain a CeninateofConsent mmlf-insure for Wnrku's Cnmpen- DRAINS- TAO ,R OF,A A, p STORIES TYPft CONS'I'RUC110N tion,ns pmvidW Grz by Seddon 3900 of the Labor Code.fn ,, he pednrmancr,f the nA fur which Ihis permit is issued `PIX'('HIGHS-PF.R'1'kAP 1 have and will maintain Workers Compcnsnion Insurance,as required by Section 3900 of the Lahti Cala,fur the performance(i[the work for which thispernin is issued. GAS-EA.SYSTEM I INC.4 U`HAlTS OCGROUP APN My Workers Compensation Insurance carrier and Policy number.m: Cameo Pully Na,: GAS-HA.SYSTIiM�OVER 4 GVC CERTIFICATE OP EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GItEASII/INDUSI1d,WAS'IY INTERCEPTOR pbis.aaion noel not tealmplemlifthe permit isfonmchundmJ Dollars($I)) BUILDING DIVISION FEE'S m Is,.,.) GREASE'I'RAP s PLANCHECK FEE I cavity lhuun rte Perlearnmce.1 he work 0n which thio permit),Issued,IxluII SIIWER-SANITARY-Sr FORM EA.200 FT. rs not employ any peon in any manners.it,It,become subject,,the Workers'Cnmpen- \ ENERGY ITE O Z Ration Wwx of California.Data WATER BEATER WNF.NT/Ei1.F.CTR z O Applicant ' GRADING ITiF. ` NOT ICE TO APPLICANT:IL he,making Nis Catharine of F.xetnpn,,n,y.a vhnuld WATER SYS]EWE REATING a > become subject .,he Workers Compensation pmvmor,fi the Labor Code,you must OILS FEE 0.1 fonhwlihe i,1y with such provisions or Ihis peovit,hall he AccmeA revoked. WATHR YIiItVICC CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB, SQ.Fr. TAI a Receiptp U O I hereby affirnnhn there is a construction lending agency for the perforcumce o1 LE. F the work for which this permit A issued(Sec.3097,Civ.CI O U Lender.,Name '1 OTAL: FLenders AJdress y 1 certify that 1 have read Ibis application and slate Thal the clal inf.rmanon is BUILDI s W rA cones.l agree to comply with all city and county oninances and state laws mining to QTY . MECHANICAL PERMIT FEE U7. building c,,nsvuc' hereby nnthorue curawnl:aive.v of this city to enter upon the SEES CFEiE ahnvc-menti JpmNry rin.ymctl.n pugnsscs ( agree m muco demnil J keep hnnnless Ne Cit f Cu PI7RMI'1ISSUANCE y an y o penton again, EL13C'1'k .FEE � Iiabilili ,judgments, nd expenses which may in anyway accrue against said City A n m amain c of t nmtin,ol'ti is panuh, ALTER ON ADD'I'O MECII. PLIIMBINO FP.P. \ SOO CABS NET,WILL COMPLY WITH ALT-NON-POINT AIR HANDLING UNIT(TO 10,000 CI'M) MECHANICAL FEE SOU CE Rli AIR HANDLING IINIT(OVP,k 10.000CF14) CONS'INUCf10N'I'AX Signer PlicamICn D EXHAUSTHOOD(W/DUCT) DOUSING MITIGATION PIE HAZARDOUS MATERIALS DISCLOSURE Will Ire applicant mount,huilding occupant pore m handle havuNoux nalumml HEATING UNIT(IO I W,IXX)IU) as defined by the Cupcnino Municipal Code,Chapter 9.12,and the Health and Safety Cala,Sardwo 25532(a)'1 HEATING UNIT(OVER 100,000 BTU) ❑yes [I No PAID VENTILATION PAN(SINGLE BESIDE Dam Receiptg Wiil the aPPlicanl or future building occupant use equipment or devices which BOILER-COMP(JIiP OR IOO,WO RTU) it bnzu al Nr enntm tants uv defined by the Bay Area Aar Qualily Mannga para ._( J DisaimY BOILER-COME(OVER 100.0001 N) `1 ❑Voss ❑Nn lhavemad the hvshd.uxlnomrialsreuirements under Chater 095 of the Cali- AIR CONDITTONEk 4 P ISSUANCE DATE [.aria Health&Safety Gale,Sections 25505,25533 my and 255341 ununity th Nat if the NEW R[SIDF,NIAI.MECII. SQ.IT. 4 iftheng mmocc c,which haveuleny a,,,t,,i.,Inyac nfaC,mnic nutifylhonmupvm '(,7 �- l� �• of the requirmnems which man M met poor m issuance of n Cenilieate nl'Oceupuncy. - Owner cr nuthonred agent Data TOTAL: ISSUED BY; OFFICE