28694 'CITY OF CUPF.RTINO BUILDING-ELP.CTRICAI. PIiPMII'NU. 2 roe 8^ ^9^ rg
4
RUILDINC DIVISION APPLICATION/PERMIT PLUMBING-MFXIIANICAL LVA
BUILDING PROIP.CI IDENTIFICATION
RUV.DINO ADDRESS: SANITARY NO. A PPLICA110N SUBMITTAL DAR
fl\ IiR'S NAME: PI10 E: C I'RACIOR'S NAMIi: LIC NO:
_ N/C CONTROL
IITF.Cl2NGINCER:,, LICNO: ADD ESS.
3 c w SSks�s
a)NTACT: PBONE: RUILDINQ PERMIT INFO
2 C ❑ Consultant pees Paid by Applicant(Initial) Blixt ELECT PLUMB I
LICIiNSEUCONTPACfUR:SULCLARADUN ❑ ❑ ❑ ❑
1 hermhy.Mrm that 1 em licensed under provisions of Cbalxer 9(commencing QTY ELECTRIC PERMIT AEE
y��C with Senfon)anof Division 3nfthe Rusineaaand Pereaaonanbe.and myneenaeia TOR DESCRIPf1ON
Fly full fora end off PERMIT ISSUANCE REHDFNTIAI•;
�UZ{❑� License .l^u _ it C, I'le.X 43� OSFDWL O KTTCBFN REMODEL
Dam Cmnmc --F4=1R['[!, APPLIANCES-RESIDENTIAL OADDIP[ON OPLUMBING RE-PIPE
z$I�prn ARCHITECT'S DECLARATION
b l understand my plane shall he need as Public raced, PANELS ❑MULTI-UNIT ❑STRUCTURAL
UPTO 200 AMPS Oz��-fG C�, r MODIFICATION
6 Licensed Prurcaamnal J ❑INTERIOR CHIMNEY REPAIR
NOWNER-HUILDER DECLARATION 201-34M)AMES IMPROVEMENT
y I hereby affirm that I am exempt from the Conical License Lew for the OVER 1100 AMPS O BATH REMOUEIIREPAIR O DEMOLITION
x 3 6 V follnwine remon.(Section)al LS.Business and ProfeWms Gyle:Any city or aunty
fY n` which SIGNS GLECfRICAI. ❑D'fHER
O nequircn a permit to wires the elate improve.dsuch rool ni m repair any structure —
nmol
�y thit heor itsissuance.also require,lh provisionants
for Contractor's
U.(Chapter
SPECIN.CIRCUIT/MISC.
y
that he is licensed pan.mnnnthe Pmviaons nano Gmo.dar:Lamm Law(Chapmr9
p,0TO (eammencing with Section)at)ill Division 7 oBm
f the mineand Pmfeadire,Cde)nt 'TM
EP.METIER OR MOLE INST. COMMERXJAIs; ,
xm eG that he is exempt thercfmm end the basis far the.Ileged ascertain..Any violation of [I NEW BLDG/A
lY in Section)07IA by my applies-fm a permit subjects the applicant to.civil famlty or POWER DEVICES EDITION El DEMOLITIONmBand
k p., nm more Its--five hundred dollar.O!RtlD OTENANT OTOO[)SERVICE
C ❑I,at owner ofthe property,or my employees with wages a their sale compensation. SWIMMING POOL ELECTRIC IMPROVEMENT
will do the work,aal the,orc ure is nm intended or dflocd formic(See.7M4,Business El OTHER
and Professions Cale:The Connacmr's License Law dies not apply or an owner of OIL I-It TS-SAT'ICI IPS-PI%TURES
a' property wbn build.,or improves the..and who does zmch work himself fir though
his own employees,provided that.such impmveman,.,a not intended fir offered for MC'
SIDENTIAL ELECTR SQ Fr.
sale.If.however.the building or improvement is sold within one yearnfcnmplednn.@eSQ.Fr.Il.fN)R AREA LSO
ownerbuildim will have @c burden of proving that he did tort build fir improve van pur-
poee of sole.).
❑I,as owner of the Pmpeny,em exclusively contorting with licensed control bTOTAL:
ce'suud live Project(Sec.)M4,Business and Hnfe.Wom CNet)The Cn.---s-
orse Law does not apply m an owner ofpmpenr whit builds or impnwes thereon,anti QTY. PLUMBING PERMIT PC8
who contra.for such projects with a monocmrtal licensed pursuant m the Contractors
License law.
❑I nm exempt under Sm. ,R&PC for this reason ISSUANCE
(Owner Date DRAIN&VENT-WATER(EA) VALUATION
WOR KER'S COMPENSATION CCLARAI'ION .OW PROTIiCT.DNVICEI variety affirm underpenlly of pe'ury o tM fllnwinx declomtiom:Theseendwillmvi mm"'cniTmmeo m t If imam h¢Workmis Compen- -FLUOR,ROOK AREA,COND.moon,a a pnxided hs Seein7) of e .a r Nethe erforf hSrORIES 'TYPE CONSTRUCTION
arkfm which Ihi pe iii is ¢ S-PIER TRAPOIhave andwilltaker Compena I ea nireJ b5i7)ODofthe laboreeperfarm .SYS'ILM-I INC.4 OUTLETSMyooers C._'._tc OCC.GROUP APN
Curri .SYSTEM-OVER4 TEATCERTIFICATE OFCOMPENSATION INSURANCE INDUSTRL WASTE INTERCEPTOR
(This section need an,he completed fine Armin is fm one hundred dollars(SIM) L tis• •BURAINO DIVISION FEES
or leu.) GRPASC•TRAP
I mail,dist in Plal,h CHECK FEE
nlayrmmer 111,1w la I ,e permit tri iamNJsbE SANITARY-.
nm mnpiny ony person inlayroomer ,m ane satyr the Wnrktti Compose SEWER- STORM EA.2(M)FT.
Oz moan laws ofC o'e Da rcp� `Ie Op' ENERGY FEE
77P O Applicant r�or"�^- 11 [+ WATER BEATER WNEWITTLP.CTR GRADING LEEFw NOTICE TO APPLICANT.If,after making this CCanattan of Esmnption,yon aha.IJ WATER SYSTI!MTfREAIING
beemic auhjm man Worker i Compenm km pnsvidom M EE
of the Lir Coe,sin ma oSOUS HE
comply with such provisians or this permit shall be deemed revoked, WATER SERVICE
� z CONSTRUCTION LENDING AGENCY NEW RPSIDENTIM.PLAID. SQ,FT. PAID
UQ I hereby affirm that there is a construction lending agency far the performance of Unto RmceipX
us the work for beffid,permit is Issued(Set.7197,Civ.C.1
0 FFD'' lenders Name lY1TAL:
{Il Lender's Address aTMAL:g1. i ratify thst 1 have reaA this aPplimmion enA seam that theNwe information is UILDING RE7gith ell city and mainly ondiumenend state laws mialing to QTY, MECHANICAL PEhuilAingconstruction.olid hereby nuthorm representatives of this city m enter upon the ISMIC FEEabnvcmentioned proloy for inspection purposes.(Wal agree msave,indcmnifystd keep harmless the City of Cupeninougoinat PERMIT ISSUANCEEMRIC MEliahilhies,jmdgmenn,mss,and espenma which....y in any way at eninst sold Cityin emore ence of the Emting ofthis panni.. ALTER OR ADD TO MF.CI I. UMPINq T EF,APPLICANTUNDERSTANDS AND WILL COMPLY WITH At,1.NON-P(IINT AIR IIANULINfi UNIT('fG IB,INSOURCE.REGULATIONS. ECHANICAL PEE
AIR HANDLING UNIT LOVER ID,aMI CFM) CONSTRUCTION TAX
Sgnewrc of APpliaeHA7ARonm Date EXHAUST HOLD IW/DUCT)
{IA2:ARUOefi MAT,-1.S DISCLOSURE IIOIISING MITIGATION FF.P.
Will the a Cliemn nr future building�e Chada emuc2.handle hvatlh in d Safer l IIfiATING UNIT'fa)IIX),IXN1 IIT U)
as defined by the Cupertino Municipal Coe,Cheper 9.13,end the Ik.hh end Safety
Code.Section 335711a)? EVEN7ILATE1ONrANISINGI.LRVSID)
IT(OVE0.IaD,IMM)BTU)
I]YO, XNa
Jfut N FAN I51NG1,E RPSIDI PAIDWd the it co ea m fumy building«sen B ase ea Air Qu or devices which Dna Receip a
anis haeeNnne air commnimms ata defiant by the Bey Aree Air Qnnlity MenoRcmentMI'1111P OR IIXI,fMD DTIIIiDistrict TOTAL.T1No ME(OVER Hallman RTU)I have mal live hteardm,mamrial,scquirenenn nNcr Chat."695 W tie Can- IONER fmnie Ilrahh&Safety Code,Section,21,9)9,253.17 and 23574,1 undemmul @at if hISSU CE DATE
building does non currently have a m t,that it Is my respomiility ser mdify tbeaccupnnlN I I AL M ECIL SQ.FT.
`dAmanirtmrnn xh�ch tort prior to issuaae afaCmificaaof0mupstmy. 1. •.-s' C',
flwneror am^—` hailed egeut "� `''s '_"-^z
Oste TOTAL:
IssultD BY.
OFFICE