S 2257 -APPLICANT-TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY CUPERTINO
' BUILDING-ECAL
N0
BUILDING DIVISION APPLICATIONQ'ERMPIPLUMBING E61ANICAC
I4llILDIN(;I'RoJECI']I)bN]IFIUA1'ION .
'
2257
BUILDINGADDRESS: $ANI'ARY NO. APPLICATION SUBMITTALDATE
21,9 21 COLLI M&U.S AltvE, Cu P�Me>) GR 95o 1 1 /' Z-VM ( q
` OWNER'S NAMIi: I �'y�� I'l1U�N\R' - CON'rItACTOH:S NAM13'. (O LICNO: r
IGR4-rH 2yry DIF-50[) ��oy 7- CONTROL#
ARCHITECT/ENGINEER: LIC NO: ADORI3SS: ❑
coNTACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG, ELECT PLUMB MECI
a 3., ❑ ❑ 2 ❑
LICENSED that
DCONnsed under
DECLARATION haps QTY ELECTRIC PERMIT FEE
I hereby otos mm 1 am Banned under pmvieens o I,Coda.,,9(el,mmmco,y JOB DESCRIPTION
wOC wimsmdon mx)a)ef Divixion3onbc Ourinesxnnd l•mfessinnx Coda.mad licuose is RESIDENTIAL:
H full force um 1'IJtMI'I'ISSl1ANCl?
<a" I.icen,-Cl'vsx LIC.# / .- DSEDWI, D KITCHEN REMODEL
17Ga One Ian ..r APPLIANCES-RE4IDENTIAL OADDHION C PLUMBING BE PIPE
ARCHIT17CPS DECj7XVWI'ANIi1.S CMH1T1-UNH' CSTRUCTURAI.
OZyZ I underspend my pions snail he used as gohlicmemot, STRUCMODIFURAL
UP TO 2'X)AMPS ElINTERIOR DCHIMNEY BE'AIR
Lsen,eI anfessumol 201-10110AMPS IMPROVEMENT CSWIMA1ING POOLS
reJ� ; OWN5R-BUILDER an III, RATION OVER 1000AMPS D BATH RHMODFIAREI'AIR 0DEMOLITION
KC 6 1 hemby alfrm'h:e I um exen'ry rnnn III,Cnmmcbmx License Law faille
O a U following reason.(Section 70]1.5,Bminess and Professions Code:Any city or count D OTHER J4' & f f
t�3r slcnsn.EcrRlcnl. !� IIF '1 4TI�R
� m which reyuims a permit to construct,aloeq improve,demolish,or repair one structure
prior toil,maturcaxivo mamma thenpptieam for such pem,iuo fileu.cigl,crlmamnmen SPECIAL CI RCU1T/M ISC. �'f•1 j '3
y
that he is I Banded pursuant',,the poosmons on he C'fintnums,License Law(Chapter 9 —
aS monnmoncin•with Section of Division 3 of the Business and Professions Coca)W,�p C b NPERMIT
ITER OR POLE 1NS'1'. COMMERCIAL
Q.4 c C (hat he is exempt thanfrrm and the basis for the alleged exemption.Any violation of ❑NEW BLDG/AUDITION CDEMDLITIGN
-,y Section 703LS by any applicant fm a g oust objceu thenpplicamm a civil pcnnl,y of EVICES
milnone'hill,Eve hundreddolliev(5500). C717NANT FOOD SERVICE
❑ I,as owner of Ne progeny,nr my emgln 'b woe their sole ctunIMPROVEMENT'
L will do the work.and thestrumure ismal mandedmofficfd l'arsle(Sea 7044,Business NG i'00 IC
❑O'i'IER
L3 m and Profession,Code:The Centramrx License law does not apply to an owner of -SWUC fiSprnpcny who held,or imprnvcs'humnn,and who d,,e.otell work himself nr thnmgl,hit own employeesprovided that such improvena:a are nn'indaded oroffered lin IDENTIAL ELECTR SQIf.howevarIbe building or improvementcsld Mammon,yeartafear,letiogtheSQ.FT FLOOR AREA VSQ.FCcr-builder will have the burden of proving that he did not build or improve for pur-
FutcofsledI,as owner of the proprny,am exclusively contracting will,licensed contractors mTOTmm.....Licause law does not apply u,an owner of prooene who builds or ireprovev thereon,andwhocommal,fo, ach'arl wih a surn.m(1)lveowd Qom' PLUMHING PERMIT •EEleeense Law. ounuanl m the CnntramnreD lamexcmglunde,Sea B&pCnlhi,rexx,n SSUANCEOwner RAIN&VENT-WATER(EA) VALUATION
D:xcWOR KHR'S COM PENSATION DECLA RAI1019 OW PROTECT DEVICEI beach,aRrm uder peachyof perjury oneof the following declamtionr1-a❑I have and will maintain a Cenificmc of Conscnl to self-inmm for Worker's Con,ce- DRAINS-FLOOR,RODE AREA,CONE.
senior,as provided for by Scelion 3700 ill the labor Cade,n,r the per of'be STORIES TYPE CONSTRUCTION
ark rel which'his permit in issued. PIXTURI3S-PER'I'RAI'
D 1 have and will anduain Workers Coenpenw'ion Insurance,a,mameed by Section
3700 1)[the LaM,rCode.teethe perfnmwnce ofthe work for which this peril is issued. GAS-EA.SYSTEM-I INC.4 OGI'LCfs OCC GROUP APN
My Worke's c'�',i on 1' f�Tmy car'cr and Policy nlpnhc
Cerricc / A Policy No.:X71 90�IOI('� GA5-L'A.6YS'1'L+MI)V ER4(RA)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASFJINDUSTRL WASTE INTERCF.FfOR
('LTi,salmer need not hecomialed IRhc not is fell chundomdolms($1uh) 101LDING DIVISION PEES
I,,lilt,] GREASE'I'ItAP NCHE - -
Icenify'trot in the pedhrancc rf the work for which this peril is issued,Ishall SEWER-SANITAkY-
not employ any genon in any manner sl,a,a,bcmmt
e subjec ,,the Worker:Co.,.- STORM EA 200 a
C) Z .smarm Law..SS�Vl�C_a II 4 Um ..
ENERGYEkGY
Z Applicant yI{ WATER EATER W/VUNT/GLI?CTR i
NOTICE TO ct"I'be AN Wal':If,afic,C-a nmking this Ccnificaof of Bxcmgoio d you should WATER SYSTEM/1'kiiATING
became subject the Worker'sC,,me,or this pounshal of the IahnrOdc,you must y, sons FEB.
forthwith comply with such provisinrvv or the pem,it shell he Aemned mvnked.
W Q WATER SERVICE
,Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.III IIA _—
U O Ihefehyaffir hat hem is a automation lendingagcncy fonhe pedi,rence of V Dam Receipt G4 H the work far which an,permil u Isaac.)(Sce,309],Co,CJ
U Lender',Name
Lender's Addrexs TOTAL: 'IDEAL,
p, I famity that I have read this application and sat¢ohm the above inb,mutinn is~ BUILDING FEF.
H 7
Tl, ancet.lagree
minch ..and with all city and county onlinanws and sac laws rc,(fi, QTY MECHANICAL PERMIT FEE
U F7 bmidingcom,truclinn.'uulh rms,se hnrieu reprewnmtiva ol'I'll mry to nose upon'he SEISMIC FEE
atone-mentionedpropene fm inspection keep ee.
Ws.)a PERMIT ISSUANCE
( agent indemnify and keep harleu the City of Cupcnino against ELECTRIC FEE
"ah.....ca judgments costs an nee.which mayin any way aecme agains said City ALTER OR ADD TO ME CH.
Is`mc
ncu Is, n his pcan.. PLUMBING FEE
APPLICANT U t . ANI .C 1PLY WITH AL1.NON-POINT AIR HANDLING ON]](TO IB.INN)CFM)
OUR IF
A S MECHANICAL FEE
AIR HANDLING UNIT(OVER It TKV CFM) CONS'I'RUCTION'1'AX
Sig aimed
IiconnCon ctor
U.
EXHAUST 1100D(W/DUCT)
HAZARDOUS MATERIAL.. ...CL"G" HOUSING MITIGATI FEE
Will theapplievm nr future budding«cupunl,tomor handle hanadoo,material HEATING UNIT(10 1(0.000 RTU)
no defined by be Cool I Municipal Cade,CMgncr 9.12,and the Ifiankh and Safely
Calc,Section 25532(x)? HEATING UNIT(OVER 100,100f)BTU)
❑Ycs
EAINRGLMlRES1]1i1UUMN(SINGLERES l D) PAIDWill he alm unt ar frame huiding ncenpom use a....ipmm'nr device,wich Dateen'i I hmardnus air continua is as defined by the Bay Area Air Quality Management (3HPOR IFF.BlEBTU)District? �I3❑Yes u IOV ER 100,0(X)BTU)I have re d d, It tNoux muJy ,regni lana under Chapter fi.91of the Cali- ERfominHca1N&Su ISec tfnsand2551] 1ualemanJatifthe ISSUANCE DATIin « ove les th myresponsibility to notify the«cupunt AL MIiCH. SR 191 _/�uim e, ihnx. ori vnuamanfx enilj este IL@ nern nh, red ager' DTOTAL:
ISSUED DY:
OFFICE