S 1968 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-EIEC'I'RICAL P17ylQ1'1'NO. � �
RUu.DING DIVISION APPLICATIONMERMIT PLUMBING-MECHANICAL L\7 1968
ISUILDINC PROJFC'r IDENrIPICATIIIN
SANITARY NO. APPLICAfION SUBMIITAppL DATE
BUILDINGADDRESS:
7s5 T�)r-- -FTE A'R,
OWNER'S NAME: PHONE CONfRA('1'OR'S NAME,: LIC NO'.
MLz.. -4 MRS. �dr6i -tQ6 3896 NIC conrkoL«
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIARCHT'1!C"I'/ENGINHL'R: IAC NO. ADDRESS ❑ �j / O
D trJ P R5eS� C2�476 I
CON'I'ACI PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT" PLUMB MECH
Z)115yVt'D 6— 3896 -14. ). >�t iss
LICENSED CONTRACT ORS DECLARATION QTY ELECTRIC PERMIT FEE
1 nereny arum nom I„n liamtand sneer positions of coolant 9 art,minennil,a JOB DESCRIPTION
'aZ with Section]IXXpof Divi.00n 3 Tome Hisor,,and Professions Code.:mdmy license i. L r (� RESIDENTIAI:
WOp PERM1IIT ISSUANCE J J
FLL_ in full fora and eRea [ISFDWL O KITCHEN REMODFL
QUU License Clas: Lic.N API'IJANCE S-RESIDI!N'I'IAI. KADDII ION DPLGMBING RI PIPIT
vgi Q L Ems CTntr:utTv
f.�M ARCHITECTS DECLARATION PANUS ❑MUI71-UNIT [ISTRUCTURAL
z C'u,z I understand my plans shall he used as public records MODIFICATION
OZ=C DI"IU 200 AMPS DIN'ITRIOR ❑CHIMNEYREPAIR
F4t:W Liermcd Profc,,minl 201-1000AMPS LMPROVEMENT DSWIMMING POOLS
C
six OWNER-ItU1LUER UECLARA'HON OV17R pay)AMPS D BATH RCMODELJRHPAIR E)DEMOLITION
a a d I nereny afrrin mat 1 am exempt Dom me Carlmctnr's Lwersn Law Ierr t th
X3yU following reason,(Section 7031.5,Business and professions Code,Any city or county SIGNS ELECTRICAL DOTH17R
W LL vFi which requires a permit to construct,cotes improve,demolish,or repair any mmmurc
F LLO
yg pro I I 'I y 'tl Ipl tl hpermit t 11 signedsnammmnm SPECIAL CIRCUIT'/MISC. -
du
that he licensed pntt the pai ofthConnector's License La (Chapter9
W�pO (con ¢ 70lingwith Serum 70toDivision 3 tfthe Business anti Pmmsaon%Code)or TEMP MET CR OR POLE INST. COMMERCIAL:
G d0 a lent he is esenipt pbractor a ane live basis lir the alleged exemption.Any violation of D NEW BLDG/A1Y) ION D DEMOLITION
ifnW Sectinn]0l L5 hY any applicant bra permit sunjccu me,pplicanunacivil penalty of POWER DEVICES
LL:-h TENANT ❑FOOD SERVICE
nt erotic than five a prop dolor n(55(X1).
IMPROVEMENT
QwiLothewits rk.the pnq+tny,mnsnotintoy ended with WrIn,erect tonalei(Sec.J,lc 0,1-4.usines, SWIMMING POOL HLECI'kIC
FZ� will dothesitna,and the Nmcmmicture,License
La offered apply ,,an Business 0TH'
F
G�w and erly issiona Codor aTar,urp overseers Liccnm law does sol apply s an.lh h OOTLITS-S\NITCHES-FIXTURES
pmpcny who ouch,or titled th thsuch i ane who dncc ouch work deed to err coed for
his was however,
he provided than oa, improvnaid w art not intended or offered for NEN'RESIDENTIAL IiLECTR SQ Fr.
mlclLh.Ider merst, lnbarin,proven,int ismidwithinone ildyear
or
s, thea,- SQ.tT.I FLOOR AREA $/SV.IT
crbudd,r will nava non nunlen of proving teal ae did not build or improve Int Pur-
01at
.a owvcrof the propmy,Too exclusively contracting with licensed contractors In T AI Q
rant me pmjacreelsr(See.7094.B- mid Pmlc.cionod
s Cn'.I Thin
Tire Curare!,Li-
c ssLitw does no,apply to an owner of property who builds or improves thereon.and QTY. PLUMBING PERMIT FEE
where raas(orsuch projecs with uu,mracums)licemed Corridors
lothe Cnntdors
I-rent,Law. PERMIT ISSUANCE r Q
❑ I am exempt ander Sec. .B At P C for this reason f
Owner Date ALDER-DRAIN F:V17W-WATER(IIA) VN,UA'I'ION ���fff
-~� WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE 3 / DOo
I hereby affim unde
rr peanity of perjury one of me follnxina Jedaretinns: J/
❑ I hmeand will nteinmin a Ccrtfli,ineof Convna msclr-insure WnrkcM1Comlmm IlRA1N5-FLOOR.ROOF AREA.COND' STORIP TYPEC(NS'1'RUCTIOn
omen.as provided for by Section 3700 oo the Lahr Code,lr ithe performance of the
work for wh th
hicis permit is issued FIXTURES-I'1E i
❑ 1 love and will maintain Worlds Cnntperxnlion Iantran ,us reyui¢J Fv Smtiun T —
3700A he Latah Ccdc,mrtne,erfirmance ofthc .,it lir which this permit issued. GAS-EA.SYST NC.a OCC.GROUP APN
My Worker's�C"mpu� ti�n lnmrance nor' and Policy�nuJnl+,e�r a�¢:� ��
Canic': I I '�7AIn 1C Policy N,s:1 GAS-1?A.SYtiT ( ERdllin) �� —� .Z1
CHRTII'ICATE OF EXEMPTION 19tOM WORKERS'
4-0
COMPENSATION INSURANCE GREASOINEUS I (AsTAM U9 ,24
(This s•ninn readnm her nnLPlmad it the%noir is for erne hundred dnllnm($ItX)1 BUILDING DIVISION REFS
or less) GREASE TRAP
Icenify Eat imhe perfornanceofmewmk forshich thispermit is issued,l shall PLANCIIIECK PEE D
not cnLpinY my'Wr n,in ung mannnrsoar to fico ne :beet ,,the Wmkes Com SLWp!R-SANITA CORM EA.21X11
,2' ration Laws or California.Date ) pun- ENff ERGY PF:H O
O WATER NESTER\V/VN;F/ELECfR
Z 0 ICE: GRADING FEENOI
NOTTCP:TO subject
to the Worker
If,Co making this Ccmm�te if Lothartio l gun should WAll3k SYS'I'NM/I'RIIA'TINC
hecomc r comp to the WnrkeroC'omns orthonpruvisionsorthemedr Code,you ranter SOUS III!
CIJ (onhwith comply with such provisions or pem,iL shallMdamcJ rcvoknl. WATER SERVICE
t1a Q
U0 CONSTRUCTION LENDING AGENCY NF,N'RESIDENTIAL PLMB. SQ.17. PAID
lJ Inn,,by Whifh his rna,is,and(See 307,Or.agency for the perfnnnance of D c Receiptp
W P me work ti,r wmnn ran nerma i-r ihx,ru(sen,3a9],cin,.c.)
O U leaner s Name TOTAL:
r W tender's Address TOl
F y I certify thin 1 have read this spplicmion and stn e,Iran the above infornuninn is BUILDING 1;- 0
h cored,1 agree,complywith.II city and,omIyordinances and sone mw.cmltum,u, QTY. MECHANICAL PERMIT FEE
U 2 building com,mc,inn.and Hereby authorize repm¢nratives of this city to enter upon the SEISMIC FEE
,Move-mericul l Property for a,yeaton purpwec.
IIRMI'I'ISSUANCE
fiabil
(Wc)agree gmenm cost,and espur and Which
hay i nm me City nr Cupenino id City I!LECI'RIC PEE
incaitiex,Jarrett the coarsing expenses which may in any is Try acerae again.,vid City ALTER OR AHD TO MECH. '� /''f 0
APPLImCANI c NDERSIANDS this WIIL. `V 1'LUb1BINC FIiIi
SOURCE N'1'ULATION'ANIlS AND WILL COMPLY WITH ALL NON-POIN"I' AIR HANDLING USEI'(TO 10.(X10 CFMI
SOURCE REGULATIONS. MI!CHANICAI.TIE O
AIR HANDLING ON['I'(OVER 10,000 CFM) CONSTRUCTION TAX
Signatum mApplinnt/Commano Ila¢ EXHAUST HOOD OV/DUCT) HOUSING MITIGATIONI§313
HAZARDOUS MNIERIALS DISCLOSURE
Will nheapplic,m to future bcalthigoceip,ntelnce,handle haanNumnmmaid HEA'1 INC,UNI'1'(To 00,D'XI RTU)
as deiced by the Caperton Municipal Code.Chapter 9.12 and the Ilcalth and Safety
Code.Section 25532(a)] HEATING UNIT(OVER IOuNM)BTU)
0 Yb, [TT]No
VENTILATION PAN IHINGIL RFSID) PAID
' D,Ic Rcaipt N
w:n the applicant or future building by[lie B use ea Air est or 'Marra which
.r. hu'r,,Nouv uircanluminnnN:ry defined by she liuy Area Air Vuulhy Management Ii0I1,13R-COUP(311POR IINI,IXN)B'I'U) ,
IL
L
BOILHk-COMP(OVER I(XL(a0 BTU)s ❑Nn a:W the bamrdous materials rcgairemcros unser Chapter 6,95 elan,Cali- AIR CONDITIONER ISSUANCE ONEE
k IturSaferynyha Sccaions25505,'5533and2553J.1,,Acolyte maiiftanNEW'TUTS IDHN'I'JAL MITCH. SQ.rLm curcndy est emi'mal owarteeponsiMty u,noify thc,acupum ments which mushM menpriorla issuance ma CenificemofOccuvency.
horirM cram Uma ]` AL:pB
ISSUED
OFFICE