S 2773 -—-"APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO NUILDING-ELECI'RI C11. PERM]I'NO.
BUILOfN , 1) VISION APPLICATION/PERMIT TING R OIPCIlI IFIC �^ 2773
BUILDING PROJECT II)KN'I'IPIG'1'I(IS O
BOLDING ADDR155: SANITARY NO. APPLICAI]ON SUBMITTAL DA)Ii
1lW
MIR �: I'IIONI!' CON'IRACCOIt'S N LIC NO:
c ��Lk" 4� 1 �� SIC CON'Ibut.0
( ARC IITECF/ENGINEER: J LIC NO'. ADDRESS: V ❑
CONTACT: PHONE: BUILDING PERb11T INFO
❑ Consultant Fees Paid by Applicant(Initial) RLDG ELECT, PLUMP MECCHH
El 11 ❑ 11
LICI!NiUGGNTRAGFDR'SDI?ChANA'1'ION QTY. ELECTRIC Pk?RMIT hEfi
1 hereby nlEnn that
I um IiameA under pnheshnnc of Chnpinr 9(conuncnclne JOB DESCRI PITON
CMZ with Section 7010)of Division 3 of the Businus and Profession,Call.and of,lie,,nw is FRESIDENTIAL,in full forte and effort. PENh1lf ltitiUANCE
ul- ❑SFDWL ❑KITCHEN REMODEL
G U U Dals. . Class Lin.M
Naw Dam Commnm APPLIANCES-RESIDE,NI'IA1. ❑pHDll'ION ❑NIA\THING RF,-PIPE
ol ANCIi1TEC1'S DECLAHAI'ION' ❑MULTI-UNIT ❑Sl'RUCfURAL
N y Z I undemen i my plans sha11 be used im 1 I' mis PANELS MODIFICATION
ZZy metro
07.�- UI"F021X)ASiI'S ❑IN'IPRIOR ❑CHIMNIEY REPAIR
�3!-Q LiccnsW11 fiveiimul 2111-IIIOIIAMPS IMPROVI!.MENT ED SWIMMING POOLS
Yf� OWNER-BUILDER DECLARNI]ON
5 OVER 11XXt AMPS ❑BATH REMODEIJREPAIR ❑DIE}10LITION
a C 1 hereby Elim:on 1 1, exempt from m the Contractors Liles¢Law,co me
iUaU follnw'ing reason(Section 701 L5,emines and l'm&scions Cole:Any city or countySIGNS ELECTRICAL ❑OTHER
LL O yQ which requires a Permit to construct,all,improve,demallsh,or repair any structure 74 - k
J prior u its issuance.also requires the applicant for such permit o files signal stun•mem SPECIAL Cl RCUIT/M ISC.
that he nelicensed pursuant o the provisions of the Contractors Liceme law(Chapter 9
LLormenci ngwit 11 Section700(pofDl -or 30 the Husim,andm
Pfesxionv Code) "CBM P.M IETER OR POLIS INS'1'. COMMERCIAL:
TS'p0
a ale flat he Is esemp 0mmtmm:oN the haxis lnnlm allagal eamnpfion.Any vlolaninn of ❑NEW BI.D(VADDITION ❑[)EMOLITION
Suction 7031.5 by anyupplimmi for a pernal soncox file pircant m a civil penally,of POWER DIEVICC
hf nwm than live hundrcJ dnllarx fSAXlI� ❑TENANT ❑FOODSERVICE
r
f-?> m' IMPROVF.MF,NT
Q D 1,us Desna o(ihe propny.or mY empluyccs with wngcs uc their rvlemfnlmrvsainn. SWIMMINGPOOLELECI'RIG
�=C'' wdl Jn the wod.anA thcuwcmmis nodimcnJeJ or oll2rtd for
le(See70,14.Resume, [I OTHER
H
W
3 m and profession,build,,,,
Cod,,:The Contractors told I law,Jas not appy s an mwncr of OUT1-ISLS-tiW'1TC11ES-FIXTURES
hisfurlawn who build nr imded that
thereon,and who Jas such work himself or ehmngh
his own employ be provided That wch imprs sold within um not intended or aRereE for N]iW RILSIDENTIAI.EI.ECTR SQ
owner. .ilder illclse 1111 hander rrcnsnl ixntlbeidoncyldtrtdcurovo ton•dmc SQ PI'.IL(%)R AREA
5/SQ.FT.
own
abuilder will hove the huNcn of pmving Ihm he did sol build or ingtmvU tor pur-
1".�xa1u.).
construct
the
Thu Nov. ly,nm Business
and contracting with.Licensed cnmctors - 'LVL\L:
tnsmLa the es not re.o an owner
of and Prot'ho bu.v ds ocp'Itm Contractors red
wfieel.awea,,xnrepplybmoxmerofpropeny whcutildunrimpmvice Colon.and QTY. PLUMBING PERMIT FEE
ncomrarn for wch pmjucs with acorn vortsl liaunreJ pursuam to the Cnntmemr's
License I PERMIT ISSUANCE
slamxc mpd undo Seo .B&PC this
t I vxan ALIER-DRAIN&VENT-WATER(EA) VALUATION
WB' 'OM - SA'IION DI!CLARA
'DON HACK FLOW PROFIiCT.DEVICE
® hcrehyaflim;(lRKIand penullyofpj.ry one or the ptllowing deluraflnnr:
Ihave and will mninlnina CeuilcnlwdCnnwnnu null-irtcurc(or Wnrker'e CnfnPcm DRAINS-FLOOR.ROOF.AREA,COND. $TORIES "TYPE CONSTRUCTION
-.alio as pn,idod Ga by Section 3710 of the Libor Call Ralik I erfor ancu at the
wvh fur which his permit is issued. FIa CURIS-PER TRAP _ _•�
❑ 1 have and will maintain N'nrl.ees Comfemnion bsummec,as required by Section f
370X0ofuse lave Costs.fol the peounamoreoffhe work far which this permit is iswsit GAS-1!A.SYSTEM-I INC.J OUTLETS ( (K) _ ;ROUP �x Al e '
My Worker',Coma,mation Incumnce carrier end Policy numticare: In,, ✓ JW/
Carrier: Policy No.: GAS-IiA.SYSTEM OVER 4(HA) Jim
r
CERI'1FICA'FIT OF EXEMPT ION FROMWORKERS' J ���
E
CON PENSAIION INSURANCE GREASI!/INDUST RL WASTE IN'HERCITTOR
�D IL _
('rhi,wmion need oaf be utmplctcJ if the pernhif'nf onchunJrcd dollars(S IfXp GREASE TRAP N NVISION FES
,it Icsv.) VLANCIIECK Il!E
I esuly that inlbe Noomanceofthc wnrk l'ar x'hichlhie lSman is issued.I shall MEWTR-SANIT\RY-STORM EA.200 ET.
not employ any person in any manner so as to beetm Zubject to dhC Workers'Comps, ENERGY PER
ZZ cation laws of Calihtmiu.D:nc WA'1'I!R 111!AI'F.R N'/VIEN'1'/I!LISCTR y
0 Applicant GRADING FEE
` NOTICE 1b APPLICAND It.adermudingthis Cemillcam of Exemption.you should WN!17R SYS I1 EM/I'RFXI ING
F� scans ba s,1 a the Wake,canmemsatian lanais on,of he Labor cads,you...as, SOE,S FIDE
forthwith comply with sold....... ionsor Thi,,pe.ol..all he Jttmul revuknl. WAI'IR SERVICE
Uz CONSTRUCTION LENDINOAGENCY NEW RESIDENTIAL PLMB. S0 lT. PAID
U Q Ihcrcby off nn that there is acatndrnion lending agency for the perlannana of Data Raeipltl
U. P the work for which this permit is issued(Sac.3107.Civ.C.I
QU taster's Name TCHAL:
U lender's Address TOTAL:
Ir" y 1 ecr ify that I have read this application and state that the above information is BUILDING FLEE
Zt "umes" agree retnnnply with allrely and Conry omllmmess and state laws relating to QTY. MECHANICAL.PERMIT FEE
U 2 building conmmmion.andherebyauthoriecm"levemalive.of 11111 lily In Infer alms the SEISMICFFF
abne-mentionel propemy in,!nspxtian purpowe. �i
We)agree it,save.indemnify and keep heartless the City of CUrynino c'musI PI!RMI'I'ISSl1ANCE J ELECT RIC
led ilices.)udgmens,costs and expenses which may in any wry recon,against said City AITER OR ADD TO h1ECH.
in I
ce of the greeting of this permit. PLUMBING 19!li
AI 'LI(ANT MUNI AND WILL COMPLY WITH ALL 'ON-POINT AIR HANDLING UNIT(TO I),010CFM O
�RIEGUI .I' )NS.
MF.CIIANICAI.FETE
2 AIR HANDLING UNIT(OVIER]I1.(XX)CFM)
CONSTRUCTION TAX
141�rlrrc of ApplealA lua U:uc HXHAUS'1'i IOOD(W/DUC'D HOUSING MITIGATION PIER
I '.ARDOUS MAIIERIAI,S DISCLOSURE
Willy,applicum or fume mildingaaUFar dorc or foodlehvalloro madenal HEATING UNI'F(TO 10.s0 It'I U)
as refined by the CU Coin Municipal Ctde,Chapter 9.12,and the Health and Satey
Cele.Satins 25532(0):' -/ HI!ATING UNIT(OVER I W.IXP BTU)
E]Ycs R4. PAID
VIEM'[LAE'ION'PAN(SINGLERI!SIU) Doe Roccip I
Will the applicant of fall a building by due m A equipment or device.which BOILER-COMP OHP OR IIXI.1KK111TU)
cnhif M1aramJam air cnnwnfin:mmn xx defncJ by Ile itny Area Air Quality M;mnge°¢ret
D"ua"l .-�!
❑Yes Lfmt ItOILEIt-COMP(OVER IfM1,lX)1114'I'U)
NR CONDITIONER
///��� I have rcaJ the M1vadnux ma¢riuls rtgnlrcnum.under Chapter 1195 rel flc Cali- r� ISSUANCE DAfI?
Ihmtl Health&S: y Core.Sttliona 25505.8533 and 25:rM.1 underslmW thud it the NEW RESIDF:NI'IAL MECII. SQ.FT. < — � �^ �
h` gJawod a ntly h; eu1enant.Ihal it is fay rtsrymsibilityro nnlifIhc acupunt -.-J /y
)y rpgly rex u ish n t b+met prior to issuance of o Cenili�C OlenpmJ
wn 1 J G Lam/ g
(lesser nr aulhnmala �nf � Uum 'f 1'AL. ISSUIED NY:
OFFICE