S 2732 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ISLECI'RICAI, PERMIT NO.
ItU11.,,Nt:U VISION APPLICATION/PERMIT
rl.unu+rrvc.nu?cunrvlcnl. O
BUILDING PROJE171'11)ES'11ppCAI'IOH O
II2732
UH.DING AIU RI f S: SANITARY NO. AI'I'LICAI'ION SUBMI'I'I'AI,UA'l Ii S 31 �b Gs
OWNLR6 AMB: `y��� PHONE: CONTRACEO 'S NAfEAp..� l LICN : DG !JL CONIROI,x
AR'llrl'ECE`A JGi NITER: LIC IN 0: A DRES
CONTACT: PHONE: BUILDING 1 :RMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLUO ELF.(y PLUMB MECH
❑ ❑ ❑
I.ICF.NSFD CONTRACTOR'S DECLARATION QTY. ELIiCTRIC PIiILMIT FEIi
I hetmy ffhnl IoW Inns ki,r,rd tone,proviximuof ChaFf,f 9 lxom.ncncing JOB DESCRIPTION
OCZ Ih Section 7000)ulDivision3ul'Ihe Bmim end Pmfc"siom Cr:de,nndmy license is RESIDENTIAI:
��� attest farce anA cRcdl, � Cit PERMIT ISSUANCE ❑SFDWI, ❑KITCIIENRI3A10UI3L
Q,UU License Clens �Lic.x 1 t. APPLIANCES-RISIDEINT1AL ❑ADDITION El PLUMBING RE-PIPF,
oFi6a Dalc Cnnlr�—n/�-N•
FDh
At :IIIIIiCI"S UIiCLN(ATION PANEIS ❑MULTI-11Nl'I [I STRUCTURAL
Z O h Z 1 une u.mJ m pu
dcalanJ my plana shall hblic rccmda SIOCHIMNEY
DIFICA1UN
OZ-O UPT02IXIAMi'S ❑INTIiNIOR ❑CHIMNBY RREPAIR
4t:
! LianscJ l'mlca.iana( 101-I(XXIAn1PS IAIPROVEMIiNT ❑SN'IAIMING POOhti
OWNRR-11UII.1)HR Di(1ARRFION
I hcmby u1Enn tnat I out mumps front the Cunoaclor'x Liccmc Low for the OVHR l(XXI AMPS ❑HATH RBM(IDL'FjEFPAIR ❑DEMOLITION
a LU follwin• (Section]1131.5.Business and Professions Cde:An I I ❑OTHER
X3 F groman )'ciYor eon)' SIGNS 9LECRICAL
LL] LL rn which""'Ares a penult to cansvuel.Wlcr,intpnrvc.dcinolixh,or mpn:v mty xu'umere
F•u'05 pnnno'nn iuwmcc.aHo reyuireuM1e appliv'vm fnrsuchlcrmit mfileasignNslatamcm SPECIAL CIRCLE FINIISC.
E�}� hot be is Ikons,)pursuant m the too,isionvolthe CofrulotLicense Lots,(Clupner9
W (commencing with Section 9(XX)).f Division 3ol the Bu%inexand Profeoin isCWc)er "rEMR.MCIERORPOL1i1Nsr. MFR I L.
a d that M1e is cxe Apt therefrom and the basis for Ilse alleged exemption.Any 1whainn of 1-1 .D UDII'ION EJ UIiMOLITION
X ons W Section 9031.5 by city upphe n,far a permit subjects(r[applicant onto civil penalty of POWHR DIWICF--S
P2 ,more than fan hundred dollars(55010. T17JR ❑FOOD SERVICE.
Viz' Qyfrllovrn
n. Q'I�iri�,ry
S4 � L:n nwnernDhe progeny,o,nryenrpluyccewithwageeuxtheif3oluamtpcnnwinn, SWIMMING NI(ILG.13C'rRil'
Eat
will doth,work.0 de Phe cumtConfro lot',Uwrro, aw do for o,apply in an Dum,ss
of O
3 m and Pmlessiom Ctdu'ITe CnnlmMd License Low Anus not apply m if owner o[ fllJ'II.IdI'S-SWITCHGS-FI%TURAS
proµay who build,or Improver IhenV n,and won ntux re n wotk intended
or or offered
fthrough
his own anployccs,uildued that such improvements s urn not iycorolJ or.leftist,for NEW'RESIDENTIAL ELIiCTN SV FT.
nul,.Il:Jnwcvcn,lou nuilJing uninpnrvnncm is wtlU within ore ywralttnnpleftist,the SV.PI'.I1.00H AHIIA SISV.hf.
owner
budder will have the hurden of proving that he did not Wild or improve for put- n r
pu.0 of xu1")
❑ I,as owner of Ne pmpeny,am exclusively contracting with licensed contractors to l(rl'A
commit,the p,.,jet,(Sec.IC41,Rudnexs and Protexsions Cede)'Ihn Conm:c7nrx LI-
wfi:e Law does not apply fn an owner of prupeny who holds to ntproveathcreon.and QTY. PI-UMBING PERMIT FEE
o contrvax for ouch projfc,s with it mntrnctorb)licemcd pursaanuo Ibc CommOofv
License Law. PERMIT ISSUANCE:
❑ I am crempt under Sc[. .B K P C for this edam
AUI'12R-UIdA1N&V ENT-WAFHR(BA) VALUAI[ON
Owner Uam
WORKER S COM PBNSATION DE Ce allcoingI ION HACK FLOW PIt(YILCI'.DEVICIi
I heathy al mai under(malty of perjury enc of the insure my Worl ces Co
�Ihave andwillmaimm.a Certificate he IelNuOwcnmmfof Workclx Conifer- DRAINS-11.00R,ROOI;AHICA.COND' STORIILS 'I'YI'H(IGN$'fllDGlIGN
nntion,os hiv ,hiE'erbySca:oo3]Wa!the I,nMtr Ctxle.I'm the pudirmnu¢[rel IM1c
work lie which Thin renal,is ixsuad. Il%TITRES-PER"('RAV
1 hath and will maintain Wndmos once no the w rk or
wo,h his per by Section
3](XI Ot the laMrt Cala for the performance no work lot which this permit is iewN- CAS-13A.SYSTI[m-I INC.(OUTLETS OCC GROUP APN
My Wit if. t 'sem c c mAl'olicy1 li r
!� C'11 nllvyNa: GAS-EA.SYS'1'EN-OVI?R1(EA)
CERl1TCAl9 PB%IiMPfIONFROE, WO
COMPENSAI[ON INSURANCE GRI3ASI%I N OUS'I'RI,WA STH INTEIdCEPT(112
BUILDING DIVISION FF.CS
(Thiswotior necJnd bccumplcmJ fthe Permit isferonchundreddollars(SEW) GRHASEI RAP
m les..) I'LANCIIIiCK FIT
I[enilythan the lidimermeofthe xark for which this permit in i...ed.l shall SEWHR-SANITARY-STORME
net omploy any Innen in any mann,,no ao to ncuomh.ahjee,u,Ihh Woken Comic.- 5S IINFRGY FFII
0 z satin.laws.(C,lilimti,,.Date WATI3R HERATER WNFXUPIAi GH N 19iF,
Z O Applicant
y NOFICI3'IY)APPLICANT:If,at,,, ouking Iris Certificate of L'.cmptton.you ShnulJ WAR
ERSYS"1'E.MIfBEAT'INC 1
M , hcome xnbjcct to the Workdx CornEcnsaenn pmvisionx of,he"herCMc,you roue 50 S H
fan'..1h comply wid,such pm nwne or 0u,Pero.,Shill h Jc[mal revoked. WA'I'17R SI?RVICR MAR 41
6. CONSI'RUCI'ION IXNUING AGENCY NEW R13SID13NTIAL I'LMe. S0.FT 1 \ PA )
7 Z Ihereh ffinn tlwt there is mnsonninn lendin for he forntance of One HecciptN
U. hereby .agency per
the rend fur,which,his permit i,,,sued(Sec.3099.Civ.C.I
U.
V (cackle Nane IO[AL
lender's Address
Lu - - NG 113:
I c rEify that 1 ha,,raid this application and ntam,hat the anew minnnal Is
F" h correct.1 agree to comply with all city and county o,Jin truci and xtam laws mla ring to QTY. MECI IANICAL PERMIT FEE
L.) Z building amsmuction.and Formby au,honne representatives ofihis city In emcr upon Ne SEISMICFpp
above-noci inned properly fin irnpec,io n pepruseS. PCRSII'1'ISSUANCHC:LECfRIC PEE
O O
(We)agree to save,indemnify and keep handless the City of Cupertino against
liuhiliucm.j.dgna7ns.....:sand capatsos whichnriy In any way nccme ngninetsaid City ALTIiRORADDIOSEPCU.
in comccotum a of,he granting of his pcnnil. PLUMBING FEE
APPLICANT UN'DENSTANUS ANI WILL COMPLY WE 114 At.[,NON-POINT AIR HANDLING UNH(TO IU,IX)O CPM)
SOURCE EO 'LATIONS. MECHANICAL F17 If
WAA
I / AIN IIANULING 11NIT IOVF,R III,fNXI CFM) CONSRUCfI(IN'IAX
Signalueof ApplicanU' URp are FXHAUST FOOD OVIDUCT) HOUSING ret I'I'wA'rREN 11313
II re b ildintorcupWNHIRIALSUISCLOhandl
Wilb,,Iic C.'ro ml Man,building C arc Ch store or handle hazardous i IS,fol 1113A'1'ING UNIT GO I(I(1,(Xp RTU)
as defined by the Cupertino Mumc}}}III'''al Gde,Chupmr 1)12,anA the Iicolth and Sid'cIy
Code Section 25532(u)'! HEATING UNIT(OVIiR Il1U.IM1U HI LIE
C3 Y" Yrs VBN'I'11.At(ON FAN(SINGLE RESIU) ('AID
c Will thea (kens m future huilJlnoccupied me e I hr)mice which Dal[ Receipt M
pp liqurpmhn If011,1311-GDMP(111P OR Ig1,IXN)li'1'tl)
mit hmanlom:ur cnntnminunu un Jct nits by the Bay Areu Alr Quality Manugc°w°, T FAL
District? I401LER-COMP(GVHR oU,miB'ru)
❑Yen g'(m
Ihr,,.ri,nchaerrelrmxmmanalso,opimmcros audit,Cham,,695.(the Cali- AIR CONDITIONHR ISSIJANCE DATE
fimfm Health&Safety Cada Se:Joro 255015,25.13 anti 255)1.I undersmnJ Thal II de NEW RIMININTIAL MECH. SV.FP,
buildmoodresnnl cu ly h: uatenant.that iGs r rsfliddy to notify thetvcurym
(It the¢qui mann bi : pl rrm: tCartilicuto of0ceupancy.
a
Owncrnrnnthnrt agent Uwc Tf l'1'A L: ISSUIiD BY:
OFFICE