S 2015APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING - MECHANICAL
BUILDING 1'ROIF,LT I "MFICATION
PESIT NO. 2015
J
BUILUINOADORESS:
SANITARY NO.
APPLICATION SUBMI'TEAL DATE
5jeaU,0A1953 /
-/7 q
UWNIi :S NAME: PHONE:
CONTRACTOR'S NAME UC NO'.
NIC
CONfHOLY
❑
AKCIDIECTIENGSNEHRt LIC NO:
ADDRESS:
CONTACT': PHONE:
BUILDING PERMIT INFO
f -2/y� Q /
❑ Consultant Fra Paid by Applicant (Initial)
BLT>G ELECT PLLU--M, BB MF.CH
LICENSED CONTRACTOR'S DECIARATION
I hereby affirm Nu I am licensed! fi l pervi.urE of Clu in, 9 bran mcreing
QTY ELECTRIC PERMITFIiE
JOB DFSCRIFTION
PERMIT ISISSUANCERE51DFNTIAand!L
with Sectimi 741 Dtvixial 3ofne Iluainc.v and Prafcainnr Code, andmy license is
in full force acRm.
❑ SPUN'h ❑ KITCHEN RFh101lEh
APPLIANCES -RESIDENTIAL
Liccnw Class I.it.0
Dare Const
[]ADDITION ❑PI,UMIUNG RE -PIPE
❑murrbublff 0STRUC7URAl,
MODIFICATION
❑ INH PRIOR [I CHIMNEY REPAIR
IMPROVEMENT El SWIMMING I'OOfS
ARair-ECl-S DECLARATION
I onknln W niY plum ahull W u: d as hire ncordv
PANUS
UP TO fill AMPS
LimnvcJ Profie.dooal
201-1000AMPS
Oat I amBUILDER mDECLARATION
tau' co the
I hereby e0ilm IWI 1 1 scsh from dIe Conllrs Cor e: Any
ng rulwa (Scctiol Iluainaw and R s Gula: Any city or cwnly
❑ BATH RFJRODFJJRUAIR El DEMOLITION
OTIIBR/
OVER 1000AMPS
SIGNS ELECTRICAL
which ce en dclai
which rtquirts a Fcrmit m cm,'fre, eller, impose, dcll.IN, or rtlrair any "Itnmt
SPECIAL CIRCUITIMISC.
(f S�—
rl
piormnniasuwlay.ulna npuller the ef4111an1lea such pemlit to tile usiglla(C1r.fnmm
InW TW Ix IiCen1LJ palwanl10111[ pVvisionF tlf tle CMtmclnix I.ic.msc In W (C11uIMc! 4
Cub)m
Dlviewfor Kled
TIJUP.MEfFR Ox IroLE 1NST.
COMMERCIAL:
thehe
Any violation o[
that he isereion]Illmll th excarWrn. Anyvi
That Ac ie the Wsi,. Gn thu allege) caweram
1try
El NEW BLDG/ADDITION ❑
POWER DL?\'ICFs
31.5 b in
Section]WL56ymddredcenlfinelcnnil wbjccu the vpplicanl macivil petwty of
appxn ian
ease mum Jiw� five M1undmd uJlun (SNXp.
Las uWacro[Nelrgeny,eamycmF4oyaa with wage ortMiewk cunpcnwtio,
will do Ibe work, and the xtrusla c is n t imcmkd ea txTetKl for. inc (Sec. ]1141. Busilrx�
FOGDDEMSFUON
❑'IHENANTMPROV ❑FWDSFRVICE
IMPROVIiMFLT
❑ OTIIFR
SWIMMING %1fl1, Eh[ITtIC
OUTLETS- SWITCHES -"0"USES
and Protessiona Code. The Cnmme7m's Jeenvc law Anes rex apply m an twtcr of
NEW RESIDENTIAL E' F'. SQ PI'.
dugh
pn,peny who WiIJx cc improve 111[Ieg1, eul who ... h work himself uw
his two enlplayee , provided that weh itnprovemendn anot intended! K offered for
vk.lf. Mscsv,lhe WiMinguimpmsenlrnt is wld within eae Ye�rn(nmlplKiun,IW
SQ.FLIl00RARF.A
SISQ. II '.
ner-IuilJer will have Ile buNneof proving Out he did Ila buil) m improve for pur-
e. nfmleJ.
I, v miler of The ,tTcnY, am ea<lusively canlraming wish Ibcnxd RMnKIea3 uI
TOTAL:
newel Be pujca (.tie. ]IWJ, Nur and ToRz ru Ctdca'llm Canlrvicetr's Li-
IvclawJtr:a rxx.pplymmnwntt of,opcnY sato build.eaimpovta lWrtim,anl
QTY, PLUMBING PERMIT FEE
who conlrJCU fnr vucn pmfKts W IIA a conlrvclnr(s) leen W parwanl lu tls Cailruclurf
PERMIT ISSUANCE S
License Law,
[� 1 and exempt utldm Sec. . B k P C (ea This rca—
ALTER- DRAIN & VEST -N'AI'ER (A)
UaIP Dam
VALUADON
BACK FLOW PROTECT. DEVICE
WORKER'S COMPENSA11ON DECLARATION
1 Errtbyaf rmntldtt pewhYM,+juryoneof Ibe fullowins ccelearnion.0
I havewW will meintein.Ccrtif Icor Cemem miadf ofsurt fu Wukcis Ceanpcn-
,atior, provided for by Seawar 3801 of me, IaWr Cta4:, ford, perlomlmwe of Nc
DRAINS- FLUOR, ROOF, AREA, COND.
'URIIis
TYPE CONSI'RUM ]ON
weak for W11ich Ni" permit k issad.
%%TURES -PE:R TRAP
❑ L have and will maintain Wittier Crmlpenxwinn mommee. as required by Section
3](glof Nc labor Cnde,fmW,rfntmadccoflW wok far whichlhiv (kmmit i,s'nwN,
GAS - IA, SYSTEM -I INC. 4(IULIT
GROUP
APN
My Worls Comracedion laaumae cut aIle Polity real art:
Currier: 1'0., No.'.A
GAS-PA.SYSIEM-OVEkd(P.A)
Irl
CERTUICATE OF EXEMPTION FROM WORKERS'
COMPENSA'DON INSURANCE
GRIASIJINDUSIRI. VAST E INfFR( OR
Lill I
tlU1LU1NG DIVISION
FT:IS
(Thi. acclitm ncN nm WcirnPMad i[IM prnnil is ser uta bunJnd dclllus Ed100)
orkss.l
CREASEvr L
row
%ANCHrec Fua
— --
Ie.nifyth.ainthep:dullwnceof New(Atbrwhiahtlil.Pamir,i.uM,Is lI
nm cm n nen Io hccmlc wh'KII41he N51Arni Gun
pl yanY perwni Yrrunterwv 1 pen.
SEWER-SANITARY-S1ORMEA.2dPTJ—_
WATER DEAVER WNENT/EUIiCfR
saliun Inw" of C.lifeania DWc
Applicant
GRADING FEE
SOBS E? FR
NUI ICE TO APPLICANT: It, anon Meting this Cenifcam of E cmplion, you should
bKom mbjml eat IIIc Workers Condicia'dion earn of the Labor Coda'oumoot
WATER SYSfIBM RFATING
WATER SERVICE
each eernirlhi.rprnnA.haB k cls ledrevolmd.
fodhwilhurmplywiN pmlxa
CONSTRUCTION LENDING AGENCY
I haeby affirm that their,k a crrancra l lendingagercy for the peffxnlnlee of
NEW RESIDENTIAL PI -MB . SQ bir
I'AIU
U lReavi,♦
the wok for which This perp it N i.ed (See. NY)]. Ov. C)
L tnler'a Name
6 C
TOTAL:
LcnY.Ye Address
)TAI_ 1
BUILDING
1 crnify Nut I Mve Ieatl Nis epplicalitm .rW ream that The aAnve mbson lien is
umva. I agreonlcomply withall city arld county ortlinuve:nW .,,,^lmaaclaringm
Wilding conslruainn. and hereby audarrire mprcmmatives of lAis city metier apn lbe
above-mcmieald properly t'tlr magnme p dirvs s.
(W, igtco to save, indemnify and ktx) hannl— the City of cti'ditm it'n.
QTY. MECHANICAL PERMIT FEE
SEISMIC IEE
PERMIT' ISSUANCE?
ELECTRIC F1
ALIERORADD'IOMIif]II.
%.UMBING FI:
LiabUms,)udgmenn, cons and experi,aswhich my in anyway aavraeagamoo said! City
in vmsegacrce of the granting of Nis permit.
plk HANDLING ON[ 'I'('IU IOIX1fl CFM)
MECHANICAL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1, NON -POINT
SOURCE kEGULATIONS.
AIR HANDLING UNIT (OVER 10.00) CFM)
CONSTRUCTION AX '
Signamn of ApplicardConuanu Due
IIA%ARDOUS MATER1A1S DISCLOSURE
FXIIAUST HCODIWMUCO
I IDUSING MI' I'IGAHON 1ti1!
Will dm applicant m future Wilding umpam Hear, or handle hveldous malmal
HTATING UNIT TO 100.000 BTU)
ns dcfnAl by the Cap:nlno Municipal Cock, Cliaplcr 9.12, wA Pe HcaIN and Safely
Code, St,eE. 15532pd?
HEATING UNIT (OVER I10,00d RTU)
❑Ycs -1 N.
PAID -
Ume kccci, N
VENTILATION FAN ISINGIJiRESID)
BOILER -CONI' f3111' OH IMI IXM1 IfTUI
Will tW applicant went, i MuWing occapuu use , Ai,tml m Mamas which
emit hvurdnus air mnuuninwa iw defnnl by Ile Iluy Aral Au Vuefty Mmlagcncnt
District?
El yes Fl No
TOTAL' f
BOILER-COMI'fOVIiR IIIOIXp H'CUI
AIR CONDITIONER
I lose rtad Jle haevdtu. Im101dls lryuilmnus under Chyacr695 o(Ne CWi-
ISSUANCE DATE,
NEW RESIDENTIAL MECIL SQ. ET
forma licalm A S.futy Cada, SKvior, 25415.1553) tx115534. 1 aoilere and mi, if the
!!1777
/1 A
Wilding docs Ialt evrmxly hvvr, a ur®nI, that it is my recti ruilblity to tetify the neeVlWll
�Y� s-
afllercquirenenes whichlnuH henict or to i.vs.ofa Certificate M Occ,p y
�Q )
ISSUED BY:
TOTAL:
0,eff,r o aaNmbN agcm Dore
OFFICE