S 0848 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
RUIIBINI:- CI ,
BUILDING.DIVISION APPLICATION/PrRMIT 1""'0
R NO. 0848 OI rUPERTINO M1GMEHANICAL
BUILDING PROJECT IDEM'IFICATION
BUILDING ADDRESS �� � � ^ SANITARY NO. AI'I'LIC�NQSUHh1��)A'IE
ra�
OWNER � / ^%Irl' CONTRA R'. NAM'L' IW✓C/lYv/
( (_T/ _ NIC CONfHOLN
�\RCHITECi'ENGINHER: LIC NO: AD S ❑
1
7wON PHON�Ey�_/' _J'� tlU1LDING PERMIT INFO
1%/ (J� ❑ Consultant Fm Paid by Applicant(Initial) FLOG ELECT PLUMB M CI
❑ ❑ ❑
NSED CONT'RACI ORIS DECLARATION QTY ELECTRIC PERMIT FEE
tn,t 1 am Rrtn,ee ander I,nvwn,m or enaptm 9(ammercmgPOB DESCRIPTION
M=Zivi.ion3ofineRuvin.1 amt Prnrc�swn Cat, Inty Bmnrtn. RESIDENTIAL'WO PERMIT ISSUANCE�41� ❑SFDWI. ❑KITCHII:REMODFJ.ZpCwtmao- APPLIANCES-RESIUENfIAL ❑ADDITION El PLUMBING RFPIPIi
rn Q FL _1 { , V ❑MULTI-0NIT ❑STRUCTURAL
FDy ARC111TI:u mE biwA PANELS
Z O Z I ur,JcrwanJ my pica.shall he usN m pu,lb ra}trJs MODIFICATION
OZ--'O I1PT01(X1AMP5 ❑IhTER10R ❑CHIMNEY REPAIR
r4tix Licenwd Pndes.vinnul 1101-1000AMIS IMPROVEMIM' ❑SWIMMING POOLS
QY�J OWNER-BUILDER DECLARATION
OC I here, room,h d I am escnt I from th Commi mr's License Inca for the OVER IdfX1AMl5 ❑PATH kEMODEI/RF.PAIR DFJNOLITION
6 P
kOLU which oc ones. (,Scotism]Or ft d. mot, to Nolcvww CMc:Anyaipyo-oemm,ounty SIGNS PJ.ECfRiCAL S ER
3 4,(a- which its iota a perms ne cem,mcl,alma imprve,dco.dub or rano any Nrucmm zt
O� pnulo its issuarce,elsorryuira the yrylicmRfor such permit to file asigncdswemmt SPECIAL CIRCUITR.115C.
ythwhi.licroscd punuam mlhe povisiona n(thc CwlruClNal,icrnsc lawlClwpla9 PIZ COMMERCIAL
00 (mmntrncing wiN Sectivn]gXBor Division Jof the Puaineca and Pmfavuu Cull or TEMP MITERORD)LEINS.
d y o c no M is esemlt therefrom end the Furs for Its,d1r,J ac.F..Any Ontario.Of — EWBLDGADDITION ElDEMOLICON
4X1 of
Section 7031.5 by any iMbeenl for a Pemon xubjob,Ne aPPliaN to a civil Penally M POWER DEVICES NG. ❑FOODSERVICE
Zp`�, not over,Ihnd five hundred d,1W,(SN00). MEM'
CSp ❑ LuoownerofW:proem,Or my emlloyea with wrtga as theirole contpcirnmer. SWIMMING POOL ELECTRIC
y22' will d,tic work rind lh wrscb.,is notitncalN moBaei for sak(Sce,704.Busircu DTVI
ly '� cad Profnsiona Cod,, EN,Cnnlrvemr's Llccn¢Le.dxw'nor apply to un owner Of OUTLETS-SWITCHES-19XTURES
proRny wW builds or impmva thrt^a amt win does such work himulf o-through
his^can entPloyces,pnrvidW ohm veer impnwemmrdtr are not intended or offered for NEW RISIDENTTAI,1.1I= SQ IT.
elle.If.however,Utc builJingaimpmvcment issokl within oto yrarofcotrydecon.the IT FLOOR AREA ESQ.ET.
owmf-W Wtr will hoe the buNcn of Imvir,that h did nm build a ini,ri for pm-
pnsc of sola).
❑h as owner of the p,,,ciy,em eseNxivnly comrmling with Iicered amwnms to TOTAL.
Go.,the Project(Sa.7014.Busioe.0 and Prorettiau'r_.,I The lormir^r's Li-
treslaw ore,not plAy to an owrcr cfpnTcny.1,o Wilds 0,inp+ntva Rr+eon,and QTY, PLUMBING PERM FEF,
who nm0a,b,for each DOj W,with a ntnhumr(s)licrn'd Punwmuo the Contmcmr'r
Lianas law. urdcrSwPERMIT ISSUANC
❑ lu,ncacmp . ,If&I'C htlhisvtmn
Owner Uwe ACER-DRAIN& F Tor KI.UATION
WORKERS COM ENSXRON DECLARATION BACK EEOW PR CG
)EVI
I hmehyarm ounder penrmy Of Perjury One of,hc follwing dedsalinns:
�-71 have ural will rimmemina Certtk9eofCon.¢nl lu KN-Imam fa WakR v Cobden- DRAINS-FLOOR.ROOF.AREA.GOND. STORIES TYPE CONSTRUCTION
tion.ns rOvicW for by Section 371X1 of me Labor Cide,for the perfor moa of the
Rr which this pe mut is i..sucd. FIXTURES-PLA TRAP
1 have mal will maitdait Workm's Cornlcnswiw Lmuw ,,m mcuirod by Section _
rforrome
hic
-1 INC
Myth"A ,a�inlle rl an ti,y oNl�nryf^vnthae iisuM. GAS-FA.SYSTEM.OVER 4 rA)I.EIS ()CC.GROUP APE
Cu L(J(/
CERTIFICATE.OF EXEMPTION FROM WORKERS' GRLASI%INDUSITtI,WA.SIti INTERCEPTOR COMPENSATION INSURANCE. BUILDING DIVISION I EES
(This—tionrcN no,bemd mPlmiflh permit is boom,hundred!QtlLvs(SIM) GREASETRAP
Or les) PLANCFIIiCK Ilile
[,comfy But innepefornotee.fthewmk fnrwhich this permit is issued.I"I SEWER-SANITARY-STORM EA.EUI FT.
ra employ.,Ic.in any man.w as to becortrc subject to the Workers Gmprn- ENERGY IEE
It
O z tylion laws of Cali forma.Dale WATER HEATER WNEWIP ECGR GRADING IEE
Applicant '
N NOTICE TO APPLICAND It,afmr necking,his C'endimtc of Exemption,you should WATER SYSTEMG BEATING
tm
,we w
orbjal to the Workers Canlcnwimt prvisiau of tha,u lCode,you w SDIIS EEE
IaEJ Form.th comlA,wi,h w:h pcovownn Thi,pend,sh lI IN,Ikcnd mvoked. WxD7.R SERVICE
D
1 CONSTRUCTIONottion INGAGIiNCY NEW RLSIUF,Nf1A1,I'LMII. SQ,17 PAID
L) - Ihvcbyichn Nat Vertissued(rclitm lending agcrcy OR Ore prrfmmmacof Doc i[n♦
fL thwttk fnr which lhiu Permit is iswdlSa.lD9],Cis.C.) TOTAL.:
Ut<mlera Namc
Lode I Aodrt.0 TOTAL'
L BUILDING IEE
ccnlfy Ihrt I Iwvc reed IM1Ix ytp inlinn cad sorts That,h dxrve mGxtmlion is
(A curter.I agree m com,ly with dI city and colmry mdinmtm erd store Incas rtlatin6 m QTY. MECHANICAL PERMIT FEE
(..) Z Wilding construction,and hereby uathonte nepawmwivex oflri city m enter upon theSEISMIC FIT
Wnve.m nlioncl pmpmy for impcctiw perotor, PERMIT ISSUANCE
(We)rgrtc m mvc,inotntmfy and kc,,hannlcvs the City ,I CO'mor,a,imo, ELECHi1G FEE
Iiabilitia.lmlBmmtS mus and capcnacs which may in vnY way acres agaimtsaid City ALTER OR ADD TOMECH.
in consequence Of Ih granting of this Femtih PLUMBING FEF.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM) D
SOURCE REGULATIONS. MECHANICAL FEE
AIR HANDLING UNIT(OVER I0.000 CI'h) CONSTRUCDON TAX
Sign...of A,,Ii,srVCo..mc Dutc EXHAUST HOOD GVTUCD 14OUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE' /�
Will Ihe.,Ikonl Or fern WidingOceoponl mom h
or handle vmdoux material HEA'L'ING UNI'I'(TO 100,000 BTU)
v def nod by the C.'".Municipal Code,Chuptm 9.11,mitt the Ilcalin,and Safmy
Rtdc,Sndiom Z 574(c)1 11KKrr'' BEATING UNIT'(OVER 11111.810 If I'U)
Y,v
VENTILATION FAN(SINGIE RF_SID) PAID Dam R¢ci,#
Will doe al'Plium m fwure Willing occupant use ryuipttrn,t u Mica whiad,
tit hmsrd,ns air nmmntimmsuddbnl I,dtc Bay Arca A it Quallly Mmagcncnt BOILER-GDMP(dHP OR IIIB,(881 BTU) IOrAI.
isWcl^ �[ BOILER-COMP(OVER 100,000BTU7.
❑Ya ( No
I M1ave rad tlic hmeNOua tmtmials AIR CONDITIONER ISSUANCE DATE.
. requirtmrnts uMm CTupm fi 95 or the Gdl-
Bntia Umlth&Safety Code.Sn',i^ns 255115,^_5533 and 45531.1 uomm ndf dot if Ih NEW RESIDENTIAL MECH. SQ.Ff. / ��
humnedoesmt /f���tcmn.thw it is mY O"Ponor ildyboolfYdrmvFvu
oflhe,.i,5E mLswann Ot.tbMr
Owner gem IM, 'rOT'AL: ISSUED BY: - 'v '
OFFICE r