S 2395 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO RUILDINr:-RI.ECrRICAI, PERMIT NO.
BUILDING DIVISION APPLICATION/PERMITPLUMBING-AIHCHANICAL S 2395
BUILDING PROJECT 111E\TIFICA'TION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITIDL DATE
1070, Ne ': iii 9
uwNl! :S NAME q 1'HUNG CO TRACTORS NAb11i LIC NO:
• ? / -//&-) a (iD4ol NIC CUNT ROLg
ARCHMICTAINGINERR; LIC NO: AODRI?SS: ❑
o 0
' CONTACT: / PHONE; BUILDING PERMIT INFO
L "o /' ❑ Coltant FPaid by Applicant(Initial) BLD ELECT' PLUJtO/ ME
.0
els If
ED
- LICENSED CONTRACTOR'S DI!CLARA'I'ION (a QTy ELECTRIC PERMIT FEE
I berth,JBmn that I am hei,o,ad under Provisions M Chapter 9lcommercing JOB DESCRIPTION
DSO with Section700(hol DMoom 3 ofthc lwnme
ein—orl PAfiw,ions Code, d my livais PERMIT ISSUANCE RESIDENTIAI:
F W, full force ansf eRm. �,i A )/n / ❑SFOWL O KITCHENI RENIODEL
ZUE1 Licsnac Class Lich Y Tom— APPLIANCES-IOR91DENHAI, ❑ADD[FION ❑PLUMBING RE-PIP:
NQLDate—Cunlr.¢ex
Dw ARCHITECTS DECLARATION I'nNBLS
C) OMGIII'1-0NTC OSTRDCIl1RAI,
Z vn L I urdvstaM illy eburs shJ1 he awl as public«cords MODIFICATION
OZ—O UP'M-NM ANI PS []INTERIOR []CHIMNEY REPAIR
�r^F'W IicrnsN Muf¢siovl 201-1000AMPS IMPROVEMENT []SWIMMING POOLS
OWNER B1311.10ER DECLARATION
x that 1 em W Q I heaby affirm eaemPr from The Com act r'a License law for he t
OVER 1000AMPS ❑BATH RFNOOP.IIREPAIR
C ❑UEh101.IT10N
O U lollewing rtaan.(Section]031.5.Buninav and Professions Code:Any city or cumry, SIGNS ELECTRICAL []OTHER
3 W which rtyuirn a perm m lon.ncl,eve,imPnne,d,a,disb.«repair any sTmclum
Prior an its uvunee.Jso mquir¢do applicant f«such permit refile a si6rrm stwement S%:CIAI,CIRCUITIAIISC.
that hclvlirenudpurnuam mTlc provtunnn ofthc C«nracuds Lkense Law TChry,Tcr9
^q0 (commrnnne with Secdnn9M11 of Diviaiw 3ufthc Husircrs and PmfuviwsCMc)« 9TJNE METER OR POLEINS�'.
d 1 oa that he is e.amPr therehon atd the basis for the uBeped es re,d..Any violation M O NEN'BLDClADDITION O DEMOLITION
MN Section 9031.5 by any applicant for a Permit suill the apphemot to a civil lnwlty of POWER UHVICES []TENANT []FOODSERVICE
mg Tone mall five hundred ro l—(55()0).
F Z Y IMPROVGMIlJ'T
Q [] Las uwcerof thepmpeny,,x my entpinyres with wager ua tMir a11c onmpenWioa, SWIMMING I'U)L ELECT RIC
W O wall do thesson%andtheo,tareinrots I-NOnseLaw Re,not
to am weinc.x []OTHI:ft
L 3$ end Yrl
who
Cult:ino wr lIh,,,a L'censc Law th,¢M1g VBhi In w r,wrtu of OUT LEIS-SWITCHES-IIX'1'URIS t
pnRcrty who Muhl.tat mtprvcs dsvchli and was,dos wuh work dad l,f m margo
his own empl 1,me pmvJm taw such,nerl obnla am oat iy.ofcor oflcrtd 1« NEN'RFSIDt1.'I'IAI.IHF.CTR SV FT.
' s:,k.11,Mwcvcr.me M1udding«impmvcncnt is xad within arc yrm of comPlvtim,thc SO IT R(bR ARCA 1'SQ.IT
mwrrv-Wilder will arc the buNcn of Proving that he did nol Ladd or lntlrmvc for pan
p,se of salc.l.
❑1,as owned of the Im,Icny,ons excl usivc ly cont raclmg with Iicensm awtracmn to IT)'CA h:
umrvct the prejm(See.9013,Rmmesa and Pn,f¢sioos Cede:)The Comnraara U-
ecioc law d—nt apply to on ow re+of pmpcny,do but kboc mPn,vc wercem.mJ Q'IY. PLUMBING PERMIT FEE
wnu a,nlraeN fin.wch ptnjoms wen a«unxnrfU lisnred I,m,e m u,me Contrec o,
Licmrue Law. PERMIT ISSUANCE v
n 1 am exempt tmder Sc,. .If&PC ru this aa,
VALTER-OR AIN R VITT-WA TIER IEA) VALUATION
O rcr Datc
®
WORKERS
rodyW SA,no UfE,following HACK FLOW PROTECT.DEVICE
1 nand will roe under parolty re perjury ane of the tNure for Wrlaftwwn
_ ❑Ihuw and will moimoinaCcnifwm a(Conknt mv<If-inwrc for Worker's Crm,pn- DRAINS-ROOM.Rt%)E AREA.COND. STp1UL5 TYPE!CONSTRUCTION
salion.as M%aded for by Seeikin 3100 of de Ichor CMB,Tor the yg nrmarce M m,
wind f«whwh his pcm,it is is,uOd. FIXTURES-PER TRAP
❑I m,c and will maintain Worker's C...o enswion motiraaac,:11 rryairtd by Smooth
3700oflle Ltu,bCnfc.mrdcperf«ovme o(thc wind,f«which thio permit in isocsl. GAS-FA.SYSTEM INC.e UVI1.Ef5 FICC.CROUP APIs'
W
My Worker's�ia p. �' mmme
Or
t)n�n losef� r and Policy raer
Cerner: ��✓pPolicy No.: GAS-EA.SYSEWJ OVER A_(EA)
i C1710IIICATE OIs E%IJNPI'ION PROM WORKERS'
COMPI NSAHON INSURANCE! GRIiASF/INUUSTRL WASTF.INTF.RCEITOR BUILDING DIVISION FEES
(fl,isvect nocylnv becmy,kseJ it dw permit is f«ore Mrndfted Jollws(51001 GREASE:TRAY - --- _-
m less,) PLANCHE,CK FEE
Icertify hot in the,PerGgoil N the wuk far which this permit is issued l shall SIiWER-SANITARY-STURM EA.20017..
nut etry,loY au,pervtm in any rwner on u m hecume.uhjwt m dr,Workers C'ompcn- ENERGY IFa!
O Z Noir laws ofcalifnmia.late WAILER HEMER WNENHLT ECTR ❑RADING FEE!
Z A,Iicanl t
y
NONCE Tf1 APPLICAMP If,after melon,his Cundicur uT fsemlxioo,you should WAVER SYSTENUTREATING
a , vemen sobject to Bc Waders Cera enswmo envisions Odds,lahor Culp,ycu must SOILS ITH
`. foMwith comply with such provisions or this pem tstall be dcrn¢d revoked. WATER SERVICE
LLI Q
6. CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PIJNII. SQ,FT. PAID
7 z' Ihcr,hY anion ThL there lnaconUrclinn lcMlnr upercY ler Ou perl'omnm,or Dale Recdpta
U _O the wan r«wn;rn,bi.permit i.ismer nSec.3lWl.civ.c.)
L4 abAL:
U Leaders Name
0 W lenders ABdrea BUILDING FEE
I eOrl taw this I nava mall opplkerian and uun draft tie ove informalin is
F m uoccl.Ia,rmmcon,ply with all Idy,mxl cowry omiamrxa wld'-Is mwa relwmpm QT'Y MECHANICAL PERMIT FEE
U Naddingcnnnmcilon.and lcrtby authorissrtprccmmiv¢uf,hincitytoetheruPu The 9isSucTEE
above-menliocd poo,rty fur imo cetian purposes. PERMIT ISSUANCE
(We)agree to save,indemnify mrd keep hunnlm,Its,City of Crl e mo upaina ELECTRIC Rli
IiaMliUes,JudB,Mnts.colts and e.,.which rally in any way acruO.,ainsl aid City AUTF.R OR ADD TO MECII, O
A m
nc,leo, OdtncgruntingM this pcm,ic PLUMBING FIE
SOURC17 RE UNDERSTANDS AND WILE.C(1MP1,1'WITH AL1.NON-POEM AIR HANDLING UNIT(TO If11NN)CPM1
MIECHANICA
SOURCE REGULATIONS.
/"12;� 61 AIR HANDLING UNI IOVLR I(LIX 1) CONSTRUCT[ TAX
Slgaumrc ApplkanhConba,lor I�Ne EKHAUS'1'HOOD(W HOUSING MITI LION FEB
HAL\RDOUS MATE IS DISCLOSURE
Willtheopplicamor baum luimm,actlpanlstore«hwdk haaokg,,nrbriul HEATING UNIT(TO BT
as dcnnN by the Cupertino Municipal CMe,CTupher 9.12,oM the I Ieahh wd Safety
Code.Section 25532(a)' HEATING UNIT(OV IX1. )
❑Yes ON. PAID --
VPIlIIfATIONRAN( GEF.RIiSIIA Date ResciP1
Will d,,a,cm,atrc-,s building by heRase,,mere-to Mirwhich
emit nn.ammt,at,rammrdnwta ax dofind by me lar area air tA,:,11ty Ma,wgenent BOILER-COMP ons f,l:j and nl
y TO L
D,wsct
�Yce []N'e H(111.IER-CnMY(nVl!R Ig1,U(XI R'IU)
�� Charged AIR CONDITIONER
I hasx reed he hvnatkvu mwenals wurider, M1.95 of the CJi- ISSUANCE,IJATFi
bcoru Iluuhn&Surd,Corte.S,,Iiam 2S5O5.25533 uM 25533.1 mdccawd mut if dw'. NIEW RFSIDENITAL MECH. SQ.I4. /) l O q
harommgdac„utemoom ehavcalcr,em.mat it is myressamsihility hnaify tko,c,mo /0 L /
nttnc rryuimtrcnty which nwsft M1c nsn pn'nr la ivuarcc M a Ccrulicmc of U¢vprrcy.
Uwrcraamh«izcJ vgcm laic TOTAL ISSUED BY:
OFFICE