99080005 - APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
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CITY OF CUPERTINO BUII,DI NG-ELECI RICA I, IipRMrr No,
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDCN'I'IFICAI'ION
BUILDING ADDRE. ( SANIT,%BY NO. APPLICATION SUBMITTAL DAH
7 37 HoR4e;(sdrf�r D � �1 • _ j- z-q
OWNER'S NAME: �� 7/ / - CCOONWTAkcIO ',/N1AI NAP jj CCT1180 -I�� NIC CUVI'kUl,p
�CHIt'IiCT/Ii1NGINEIiH: LIC NO: i ,li-IIQ4/�RLHEI IV.Lt /`_JST— 3ITL� ❑
I
CONTACT: PHONE: BUILDING PERMIT INFO
D _ zl� 2-75-07 Z Z ❑ Consultant Fees Paid by Applicant(initial) BLDG EC 1' PLUMB MEC H/
LICENSED CONT RAC'TOR'S DECLARAI TUN 1 QTY ELECTRIC PERMIT FIEF, IL✓-1�/ IrJJ
I hereby of ror that I ant berm,under powimons of chapter 9(contmturing JOB DESCRIPTION
MZ 'm SacfonlOWsm Deckour3onhe Business and Profession,Codcrad my fcrnde is RESIDENTIAL:
F in full force anA c@a. _ PERMIT ISSUANCE
QUU LianaeC C ❑
Lic.p SFDWL El KITCHEN REMODEL
an<m.a U:nc Lie.# t APPLIANCES-RESIDEMI'1A1, ❑ADDITION [I PLUMBING RE PIPE
F-prq ARC( TECFS DECLARXI'ION PANELS
❑STRUCfI1RAh
Z O N.Z. I vndersmvd my plans nhnll he was uc public recons, MODIFICATION
OZ-Ls UPT020RAMPS ❑INTERIOR [_1 CHIMNEY REPAIR
1-4F-IY Licenced Preleainnal 2111-11XNIAMPS IMPROVEMENT G`al t= OWNER-BUILDER DECLARATION ❑SWIMMING POOLS
C - OVER 1000AMPS ❑BATA REMODEUBEPAIR ❑DEMO[.1'I'ION
C ¢ I hrmhy user mat I ant uadpi tmm Inc Comrdaor_r Licca..law for the
pj 5 LL F following reason.(Section 7031.5.Business and Professions Cole:Any city or county SIGNS ELECTRICAL (]OTHER
y O usQ which or,aire.s a permit n1 connmuet,titer,impt'ove,dcnmlish.of repair any structure,
N.] prior to its issuance.also9 s the applicantfor such pe il to File a signed slamanced ,PECI AL C I RCIIITIMISC.
}n- hash I ' Ipursuant l J , ns It C t t ':L ' (C
Ihopter9
ad 0 (commencing with Sceuonl00)ofD'viion J of the Business and Pndsraions GdOof TEMP.MEfER(OR POLE.INS'f COMMe RCIAL
d :
4 e C that he i,cmnt,thi..n and the M1rs1s ter the allcgW..empllan.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
x^,y Seen..7031.5 by any applicant fur a permit cbjm.th,applicant to a civil penalty of MOWER DEVICES
�,zy nal mom tllmlfvchundreJ dnllncs G500). ❑TENANT ❑FOODSERVICE
�=Q [11.as owner of the pro,i or my employees with wages as their sale compensation. SWIMM ING POU.ELECT RIC Ih1PROVEMEMI'
N will do the work,unit the sit tnum is not intended or attend fa sale(Sec."I044,Budde, [I OTHER
6 3 m and Professions Code:The Contractors License law does not apply to an owner of (OIITI,IRS-SWITCHES-FIXTURES
property who hirld or improv,,mencon,:md who does such work himself or through
his own employees.provided that such improvements arc not intended or offered for N17W R17SIDENTIAL E!LF,CI"R
sale,ll;howevcl:the building or improvement is sold wiforme yearrd nonfiction.the S ft(ROR Rf� $1S
n b IJ IIhave th burden fp Rthat hdid our 6 Id p frpur
o u D Lf D
per
Cl I to p puny - Iy i 8 with J t' mrs ht TOTAL:
lardont,0 project(S .70Ll.Ensure,add P I '.' Code:)the Ct ctr.Li AUG ^ 1 99
cense Law Jacs not apply in an ownerofpmpeny who bold.oriousers thereon.red QTY PLUMBING PERMIT FE n/,
whomutants forsuch projects withvaordons p licensed pursuant to the CommcmrS
License I.;,.. - PERMIT ISSUANCE.
❑ I um exempt under See. ,B&P C for this reason
AIXER-DRAIN&VENT—WATER(EAJ AI
gwnct DAtc �
W(ORK17R'S COMPENSATION DECLARATION BACK FLOW PRCUEC I DEVICE
I hercbymfrm undcrpenahy of perjurymic5fre following declarations: r U
I] Ihamided will andominrCedifancofConsnn rosulf-ino-e fur Workcn'd Coogan- DRAINS-FLOOR,ROOF,AREA,GOND. $TO 'S TVP6 CONSTRUCTION
_anion,as provided fur by Scetinn 3700 mine WM1nr Code,far the Kn or nonce of the
r for which this permit i.issnnP VIX'I"OREiS-PERIRAV
w I have .it will maintain Worker's Compenrnioa Insurance,as merited by Section
3 pot the Lib afCodd,fnthe pedrmmn,rof the wok fjut,Pw1diiydiflhi,varrmit is issued, GAS-PA.SYSTEM-I INC.4 OVI LE'1'S OCC GROUP AIN�/
My War Nt1p41aWY or 1ptmrlVice:i 'ol cy Na,/�s 1-1 l✓ta o.e7 GAS-CA.SYSTRM-OVER 4(EA) 'O
artier: IAR.rL 1! 2 2
CISRI'l1ICATE OF EXEMPTION FROM WORKIiRS'
COMPENSATION INSURANCE GREASIVINDUS"I RL WASTE INl?RCEI'TOk
(The,aselinnveedir be residetW Ann, .it is for one hundred dollars(SIM) BUILDING DIVISIO_FEES
it kos.l GREASE TRA('
(ochry thatilvhe performance of the work fur which Penni this tislared.l shall I'hANCHECK ITE
rn em ilo SEWER-SANITARY-STORM I3A. 11IT.
ENERGY F
I gong pemnn in anyone so,,to heemnc mhjecunthc Workcrs'CamMo- N1FEEZ udation Laws of California.Date
z Applicant WATER IIGAI Ek W/VRNT/IiLEC'I'R
GRADING PEE
t%] NOTICE TO APPLICANT:If,ager making this Cisions of
Eubor io r you should WAFER SYS I'lipl/I'REAITNG
a ; become subject m the waken'.Compensation endisions of the coed Gale,you must SOILS PEE.
W Lmhwith annply with weir ptovisirnd nr this permit shall be AcemcJ revoked. WATER SERVICE,
d
U Z CONSTRUCTION Ltion lending
ENCYagency NEW RESIDIiNTIA1.PLM5. SV II'. ('AID fV
C..) Iherebyich nthat there isaco (Sdct 30 len ding agasy for prrftmtance of Dam Recci
W Fthe work for whicM1 thi.pcmtit is issued ISec.309),Civ.C.)
ULender's Nunn
LU Lenders Address TOTAL( '1' 'A L;
y I certify that I have mad this application and vats that the emwe Inmrmaion is BUILDING TEE
(A correct.)agreemereplywith all city and county ordinances and smtclowc relating n. QTY, MECHANICAL PERMIT
U Z moldingconammiuq and hereby ruralize representatives of thiscity menterupm the FEL SEISMIC FEE
A nne-nmmloned po,edy for impeaum purpose..
(We)agrme m save,indemnify and keep harmless the City of Cupertino agaimt PERMITISSUANCE ELECTRIC ITE,
Iiabilitic.,juJRmems,codiand expenses which may in any wry recmeagaill"said City gC1ER OR ADD TU MECH.
in asequence of the gnmmi
ting of this pert. PLUMBING ITF,
APPLICANT UNDERS'FANGS AND WILL COMPLY WI'1'11 ALL NON-POINT ALR HANDLING UNIT(TO IO.000 CFM)
SOURCE RtiGUI.,\TIONS. ✓-��� MECHANICAL FEE
AIR HANDLING UNIT(OVER 10,000 CFM) S
COCONTRUCI'ION'PA%
Signature oflimon/COmnlcmr Dam EXHAUST'HOOD(WE)UCT)
HAZARDOUS MATERIA DISCLOSURE HOUSING MITIGATION Fl9i
Will the appdcal or future budding occupent smm or handlehazari'm material HEA'L'ING UNIT'LPO R10.0001TU)
as defined by the Cupertino Municipal Code.Chapter 9.12,and'he Hcahh and Safety
Cn te,Scetinn 25532(a)/ HEATING UNIT'(OVER 1000.001 BTUs
El Yes LJN1
VEN'I'ILA'IION FAN(SINGLE RFSID) PATO Dam N
Will the applicant or fuwrc building overpass one equipment or devices which 'asps#
out haeatduusmrco..tan'mants m defend by the slug Are,Air Quality Management BOILHR-COMP(31 IP OR 100,000 BTU)
L
'R T .: r
s �i HOLLER-COMP(OVER IM.000H IU)
read lire hanrdous materials requirements under Chapter 6.95 of the Cati. AIR CONDITIONER
ISSUANCE DA'Z'E
HeaM Solely... Gds.'ever no 235115,25533 and 25534.1 undcmnnA mot if the NEW kfSIDENTIAL.MECIL SQ.rT O �'—C:T
nal nlnxntly bavcatcn:mtthat it is mresmsihilitto notifth ' o (�Ymems wbieM1m she matpdonoi,ouvncualaCeni( sof(kn1 uld,in.eJ agent U' e IF TOTAL: ISSUEDBY:
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OFFICE