S 1664 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
BUD DING. C - -
PFtTN2
CITY OF CUPERTINO PLUNDING MECHANICAL
ECHANIA
BUILDING DIVISION. APPLCATION/PERMIT BUILDING PROJECT IDENTIFICATION 1664
HUILIAN .ADDRESS SANITARY NO. APPLICATION SUBM I'1'1'AI.DATE
/(.d I ala PD as dvw n
Dr. S-LAG-98
QWNER'S NAME! PHONE: CO RACTOR'S NAM1IG[ LIC NO:
i� �/LLN I —`) C/ �thJ p� GZgg0 NIC CONTROLN
ARCHIL ECI'IENGINEER: LIC No ADDRESS: ❑
CONTACT: PHONE: BUILDING PERMIT INFO
-/ ^ `3-045 1 O ❑ Consultant Fees Paid by Applicant(Initial) HLDG ELECT PLUMB MECH
�L1NV9..� /�J �V Y D ' ❑ ❑ � ❑
LICENSED CONTRACTORS DI!CLARATION QTY ELCCTRIC PERMIT. PEIi
1 Itereny uni'm Inco I me Bee..ed under pnwixiall of Clmpter 9(eommeneing - JOB DESCRIPTION
D0Z wlm Secllon]1XN1)ofDohdou 3ofma Busine..ow I'fics4om Cmlu,mOhny license as RESIDF_NTIAL:
W OO PERMIT'ISSUANCE
U^ in full force snJ eRecl. ❑SFDWI. ❑KITCHEN REMODEL
QUZ�j License Class Lk.N APPLIANCES-RESIDENT UU. ❑ADDITION RTLUMBING RE-PWE
F-61 Date Contrdanr
ARCIII I'HCTS DECLARATION ❑MULTI-UNIT [ISTRUCTURAL
L.,p w PANELS
!!�� 1 undcrnomA my plans xbull he used as public rcc:nds MODRICA'I'[ON
OZ%�0 UP'H1200 AMPS El INTERIOR GCHIMNEYREPAIR
F.�.1'.0 Licensed Professional 201-1000AMPSIMPROVEMENT 0SWIMMING POOLS
Y�; m th
OW'NER.BUILDF.R DECLARATION OVER 11XN)AMPS 0 BATH RE1,10DEUREPAIR 0 DEMOLITION
IY C Q' 1 herehy mn.Thal I am exempt froe Cnmramnr's License Law for the
155.06 U following reason(Section 7131 5,Business and Professions Codc:Any city or county SIGNS ELECTRICAL OGIHER
rR 3lah which requires u permit to consurom e]mr,improve,demolish,m mpoir any abanure
prior to its lnsmuae,also requimsthcapplicam bused,pcmhiun filer,igaeduramenl SPECIAL CIRCIIITIMISC.
�y that heislicausedpurmannatheprovisionsoftheContractorsLaroseLaw(Chapter9
U�p00 (commencing with Section70had of Division 3 of the nosiness and Professions Cade)or TEM It METER OR POI-17 INST. CO&IMERCIAL
mpt
E xd c that be is exeIminfmnl and tire basis forma alleged exemption.Any vmaaion of 0 NEW BLDG/ADDITION 0 DEMOLITION
W^m Seniun]o3L5 by any applicant for.Iermitsnhjeu,matipliemn to a civil penaltyor POWER DEVICES ElTENANT [IFOOD SERVICE
1„ not more than Bvc hundreddollera($50(b, IMPROVEMENT'
p O 01,ax owner of the prnpeny,ur cony eripleyws willh wu6os us Welr wlc mmpenaation, SWIMMINGPOOL ELECT RIC
dd p.t will do the work,and Ne stmcmrc is not intended orol'I'ered for sale(Sec.7044,Business - ❑OTIIER
W^m and Profession,Caste:The CumrncmLs License Law does not apply m ua owner of OUTLETS-SWITCHES-1:1-1 UR-I -
�'3^ property who builds or improves thereon,and who does such work Moselle ffiami h
his own employees,pmvidel aha such improvements not not intended or offered for NEW R WiDENf1AL ELECTR SV PT.
sale.IL however the huildingor impowemet is sold within one year ofcomplmioo,the SQ.FL FLWR ARIA $ISQ.FT.
u-hullder,will been the bunko of proving thnl he did not build a Improve for par- ,
p se of xmde).
Lea owner III the properly ant exclusively contracting with licensed contractors m 'f(TI'AL:
construct improper,(Sec.9144,Business and Professions Cm,:)']be Conlrwrmea Li-
nLawdoes not apply to an owner of property who builds or improves lhemon,and Qrry. PLUMBING PERMIT . FEF.
wtswho contracts for such projects with a comacmr(s)licensed pursuaneao the Contractor's
License Law. PERMIT'ISSUANCE r �0
F-] I ren eamnpt under See. .B&P C for th,reason
ALTHR-DRAIN&VENT-WATER TA) VALUATION
Owner Date
WORKER'S COMPENSATION DECLARATION BACK FLOW PR[TfECI'.DEVICE
1 hereby affirm under penalty of
to perjury one of the following Wdeclarations:
-
FI [have and will maintain stion 3vae of CooWel o Codensure for WorkersCompen- DRAINS-FLOOR.BOOK AREA,COND. S'IORIF.S TYPE CONSTRUCTION
snti kf us pnwited for by Soden 3]fN)of the Luhnr Code,for the pprfnrmance of the
work for which(his lmrmit is lxsual. � PIXTURI!$-I'1?R TRAP
0 1 Hove and will mainmia Worker's Comlxnsahiun Insurance,as commit by Section
3900aflhe Lubin G-0e,forth,performance oflhe work for�which tNh�ispennit is iauel, GAS-EA.SYSTEM-1 INC.4(tUTLTIS OCC.GROUP APN
My Wur e Q err and l'oliq�apbsr yty 9�0/ GAS-1!A.SYSTEM-OVER
Cubic
ub _=-R_
/ Policy No.: 9 JJ
CERTIPICCO
COMPENSATION
1TIONINSUAN WORKI!RS' GREASH/INDUSTRL WASTE IN'I'ERCEPT(IR
CGMPI!NSATION INSIJkANCP. BUILDING DIVISION FENS
(Rmi,wrlenneelmn leeanpleed it bepermitls li+rmolundreddollvrs($100) GREASE,RAP nr less.) PLANCHECK FP.P.
lacnilythm intheperf..... sof thework Lrtwhich thispcnnih is i...ad,ldadl SEWER-SANITARY-N ORM EA.200 PC
nor employ eny person in any manner m as to become subject to the Andres'Corsica- ENERGY ITB
Z senna Laws of Califomia.Date WA
C)
WNENT/Ii1.liC1'R
Q Applicant
I GRAVING FEENOTIC '
y hernme.'Tf1APPIthe ii Illt',ntcrmuoiliwrm hisC,ailwateviumaxof m l Labor Con.de.you ould
Wq'I'PR SYS'DiMTREAI'INO
M heuhmch comply
the Wod pr visions or this erovixihal of Nu Ichor Cndo,you most - rT SOILS PIiE
Y^ forthwith comply with such provisions or permit shall bedeemed revoked. WATER SERVICE X,P
0
azCONS'1'RUCf10N LENDING AGENCY NEW RESIDENTIAL PLMH. SQ.17. PAID Dare Recei
C.1 0 . I hereby affirm t rt tine r k.aonmmeduar lending agency for the poformanc,of CL
E~ the work for which this permit is karat 1111,?fNZ('Iv.CJ
ua Lender's III re A L:
WLender's Address TYPAL HIIILUINC,1'I!E
1 certify that 1 have read this application and state that the above information islit, V
Ir la/1 correct.l agree to comply with all city and county ordinances and nate laws retailing to QTY. MECHANICAL PERMIT FEii
Z building construction,and hereby authorize reprtati
esenves ofthis city to enter upon the SEISMIC RiIi
abovoanamioned PoTerty for inspection purryhecs. PERMIT ISSUANCE1 We)agree to save,indernnify vnd kap hunnlces No City of Cumar ino ugalnsl ELECTRIC FEE
liabilities,iudgnenL,eosrs undcxlwnses which may in any way aecrnnagnino said City ALI his OR ADD'M SUCH.
in PLUMBING FEE
asequence oftbc%ramin,oftnis t permi
APPLICANT UNDER AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNITOO I0.000CFAU
�/ / z�— CONSTRUCTION
MECHANICAL PEE
SO REG' S
S_��,/�9ta AIRHANDLING UNII'(pVl!R10,(IftOf.FM) CONSTRUCTION TAX
S"namrcol' +ploam ntruaor I Eric BXHA UST IIIXID(V/DIIC'11) 1101G MI'I'IG ATION THE
IIAZ RDOUS MATERIALS DISCLOSURE
Will the applicant arfulare building occupant someorlardle maxamoustraterial HEATING UNIT TO H10000 IT U)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the health and Safely
Cade.Section 25532(v)] HEATING UNIT(OVF.k 100,000 BTU)VEN'Tll .F
[:J Yes 0No
A'PION PAN(SINGLE RESIII) 1)NJ Rwcipl N
Will the appl'menl or fume building occupant use equipmcnl or devices which pOILBRC(1MP(3HP OR IINI,Oq)BTU) V V'
`emit hazardous air contaminants as defined -
by Inc any Area Air Quality Management 'TOTAL:
nBOILER
Dia
n? -COMP(OVER 100,00)BTU)
0Yes Fl No
AIR CONDITIONER
I have ,S the Code.S.a mamr255 requirements under Chapter h.9.5 l(bel Cali- ISSUANCE DATE
forma Mott,&Safety Code,e n anee 25505,25533 and 25534. to mlHy the
(belittle Ibe NGV!RIiS1UliN'PIAI.MGCI I, SQ.PI'.
building Jaws nor cutmmly Nuc a mnunL that it is my resposihility m notify the oaupem
oflherc mull ria mi....arelnf.Cen'fcam of(kuvpanry. ✓
�u
Owneroruwhonred agent Date TOTAL ISSUED L1Y��`-' • ' �O
OFFICE
o +