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S 2718 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY j CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATIONIPRRMIT PLUMBUNG-MECHANICAL C^ ��1 O BUILDING PROJKC'I IDEN11MCO ATION 1 v BUILDING ADDRESS: SANITARY No APPIACA'1'ION SUBMI'ITALIIAT Io & -3. Pz . 3 %T q9 01'NIT,'SN AM13: PfIONE: CONTRACIf�ICF/KA�) _ � LIC NO: _�v . (J (N�u/�� NEC CONTROhp HCIII'I'li r/ENGINf313R: LIC NO'. ADDkESS: ❑ l� 112 CONTACT: PHONE: BUILDING P8 MIT INFO ❑ Consultant Nees Paid by Applicant(Initial) 13LIlG I?LLCT IAMIt MECH LICENSED CONTRACTOR'S DECLARATION QTY. ELECTRIC PERMIT PEE 1 hereby Tirana amt 1 an praised order v,eei.io.out Chrpmr 9(yommcmmng JOB DESCRIPTION 0w2 with Scditn 91009ofDal,.an 3nflhc Bnvico,,cnd Flat Coda and my balls,Ll lLr RESIDENTIAL; LLIO PERMIT ISSUANCE �J F�fy� in full force andcfmat. -Q,FR WL ❑KHCHFNREMODL'L QUU Liccnnc Class [.i,.At APPLIANCES—RESIDENTIAL ❑ADDITION ❑PLUMBING BE PIPE F Z In Dult Cold radar mQn, ❑MULTIUNIT ❑STRUCTURAL. ARCHITLCTS DECLARATION PANELS MODIPICA'I'ION ZO`y^z IundarxtunJ my pinhe shall be used as public records UP T020f1AMPS ❑INTERIOR ❑CHIMNI?Y REPAIR u] Licensed Pntfetiriowl 201-I00 AMPS IMI'ROVEMEl E]SWIMMING POOLS aBn t amOWNI3R-I3UIL�lI?k IlEC1.ANA'IION OVER I0k)AMPS ❑BATH REMODEL/REPAIR ❑DEMOEc) LITION a Q I hereby1' t I nm txem I Irum the Contractor's Lauver,,,I,aw for roc G U ii,dowing reason.(Section]031.5.Bitand Probe...ren,Code Any city n,court, SIGNS ELECCRICAL El OTHER 3 W h which rrVnires a Panna m ctndroo,a e,union,demnbsh,m papal,any,mar art =meg fourt the ppl' arn for suchfi tt tdc a signed sorienern SPI.C1AI.CIRCU I 17 LSC. W'Y that be d 1 t thep f d Contractor:I 1 (Chapter COMMERCIAL: (W (enWo onetengw Scot f 9Wt1)ufllveot 3 ofde Eas'tc:xnul lr t .. tsCodyor rTMP.METER OR POLE I NST. 0.pt o a thm Ill.,he is exempt Trial Trials and the basis or the sllcgod exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLD'ION Section 9031,5 by any app eend for n perntit wbiall the applicant to a civil polity of POWER DEVICES nutmorcthun live hundreddolk..r$5110). ❑TENANT FOOD SERVICE CZO I,as owner of the rt .arm lice,with wu 'bell ole corn 'lion, SWIMMING POOL ELECT RIC 01 HER IMPROVEMENT 22 ❑ b,,,r YcmP Y gcsae Pcm:.t ❑O'1'H13R �P.. will do thcwork.nnJ tM1u svudurc is not intdtdcd ontffcretl❑n mlc(Scc 9044.Bill ties, 3 no and Puncs,io is Code:The Contntclors License Law dee,not apply to an owner of OUT LETS—SWI TCHITS—FIX'I'URES .. ,,,,,,By who Furtive I so,,thereon,and who docs such work hinnclfor through his own wnfilnyers,pmeided that such Impmvcnmnts an nut imcnded or oEcred for NEW RESIDENTIAL ELECfR SQ Pr. ,III.It.however.The buildingori mpruvcmcal is sold within one year of Complednn,the �] SQFIE FLOOR AREA $/SQ.FI'. crh 'Id 'ilk t burden fp flavor,that b did of hit II I Rnpur � / 1 tv� A y�y�� co�Q f tireF . ly IY t y I'llad r Icontracts,sm 61 1 constructtl project ISu-TW413 :' dProfessions Cd ITh C I t e1, T�.Z� cause l d t apply t f property I l Fds p :E and QTY PLUMBING PERMIT FER Aar,C / who ontrads hoorah projects x macono.emq,)bended pur,aanun theCneoscon, l�T�, 1+ License Law. PI!RMI'r ISSUANCE 3S e ❑ lamexemp dcrSec. S ,B&PC forels he on, N:1'lilt—IJHAIN&VIiNT—WA'T'ER(F,A) VALUA'T'ION . Owner Dom WORKER'S COMPENSA'T'ION DE .Ak cI1ON 13ACK FIAW PROf1,.C' )EV O© O I heMy ullinn under q.nxlty of p jury enc nl the fnllnw:ng dmlurminns: e]Ihuvcundwi llmmnminn CcniOeam ofCnnecmtoscll-unsure for Workers Compcn- DRAINS—FIGO ( - .COND. STORIES 'I'VYIi CONSTHUC'1'I(Ip ]iia, air vs prewired for by Seaton TRIC of the Laho,Code,lar the perinmtanec at the work for which this pc,mlti,i"ha, 12IN'PURES—PER TPA 2- ❑I I have and will maintain Worker',Compcn,mi le Insurare,as crushed by Section V IA 39110nfthe Labor Cost,fonhe perfnmmncoorthe work for which this pcnnit Is incased. MS—I:A.SY$Tli INC OCC.CROUP AI'N My Worker,Compensation Insurance carrier and Policy oun bseram: Carrier. Policy No: OAS—G'A'//SV VER k. +f CERI'II'ICATEGIT L'MP'HON FROM WORKERS' GHEASKil IJ I,W Ti INT'RClil �-� COMPENSA'HON INSURANCE BUILDING[)[VISION FliES p hre"cctinn need ern be mnlplacd ftbcpermitlx Cuune hundred dollen 1$I pp GRIT S1 RAI r loss.) YLANCHECK PI?E Icv,,dy that in the Perttmnanecol'Ihewnrk fur whlchtbi,peanut,I...ad,I shall $IiWER—SANI'PAk — )RM11 EA.211 not raptly Troy Far.on in anymanncr,nu1 to hcutmu whjwuo the W..kers'Compcn- '141ENERGY I: onotion Laws of CnBlbrnla.Dam WATER HEATER W/VENT/EL 3C G Q Applicant CRAI N FEE ti NOTICE 10 APPLICANT'.If,after making this Cenillcatc o1'H.cr for,yea should WATER SYSI'IiM/TRP.ATINO (1 bar a, Wnrk,i,Contpensmiu I pro ,intoaf the labor Coca,yo must SO SFEE .�j Emhwith umtilly with such provision,or this perntit shall be dreamed revoked. WATER SERVICE WW Q a' CONSTRUCTION LIiNDING AGENCY NEW RESIDENT[At,PLMI1. SQ.PI'. PATI hereb fflnn Sahara ieaeonstmmion lcndingagcncy for the perfnmtnnceof ])!air Beretta It x W � the war for which this pcnnit is ixnudl(Sec,3097,Cm.C.) Lcnderx Nunm - I WLender's Address 0 TALI Q O 0. flyfair Ih IIhis l' t d It thtth M1 f 'tons BUILD CPR:3m ,Fn r/p tome t.1 b t fits rh II ty d nY I' 1 t t I foe t" QTY MECHANICAL.PERMIT FEE S17ISMIC l • p Q U huFldngc t,amefon,and lterehy authorize represent.fve.tftb City to cncrupnn the nhts oration.)pmprny lap ln",ton purPoIts, =0MECH. ANCE (We)aglre m suet,indmnnify and lover haunle,s the City tf Cupertino againstELI3C'1' Ir' I iabiliti....... nom,e�st,anA cxfiennc,which may is any way.....a arlamstmid City DD'IOMECH. III nn:yurece nl'the granting of this perntit. r APPLICANT UNDERS'T'ANDS AND WILL COMPLY WITH ALL NON-POINT NG ON I'I'H 0111,100 CFM) MIr EC TISOl1HCli [GULAI'IONS. + .r� �� ING UNIT(OVER III,INHI CIkM) CO S U. ( 'A% Signmureof ApplicvnUConwcher I Dam Oo)W"ICC'II HOUSI GMI'rIATIHAZARDOUS MAI FRIALS DISCLOSURE Willthr applieant or futre hnlld3ngoccnfiantsmrear to dle M1.'rapdoa,mmnnal IT LTO 100,100 BTU) It,defined by thr Cupenme Municipal Code,Confiner 9.12,slid the Health and Saidy Clxlc.Spatia 25532(x)9 HEATING UNIT(OVER 1II01(H013'I'U) El Yee, fes" VEN'I'FLAIION PAN(SINGLE RL'SIII) PAID Ilvtc Hccciptp et. Will the applicant or fuwrc hnllding amarum ns<cympmnn m devices which BOILER—COMP(?IIP OR 11111.10013TU) mit hu'r.vnlo Ise..ronlnntton fnx:nt as deioed by Bay Arca Air Quality Management Ah District? PORTER—COME(OVER 1011,00013 I'U) ❑ye, I have had the hamrJeux materials requourancov,under Chapter 6 95o the Cali- AIR CONM'11,) R ISSUANCE I)A'PE fnmin Hcnith&Salta Code.Barron 25.505.255??and 25531.1 indent,th that a the NI?W RESIDEN'I'IAL MUCH. $Q.PI'. ' huildingdne,not evrmntly Fee cu¢nunL tom it is my rcspme,ihillrywnotily thetueupvm - )Ithes4oi nae whOustot No Iprir toinvuall`of a Cenilicnm tf pa �y owner e,.h ngrn O laI asDEO BY: OFFICE