S 2142 APPLICA4TTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
"MY OF CUPEWI'INO HDu.Dwc-ELECIRIC,AL PEI\WITNO.
BUILDING DIVISION APPLICATION/1'IsRMI'P I'LUSIIIZ;-MEEHANICA1 v 2142
HUI HNG PROJECTIDEN'FIFICS1'ION
HUILDI G ADDRESS:le SANITARY NO, APPLICATION MIBMI'ITAL DATE
3 e woo rV/ _2c; _ U _ 4g
�' SNAMS /i ce CONI RACFOR'S NAME: LIC NO: NIC CONIROL#
CHIT CI'/T?NGINEER: LIC NO: ADDRESS: ❑
c.GyTACf:� PHONE:: BUILDING PERMIT INFO
1(/((`e// H j ❑ Consultant Fccs Paid by Applicant(Initial) Bu; El,fc'1'_ PLUM M�cC{ly
i I , / LJ Efl�— 14--
17
4 LJ
i .I IiLAKW'1 , TY ELECTRIC PERMIT FEC
'I thereby sffnn Wm I an licensed under Provisions of Chapter 9(Commanding
J06 DESCRIPTION
O=Z with Section 7")of Division 3 of the Business an PmfesC mC e.an ny licenxeis RESIDENTIAL:
WOO PERMIT ISSUANCE • fQ
1-� in full fame and effect. ❑SFDWh Cf11iN REMODEL
QZ ase Clgs_� �Lic.M APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
l vFi Dom �� Cmnrucna
ARC]11'1FC'TS DECLARATION ❑MULTI-UN[T ❑5'1'ItUC'I'IIRAL
jZpso 7�. lundemwnd lay plane Shull he usnlmpuhlio rearztls PANELS, _ MODIFICATION
OZ— UI'T021N)AMI'S El INTERIOR ❑CHIMNEYREPAIR
dal Licensed Pmfeedinnll 201-1000AMPS IMPROVEMENT' SWIMMING POOLS
'gwf� OWNER-BUILDER DECLARATION OVER IOWANI'S ❑BATH REMODELREPAIR ❑DEMOLITION
Q' 1 hereby affim+that 1 am exempt from the Camretnr's I-icense Law for rhe
O d V fallowing Tasan.(Suction 7031.5,Huxim,,and Prnfessiaas Cade:Any city or County SIGNS ELFCTRICAL ❑OTHER
';W ej which requires a Iwnnll u+canstruc(,alter,improve,demolish,or o mil any dmeturc
laos-tons ascounce.dko requires the Ipliczaa katurchiperroilf 6 1:Ple...an, SP11CIALCIRCUI'I'/MISC.
chat he illlp l come provisroasol hrCoulowturs I I (6h pmr9
W CC0 (commencing with Serrano 7")of 3ol'the Busrer,and lrafuni ns Crde)nr TEMP.METER OR POLE INST. COMMERCIAL:
Q.y o E that m
he is exnpt therefrom and the basis for the alleged exemption.Any violation of ❑NEA BLDG/ADDITION ❑DEMOLITION
iWG LL.
Section 7031.5 by any applicant for a permit subjals the applicant to a civil Penalty of POWER DEVICES ANT ❑FOOD SERVICE
w not more than five hundred dollars($5 0f
F Z Y IMPROVEMENT
��m$9Qp ❑Las the wornfthe the cloy.nr isno,oad,doilhwagesas their...lC(Sole cumpemation,es, SWIMMING I'O(11.IiL[CTRIC
will do the won,mal the suuemre is no,intended c+rolo,does r sole(Sol 70,14.Puniness O
nit Pmle. C 1 II C I�m I' + I does not niquyt an owner or OUf1.F.TS SWIICIICS-FI%TURES
pop ny who toulds or inclaccesithereuc. +I whu doas. Ik I If Ilam gh
bin ownctply 1noJdchat such ulpn t, rc cc:uwil�,(rodftTcl Itictroadolor NEW RCSH)HIS I[Al.HLECTR SQ EI'.
sale If.however.the building or improvement isstlJithino y onto nplebon the SQ.PI'.P, R EA VSQ.FE
owner-buildcr will have the burden of proving iliac he did nol buil)nr impmve for pur-
pose of sale.).
Fl1,as owner of the property,am exclusively contracting with licensed contractors to T(
Construct the cancel(Sea 7IW4,Business and Professions Coca:l'Ihe Cantracmr%Li-
censeLaw does out apply to an owner of property who builds or improve%thereon,and QTY. PLUMBING PERMIT PEE
Cohn an(mcti lar aneb projects with a connllemr(s)licensed pnrxwlnl to the Cnnlmcto"
License Luv. I'IiRh11T ISSUANCE 1
I am exempt under Sec, ,B&P C for this revs...
ALTER-DRAIN&VENT-WATER H?AI VALU ON
Data
WOR KEk:S COMPENSATION DECLARATION 13ACK FLOW PITTIECf.DEVICE O O
ncr 1 hereby air nn under penally of perjuryone of the follow ift,desdoulinnr
I have and will maintain a Cenificale of Consenuo self-insum for Workers Cornish- DRAINS-FLOOR,ROOF.AREA,GOND, S'I' RIES TYPE CONSTRUCTION
salmi,us provided Int by Scelion 3]00 of(he Lubar Coda,for(ho Imtl irzmanec of the
,,,,it Iia which Ihia permit Is issued. FIXTURES-PER'IRAI' 0
❑ I have and will nnaindin Worker's Cramlx'dso(ion Insurance,ax required by Section
3710 of We labor Code,for Terrmancytnil the work for which dais fiction is issue) GAS-EA.SYSTEM-]INC.40 ' >S OCC.GROUP APN
MyWcsCarticr:rkers L. ne_ y/ca rand l'nl cy No.Y7r�" J GAS- STEM- R4(E I
CERTIFICATE,OFF FX Ystf `EMVI[ON FROM WORKERS' GRp AN RL WASTE l ?PI OR
COMPENSATION INSURANCE BUILDING DIVISION PIKS
Tissemin i need nntbecwmplcwd 11the drand is forono hond(eddn0am(SEXA G > "RAP
nr fe"r PLANCHECK FHE
I unify Italia the parlorcents,ol'(he work but which(his permit b issued,Is hall SH L -SAN,l'AliY-S'fORM 1IFIL
not employ any parson in any manner so as m become subject to the Workers'Comped- ENERGY IEP.
O ,Z carina Laws of Culifumiu.Dam WATER HEATER WNIiNT/ELECI'R GRADING FEE
Z O Applicant
fn NOTICE TO APPLICANT.If,after making(his Certificate of F,xemption,you should
abecome subject come Waders Campenwumn provision,of the alba Code,you must SOILS FEF.
(Il fn thwinc,omply wish curb provisions or this purma,ball he Jame)revoked. WATER SERVICE
Q
UO 'I3
CONSTRUC0NetiG
NpGENCY NI3W RIiSID1iNq'IAh I'LMN. SQ.FII PAID Ume eceiptk
1 hereby alfnn thrvl Were G a ennswnionun lending agency lar Ore perlsnnvnea of
the work for which(his permit is issued See.3097,Civ.C.)
TOTAL
1<nders Name
V Lcuders Address y1 -2 �O
[t1 BUILDING FEti
1 certify that I have real this application and orate that We above infum+aion is (
il"'i r�A rnrzecL I agree m canlply with all city and wmnry ordinances and mom lows relating to Qry, MECI IANICAL PERMIT FTE
V building construction.and hereby amhori'ee represen(a(iver Cf m6'City laenler upon the - ^ SEISMIC FEE Q
nhovemond out prpeny foo inepecliwn purpuxcv. I'i?ItMIT ISSl1ANCE (/
(We)%gra Io are,indemNfy unit kcal)harmless the Chy of Cupertino against ELLC'I'RIC FEE -'3 Q
liabildiesmdgmm�u,castsanJ expersa which lay in any way oars against snit Ci(y ANTER OR ADU'ID h1ECii. III I
in PLICAN cI WERSTANDS Aispem+it MECHANICAL
INGP ' f p
APPLICANT I ERSTp ND$AND 'LI.COMPI WITII. L1.NON-POINT AIR HANDLING UNIT(T010,000 CIsA)
SOURCE RE PIONS, hfECHANICAh h': P
AIRHANDLINGUNI'1'(OVER IO,fIWCFM) CONSTRUCT ION TAX
Sl gnawre of A,,fi,l,rtA2SbftCCnC, Dole EXI I AUST I IOOD(W/DUCO I IOUSING M I'I'IOND ON PEE
I IALARDOUS MA I'[TRIALS DI SCLOSU RI?
WIII WcuPplicum ar fumrc M1uilding nccupmn xms or hmulle thnaonlm(x mmorial HENTINGIINI'TDR)100,000RTU)
as defned by the Cupcnino Municipal Code.Cimpler 9.12,and the health and Safety
Codc.Scelion 25532(apl HEATING UNIT(OVER 1010,000 BTU)
❑Yes nNo PAID
VENTILATION PAN(SINGLE RESIU) Data Rari,t#
Will the applicant or future building eccuperd use equipment or devices which '
Dist hosolo.,od,Cuotuninards as defnel by the[irvy Ara Air Qi lily Management BOILER-COMP 0111'OR 1(10,000 BTI])
vin'] y g T A{,:
O ye, ON. BOILER-COMPWVRR MAA B'IU)
I have sezv
rf the hadomaterialsireme
os materials Iegnnts under Chaper E95 of NAIR CONDITIONERe Cali. ISSUANCE DATE
forma Health&Safety Cole,Sedima 255(15,25533 and 2553L I understand Thal if We NI?W RESIDENTIAL MECH. SQFC
building does not conically have a Inward,that it is my responsibility to notify the acupanl
ofrhe mquircn+enmwhich run he mel pri�rmissuance ofaCeniticum nf(kcupuney. J�J'��'� /I� {`I
Owner or amhmi'd ager Hao TO'fA ISSUEU RY: I/ U(� '
OFFICE
• • t
I ins F
APPROVED •
Gm WITH THE CITY Di
M lA p(�ORDANCE
o AND ORDINANCE..
.. NO CODES 3s9
o Ci11P�n u
9s - -- �2 as g
n �� p
vo
@9�- SIGNED_t=_--
This set of pians a^ sp. •-ati•.ns l"U' 1W wig
F be kept on the )o:, zs a' '.;n.as �nG r, is m
�41
DISX 34'
a lawful to make any e
on same mfhuu� W _: n ce m,ssien it r <Y
g f. ,po :no. x1
the building Dep°. /}1Q✓C
The stamping c. 'hs p ❑ nJ -peci:,oa i, rc
ytK SHALL NOT be he d i !r r n of t ea �M 10k
vppfoval of the v.Jz,;cn
i€4 ani C:;': 0 d.rar..,•nr S;afa T/ eos eD a a 51;FL u242496L lift 34
•' W��+ "- �) ` 149 ,$
p,n W
bni&hw.e.
Q�
-�����L r
Phan gip 0 9 1998
d�UU.INSPECTION DEP yP t NrC'v t
g <,TY OF CUPERT'No
3