S 2542 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL PO IT PEN ONLY
CITY OF CUPERTINO IS,11,111NG-EIXC'I RICAL PHHMI'I NO,
BUILDING DIVISION APPLICXFION/PERNI1T PLUMBING-MBCD,MNHGM. S 2542
BUILDING PRO78CT 1 Dh:N'i'IDICA'RON
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMI I'1'AI.FINE
c ro A pa moo Z--( - W
OWN" SNAME: 1'IIGNP: CON I RACfOR'S NAMH. LINO:
D -�� N/C CON 1Rod.N
il\RCHO'ECTTNGINEER: LIC No: ADDRESS Col.. f�;2rr ❑
S(o
CONIAC'I:
PHONES: V W 1510 G g4L -U BUILDING PERMIT INTO
RS Sm �p,K, 1 qpg 375, 2 ❑ Consultant Fecs Paid by Applicant(Initial) [I ELECT PLUMB NI?Cl/
LICENS12D CONTRACT'OR'S DECLARATION QTY ELI?CTRIC PERMIT FEE IrT�'ES LrTIO Llf
I herehy;Joon that I ale riCCluCd under Provisions ofemincr u(.m....ne JOB DESCRIPTION
DOZ wall Section7000).fnivision3aDb.amanessaad Pode,simsesde.a.dmy licensei. RFSvaul AI'
u1 O O p I'IERMI'I'ISSUANCE
H LLl" in full torte ail c- I.i+ D-� }3�05� ❑$FOWL ❑KI'1'CHIiN REMODEL
QUV T.iccntt Claes Lio-x APPLIANCHS-RF,SIDHNf1At- ❑ADDITION ❑PLI1MHPdG1tli-P1Pp
FZW Date Comnnva
onQ a ARCHITECTS DECLARATION0 SWEETUNIT0 STRUCTURAL
Fpm PANELS MODIFICA11ON
Z O yZ. I mulmunnd my plane shell he ascii us public rccurab
OZ�� UI'T(12(XIAM PS 01NTIiRIQk 0G11141N1SY RIiPAIIt
F4•„Q J,e-ed Professional p 201-HIWAMP IbiPROVHMENT 0SWIMMING POOIS
CN J OWNISR-BU11,DER DHCLARATION OVER IOIxsAMI'g [IN]11 REMOOF[JREPAIR [IDHMOLI'I'ION
��
C C 1 hm by N'lion that I vat exam 1 houndo,the Comraclor's L I.uou Lnw Inr the
i O 131 V - El OTIiIiR
X 6 fallowing massae.(Saline]B3 L5,Business and I4ofcssiom Code:Any coy or county M[iM1'S ELHCfRICAi.
lai- which requires a permit to construct,alter.iinprove,demolish,or repair any stmemrc
F�OQ it ort 1 '1. 1 N ppl tf hpc 'It fl g J.I'Nnu'nt S1'LCIAL CIIiCIJI'1'IMISC.
WY`I
thea,h I' . It, n th p fN Cm t L Tw — pmr9 COMMERCIAL:
Iwm bwibSen s 7000) fD i, 1 ftltl b. JI f..- Code)or T17MP MFI'LR UR POhP.INST.
a a C Thal he ns cxampt Therefrom and the bast.for the ellegW me opt on.Any vmlation of EW'NLUG/ADDITION ❑DEMOLITION
X oat W or
Scutt 7011.5 by any applicant for n Peoutit s.bj,c,,the apNicaot ton civil penally of POWER DHVICHS
m al more Nan live hundred dollars C1500). [MPROO'1'HNANV OFGDD SIiRVICE
.F+=6 Lnsownv+otthc n to m wines nslhcirsolc cuntmnvatiun. SWIMMING 1'001,EXCI'RIC OTHPR IiM1iNT
Q 0 phase y.oniryot ip yens xl b i ODTHIiR
F. will Jo the work.and the structure is not intended or nlTcaeJ for sale(Sec.](Hi.❑usinesz
C�m and Pmfessin to Code:Th.Cmm�lcmrn Gecn.ce law Anes not apply to an owner of
(2,"', OIl'I'LhrS-SW)'I'CHES-PIX'll➢tGs
i3 progeny who builds or improves themon,and who docs such work himself or Ihnmgh
hisawn cmpinyre"innvidcd find each imprnvnocnp arc nal Nladed ur nuirnl fm NHW RISH)HN'I'I Al,IELECI'R SQ FI'.
sale.If.heoxeser.the building or impmvcmctn is said within one year ofcompletion.the SQ.I.1',FLQOR AREA !ESQ,FT.
ca•bailder will have the harden of to ing that he did nm lould or mproc tat'pu-
I:) I.asown)cr of the propen '
y,a xcbuivcly contraeti ng w illi licensed conm:aars to I'AL: Q
instruct the prajccl(SCC.]DU,Bu.siness and Prufessians Com:)The Contracous Li-
cenmLaw duc,no,apply to;in owner or properly who ho nes,or improves thereon.and QTY. PLUMBING,PERMIT FEE
who comrals for.wch pmjecu with a contmcnal licenced pursuanun the GnmmctoHz
Lion Dos. ,B.@ Y C for this reason I PHRMI"T'ISSUANCE ( Q
1 am exempt under Sec. _
AIA ER-DRAIN at VIENT-WAI HR(RA) VALUATION
Ow Dale
Owner
_ WORdf, nDHCLARYrION BACKPROTECT.DEVIC1
I therebyufGm unerpnob,cpeum,ecofthe
�� AO
following Jularnionso V
(]Ilwm and will maimaina Cenilicale of Conn msell"inwre for Workers C'nmpen- DRAINS-FL(R)N.ROOF.AREA.GOND' Sir) ISS TYPE!CiDONSTRIECIIO•Y
anion,as provided for by Section 3700 of Nc LaMn Cade,for the pelf lmmncc of the L o
work fm R
which this permit is l<med, FVCTU LS-E'ER TRAP `—�
I have end will maintain W.kers Compcnswiun Montane,as rcgnircA by Section
3700nf the Lobar Cale,fnme perf.....ecof Ne work farwhi,b.hi, .it is issued. S-HA.SYSTEM-I INC.J DOE TLI?Inti OCC GROUP AP/I YY
My Wur):"Copensanun Irvsurunw mrricr;mA Policy m
3(-G ( Q l
Caaricr.�Fwl N uS< Policy No.:l J 775�Z1 �i�+ -ISA.SY .A7 vg
CERI'FIICA'I'E 01'EXEMPTION FROM WORKHRS ASV WASI'iI 'CERC' U G
CoMPENSAI'ION INSURANCE RUB.DING DIVISI(1N FPBS
(Thinsei, nenl notbeunaplemd i[the puma it is torsme hundred Jollerx(SI10)
En 'sTlb\P PLARC111iCK 1:1217or loss.)
Icunl l y than inibc p,b........,OoDhcwork fon which lhL pul'tnil ielnwcU.l skJl SHWER- A I R -S -A J0
naI employ any pc,.a in any manner m os to leonine abject as the Woden'Cnmpcn- IiNIiRGY FIR
Z s:aion La—of Cannot—Uwe WATER HEATER W/VENT/til-111'
Z Applicant GRADING Ilii
NOHCH TO API•I.ICAN'I':If,after making this Ccnificam of Exemption,you should YSTGM/TRfEATING
h $0145 PIEIi
a ? heCamembjeaas the Woloproviki—solmi, emvlGoml of the IanMr Cub.you muss
�r forthwith unnply with wch prnvisinm or Nis pa:rmil shall M deenaeJ rcvnkeJ. WATER SERVICE?
in PAID
CONSTRUCTION LENDING AGENCY Slow RISIDBNT1AL PLMB. SQ.FI'. .Da Rcacjpt N
U O (hereby affirm full there join conswmiun leading agency for the peHonoance of
Fthe work far which his permit uissueJ(Sec.3097.Ci,C) TUI'AI,:
U [,.dery Name
1.14 1,ndoev Address IIT
I cenify Thal I lcoc toad this application and stale that the obese information is IIU11,1 P E
. L
h coil l agree R.comply with all city and county reprances and state laws relating to QTY. MFCHANICAL PERMIT FEE SF;ISMICI iP O 0
U �. M1nilding ennslmClinn,ones hcrehy:,Itire repmWnuai msnfnde cilym enmrapon the to
abawemamioned pmpeny,for inspeunm purposes. I /''1 PERMIT'ISSUANCE �.J IiLECI' f,PGI: 4../
(We)agree m save,indennify Ted k,,,,In ]us,Tho City of Capcnino again.
1Fabililies.judgmena,cmnm and expenses which may in anyway accrue against aid City ALI'HR OR ADD*10 MHCH. pIx LING ITIiD
APPLiniaLe
c of IIIc grunting ell Illy axil. t
ICA ' aNDF,RSITNDS A WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000 CFM) MIE( IANICAI,ITH
SOURCE IiG 1LA'HON s
AIR HANDLING 11NIT(OVIiR I0.008CFM) CO :I'RUCIIDN TA%
Signal cola pl svn olmemr ale HXHAI1STHOOD(W/DUCT) HOUSING MIIIGA'IlON TU
HAZARDOUS MATERIALS DISCLOSUkH
Will the applicant nr fume builiingaccup:nn star.ar londlc hamnlous material HHATING UNIT(TO 100.00 BTU) Z'V
as defined by the Cupertino Municipal Cade.Chapter 9.12,and the Health and Safely
Cadc,Semon255)2(.)1 / HHAT1 NG UNIT(OVER I B(I,0iBTU)
❑Ycs a 2 VHNTILAI'ION FAN NINGIX BUSED) PAID Det. Be,CiptN
Will the applicant or houm bidding accupum use equipment or devices which BOH-HR-COMB'(HIP OR 100.010 RTU) /�
it haeudons.nr.nntamimmte an defined by Ili.Bary Area Air Qndny Maa,enenl IO 1.: 0Iw
stHcB OUll,liR-cUMP fOViik IIA.IxNI ifT111
(]Ye,
AIR CONDI I IONFR
Ili aITI I N �t `els y ' t 1 6h'FI fJ5 Illi Ca ISSUANCE IJA'fl3
Gam II it,...Safety Sections that 25511 J2551.11 J .t dNm'f Nc NIiW'RIESIDIiNTIAL MIiCH. SQ.PIT Z�/ l ��
wild bd Idyl t IM1 y 1 'I Ilya I'ly th ax'loot 11 C
fN req a. b b thea � nf(k 1 y.
NneToruathori' dace al TA ( ISSOHD fly:
OFFICE \