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S 2612 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMrr no. BUILDING DIVISION APPLICATIONAPERMIT I'hI1n11tING-MI?CDANICAI. S 2 612 BUILDING PROJ E<,1'IDEN'1'IFIGA'NON IfI111,DING AUDHESSo SAN["EARY NO, APPLICATION SUBMITTAL PAT 1: O ��I 60 I ��E _Z S'= 4 9 OWVEI'SN ME PHONE C N RACfOR'S NA E; NO: V N/C CONTRUL- K U ENGINEER: &a. NOM A� ❑ C -1(4192:l 33OF ?Lg CONTACT: PHONI?: BUILDING PFRMrr INFO -110 ❑ Consultant Fees Paid by Applicant(Initial) BI DG ELECTPLUMB ME❑CH PW PWW6 q4 LICENSED CONTRACTOR'S DECLARATION QTY. ELL'CTRIC PERMI"1' FEE LHJf I nerchy anrun that Ian,lam aed under m'I'viaio.l.nr chalmcr v Bmn perming JOB DESCRIPTION u100,CZ with Section 9000)uf Division Joflhc Hu,incsx vnJ Pmfcs,ker,Calc.andmPERMIT ISSUANCE ylicube,, RESIDENTIAL: in full force and cRen. CSFDWh [I KITCHEN RHAfOUIiI. =VV Use—Class Lis.# APPLIANCES-BESIDES I IAL ❑ADD)T]ON El PLUMBING RE-PIPE F i'W Dae In Common 6 CMUCI'I-UNIT CS'1'RUCI'URAL ARCHITECTS DECLARATION Z O y Z 1 understand my plans shall he used as public record. 1'ANEI ti MODIPICAI'ION CZ-0 UPT021X)AMPS ❑INTI?RIOk CQIIIMNf?Y RI?PAIR [=Q!QF-'m Limned l'mfcssiourl 2111-1000AMPS IMPROVEMENTCSWIMMINGPOOLS X O a U fidlowing feat nn.Seci10WNERSBUu,in OWNER-BUILDER unJ Profession,ARA'1' r I,cause Low for the OVER IIXp AMPS C BATH REMODIiIJItEPAIR ❑DEMOLITION Y� ]ON a y a an inn,I nm clnl„rrm.1 n1e annnemt,1. a rex COTHIik 3 repaAnyir an oranmY SIGNS ELECTRICAL W Cl y which requires a permit re ui Ins t eL al¢[impnne,h vorni,..nr repay any,uvcom XE .� Foes o t "n '1 1 Ins the f ape n ,, -b J.mateml.^t SPECIAL CINCl11T6115C. >� man 1 1P IIB P- lT c tat + I L (Gnnprr9 NICCO fmmmeneingwmSecTmm 7(M)af Division l of the Rocar—rd Prf:' m CtlJclnr I EMP.METER(OR POLE INST COMMERCIAL: d Ihut he is eve fro Iherefrnla and the basis for the alleged exemption.Any violation or ❑NEN'BLDG/ADDITION L1 [T DEMOL [ON X e C X"N .Section 7031.5 by any opplionn ran.pcnnil xubjcct,the uprlkannoa civil Pcwlty of POWER DEVICES 4?fENA N'I' ❑FOODSERVICE r mom than live hundred dollars(8510) IMPROVEMENT FZQ I]1.vxowncrnf the prory:ny.or myclnployms with wages as their alecon,swation. SWIMMING POOL.ELECT RIC $y�FxsO velldolhewnrk I meanmauc knntlmendnloridficed fro-ale lSm.Jni4,Busine,x CGTHER ly m andm PfessiGale nt ots The Coracndw s Liccnlaw deep not apply m an owner of OUTLETS' SWITCHES-PIXTIIltliS ell d'3- ,rapid,who build,o mpnrvee thereon,and who does such ctrl,hur elf or Through his w employees,provided that such imprnvemenas aro not intended ar offered far NEW RE AI.ELECTR SQ E.. sale lLIb ,alts,huildillgorair enllsnnld volabout,cn co.......t nm SQ.F,FLOOR AREA 5/SQ.FP. overnebuilder will have the MnJcn of proving that he did not build or improve for pur- rys e nr du.). 0 I,vs owner of the pmpeny,am exclusively contracting with licensed contractors to TOTAL: answer the po.jem(Sec.90+1.Bieinc„and Profession,Coda The Cnbarriers LA. roeLaw does mol apply loan owner ofpmpcny weobuilds or improves thereon.and QTY PLUMBIN MIT FEE wfio n.nwca far vnch pr.jecw with a emaocmr(s)Beene d pursuant m the Conwemrs License law. I'IiRMIT IS 'li I] I am exempt under Sec. .Hk PCfmlhismawn ALTER-D &VENT-WATER(PAT VALUA'T'ION Owner Dom 2© !^ WORKER'S COMPENSATION DECLARATION HACK FLOW PROF 1' )I! ICI? O V I hereby a1Bmn under penalty of Perjury one of the fallowing deelaraime: if l havemal will maintain n Ccniticnm of Ca.uenuo,clf-inter,tut Workch Compen- DRAIN. Q/.ROOT. ?A. NO. STORIES TYPE CONS UCIION "tion,as provided for by Section 3]1X1 of the Labor Gale,for me Izdim....... of the jam" ark Evw'hiehmi,permir isi...ed. FIXTURES li UC 1 Lus'c and will maintain Worker's Compensation Insurance,as require)by Senior 3TB11el the LabourCode,III,the ribunarle or rhe wank l int whirl,This permit.,isasrd. CAS-EA.SYSTP.M-11 -.4 JI' TS OCC OUP APN My Wodars Compensation ltsura.in cirricrand Pnlicynumh,mc: / 3Z Carrier: Policy Na: GAS-EA.SY _ /s CI!Rfll%CAI'F OF EXEMPTION FROM WORKERS (IREASEYIND 1"I LW'AS' i4N'1' CETTO e' COMPENSAI]ON INSURANCE BUILDING DIVISION IVIS (Thei,muonaeelmntlecumpkleJ ifthe pemnir isfonme M1undred dollars(Slap GREASETIGI �' or teat,) JJ I'LANCIIIiCK PEI. D [cenil,foommeperfnrmmmc of the work for which This permit i„esucd.l shall Si" FR-SA 9ARY WD 1 �)I y, a..enployamy pouch m any manner,,as mueLame,anjeetmone andel:Cmnrcn. •4 '� O ENERGYFEE l9 G count Law,nl Caliminia.Date WATER WNENYELECTR Z O Applicuet - GRADING FEE h NOT ICiTO APPLICAN'1:If,mem making This Cmifea a of Exemption.Yau should W'ATI7R SYS T REA'1'ING f••' become abject To rhe Works,(,Compmelmian provisions of the Labor Code,you must SUITS R]i fI u I'nnnwith comply with such provisions or this permit shall he domain revoked. WAFER SERVV1."�'^'•�•- 1 PAID CONSTRUCT is ION LENDINGAGGNCY NEW kLS[UIiN'f1AL PI!.11f. SQ.FT. Receipt, T ne<eny upon m...nlcm i,a ennxtmmion mooing agenar rid he perrormamo ar U0 , work hlrwbmin Tnia pem,il i,.sated(see.]009,eIX.ca 'Hn'nv UUnder',Name Leader's Address I(YfAI.. yIwnlly t hat l have read aprlicationand state that theulnove int'ermwion lx BUILDING F.E F tR1 mrea.I agmc to comply withal)city and county ordinances.,,it stne IawxreWnng to Q'I'Y. MECI IANICAL PHRM I'I' FEE U building construction,and hereby anthems,representatives of this city in enter upon the If 1.M '.E above.mcidonal property lin lestel an purpTlscs- PER M I ISSUANCE ELEC 'PEE (We)agree to save.indemnity and keep harmless The City of Curani,m against hahilirics,jol,nob s.cnasand ev,cam,whiohlnar many wayaccmeagamuctid City ALTBR OR ADD TO MECH. PLUM NG IZE t¢yuemcaefthcpemnit. AAZA, DWl1.l.COMPLY WI1li ALL NON-POINP ADZIIANDI.INCUNII(IOI(),INX)CPM)AIR HANDLING UNIT(OVER InUMC1:Ap CONSTRUC ION'DIX gnaTurloppactor Date EXHAUST' IOOD(W/DUCT) HOUSING MI'I'IGAI'ION FI7II HAZARDOUS MATERIALS DISCLOSURE? Will The nppli.ru or fdan,haddinglccupamsmrc nr handle hamrdou,material HEATING UND'(TO 100.00r)BITE) as del Ned by The Captain,,Maliaip; CnJu.ChnPtcr 9,12,.uul the Hu11Th and SActy Code.Section 2.55321u)2 HHA'f[NO UNIT(OVER 1 W)X0111 Of C Yes aVENTILATION I-AN(SINGLE RESID) TWD Date Reempoa Will the artificial ar future build ng occupvnl use eyuipnnnt ar devices which BOILER-COMP(3HPOR I W.aO ETU] mit narardous air contaminants as defined by the Buy Area Air Quality ManageTwm AL( Disui,C 1J HOILER-COMP(OVER 1W.0003TU) ❑Yes y'f No I have read melto Mo.'beacons remdrennint,trader Chirpier 6.95 fthe Cali AIR CONDITIONER ISSUANCE DATE fa '' 11 TTI RS I'nyC S 2551)5 25533' 12551) 1 J '.n dthalilthe NI!W IZI!SIDI;NI'IAI.MI!CH. SQ.III i-1 '7 - be. I' gdw t���ttRlG I k r.m1l - Y ,PI -bot/t IlY the reacupant (/� L- 1't cream, L apo T xeciam of a Cen7�cllc aft ��/�• 0 Ian- Date 'TOTAL: ISSUED DY: ]� ge OFFICE 0) 0) 0) Cl) Cl) -0 N N N N N m O) W O O 0) N N N N N 3 N N N N N y O O O O O A A A A A 1 O O O O O C 0 0 0 0 o y CA IfDa�1 ;0 �] Z7 CD D DDzzzzrA- �m m 0 c> 3mc :50 ' m m mz mm co 0 co ZX -I 'n ;1y --iz O w o m g C1 y O Z M m X C 1 0 -1 p c m m � o m / D y a m0 v C A A A A A m n N w y C (D A A W W CD <D (D (o (D (D m 3 (D (D (D (o (D - d A A A P A S N � � D A A W W O (O (D (D (D (D 7 (D (O (O CO (D C W L n L CO Co Co n Co y 4 W: a 0 O C W W N N N N 'U -o T - y T d z n 0' a CD