S 1539 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO
BUD in NG-BL1!CI'RIGkI, IP' 'T"Q 1539
BUILDING DIVISION APPLICATION/PERNIJT PLUM MECHANICAL MECHANICAL
BUILDING PROJECT'IDEN'TIF'ICATION
BUILDING ADDRESS: //�� ,�1� SANITARY NO. APPLICATION SUITMII'InI.DA FE
1 It 5 lWe X C cL-a,n l6lot oL Lv -1, //10 &4 9S"ol -
OWNER'S NAME. PIIUNI:': CONI'RACIOR'S NAME: LIC NO:
JWA/ Mthly+ e/0.0 'L S2 0 g$ iI1zA1*nD m HZO//!( `e W76J/o wC CONIR<R.x
't C111'1'CCGENGINEIR: LIC NO: ADDRESS'_ ❑
Po,.L2SV ✓/l /del
CONI'ACI': PHONE: BUILDING PERMIT INF-
0
liell'i m4v/lf 110
i � Oo ❑ Consalmnl Fees Paid by Applicant(Initial) 61.1 G cr PWMB MECH
L� ❑
LICENSED CON
ensedRACTORS dericicLnR ICON QTY ELECTRIC PERMIT FEk>
1 hereby afrmh that 1 am licensed ander provtaol„of Chapter v fao,hhmena;ng 1013 UIiSCRIPTION
QWUIi I'n 1111 colla nal affs Hushharos mt7r:rl4lons Codc,und mY li:.:nscs RESIDFNTIAI
Izl O !( PINNII'I'ISSUANCE
H O 570 ❑SFDWI. ❑KITCIil'N H:P[PI.
U non Its Lic.N APPLIANCES-REST[)[iNTIAI. ❑ADDITION ❑PLUMHING RI PII'13
F Z W Uu,O Cartoon, /21a./111jj X
tnQa ❑MULTI-UNIT ❑STRUCTURAL
ARCIII f13Cl'S UECLARA'I'ION
[ �uti
TA z I aodemmnd lay plans shall M local as public counall PANELS MODIFICATION
OZN,> UP 1021X1 AMPS El INTERIOR C1 CHIMNEY REPAIR
W Licensed lk^fcssional 201.100IAMPS 1PROVF.MENT 0SWIMMIN'G Incr
OWNER BUILDER DECLARATION OVER U)00 AMPS ATH REMODELIKEPA1R ❑DEMOLITION
C C Q I hereby affirm that I am Oscar,,Ga
m the Contractor'sm
Livxe Law for the
X 6 U hallowing cram.[Section 7031.5.Bu,i.e,s and Profession,Cade:Any cityor county SIGNS ELECTRICAL HER
W 3 0.F~ whim eq.lrc,o p,atit Ib m....... alter.3mnrove,deoli
msh,or met'a^y xmmmre
OQ p-on , I. h II p11' n ,I hpv to IIsignedLt't Hent SPECIAL CIRCUITIMISC.
COGS (hath Imutant, Ill,P rift C t T,I1 Law Chapter 9 COMMERCIAL
nlaG0 (crhn u^v a,wth Sul 7(XXhl fl) sin 3 flu B . T dl Cdc)nr 1'I:yHP M LTLR OR I'OIIs INS'I'.
a a e G Thal he Is exempt Therefrom and the basis For,he alleged exemption.Any violation of ❑NEW BIDGIA)DI'1'[ON ❑DEMOI.I'IION
X-H Section NU IS by any applicant for a pemno
hit subjects the applicant a civil Penalty of POWER DEVICES El TENANT ❑FOOD SERVICE
a",more than Gvc handled dollars(E5,XB. IMPROVEMENT
f20 DLar owner of the pmpcny,ormYcln,lnymswithx'agm a,Theirvdc compcnsadnn, SWIMMINGPOOLEL.
p. will du the wak.sandayswcture is not imendcdoroReredlimale(See W.RuGness [I OTHER
W m and IPndeaions Code:no Contmcmh License Law dins not apply to an owner of (OUTLETS-SW ITCHES-FIK S
property who build,or imptnves Thereon,and who dues .all work home,11 orthmugM1
his own ando,ces,provided led such improvements are no,hounded ur offvad bur NIT RI:SIDENTIAL I'hEC!R FT
,are 11,lamevcr,the buildln,or improvu.rent is sold within one year or completion,the SQIrI'.Id,0UR AREA 5/SQ.1'I'.
.
h Orb^ildcr will have the harden of proving that he did not hold TO inpunve for mar-
Ile,IT TOTAL: • A I D
Fj I,as axmer of the popery,am exclusively contracting with licensed contractors m
conslmctthe i jest(Sec.90,14,Rumina,and Professions Cadc1 no ComrunoLs L1-
cceseLowdcesnot apply in an owner ofpropertywho for orimprovcothereon.and QTY. PLUMBING PERMIT FEE APR 21 gNgr®
who contracts for wch pjccu w ill a amct
tmor(,)licensed Puneam m the Commctars
Liccess Lw. I'13RMIl'ISSUANCE:
C)I am eland under Sec. ,IT&P C ba,hi,reason Cl
f
ACT ER-DRAIN&VENT-WAfITS(FIQ C TION
Owner Du¢
WORKERS COMPENSA'I'ION IIECLNIA'1JON BACK FLOW VH(MECI'.DEVICE
lr,cry nfBrm coder pandly al pi ricry n^c of rhe tolluwing dedarnio^s: �-
Ibaveandwiilmardan a Cetlif,dral Co n,cam,olf-inns tar Worked,Camper- DRAINS-FLOOR,R(IOI.A REA.COND. S'I OR
117 'IY PI?CONS if[1(,1'!ON
inion,a,mottled for by Section 79,x1 of the LaborCodefor the pcdammncc of'he
work for which his permit is i...of FIX'I'URI S-PER TRAP
[;l1fhav,and will maintain Worlds Compensation Imamove.as required by Section
771X1 of The Lahnr Code,lot he Performance of the work for which phis permit is issued. GAS-EA.SYSTEM-I I NC.4(U`FI.EI'S (ICC.GROUP APN
My1:11" f'n Co n hili�l unnce nnic{'ol No.� f ��6V�'�� GAS-EA.SYS'BM-OVFR J THAT Carrier:
CERTIFIC OMI-17 SAI ION
W(IRKIiRS' GREASHIINDUSTRI.WASTE:IN'I ERCEPTOR
CIIMI'13NSA1'ION INSURANCii BUILDING DIVISION FEES
(I'hi-tak..cedn Ibe.nmplumdode perm:,i,latvnw hundreddollars($In)) GREASE IRAP
nr Ics,J I'LANCHECK IT31i
minty To.,in cul ol'The work for which Itis lerind iv i,acd,I shall SEWER-SANITARY-S9Y)RM EA.20()Ff.
as employ any isa,m i^mhy on.mcr en as to becomu,tAtcel m the Wormrx'Conation- ENERGY FEE
Z O cerin LIO ,of California.Ulm AIN]ER HEATER WN 1,11'12LECI'R
GRADING ItiE
NOIICE TO APPLICANT:I.after bunking his Certificate 411 Exemption,Yon should WATER SYSTENUIREATING fA[D
E
become<object to,he Wmkers Compensation provisions of he Labor Code.you most
B7 fnnhwal,comply wi,hsuch provision,,This pc.it hall be d«med mvakcd. WAFER SERVICE
CONS'I'NUC9'ION LENDING AGENCY NEW RESIDENTIAL PLNIH. SQ.FT. a. HccuipT p
I hcrehy air...r hal da,m is a vunstoaion lead,.,agency lin he mi-forater nl
J 0 the work for which lhR,ndnil is is,a,I Not.7197,Civ.C.) TOTAL
0 V lander',N....c
Ianded,A6,m, 'H)TAI
r S 1 ceblfy,led 1 have cedi This uii,imation and onto Ibat The aMrve information is tcome,.l agree m comply with all city and county Ordin:mms and state laws coming In QPY. MECHANICAL PERMIT PEE EUZ building crreruaion.and hereby aohhon,mrepresentatives of This city to enter upon the
^Mme-mentioned poporry for inspection popmes. I'F.RMIT ISSUANCE FEai(W'e)agree m smc.indenmify and kcc,henbless he City of Cartoon againstIiabilai,judgmems.costsandclKnses which may in any xmy acme against said City ALTER OR ADD TO MECH. GIT i' nsequence of the Fmmmg of this permit.
APPLICAN"1'UNDERS'IANIIS AND WILL COMPLY W'I'I'1I AL1,NON-POINT AIR HANDLING UNIT(TO I0.SXI CFN) IC .1'1:13SOUR R/EGULAT'IONS/J�A�� c is 4��s� //�/-/J rJ AIR I IANULING UNIT IOVHR RI,000 CPM) C' ION'I'AXSiF^aturc ApplmlmdG�ivh�ra�mnr W `'' 7Date [iXiIAUST HOOD(W/DUCq ITIGA'I'IONIZP-
HA].ARDOUS MATERIALS DISCLOSURE
Will he applicant mature holding recupam store orhandlehaanduis material HEn'1'ING UNIT(TO 100.00)ITT U)
a,defined by he Cupen3no Municipal CWc,Chapter 9.12,and he Health and Safcy
Csee HEATING UNIT(OVER I(X).(XM)H'rU)
u .Semon 25532(a)^
E]Yo, IWno VENTILATION FANS INGLE REST Of PAID
rt 'i,
Will the a,plicate or once hal lBln,rncupum use cquipincm or Aeviecs which BOILER-COMP011PON SO'coIH'1'U) , e
ft hil harridan.,air until m
ina.Fs uv defined by the tiny Arca Air Quality Management TOTAL
enn"l BOUA!R-COMP(OV I?R 100901 To IfrU)
II` ❑Ycs 21<11
I have read he hvaNaus detectors requirement,under Chapter 6.95 of the Cah- AIRCONDILONER ISSUANCE DATE
formal Health&Safc,y Cade,Sections 25505.3533 and 25534.1laden^d,ha if the NEW RESIDENT[Al.MECIL SQ.F1'm
bu'Idin doesn't cutrentyfame a tenant.that it is myrmpu^sibiiiym notify the accupant
orlth � mimnls hich n�Ic mc,pnuc to issuance of a c�iBc:rtOceanancy.
Owner ar nu ooh and agent ",O IJatc TOTAV ISSU[D HY:
OFFICE
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