S 2662 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING..E.LE.C'I RICA], PHRMII NO,
IIUIhDINc DIVISION APPLICA'T'ION/IaERMIT PLUM BIN'G.-MECIANICA1, S 2662
BUILDING PRO RCT IDE.N'IIFICA'TION
i
BUILDING ADDRESS: SANIfAItY NO. API'LICA'I'IUN SUIIMI'I'I'AI,UAI'13
C l �Ah Rd eJ'rfiho 0,1+ q5-0/ 3 ��� g
O ' CR:S NAM[ I'l1UN�o. CO TRACT kM1 NAMIi: LIC NO:
ryL C y NIC CON'I'Roil X
ANC II'CCT/PN JNISISR: VG hIC NIJ): J O )URLS'. N/ ,,..NN.. / ❑
70" o�� l
CONTACT: PROM;; BUILDWG FINER)
❑ Consultant Fees Paid by Applicant(Initial) Bux7ISLECI Pl.lJhnt MIiCU
1 3 nz D I a ❑ ❑ J1 ❑
LICENSED CON'IFACTOR:S DhCLARA'I[ON QTY ELECTRIC PERMIT FCF-
1 hereby anion mal Iain licensed under pmvhbm of chapter 9 ummmmdag JOB DESCRIPTION
O8Z ,,in Sell 070f3)of Did:inn 3,,Ilhe Business and Profession,C+de.and my licenm is RESIDENTIAL:
WOO PERMIT ISSUANCE
F full force.wade �� Q/3.-,,-2 ❑SFDWL ❑KI'I CHRIS RHMODIA,
%U, In
QUU Lmcn,e .lee Lim. APPLIANCI3-RFSIUENTIAL ❑ADDITION ❑PI.Dh1BING RP-PIPE
F-ZW Da¢ C,nlr.On
m6a ❑h1U1,T1-UNIT ❑STRUCTURAL
ANCI{ITTiCTS DI'CLARATION
I ;?; I understand my plans shall he mad as public mcom% I'ANEIS MODII'ICATION
ZO Z-^ UP TO 20)AMPS
❑INTERIOR OGHIhIN1iY RISI'AIR
Litcmend Pmfcssinnal 201-IkM)AMPS IMPROVEMl:NT 0SWL\Ih11NGP00IS
DECLARA
S
OWNER"BUILDIR HIN
OVER land AMPS ❑BATH REh10DEl/REPAIR ❑DEbl01.1'I'ION
x Y Q 1 hereby afit.that lam exempt form the Connor, s Liceave Law for the
XOIL Cash:following ral oo.(Section 7031.5,Business and Professions CrKind u :Any City or count)' SIGNS ELECTRICAL
which
.1/
Y:3 LL y which requires a d ,construct,alter.improve,demolish.or repair any swnurc �,a�� � � tTIV 1 A50E'4'OQ prior m its issuance.also requires the applicant liar such pemlit u+file a signed statement SPECIAL CIRCU IT7M ISC. �/�j
that he is licensed pursuant o the provisions of the Connacmrs License Law(Chapter 9
4:ZO17 O (commencing with Section 71000 of Division 3Of the Business and 11..e.lmets Cadel or FRmp.MIffEROR I'OLEINST. COMMERCIAL,
a d C mat he is exempt therefrom and the basis file the alleged exemption.Any violation of ❑NI7W BLDG/ADDITION ❑Of;MO1.ITION
W M y Section 7031.5 M1 permit su6'ec¢the a pi"oat to a civil penalty f POWER DEVICES
y handldicarn,($ ) P Ys+ ❑TENANT' ❑FOOD SlikVICE
=0 +t masewnn lifthundreddolours(SSW0. OIHFR IiMENT
❑ Lo the work.the,ropeactum mY emnterab,wim„vges rsale uelc compemation, SWIMMING POOL ELECTRIC
g•
will do the A 0th t t n n JJ u'redl I ISc71HJIT . ❑Ol'HI:R
00,
aim aadP t Cd ThC t t I e. I J t ppIY1 cul OUTLCIS-IS -FIXTUkF.S
,mp ny h hila. p :th I 1 1 : ch k l If th ,h NEW RESIDENTIAL.ELECTR SV Ir.
I+LIHIk ARIIA
SV.I'1
his employee,,pia v ded that such I+p a nx an no,it need or effard for
,air fl.however.the M1uildin6 nr inlprnvenlenti„+IA uof'ilM1in otic YcarconlPktioq the '.
0
er-budder will have the burden of hissing mm he did not mold or imprnvc lit pur-
pleal.artsre
f th
I,a oe peoples,v xcln,ivdy c educating with licu,wd nmtrucmrs 1, TO'IA L:
w
amatM1epr Jccr(Sec.71H4,oniallxand1'r,ruI haid,(ica'rocCunlruhrrxI.i-
,clawd,cxact,plym,n ow 1a (sam,eny who haild,or inlpnrvexthercrn,nml QTV. PLUMBING PERMIT PEE
who amtmax lot umh Pr+,ice,wllh a tonwcmrh)Ilccnscal pursumn In nm Gmtmcuv'x .
Lireme Law. Pl,RMI'IISSUANCII,
It I<,mupI dtt Su. .It AC P C lin Thi,reason
AMFR-DRAIN.&VEIN WATER(ISA) VALl1Al'If1N
Owner ITno
WORKERS COMPFNSA'I'ION DECLARATION BACK FLOW PRO I'EC T.DISV ICE
hcrcby altinn undernulty oI Per,jury one al me follnwmg JmIllutuan,. X
Ihuvc,nd will nwtnmin uCcnitic:ec,I'Con,cnuoxalbinxurc our Worker:,Con+,un- DRAINS-PI OUR,ROOF.ARU.COND' S'IORIFS 'I'YPIi CONSI'k11Cfl(IN
nation,as provided tin by Section 171X1 at the Larsa Code,for the Imrfuneance of the
work for which his ,,,III in La,old. FIST BOORS-PER TRAP
❑ I hav,and will recann Wnd.cr,Cn a,en,minn In,uru¢c,an.mcnimd by Sccti,n
3700 ofthcLabor Cn 10.too'he wdor,,rmO,lthc wild role which loin p+,I1111 ix is„wl, GAS-LA.SYS"ICM-I INC40UTL11TS (ICC.GROUT' I'N
My Wnrkcr'yyt(�ypyµy lR RyfyWc�atricr and l'oliry +I GAS-ISA SYSTChbOVERJILA)
Curries_(' fA t lA l—fl//II��YI I'ollty Na,
CIiRTIPIC o Milli CXISMP I N FRANCA ISkS' GREASUINDDSIRL WASTE INTERCEPTOR
COMI'ISNSKDON INSl11tANC11 RUILUING UIVISIl1N Id!ES
ITto-ecnionmadnot beann,leied i l the planar i,liar one hundred dollars IS l top OREASL TRAP
PLANCIIISCK Plili
orI .)
Ioyaythmor many once to perthe W rloas'cJ.lshoot SIN'ISR-SANTfANY-SIDkM F,A.'_IX)1'1'.
not employ any,conn many manner so as m hcunne,ubjtt't In the Wnrken'Campcm ENERGY Plili
Z ,union huwx of California.Doc WATHR HEATER W/VENT1ELIiC1 R
z� Applicant CRAVINGIEIi
NOTICL TO APPLICANT:IL after making this Ccnifctil-of ISxeniptinn,you should WATRR SYSTEM7TRIIATING
becomesubject no the Walker'x Compencnio n pro , bn
f the IaCode.You most SOILS Plili
f,tihwilh comply with such provisions Or this enol shall M1e dcancd revoked. W'A'TER SERVICE,
U O CONSTRUCIIUN LENDING AGENCY NEW RPSIDF:NTIAL PLMH. SQ. PAID
FT' Dam Recci,n B
1 hereby affirm thatthem is a Coasuumdi
lan lending agency for the performance,of
lac work for whichad%pramit i,issued(Sac.3197.Civ.C.)
Lerdor,Namc IOTA 1.:
TOTAL:
U Lenders Address
} y I cenify that I have read this application and sane that the chasc inf,aruninn i, BUILDING hili
EN correct.l agree to comply wim all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE SEISMIC FIT.
UZ building construction,and hereby millrim reprexntalives of this city reenter open the
above-memioned propcny for impaction purpne,. PERMH'ISSUANCE Ii1.ISLTRIC Ili
(We)agreem ave.indemni fy and lace,nannies,me City of Cupenim,against
lIahIIita .judged expenses to h tray in any way action against said City ALTERORADDTONI PLUMBING ITE
'W-, - h.ca an6 finis peA .S I'A ')S A. nIl'hY N'ITII ALL NO -I'OIN'1' AIR HANDLING UNIT IT O IQp10 CPM) MF.CHANICAh I'L'SIONS
d AIR HANDLING UNIT(OVER Ill."CFM) CONS'TRUCHON'IT'
Igmwre of Applmm VU umrz D Data EXHAUST HOOO(W/DUCq lIOUSING MI'fIOA'I'ION II?IE
HAZARDOUS MAA PEI S DISCLOSIIRB
Will the applicant o,lmum building Occupant anmorhandlc hamrdous material HEATING UNIT('1'0100.0s)BTU)
ux defined by he Capetian,Municipal Call.Chapter 9.12,and the[Icahn line Safay
Cade,Section 25532ta)'l HEATING UNIT(GVHR 113,000 BTU)
p ye, ♦ VENI'ILAI'[ON FAN IS]NGLE RES it)) PAID Dam kccciprp
Will the applicant lir future building Occupant use tquiptnenl or,levices which 03
MOILER-COMP(3HP OR 100. 0 BTU)
emit felonious air csmtaainatns m,defined by the Bay Are,Air Qualhy Mamtgemem 'r( IAL:
District? Va ,',/ BUILIRM (O
I -COPVER 100.00 BTU)s lynn a Q
I have m+dme It en,mmrri:d,esoloelnente noodle Cha,lm M1Y5,I Ibc Cali. AIR CONDITIONER ISSUANC17 URI'E
taenia IL:dm Ne.Sale,Cn ta,S"non,255115,25513 and 2551J.1 mater,lvm Ilial it the s RESTOF HAL MECI. SQ.IT.
M1ulldng J+m,n to ally bavuut ill,Wer It i,lay rexptnrihillly tum il'y II +v tot
orthc raluim ams hicM1 P an to iawance tit,Ccnitt d ,
Owner or tmlhnriacJ agent
ate TOTAL: ISSUED IIY.
OFFICE