S 2242eor CANITTO cH I IN IMF0QI IATlnd1 WITUIN Rim I INFR - [TIRE HALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - RLEC'I'RICA L
BUILDING DIVISION APPLICA'ITONIPERMIT PLUnHRNC. MECHANICAL2242
BUILDING IBOjECI'U1FNI"IFICAI'ION'
I'HIgi I NO.
k`i
BUILDING ADDRESS.
xrX—k01--
SANITARY NO.PPLICAI
I(y SUIth111'1'Ayy DATE
3o/1
cl%log
OWNER'SNA li: PHONE:
COM"RACTOR:SNAME; LIC NO.
NIC
CONI R(lha
ARCHETCI ENGINEER: LIC
❑
��0�
ADDRESS
E
C(lN'1'ACI': PHONE:
BUILDING PGRMI'I INTO
BIJIG _ ELECT PLUMB MEH
Q-/
"' r�❑
COnSuI[9Rt Feel Paid by Applicant (Initial)
LICENSED CON'TRACTOR'S DECLARATION
1 hereby affirm that lain honor) under provisions of Chapter 9 (commencing
with Section 7U(X17 of Division 3 of the Rosiness and Prnfccsionc Cede. and my license is
in fail armnnd effort.
Q'IY ELECTRIC PFRYIIT FEE
JOB DESCRIPTION
RESIDENTIAL:
[IKITCIH;N REMODEL
I'ERMif ISSUANCE
'
APPLIANCES -RESIDENTIAL
Liccnsc Class Lich
k❑�SP�)WI.
DITION [_1PLUMBING RE - PIPE
Darr Conwcmr
[MULThUNI"I' ❑ MO GIFI NTIO
CHININ Y BION
❑IN'1'IiRIOR ❑CHIMNEY RIO'AIR
IMPROVEMEW] E]SWIMMING POOI.S
El RATA RpMODbIARGI•AIR ❑UIiM01,1'FIGS
❑ 0'1111312
ARCIII'I'1,C]'S DECLARATION
I I lo,rsend vty plans,lell he used as public records
PANELS
❑I"1O 20X1AMI'S
Liccnsc) Profmslon:J
OWNER.BUILDIIR URCLARNI ION
I lureny ut'Onn thin 1 n l] exempt troll] one Conotacmd License Law fur tl,c
s.r" I I l'mf...lines Cloth: Any city nrrund,
Itdlowing rea on. Net 17031.5, Bu..
willen requires a Pamir In tnnstn ll, after, improve, Jrmulish, a nopait any nmaurc
prior to it%els " (he applicantf 1 Nermato life a signed stateracal
bar Too JI.... ' In ole i (tire C tut Lisert L (Chapter 9
ten, b 11 Section Told fDivisioni Ill tile 11 _' ca 11 (:. sCode)or
,hut fie a exempt theretrnm and the basis Lor the alleged r.raidnn. An, viclntiorl of
Section 70315 byonyapplicaafr a{eamil,objecs thcupplicam,, acivil pcnuhy of
201-10WAMFS
OVER 1000AMPS
I,e
SIGNS ELECT RICA
M'LCI AL Cl RGI) IPI IM INC
TEMP. MI:'I'ER On PULE INSf.
COMMERCIAL'
NEW HI.DGIAUDITION ❑ DI-MOhI'UON
TIiNANT ❑FOODSERVICE
POWER DEVICES
tow marc Than live hundred Jdlms ($5(X11.1
❑ Laow'net of the pmpen% or my employwa will, wages as their sole compensation,
will do the aids and the structure is not intended or offered for sale (Sec. 704,1, Business
and Prnbes,ines GNe: The Contractive, Liccnsc Law dues net apply to m owner of
PROVE
THER
SWINT M INC, POOL ELECT R IC
OUTI.ITS - SWI TCIHLS- FIXTURES
pmpeny who M1uilJs or improves rheran, and who drcs such work himself or Through
his town employees, provided that such impmvemmnts arc not intended or offered file
sole. If, however. the building at improvement is sold within one year ofcompleticn,the
cr-budder will have the burden of proving that he did not build or improve for Par-
NEW RESIDENTIAL. ELECTR SQ ET.
SQ, 1-7. 11 -COR AREA
ESQ. FI'.
TOTAL:
1 36- O
,,, at wilco
f1. its owner of the properly. a t eveluaively cornracting with licensed conterems m
mums the Palliser (Sac. 7(W1. Business and Profcaiure Code:) The Criminal Li-
cemo, Lowdte% not apply to an owner of properly who builds or improve%thereon, and
P/
QTY PLUNKING PERS1I1 FEE
who contracts for such projects with it contractual,) licensed punuantto the Conroaers
License law.
PERMIT ISSUANCE
0l umevent" rSec, , B A, PC bonnie reason
ALTER - DRAIN k VI3N1'- WATER IIiAI
VALl1Ai'[ON
s�—
�K® j
Ow Date
RACK FLOW IR(YTI!CI'. DEVICE
W tt ° 'S C(1M 'ION DECIARATION
evang
Iharch nontracnuhyofperjury not I"'hefnsue for dedWarom,inn
Ihuve"I will main by llf.'orlI 37(mof Conxnno,aI... the Wudtta Compcn-
,ai p 1 11' by S ,' 171X1 1 rh [.all... Cal l the R f f the
,,,,k To hill, The, losI is
DRAWN - IlUOR, ROf 1P.ARIiA. CCNU,
S'I'UklliS
'f Yl'1!CONSIRUc'IION
r
FIX 1'lll(LS PER IRAI' I
i] 1 1 lk a W 'k ': Clan'llolonsan boaaaa,, as I i d I, Section
37fW 111 hnaCod it lnfurna l 0l wtak till witch lits perm -,-::ad.
Go hA SYS] IN a( 'hEILS
OCC GRGGP
AI'N
GAS _ li S IM"VE a 113A)
My Worker, C...nlemutian lnw,rmce m,dea u I Policy number are
Carder Policy Nom :
R_
CEIITI71CA'IEGII1X IIMI"1'ION III WORKP,RS'
COMPHNSAI ION INSURANCP
GRt?ARI INDt1S'IRI A.S`IIi IN'I-LNCIII'lY)k
BUILDING DIVISION FEES
CREASE I'RAI'p
i'LANCHT;CK 1I13ii
Ofie,wculainsedn Ibecolaidled it fin,cmat uYoronchundreddollan($100)
,or less.)
I tnnify,not inThe peforniance of rhe work for which thispworit is issued, )shall
not couple, any penal] in any mmmeno as m M1ecorne"hied ors the Worker: Carmen -ENERGY
$IiWI!R-N I'1'ARY-STORM EA. 21N1 EI.
PLT.
W"TERI sATERWAIEN-TIELECfR
GRADING FEE
,niton law, of California. Dae
Applicant
j NoTicE TU APPLICANT: If, alter making this Cenificste of Exemption, you should
' become subject to the Wedcr.Cumprnsatian provision, of the labor Cude, you mast
• forthwith comply am, such prnvisinna or this Namit%hall be deemed revokra.
C(lNN'IDLENDING AGENCY
I hereby affirm that there i, a construction lending agency fer the pnfomance of
the wild for which Ihiv pemlit is issued (See. 3097. Civ. C)
WA'Tli SYS'IEMIT REATING
SOILS VUE
WAIT&SERVICE
PAID e
ILS
N l - Receiptp
49Y
NEW RI!SIDFiNTIALI•hMB. SQ, FT.
TOTAL_
1,wl Name
j Lcndcr'x AJdrtss
I certify that I have read This application and state that the abave nomination I,
7 cnrrca. I agree to comply with all city and county achloocra and sae laws relating to
building canstrantn.and hereby antharim representatives of Nis city to enter apart rhe
TOTAL:
BUILDING PEI!
Ql'Y. MECHANIC
I SMICITH
�Q
aMrvcmrndnned'a"my far Impeeiien PmTa1v1.
(We) agree tu ua e, in le..... fy and keep front... the City of Cupertino oguimt
Ilabilitic%.jWgmmnr,, coxte;unl expcnws whicharay in city way ue'me against said City
PI2HMIT ISSUANCE
iCl'RIC I lilt
ALI13R OR ADD10) MEC1
I IMI{INC PEE
rmdng ob this permit.
S NU; NO WILL COMPLY WI" III ALL NON -POINT
AIR I IANDLINC UNI' I' IT
,talc'
I HANICAI'
ONS
AIR HANDLING UNIT,(())
.Ill.(NIICFM)
CO S'IRIICI'10
X
All
/:on{sour Dmc
AZr DOUS MAi'I!Ri-NI CLUSORT''
wlllihcuppltcana nr fuwrcbuildln"Nia,ant Xwrunr M1undlc hvordnus mutenal
us Alined by ,he Cuinc,dno Municipal Code Chapter 9.12, and the Hmhh anA Sntmy
Code. Section 255)2(m'f
Iia
EXIIAUS'1'll(lOU (Wllll
IIIIA'I'INGUN"1' m.tt "U
(SING MI'flGi llON ll!1?
IIFiAIING UN
OV17R llt 111 OD
VEN'11LAI'ION IeAN Q CLT: RESID)
p Ye, F-1 No,
PAID Due ITT, IT
Will the appllcun or future building occupant me cquipmem w devices which
nage ent
e mil h l t rdous ter cannon...,, m defined by the I{ay Arm Air Quality Management—
BDILI!k-COMP {P OR LIMl ,ga1 BTU)
UI
BOIII3R-Col (OVER 10T.000RTU)
District?
❑Yes Fl No
AIR CONN olNER
I� ISSUANCE DATE
I lave read the lmmNnm imenals requirements under Chapter 695 ofthe Cali-
fnnin Health K Safety Code. Sections 25505, 25533 aM 2553a.I will- ad that if Je
NEW RESTDrffI'[Al. MECIL SQ. p..
M1uilding dies tool curtenrly have a mnan.,hat it is mY rtspnmibility m urniolthe aecupnm
of da requirements which must he met prtor In issuance soft Crnifcate of occupancy.
V
TOTAL:
ISSUED HY:
Owner or authorized agent Ue¢
UI -Flet