27535 AYYLIUAN1 1u PILL 1M 11fruT11DAf tuff fOmut acv Lrrfco•xaoc un-r n v—r
BUILDINGCITY OF CUPERTINo PLUMBING-MECIIANICA6 I'GRAII I'NO.
BUILDING.DIVISION APPLICATION/PERMIT
,pats!aRU1LDIN0 PRO F.CT ID IPIC TIONox+;+a++'ani�'
B27535
UILDING ADDRESS: �� SANI I'ARY NO. APPLICATION SUBMDIAL DA'11'
I //SILa UNIT'0 LOTN —' 1;
OW
ERS AME � PI IO CO ACTOR'S P{y{F.:� LIC NO: NIC C(1NIROLN
ci
CHIIFC`F"UINF,ER: LIC NO: AD ESS:
CONTACT: PHONE: W. NI ap""�Ea(Wiry1RI �PHZRylM�I"'� �,h}{t �}elf" ,A-� 'S=iBU1LDING PERMIT INFO '
_ qrc }-N:fq�.. .-rera+lv�^"'Clq gel',' Cr BLDG ELECT PLUMB MECII
PERMIT ISSUANCE / -
LICENSED CONTRACTOR'S APPLIANCES-RESIDENTIAL JOB DIL9CR11'IION
Od'Z IM1m
ebyaffnnlnal l am Licensed under prnvisiom of Chep¢r9(mmmmencing with
µl00 Sectirm IlxxB mf Division 7 of IM1e Business end Pmfessiom Code,end my licenseE in PANELS
FmC fullforceandeffect. t Y'fA W i�
F,Zua ,Lions,Clo.as Lic.N UP t0200 AMPS I—fWFw\I
PaQy Dam Commnor NI-I00OAMP5 SO.FT.R.WRA0.1iA SIS0.19'.
ZF yZ ARCHI'IF,CTSDECLARAIION OVER IOW AMPS
Iunocmtamlmyplainshallbe..d as public reco is
ty SIGNS ELECTRICAL
QyE� Leaned Profecsirmal
'KYfr-( OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MISC.
px�j,OaU 1 lorehy affirm Nat 1 em exempt from IM1e Contractor's License Lew For IM1e
'ta73 arra following reason.(Section 7031.5.Business and Professions Code:Any city m county TEMP.METER OR POLE INST.
t�'oo which requires a Permit to constmn,slier.improve.demolish.m repair any structure POWER DEVICES
S;!fYf prior or its issunnee,uborequires the applicanffor such Permit file a signed statement
paaQO that he is licensed Pursuant to the Provisions mf IM1e Contractor's License Law(chspler SWIMMING POOL ELECTRIC VALUA'I'IUN
dao ff 9lcmnmencingwiN Section20n0)of Division 7mf Ne Business and Professinnscods)
W^y arthar he iscaemNdrerefmmendthe basis for the alleged ascription.Any vlonmel of OlffLl!TS-SWITCIIES-FIXTURES
C Z 2Section 10715 by any applumn rte•Icrmiuubjecta Ne applicant a.civil penally of
inn norm than Bvc hand ed dollen D5W).
5 O NEWROIDFNIIALEL.ECfR _SQ.M. SIORINS TYPE CONS'IRUCIION
,�:L ❑ oche wr ttof Neprnperty,orm of intndenwiNwegcusNeino 704,1.minion,
y3— will Prfesions end Nemru Contrapues,in notintended
Law ffered does
applySee 704,1.Business
of
aro PmfasMm cndr:improves
Contractors License law docs rot apply lf m owner or
prnpertywhmhuihovi improves Nereorovements weell Nmughhis IaCC.GROUP RIi..UNITS
employees,providednoonversimpmvld wit inanns e yimOndcomplfttaf rte sale. r.
MilderwNe bvetie burimprmemOminmt he withinonebuild
of annotation,the owner. N
Fuildcr wJl have the burden or poving Net he rid tax buik m imryove for puryox fQTY .A. RAxIDZONIi npNI,asowner ofNe proprty am exclusively crminethngw N licensed conic eto m Iconswet Ne project(Sec.7W.Businw end Protest Cde:)The ContractorspERMIp ISSUAI.icen.alawdmexnmapplymanownerofpropenywMWildsmimprovesNemm.endvhocrmvocts fmxucn pnrjects with.co mensgs)licensed pursuer,to the Contractors RAIN&VENT-WATER(EA) FEESUMMLicense law.❑ 1emeaemmuderSec. ,D&PCfort1dx rt DEVICE SANITARY k' N_RECEIPT'X
Owner WORKMAN COMPENSATION DEOA0.AT1 DRAINS .AREA.CONSCHWLTAX Y N_
❑ Iherbyoffinn Nnt l have.certificamofconsem toselbi m,maceni0cateof RXTURFS-PI RAP RECEIPI'N
1 IIB Leh C, which
PARK FEE Y N_
Wudm'Crmperamin.Insurance a cenifed copy thereof cc. ) RIiCEIVIN
\�- nett emloee'suMer Nis t. GA STT!M-1 INC.xO✓II.EIS
Polv P Y Ix^n' BUILDING DIVISION TEES
coir,N
Cmmpmry A -CA.SYST:M-O IIA) PhANCIIIiCK IIiL•
❑ Cenill,denoyi.sherehyfurs, .
❑ Ccnifted ropy is Eld with Necity innpmtion di isimn. IiASFII WASTE IN GRADING FF.f;
CERTIFICATE Op EXEMPTION FRU WORKERS' GREA ETRA .OILS FEE
COMPENSATION INSURA E
(Thinumion red nal hecmnrpletd if Ne permitisf onehundrddollan(SIM) -SANITARY-STORM FA.200FT. t IiRGY FEF,
m less.)
-reify slut in the performarxe of Ne work fm which th -limit isinud.lshell WATER IIEATER WNENT/Fil.cm
employ any perms in any manner ar n�m beermx 'ct to the Warkcri P D
nmpenati of Celifomia. Dole _ R- WATF.RSYSI'E!'I'TREA'IING Dam ReceiptN
O Applicant NEW RESIDENTIAL PI.MB. SQ.FT. TOTAL:
7 NOTICH TO APPLICANT:IL afro makin Nb Ccnifrnm of Emmp nays sMntlJ
L--iN flUI VINO FEEhcaanesuhyw. ,,be Worker's Cmmpensation Provisions of Ne labor e,you must
FF"" �"" fonhwiN emmply with inch govinionam Nlo permit nhsll be deemd rev eJ. .
a >
CONSTRUCTION LENDING AGENCY $Fa. IC IFF.
r:j
z I hereby affirm Nm there lee construction lending agency for the pcRrmm f TOTAL: Ii .CIRICITI:
rM1e work An which this pe.it is isao (See 157
7 .Civ CJ
U d laodcrs Nam- rJ r a a + v'+{...-, r, t - . •".'
W "'' 3ti hI6CFIANICAL PERM a lir PLUMBING nsE
O Under e tifyflAddress— (y i4y< { ,..m. ry ktl�.dlkas'
1.mite that 1 have rod Nis ap anal- u ty sine Nat the stove iws rmning r MF,CIIANICAI.IIF.
D.s neer.lagree to<mmply with all city and county ordinances AM stale laws relating to PERM RISSUANCE
building con.ahudion,end hereby inNndm rtpresrnutiven mf Nle city to enter upon the .0.O OMECH. CONSTRUCTION TAX
U Z atnve-mcmiund pmperty for inspectim purposes.
(We)-gree m save,indcmniry sod keep harmicss the City of Cupertino against
liahili'es,judgmenn.costs end exoenuswhichtwyin any way accrue eg id'ily AIRIIANDLINGUNR'(T010,000CFM)
sequexe n(@e gfamingof Nix Permit. `lgb
AIR IIANULING UNIT(OVER 10,f1(gl CIM)
CZit,c�c.
Signature of ApplicanVC'onimcmr Dam EXIIAUST II(>nDfwpNCtl PAT
IIAYARERI
DOUS MATALS DISCLOSURE BEATING UNIT(TO 100.0011 BTU) lame Reacipt X
Will the it,livam or lame huilding occupant stem or handle bcrmulle,material IIf:A'I'INO IINII'IOVIiR IWJxKI Ill U)
a drflnd by the Cu,s,mor Municipal Code,Chapter 9.12,and the IIca1N and Safety
Curie.Section 25532(.)1 VExIIIATION FAN(SINGLE RESID)
❑Yea 0N IS ADICIi DA Ili
Will Nee licamor lmurt huildin Luse mrdevim wM1icM1anit BOILER-COMPp11POR 100.00 BIG) N'i D
pp gnby the Area inn
M1aenrJnus air contaminants n AcfirreJ by the flay Area Ai.Quality Mnnegcment flfID.ER-COMP(GVER I0(1,(KD BTU)
Ui.ev n1
❑Ven ❑Na NEW RFSIDFNDAI.Ml-XII.—SQ,IT.
I have rend the Imsnrdous mmerials rcyuirenmnta under Chapter 6.95 of the Ga r Up - 1995
Califmmia Ileahh&Safety Cde,Se<tiom 25505.255E end 255Jy. I uadcmend Net LV f rNe.�t�
ifthe huilding Jrnxnotarremlyhaveatenet,thenh Ie 1. is...crof. cramify the lR1�1y/y/moi
warpnm of rhe myuiremcma which mint he met prior m issuance of a Certificsm of
G4eupency.
Owner or emhoriseJ-gem Date TOTAL: ISSUCD BY:
OFFIC