S 3348 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
�BUILDING
'PY OF CUPERTINO BUILDING-ELECTRICAL PE IT NO.
DIVISION APPLICATION/PERMIT PLUMIUNG-:MECHANICAL. 3348
BUILDING PROJF,C'I'IDENT'IFICAT'ION
LDING ADDRESS: L SANITARY NO. APPLICATION SUBMI'FI'AL DA[H
OWNER'S NAME, 1,IONI?'. CONTRACI RVNA`E: � LIC � — t0101o.5N/C CONrRp
'
Ol.
�CI IFI'I!CI'/1TNG EER: LICNO. IIDDRIiSe ❑
CONTACT: PIIONP BUILDING FILE
INFO
�� ❑ Consultant Fees Paid by Applicant(Initial) III DG / H.E PLUMB MULCH
El
LICENSED CON ACCORs necLnRrcnON QTY. ELECTRIC PERMIT FEE 10B DESCRIPTION
1 hereby film,ba,I ant licensed ander pord'inn,nI Chapter 9(cotnmmocing
ZaZ w'ahSecti-701X»ofDiviou.3df heBudnecexnd Profwxlnan Code.and my lacare i. RESIDENTIAL,
wo in P17RMI'FISSUANC17
F� full force and ,. , 11 ❑SIUWL El KITCHEN RI?MOUGL
Z� Dae Conwcmr/ APPLIANCES-RESIDEN'T'IAL ❑ADDI'TION ❑PLUMBING'REPIPE
PZ ❑MUUFI-UNIT ❑S'IRIICTURAL
ARCHI'PECC'S DF,CLA ATION
~ Z I unecra;mA nt hill be used m bike recant PANELS MODIFICATION
Oz� ypan„ a public UP LO 200 AMPS
El INTERIOR El Cl REPAIR
Pa:��L� Liccnml Pmfcexinnol 201-101X)AMPS IMPROVEMENT 0SWIMMING POOLS
OWNER-BUILDER DECLARATIONOVERIfNX)AMI'S ElBATH REMODEURITAIR C]DEMOLITION
C C Q L hereby affirm that 1 ant exempt hour the Contractor's Licence Law Tor the
GV following (Section 1031,5 Re IP le Code:Any city larceny SIGNS ELECTRICAL. ❑0TH R
1x113 W 1"' which ' p I Iconstruct, f 1 11 t Y "neer I1
ti N�� tprior hat he
t y prapplicantf Ipmin [1 6 I:"pacr9 SPECIAL CIRCUITIMISC ME
y (hath license(]lpursuant the provisions flit Contractors L L (Chpor9
� �� (u,omens g lb Su' 1110111 [D vision3 nit Hour dP f " Code)or PFMP ME WE OR POLO INST COMMELD(VAD
4'20
C
flat he to exempt theof or.,d the baric Inr,he alleged-coalition,Any v.1od „ n ❑NCW BLDGIADDITION ❑UGMOhITION
X m_W SGBinn90315hyonynppllcanlfora,v.... wM1jcc's the upplsmnwuclml pcnndy of POWER DEVICES ❑TENANT FOOD SERVICE
of more'Mm five hundred dollar,($500).
�Sd I,uc owner nf,hc n SWIMMING POOL ELECTRIC IMPROVEMENT
prove yurro onnuentedorebrodhist'ric(Sc .7044,urounes, ❑OTHER
wi 11 An tbcwork and Mc even.reJenor,Li,enew Law does no(apply b,an restrict
of
3 one Ytoyo bs Code:The Confmaten L dd who
docs nal apply m an owner N OUTLG'IS-SW I'TCIII?S-FIXTURES
his nasty who hued,nr impeach intent,,and who Boca milt wad hled or owned f
his own dmPlnywn,provided that such in,pmven¢nu are nm In'wdW or ollbred for NEW RESIDENT IAL GLF:C'TR
sale.l l;howc c the building orimpmve int is sold III n one year of n,mplction.thc SO.IrI'.FLOOR AREA $/SQ.PI'.
r crbuilder will have the bunion of proving that he did not bold ur impmvc far per-
'weufcale.). v OT
1,as owner of the Property,an,exclusively contracting with Ilcen.vd eonveaor,,o
msdart the Project(See.9144,Has to,and Pro[coiens Code:)The Rmvanor'e LI-
close Law,does nolapplymanowner lot bull solid builds orrepmve,the on,a P G 2 FEE
who contracts for such projects with a conlncmr(s)licensed pursuant b the comma
hiccn.vc Law. PER SUA z.
I nm.....Iunder Sea. ,B&PC[or'hi,rent.
ALTP D ENT-WATER IEA) VALUATION
wncr Dora
WORKERS COMPENSATION DECLARATION LOW PROTECT.DEVICE
I hereby affirm seder penalty or perjury one of file following declarations
Ibuva and will maintxinaCcni[cute of Gmscm roulf-inmrc for Workch C.mpcn- DRAINS-FLOOR ROOF AREA!GOND. STpp ;S TYPE C(lN5'rRUCTI(lN
,orlon,as provided for by Section 39110 of the LubnrCale,on'.'perfoonuned of on- Ii,. I
work for which this....,Iv issued. FIXTURE -YER TRAP
❑ I nave and will tnaimahh Worker's C.rpaboadon mwreaee,as re4uireal by Section 1 t I z
3900 of the Labor Code,for the per[urnancc of the work for which thi,permit is boated. CAS-UA.SY STEN-I INC,4QUTLEI OCC.GROUP AI'N
My Workermm
,Cmnpentlon incunc let arie,and Policy attitude, GA -Eh SS SEMOVF.k are: ) R (EA,
Carrier: Policy No.: S � 4
ChIO IFICATE 01:EXEMPTION FROM WORKERSGREASE/INDUSTRLWAS'L'E IN'FERCITIOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
('Ihi.xcbonne,dnulM1cmtnple,cditoutran.,i,foronchu adreddollan($100) GREASETRAP -y
or lens.) PLANCHECK HGH
redii,ltrt' 'h f flit k lor,hu,h0 p :"wed,I duall MEWLR SANITARY S'TORMFn.200111
h, t it u O W k Cohpc, ENERGY FEE
not nl > [bb[p r 1 i yF FY
O z wt ,1l-al for D t `( 9 Wn'TCR HEATER W/VCN'F/ELBCTR GRADING FEE
Z O App1 Nd
NOD ICL C WELL so
If after ranking this Certifcme d Usebab on you should WAFER SYSTCMRRPATING
h OILS PER
(•" buonm xnjw'mthcWork...Compeerlion prov...in.cofthe Labor Code,you mus
ti
�i '� forthwith amply with such pnwisiona ar Wi,permit nhall returned revoked. WAGER SERVICE
Q Q
] z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMH. SQ.IT, PAID
I hereby oftinnthat'he'dI,a cnusOurnlon lending agen,lot the perl'nm,unce of [),air Reecipt#
O the work for which this permit N issued(See 3091,Civ.C.) TUFAI„
O U Lader',Name
LGhdcix AAdrv,n TOTAL
W I clodly that I have fwd this application and state that the above information is BUILDING Illi
F-i 0' correct.I "ee1.comply withell cry and cnumynrdlnince,and dole laws miming to QTY. MECHANICAL PERMIT FEE SEISMIC FEE
U willogeonstrnaioo,andhereby amhorize.mpm.wn'mives el this city to enter nom the
bob'd-roblionedp np nyI ob"tanep r,u PLRMI'1'ISSUANCE EL17 RICTEC
(W)ay I, undeniably dk phandlessthe Cty ICupertinoag. mt
'^bl'i 1dg t'. ' J p 1 h .Y enywy .a
6insid Cly ALITR OR AILD TO MECII. PLUMBING IEE
q T to gra.rinlol it',lould.
All 'I IIM1DERS LANDS AND WILL COMPLY WITH ALL NON-P)INT AIR HANDLING UNIT(TO IgO(X0 CPM) MECHANICAL I EE
SOUR I!GULATIONS.
AIR HANDLING UNIT(OVER Ip,dJU CFM) C0N5rRUC'FION TAX
/ L
:ig n re fA,dicanOZunenctor Dam EXHAUST 110(1DIW/DUCT) HOUSING MITIGA'T'ION FILE
HAZARDOUS MATERIALS DISCLOSURE,
Willthe pheal or future budding"crupmnstem nr handle hmardounmacnal HEATING UNIT LTO 100,000 BTU)
as defined by Caperton Municipal Cu le,Chapter 9.12,rad line[Icahn and Smcy
Cale Steelton 255321x)^. HEATING ONI'I'(OVER 1110,00X1 BTU)
❑Yes E]Ed VENTILATION FAN(SINGLE REST) PAID
Dmc Rxcip'#
Wtll the uppllwn,or let...hankl ng occupant use etluipmem or devices which BOILER-COME CHP OR Eldora)11'1'U)
Ill(hazardous air con,mnieanb to defined by(he B,Arca Air Quality Managenunl A 3 Q
District? BOH.F,R-COMP(OVER 100.000131U)
El Yes ❑No
I have,read In,Inboard...%mmerials t e ' 6e,order Chapter 6.95 onhe Cali- AIR CONDITIONER ISSUANCE LATE
.25533n
f.miu f{wph&Safety Cork.Scdinre 2551)5,25533 and 25534.I understand thad it NEW RESIDENTIAL MI1CH. SQ.Er.
of,hergface con,
bulls h:rvc auger(that Thema reoomCeriibility ton''irytheameapam
� .non rryaitanw'a wnidh most ne tactpear'.'tsmanecela edmfiw,em oddapaney.
Owners authorized agent Dart TOTAL: ISSUED BY:
OFFICE
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