S 2558 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING..ELEC'I'HIC\L PERMIT NO. .r�
1{I111.DING DIVISION APPLICATION/PERNIIT I4UILPLUMBING-MFIDENI ICA. S Z5
UING PROJHCI'IUEN'I'IFICA I'IUN
58
BUILDING A DURESS: SANITARY NO. APPLICAHONIanimn'1'ALU6Ili
OWNEH:SN!+r� RHONE: Cs�+ A I(IR:S NAME ��--JJ .1 (JO:7 NIC CONTROL#
— !>E2ut(Cj `I +Wsl51!51 L �J
ARCHHEC1'IHNGINEER: LIC NO. ADDIO': 71 (,r_arKA^`•4w �'_-If It d ❑
CI)N/,h"ACT: PHONIP. BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) B%DG 1:11 CT/ PLUMIy MECCH
hICENSEDCON'I ACT'OR'S )I!CI.ARIYDON QTY ELECTRICPERMIT FEE
I hereby alarm Incl 1 am rice.wit order prooi"inns of chapter 9(commencing JOB DESCRIPTION
��z hsmionm#0)onli�;ain.3onne Buainca.wd rmresar..Code and myliecrxe i. RESIDENTIAL:
moo nn PERMIT ISSUANCE ,
Ca'F- full farce and eff.. I ❑SPUWI. ❑KITCHEN REMODEL
aVU Liccx Cl I Licx APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RI PIPE
FZm Uatc C, )3CIr
tn¢a ❑MIUI:FIUNIT ❑STRUCFURAI.
ARCf11TF.CTS as It or A'1
1.,7 m I'ANIi1S MODIFICATION
m 7 understood my Plans shall be uxJ as puhlic r
--11 111'TO 2IX)AMPS []INTERIOR ❑CHIMNEYREPAIR
�4 t:W Licmncd Profession:.) 2iH-tkX0AMPS - IMPROVFMENT ElSWIMMING POOLS
OWNH&BUILDER DECLARATION OVERIINX)AMYS BATH RFNIODF,UREPAIR ODF.MOLI'IION
1 hereby altar o Thal 1 or x mire hoot one Camnwmrn Licenv'e Law for the
XOLU folWwia,mnson,(section 7031.5.Bron..oull'rol'cseinns CoJc:Any CITY or county SIGNS ELECT RICA). COMER
m 3¢y wlodi na ims a Rcnnll to ,ecsraon .Ilan,improve,demolish,or repair any structure
0� to it.issuance.alcor uires the Uormeh no rile u signed prior W PP tan Imrmi gnc SI'IiC1A1.CIRCUIT/MISC.
� y Nat he is licensed pursuant totheprovWsnsof the Contractors License LawtCnapnerit
W <0 (conrnencingwilh Seelm.7010)Of Diision.3 ofthe BusinczsanJ ProfcssisnsCedOor THMP.MET ER OR POLE INS'F. COMMERCIAL'
a a e rY That he is exempt 1M1erclrsm and the basis for the allcgN exemption.Any violation of O NEW DLDG/AUDITION ❑DEMOLITION
W-y Senior 7031.5 by any.,fcanl for a pem,itmbect,the r,dicum tea civil pe..],yet IY)W'I!R DEVICES ❑Tf:NAN'I' ❑FOOU$IiRVIGIi
our.,on than five hundred dollars 18500). IMPROVEMENT
SSC (] Las owner of the property.or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC
�F.m rill do the work,and the% uctom is not intended or offered for ale(Sec.7011,Business ❑UTIB7S-���-�.,�..
6'3 and I'nticnsi.ns Csdc:The Cnntr curs License law Joex not apply m w owner of OIITLLTS-SWITCHES-PIX' IRE, O f ;^
property who builds or improves thereon,and who Arms such work himself or through I )
l,ix nen candoycea provided that such in o me nor amended or offered for NEW RESIDENTIAL..LEC IR
sale.IL howcvea the building or,mpmvcmenr is sold whhin lac yanrf enmpiniOn,the r"SV TTI'.FLOOR AREA S FI'.
crladhil r will have the burden of pawing chat rte did run build or improve riot par. MAR 1 1 199!1
p�c otsde.). �,
(] Las or Inc 11,11ny,a xclnsively contracting will,licensed...mason.u: 'r0' h:
ennsvuct the Pmjul(Sec.9094.Business and Professions Codc)'lar Commaorn Li,
arse Law does,ran napply to an owner of pfnpertr who builds or improves thereon,and QTY. PLUMBING PERMIT E nVV
who contracts for such projects with a mrmractogM l accred pemuanl to the Contractor's
License law. 1W%TFRHEA1
ISSUANCE 3 Q
o 1 am exempt under Sec. B&P C for this mason
-DRAIN&VENT'-N'.\TIiR(EA) VALUATION
Owner Dam 2 0
WORKER'S COM PLNSA'1'IUN DECLARATION BACKLOW PROTECT.DIiVIC1! D +�
I herebyaffirmair air C R f J (th following declarations:Y pt
'❑ Ih d 11 m Cnf 'I IConsent lf in< f Workerscamper -FLOOR.ROOF AREA,CONE). S'IOHByS TYPECONS HUCI'ION
:alit provided f h Section 37101 Irh I M Cd f theperformance (the --�- �nrkl hth, t d LS IERTRAI`[] I I I I W k :C 1 -t I : y J by S ,57011 lIlo#�+hyaChyCC�o�d�vlotin ry..l ..rance fol kl llyxhrthhs pyw�nhis wod. A SYSI iM 11N(..40UI' 'IS I OCC.GROUP APN
C.rYrW 1y[l+PI I�IJ N(f 1 I'rV [aT 1r�_ r SY� M OvJ Rallis)CEIGIHCATB01 EXCINUMON IROMWORKERS' IN # ✓ OCOMPENSATION INSURANCE f1S L :T131 E BUILDING DIVISION IIS
(Ibis section road not W complcmd ifthc permit is furore hundred dollar, SHXBETRAPnr less.) PLANCfIISCK 19311
I certify than in the performance nDhe workfor which this permit is issued,I shallySANITARY-STY)RM LA 21X7 FF
nm employany pens.in any mannerm asto become subject tothe Warkcri Cmr,.- ENERGY FEE
z. ation laws of California.Dec HEATER WNEN VELF.CfR GRADING FTE
O
'Z' O AppHc:tet
h NOTICE l,I APPLICANT:If,arm,making this Cer iticulc of Esemption,you.head WATER SYSTEM?RUTINGi SOILS i9ili
E-' becon a.object m the Worked Compcmasnn pmvininre of he Labor QMe,rill most
WI..nhwhh Imply withsuch provisions in this permit shall Wdemned revoked. WA(ER SERVICE'
Q
Lk: CUNSTRUCI'ION LENDING AGENCY NEW RESIDENTIAL PI,MI4. SQ,PR PAlll ),I Rccuipt#
U 0 I hereby aRrnnhat there is acor))sI ail lending agency for the perfnnnanee of
the work for which his perms is ill 3097.3097.civ.Cd
P. U Imdur'..Name A TOTAL:
rD.1 Lender's AddressTOT O
6. I molly that I have mad this application and state that the a nuc information is I4UIL1 G 9ili
F N cormm.I.greetocomplywithallcityandcountyordinancesandstatelawsrclatingu' QTY. MECHANICAL PERMIT FEE 00
U Z building construction,and hereby aunrim representatives of this city to enter upon the SEISMIC :E
uMwom ailln al pmpery for inspection purposes. PERMIT ISSUANCE DG:LIfCT C PEIi
O
OV.)agree to cove,indemnify and keep mottles,the City of Copenins againstin
liabilities,judgme. ,.,sand essmes which rat may in any way acee against aid City / ALT 1!R OR ADD TO MECU ZD PLUMI41 SITE O
amor,uenreor the gra tin8 Thu Aconin.
API'hICAN"I'UNDI!RS' SAND WIhI.CUMI'hY
WITH AEI.NON POINT AIR HANDLING UNIT(TO H.k0CIM1 MIeCIlAR1C 11J1!L' z-1 7—
SOL��Tl(
3 99 AIR HANDLING UNIT(OVIiR Io,00fi CI'M) CONS'I1tUC'IION TAX
SignnlumnfAppllcen Cnnlmc r Dam LXHAUS'I'HOODIW/DUCF) IOUSINOMMKINHONFHE
HAZARDOUS MA'I'HRIALS DISCLOSURE
Will tl,c applicant m futum midd ng oeenpan aloin or handle hamrduue material III!ATING UNIT(FO 100,000131U)
as defined by the Cuperino Municipal Code,Chapter 9.12,and the Health and Safety
Cale,Section 255320)? IIHNI'INC,UNIT(OVER I000R)IIID
❑Yes E]No PAID
VP.NI'ILA'I'ION FAN(SINGLE R131D) Dale RtteiptIt
Will the applicant or future Wilding occupant use equipment or devices which I{OILER-COMP(311P OR I(XL1XX1 BTU)
emit hmaNnun air contaminants a%defined by the any Area Air Duality Management TOTAL:
Uisvim? BOIId R-COMP(OVER 100.0X0 BTU)
\ ❑Yes
Fl No
` AIR CONDITIONER e
Ih r Jhcl d Trial eL- Jc Ch pl R95 n1'th Cull, ISSUANCE AI17
fon 11 III hS'fGyCd Sections 5 5s13 12553!.1 understand that it NEW HI!$IDENTInI.MI1CII. SQ 17.
null yl d 1 .licitt ,el 'Fltyt tfY the Punr �:��—
inlanan ren: p arfn I c�oc
Dust nor agent a Ume T( AL: ISSUED BY:
OFFICE