S 2294CPPI IrANTTO FII 1 IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - OLECI'RICAL
IIDILDING DIVISION APPLICATIONAPERNIrrPLUMBING- MECHANICAL
IIUIU)INf: PROJECT' IDEN'TIF'ICATION
PERMIT NO.
S 2294
BUILDING ADDRESS;
SANITARY NO.
APPLICATION SUBMITTAL DA[ v
2-8 \ c.
//- 3 - 2�
O ' 'S NAME: I'I ONLa:
`
CONTRACTOR'S NAME'.: y� LIC NO:
\ ku
NIC
❑
CON TROL#
IARCED CIENGINEER: LIC NO.
ADDRESS:
a L Q o hlu
CONTACT: PHONE:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
❑ consultant Fees Paid by Applicant (Initial)
�N c
❑ ❑
LICENSED CONTRAC'TOR'S DBCLAItA]'ION
I hereby action mal 1 an, IsO n.ed mmc, p..sb otc, of Chapin, v Cuncen,ing
wiWM1 Sacnion]Oq))of Uivixinn hdtbe Business anJ l'rolccsinnn Cole. andmyliamse is
in full farce and eRc (�
License ClaNs 1.ie.a `� z ��
[)at I, Connector bTk CTj
QTY. ELECTRIC PERM II FEE
JOB DESCRIPI'ION
RESIDENTIAL:
❑SFDWL O KITCHEN REMODEL
❑ADDITION ❑PLUMPING RE -PIPIT
❑STRUCTURAL
MODIFICATION
❑ EST 'IiRIOR 0GIIIMNfiY REPAIR
IMPROVEMENT I] SWIMMING POOLS
❑BATH RIiMODIiI/REPAIR ❑DIiMDhITIQN
❑ OTTER =
V C�
PERMIT' ISSUANCE (� - O
1
APPLIANCES - RESIDENT[At.
AHCIII IliCTS DECLARAI'IUN
1 mdcrxnand my plannxhall be—d ao public re, us
PANELS❑XIULTI.UNIT
UP 10 10 'o 2AMPS
Liacowd Prom ... v nal
OWNER -BUILDER DF:CLARA'I'ION
1 hereby uffi,nn Ilial 1 am eaanm fnm, the Conlmcmr'.N License ].me lie the
folowing semen. (Semi.... 71131.5. Business and Pnde,dons Code: Any city or County
which requires a permit It, construct. alter, Impn,ve, demolish, or repair any structure
prior in itsl: 4 rc the pplc t for suchPermit file a sigrowl.statcricera
that he licensed pa tt The provisions of the Connector's License Law (Cnapter9
(urnuncovi ng with Scui WXX)I of Division 3 inthe Busi rco, and P r'.' :CdO or
?hal he is c cmpl Ihcrct'mm card the Noi, Ib, Inc alleged cscmpl N n Any vio ltior cat'
Suction]1131.5 by unyllpph,t Ihaapermit'able"' the upplieum tea civi l l -'ally of
201-1100AMPS
OVERHXXIAMP$
SIGNS ELECTRICAL
SPECIAL CIRCUF/MISC. is
h L1 p,G
TEM P. MET ER OR POLE INS' I'.
COMMERCIAL:
❑ NEW nLDGIAODITION ❑ LEMOLITION
❑'IANAN'I' ❑17001)SERVICE
POWER DEVICES
of mare man five hundred dollars ($5(X)).
E] 1, mawnerof the propcny. or my copki,ec,.RM1 wagexas lheirsole cmnpcnsmina.
do the work, and the ammnm is non amended o, oftemd for uk(See.91 W. Ravines
and Professions Cadc: The Com actor's License law dies not apply to an owner of
IMPROVEMENT
❑ OTHERwill
SWIMMING POOL ELE
OUTLETS - SWITCHES-EBX]'URI
A",
W
property who md, N or improves Whereon, and who dm, such work himself ar though
his own employees, provided that such improvements cart not intended m offeral for
,ale. if, bulldinBor improvement iisNnld within notyear of complcnion, the
NEW RESIDENTIAL EL
SQ.IT. kT,DGR ARBA
$/SQ. IT.
c,-holder will have nice harden of pn.... ,Iatt he did, I build n, improve lin par
otrL
Pmcotnde.)
❑ Lav owner of the property, atm exclusively camlaelhtg with licensed comntam, to
instruct the pon,NO (See. ]oW. nosiness and Irrotc„inn, Pace) file Cmnrannr, U -
,Ne law dors not apply to an owner of property who builds or improve% thereon. and
O
QTY, PLUMBING PERMIT FEE
who commis for utch projects with a cammerod.N) licensed pursuant m the Commctor's
PERMIT ISSUANCE (�
License law.
I am exempt under Sec. , B A Y C for this mason
ALrFR - DRAIN A, VENT -WATER (ITA)
VALUATION
—e
Dam
Owner
W(IRKER'S COMPENSATION DECI.ARAl1ON
RACK FLOW PROTECT. DEVICE
I hereby allb'm node.pmmhy of perjuryone ul'the following dedmmior,t
I havemd will mnninrnin a Cenilicamnf C..m,cnt to,elf-inure tar Worker's C...... -
Nation, as provided liar by Section 37W of Inc Labor Cade, for the pedammnce of the
irk fir which this mount in issued
1 have and will maintain Worker's Compensation Insurance, as require) by Section
X) of the labor Code%for the performance ofthe work for which this permit is issued.
; 1)R AINS- FLOOR. ROOF. ARI: . FIND.
SORIIS
DCC. GROUP
'IYI'Ii CONS9RUCfION
APN
FIXTGRES - PER TRAP
GAS - ITA. SYSTEM-] INC. J OUTLETS
GAS -ITA. SYSTEM -OVER J IIIA)
MyWa'a WortmrlClt'jlowpmalitm 'y NoY hef f5X..`O _l
: \\f0 ��.]1.�. • 'cYNe nu,42 `
CEICI'IIICAl 1: OF EXEMPT ]ON FROM WORKERS'
COMVF,NSAfION INSURANCE:
CRE SIT US'TRL W S N'1'I;RC1 s )R
BUILDING DIVISIGN Isl?I?$
GRIiASIi
SEWIiR-
TA .TER I' .2
YLANCIIf:CK THE
TInk,eclion need not IN crmplmat 11 the panni, i, Moine huncnl dollars($ 11X)
omM wodmewhichrets the ciaW rkem' ompc11
nm employ any penin in any manner voce. ha Mame subject m the Woderi Camper-
Io,, any thatinthe any manner
ENERGY FI31i
GRADING FEE
SOILS HE
Nation Laws of California. Date
i
WATER H i
ER MiLECTR
Applicant
NOTICE TO APPLICANT; IL after making Itis Certilidmt of Excmprior, you should
Itthotith subject to the Wmkcr's Come 11n, coup, hal ofthe Labor oced'Coda you nmxl
lurmwilh cnanply widuucM pre ions or Chia rennin ,lull be Juaned ruvnkcA.
WATIiR S
BMl1'REATING
WA'ITR SI R
i
]Cf1
CONS] LENDING AGENCY
I hereby YBinn that mem is a comwclion lending agency for the srforniance'd
NEW RESIDENT PI-1,111.SQ. Ff.
PAID
Oeste c,6, a
s ret work far which this permit is i ... of Ncc. 3097. Co. C.1
TOTAL:
TOTAL:
Lender', Name
Lendor', Address
,
BUILDING ITT
1
1 codify that I have read this application and start, that the above inoculation i,
I correct, l agree menmply with all eltyandcouonyurdinanam,ned,a,C luwemlatingm
mildlrg,vnsuuetion.; Iherby;mthonce termemotive, of?has city m enter, ithe
n.
ahovcmcnbnncd ao,rly lar iaspcNna purPc
(Wt,) agree as ,ave, ode tom y and keep harmless lie City of CupeNm against
haallics.judgmnn..costs and expi which may in any way accme agxina said City
QTY. A1ECHANICAL PI:RMIT hili
SEISMIC Hili
PIHRMI'I' ISSUANCE (�
IiLIiC'I'RIC PER
ALAHRORADDTOMECH.
PLUMBING FEE
in onayucnceoflhe graccom,oflia, permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
AIR HANDLING UNIT (To 10.000 CFM)
MECHANICAL ITE f
SUI' CE REGULATIONS.
\s
AIR HANDLING UNIT (OVER 10.RX) CFNE
CON'SIRUC'1'ION TAX
tlContaor LatecJ
ur t^Aypplmnnra
Sigmama o
EXIIAUSTH000(WIDUCI)
HOUSING hill ION] 'ION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant nr future building occupant store or handle haontl material
aN dehned by the Cuprdino Municipal Code. Chaplin 9. 12. and the []Catch and Safety
Cock. Section 25532(:)? /
III?ATI NG ON] '1'(TO 100,000 [11 U) IIii
HEATING U NIT (OVER 100,00( B' I' U)
VENTILATION FAN (SINGLE RI SI Of
E) Yes No
PAID Dim Receipt
1 e Will the applieum or future huilding ®cupam use equipment or AeviceN which
mit Mumrdous air tlmmmimann, as delinN by the ?fay Arca Air Quality Managemcon
BOILER -COMP (3HP OR 11XLIXXI B"TU)
'TOTAL: k
BOILIIR- COMP (OVER I Scott)[? I U)
Uhlric1?
�Yev yJavo
AI R CONDI' I'IONER kq•1;�C7
ISSUANCE DAI'li
`3 i
I have rend the Wardrm,metedal, remmmen u oder Chapter 6.05ol the Cali-
bmia Realm Safety Code, 25 25533 that if the
34. 1 undmfy
NIiN' HESNIiN'I'IAL AtIiCl1. SQ. FT.
c have tial i es cosi the
buildingdm eats which Must he MCILior Ill is carom aCertycate ofythe mcupam
qui ems which mumb mel ptiann inuame ma Certificate of OccuPrncy.
e
r %
TOTAL:
A ,� �..� 5
ISSUED BY
Ownerre mamin iugenn Date
UI-f-ICt