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29488 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CI'T'Y OF CUPERTINO " BUILDING.ELECTRICAL, PERMIT NO. �w{s.J! BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL BUILDING PROJECTIDENTIFICATION BUILDING ADDRESS: " - , SANITARY NO. APPLICATION SUBMTITAI.DATI 2114T31 0.kv►A or fix; ` OWV12: 'PION HZJIMCONRACTOR:S NAME LIC NO: - rdA NIC CO R(4 RCIi1TECf/1?NGINEF.R: LIC NO: ADDRESS: ❑ 1 L " 11(V, CONTACT. -PHONE' BUILDING PERMIT INFO - ❑ Consultant Fees Paid by Applicant(Initial) LDG E{,E¢ PLUMB MIiCH I� ❑ ❑ LICENSED CON]camedi ncrOR,DECLARATION QTY. ELECTRIC PIiRMIT FEE - 1 hereby amen that[.it,famed ender ndProfns df chimer v Ibhmmen e is JOB DESCRIPTION. �a'Z with Satiun]I%X))nfDivisionJofthe Business and l'mfessionsCode.vnd my license is - � RESIDENTIAL: ' ❑100 ' eg-l- Lt<etoll force and effect, l PERMIT ISSUANCE D,FDWL [I KITCHEN REMODEL QUV Lt..-Cl... 'Lic.N _ APPLIANCES-RESIDENTIAL DADDITION [I PLUMBING RF,-PIPE FF..Z W Dam Comers mr } Fly ARCIII'=S DECLARATIONPANELS ❑MULTI-UNIT [D STRUCTURAL 4 L O p2,� .'I undcra:mJ my plans shall be used as pnhlic numJs `, ;v •MODIFICATION UP-1'0200AMPS'} :,Z—O [_1 INTERIOR DCHIMNEY REISAR Licensed Professional 201-1000AMPS " IMPROVEMENT 4,01 Q 1 hereby affirm OflaWN R BUILDER DEC RATIOor's License Law for the OVER B%Xt AMPS D BATH REMODELREPAIR D DEMOLITIONS ' J3iU following ream..(Section]0315,Business and Pn,masinna Cale:Any city or county SIGNS ELECTRICAL ❑OTHER .�1�,r�{Y- O�aj, whiebrcq re: pe a o t h rep d Lh p'r Ya «ore TjZ'" Gq�V1L ppq�10 ] pr or to l: 1 4u ih al pl' ml r' bl telt 11 'y d.t t eat SPECIAL CIRCUIT/MISC.' a9qG CC} that he licensed p pursuant fmC t tr:L 1 (chapter 9 rLwit ti�Q� (commencing nil Section 2IX00 of Division J of the Business and Prore-. Code)or TEMP.METER OR POLE INS'r. COMMERCIAL:LM o oC that he is comp therefrom and the basis for the alleged esemmmn Any violation of D NEW BLDG/ADDITION D DEMOLITION X 4• Section 7031.5 by my applicant(or aperr it subjects rile applicant to a civil penalty of POWER DEVICE S y1=y - ❑TENANT ❑FOODSERVICE. not more than five hundred Jolters y ampl IMPROVEMENT ❑ 6 wi Lo the work)the Property,mmycmntendes with wages vs tale(Sesole comp Business SWIMMING POOL ELECI'k IC A�G will do Newmrk.and the nm«urcicurs License otficrodLawdo lis sale toan owner W, and Pmfrosiob Cod e:The Com therco License Lawdoes sucnotapply himself owner of \ OU'TLI?TS-SWI'T'CHES-FIXTURES properly who builds or improves thereon,and who duct such work himself or through his own employees,provide)that psuchrov improvements w are not imemleJ a,te, for NEW RESIDENTIAL ELECfR eale.IL M1owcvcr,the building nr improvement is sold within ane yd or impmplefor pm- [�� SQ.Ff.FLOOR AREA EISA.hT. owner-builder will have the burden or proving that he did not build or improve for Aur- . Pus.m orleJ. .'' , : .•' .. - •. D I,asowner of We properly.amre licensed commemrs to Ya' •. construct the project(See.7044,Bu.samss end PoneWuna Code:)The Ch « ntrnn,' Li- 9 came,Lawdeas not apply man owner ofpropcny who buildsor improves thermos,and QTY PLUMBING PERMIT' FEE who contracts for such pmje«s with a calumnious)licensed pursuant to the Contractors ^� License Law: PERMIT ISSUANCE m twer"under Sec. .B&PC for this son \ - Owner Dam ALTP,R-DRAIN.@VENT-WA]l?k(eA) �� r Gh AEUA'TIUN ' R'S COMPS NDE' RATIO - BACK FLOW PROTECT.DEVICE �Vrl I M1emhya um uiMcr Pcnahy of perjury one n!Ne fnlloxing clamti a ///Y(/ I have and will maintain aCenificam of Conant to self-insure for Workers Compcn- DRAINS-FLOOR,ROOF, A,C AREOND. STORIES TYPE CONSTRUCTION cation,as provided far by Section 370h of the Labor Code.for the Psrharmace or tile' work for which this permit is issncd. - FIXTURES-PER TRAP , ❑1 have and will nwimaln W..ire,Gompcnsaioa Inaumnce,as required by Scene, i 37W of the L.aMm Code,for the Performance of the work for which this permit is issued. GAS•-IiA.SYSTIiM-1 INCA OWLETS OCC.GROUP MIN My Worker's Compensation Insurance carter and Policy number arc: Carrier: Policy No.: GAS-EA.SYSTEM-OVER 4(EA) CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE/INDUSTRL WAS'T'E INTERCEPTOR �, COMPENSATION INSURANCE BUIL NG DI SION FjFS (This sari on need not be enn,plerIad if the pert is throne hundred dollars GREASE TRAP- a - less) miw I'LANCIiIiCK Pbili Loy anychatinthein mvshannror stobehe kmrwhicM1th o thepermitWuiawuLlshall SEWER-SANITARY}STORM EA.200 FT. nen employ any Action in any m her m az to Income whject m the Workers'Comlacn- ENERGY FEE O Z mi.Lawsuf Califomia.Data WATER HEATER WNENT/ELECTR GRADING F ' Z 0 Applicant -. lA NOTICE TO APPLICANT:IL after making this Ccr ificaa of Exemption,you should WATER SYSTI?M/fREATING SOILS F ? becni e.mhlen loda,hWorker's CPcn anon pr, ainw of be Labor Code.Yh_u asst UJ forthwith comply with such p16„'n, ns rthis Permit h.11 he deemed revnAN. WATER SERVICE. yZ 7Z CONS TRUCcIONLENDING AGENCY NEW R[SIDENIAC PLMB. SQ.FT. PACU Dae Receipt n.x G0Iber,hich affirmthatNem issued(S .30 lending agency Thrthe perfomance of thework Name hthis Pamir is issued(Sm.)119].Civ.CJ u” f` LcnJer'e Nunn .. y 'fOTAL • �L) i ardor's Address .i ' TO'1'AI,: Q.1 - - BUILDING FE. I certify that 1 have real this city and application and site that the above information is N buildinlonstr mens and with allanoriz county ordinances osand stain lows Liars the QTY. MECHANICAL PERMIT FEE ' V to Z building constructions eiW hereby uumurim rtpmsentativcs of this<iry reenter upon the SEISMIC FE above-m actioned property for inspection Aur soi PERMIT ISSUANCE (We)agree to save;indemnify and keep harmless the City of Cupenlno against ELECTRIC EE habilities,judgmcnrc,costs and cspcnscs which in,in any way acme against said City ALTER OR ADD TO MECH. in consequence of the granting of this permit.. YLUMBIN I Flili APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI,NON-POINT AIR HANDLING UNIT(TO IBM)CFM) '• MECHA ICALIiEf ' SOURCE REGULATIONS. - AIR HANDLING UNIT(OVER 10.000 CFM) CONSTUCION TAX Signature of Applamr/Contrueler - Data EXHAUST 11001)(WMUCG HOUSI GMITIGATIONFEE HAZARDOUS.MATERIALS DISCLOSURE Will Ne applicant or future holding occupant store or handle hazardous material HEATING ON IT CM 100,000 BTU) as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safe,, Cade,Section 25532(a)?' HEATING UNIT(OVER 100,01X1 BTU) [3y. D Nn PAID ' VENTILATION PAN(SINGLERESID) Dae RecoiptY Will rho air contaminants or amok but Wing by the Bt nae equipment or devices which HOILER-COMP CHP OR 100.000 BTU) .nit ict? us air contamimmnna set Jetine8hy the 11ny'Areu Air Quality Management TA )ismctOY. 0N - BOILER-COMP(OVER 10(1,0(0)BTU) - s I have read Ne hazardous materials mr,uimini under Chimer 6.95 of the Cali. AIR CONDITIONER ISSUMA E fumiz thiceealth&Safety Cade,Sections 25505,25537 and 25534.1 understand th mat if the NEW kE51U1iNTIAI.MECH. SQ.FI'. forbuima Hdoes&Sa�ty Code, v tenant 50 it May and 25534.1 m deri ltathexmupant of the requinnanta which must be met prior to issuance of a Cenificam of(kcupancy. Owner or mancrured agent - Dom TOTAL: ISSUED BY: OFFICE - I f - --- �. - --- - r- - - — - - - - - _ - - - - a ' - - - _ - - - - - -- : - - - - - -. _ _ - - -_ .. -s. _- _ _ - - -. --. . r, . -. - - __- - - - - - _ - . -C. _ - - - - - - - - - _" _ - - - - - - -- - - - - _ - _. y _. . - - �a y - - - _ t _ - - _y _ _ _ _ _ _ _ _ _ _ _ _ - _ _ _ _ _ _ - - - __. - - - - - - _ - -" - - - - - - _ _ - - - - J _ a _ - _ - - _ _ - - s f• - _ - _ _ _ - _ _ _ __ _ _ _ - _ - ..,1 _ - _ _ . - - - - - - _ _ _ _ - _ - - - - _ - - _ . - _ i _ . _ - _ - - _ - " . _ - - - - _ 1. r. • - _ _ _ _ - - - -� _ _ - e- _ .. 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