S 1505APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
OFFICE
CITY OF CUPERTINO BUn.)ING-ELF.CI'RICA].
BUILDING DIVISION APPLICATION/PERMIT 1'I,utIBING-MECHA:NIC'AL
BUILDING PROJECT ]BEST IFICNI ION
Pe IT NO.
1505
BUILDING ADDRESS: - //1• -
7 O
sTN AHY NO.
APPLICAI ONUSBM1'PFALDAT
6 0A
Z`
1 li r
J
OWNER'S NAME:
►:)stn 'HUNT?:
1
C TRACTORS NA li: LIC NO:
NIC
CON 'I'Rol. of
.
AlRel1'IT("' yGINEHIR: LIC, 1:
!/�
ADDR 7 S:
/ A A A Qb
CON'I'ACI` PHONE:
I
ILDING PERMIT INFO
; 1.DG GLECi' PLUMB MECH
O Careadtant Fees Paid by Applicant (Initial)
LICENSED CON'TRACTOR'S DECLARATION
I hereby affirm that I am liamsed under provision, of Chapter 9(emnarencins
win Section7000) of Dismount efthe limi nes. and Profession., Cdr and my license is
i n full Ibrcc unJ nlFen
IJnvnc Ch se l.ic.M
D:dn C,nv:mmr
ANCIII'1'T;C'I"S UIiC1.AkA Nr
Iumdcrstnndnlyplans shall la awda,, publicrenurd,
QTY ELECTRIC PERMIT FEE
JOB DESCRIPTION
RESIDENTIAL
❑ SEUWI, ❑ KI'TCIIFN REMODEL
C1 ADDITION ❑III.OMBING BE PIPE
❑MUCI'I-I1NH ❑SIRUCI'URA1.
MODIFICATION
PIT PRIOR El CHIMNEY REPAIR
IMPROVEMENT SWIMMING 1'001.5
❑ BATH RIiMOD .UREPAIR ❑DIiMQ1.TIlON
❑OI'HIiR
OZ
Oct
ty F-
VV
Q 0.
pm
=Z
Fpr'
t-
WQ
dU
W v
Oma;
'yam
QO �OPationancingth5fr
;SQ
;F-
PEkhfI l'ISSUANC,I!
APPLIANCES - RESIDENTIAL
I'ANIiLS _
UI"IU 2IXIAMI'S
licensed Pofe.aianal -
OWNER -BUILDER DECLARATION
I hereby affirm that 11. exempt from the Contractor's e: AnOc Low for the
bdlox'ing,,awns(Semon]Or'1.5. Puxinez, and Profnsinns Cade: Any airy 1,r county
which restores a permit to construct. alter, improve. demolish, or repair any struma
prem in, I: q tit rppl tf h parnowl torica signed.tatement
that he licensed pursthe provisione,of,he Cournalam, I Low (Chapter 9
714X1)f Diskin. 1Ill the Business ad P lChou,
'llal lie is pt therefieurn antiI book ka,heIIyJ cote far Ay siolari ....of
Swtlot7031.5n tont, r+Psnl nuluers tire applicant
y any app 1
n oneer,than live hundul dollar, ($500)
❑ I.au+ aanfine pmpuny, Or employees wish wage, as their sole en....s, ation.
will do the work, and the otandre is not intended or offered for svic(Sec. 7W4.13usines,
and I'ro(esions Cade: lbe Cuntmetol'to License Law arcs not apply In on owner of
progeny who builds or improves thereon, and who does such work himself as through
his awn anployces, provided! that such imps rvxment. am nom intcnaN er nRercd for
.ele.If. Mwo'en the building or Improvement is sold within one year ofa+mpieinn, the
201-IIN0AMPS
OVER BNNIAMI'S
SIGNS ELECTRICAL
SP CIALCIRCUI'1'/MISC.
TEM R MET ER OR POLE INST.
COMMERCIAL.
❑NI:W BI,DG/ADDITION ❑DCMOIA PION
❑'l1eNAN'I ❑ POOD SERVICE
IMPROV)?MI?NT
❑GFIB,R
POWER DEVICES _
SWIMMING 1100I, ELECT RIC
OU'I'I.EFS-SWIICIIP_S-FIXTURES
NEW R )SID : IAB :LEC£R - SQ IT.
SQ. PL FLOOR AREA
Q '
ovenenbuilder silt have the burden Of flowing that he did not build or improve for Pur-
'IOI'AL:
poscafxale.l.
nmn to
❑ I, as Owner wner of the pmpeny, am exclusively contracting with licensed comm
m L . U
f ' Cain) t un
+ts1 I Ih p Jco (5 ]144 B ., it :.
ssLaw ons'nanapply' l pro,anly who b'IJ.,or I to ve, thercoo.,nd
AP
1 {•a.
_( hunt
v /411
_
QTY. PI,UMBI FEE
wl+m +mmml.f rwcbp Juts soma anrwndylwnsel unalon,l i1he C onerous
J Uf
VV!-eJy �JNI
Uccn.e Law,
nm exempt union, Sce. . B & 1' C tier This rea,on
PERMIT ISSUANCIi
ALTER - DRAIN &VENT-WATE E
VALUATION
Du'e
Owner
WORKER'S COMPENSATION DECLARATIDN
BACK PLOW PROTECT. DEVICE
.t
thereby affirm under pyndlyof perjury ane of the follroving Jcclantiu^s:
❑Ilia,, unJ will mammin oCcniOcae ofCnnwm molt-inwm ha Workc/.Camper,-
DRAINS- ITOOR. ROOF, AREA. COND.
STORIES
TYPE CONSTRUCIO
valiun, as provWod for by Section 39110 of the LuMr Code, for the performance of the
work Biu which this permit in iatud.
PI XURES - PER TRAP
GAS -EA. SYSTEM -I INC. 4 OUT LETS
1 have and will Overran Worker's Compen.valion Insurance, as ralnired by Section
3700cltire Luhor Code, fur the alturnaolool the work foufwhich lin,wrionO, iew.J.
OCCGROUV
APN
CAS - ITA. SYS'fEMAVEk 6 (13A)
My W edail s Cunpcmullon In,unmoc,halo, and Policy mmbcr am:
Carrier: Paliey No.:
GREASEIINDUS'IRL WASTE INTERCEPTOR
CERI'IIICAI1:G1° lXEMPIION FROM WORKERS'
COMPENSAI ION INSURANCE
BUILDING DIVISION FEES
IRE, 11 1RAI'-
I'LANCIIECK PEE
Clmi,.vation rated not be c leled if the permit is for one humored Jnllars S 100)
ar ns.)
I
I cenify that in the pedommance of the work for which this permit is issued. l shall in any m5n,
no, employ any person sed as m become subJen m me Workeri Camper,-
$IiWIiR- SAN] 'I'AHY-STORM1t F.A. 200 IT.
ENERGY VEE
WATER DEAFER WNEN'I/E,LECTR
-
WATER SYS'TEMIT 'RIiA'TING
GRADING IRili
.J
itition La xuksCalIt
o-Z.i y
1•-'
1,Q
Uz
U O
� F-
0 V
�•"
a
UZ
V Z
6655 //,, U�/
¢u J/
r•
NOI Cli TO APY1.1 ASC lf, after muking'his Cvndicate of 6aunfltinn, you should
o
bClnamC xuhivO m the Worker's Cnmpce,al'lOn floviaa^s of the Labor Cads. you ma
limhwhn comply withsuch ton I,,,, Ili permit ,hall be Jcemcd invoked.
CONS I dieneis a'IUN LENDING AG ENCY
I hvreb ff nn that there i.ucanstmction lending for the @mmmnccnf
y° sats) per
the wok for ween his pem,n is i,ared (she. 31197, nix. c.l
Leader's Name
SOLI 4 Plih
WA'1'HR SERVICE
PAID
IJwe RettiplN
NEW ItE$IDIiN'I'IAl. I'LMN. SQ. PI'
TOTAL::
TOTAL:
Ixndce%AJoass
BUILDING ME
1 readan 1 have read chis a,Iwitain and state mar the Nice information i,
emdingugmetocomply
and with all cou^tymntives Of and sten laws ntr upongtu
building c^^swdron. and heathy umhnria apmwnutive>nf this city menmr upon the
aMmve incarnated prol+eny for lnsRclion prefaces.`
ast
(We) agree w soon, indemnify and keep h:mnles, the City of Cnpcninn agin
Iiuhilines, ingmens,mvls:md expenses winch may in any way accent against said City
QTY. MECHANICAL PERMIT FEE
SEISMICME
PE,RMI i' ISSUANCE
ELIiCI'HIC ITill
ALTER OR ADI) TO MECH.
PLUMBING 1' 1
in n.cgnonce of the granting tl mi. fl,...a .
AI'PLICAN'E UNDERS" AND WILI, COMPLY WITH ALL NON -POINT
AIR HANDLING UNI 'I'(ED 111,14X) CFM)
MI!CHA 'A PE
SOURCE REGULA'T
AIR IIANDhING UNIT (OVER IIIJNXI CIIM)
CONS'THUCIION AX
Signemea AFPIkxpmCommcto, I te
HA9ARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle lovarous material
as Joined by the Cupertino shmicipal Crede. Chapter 9.12, and the health and Safety
Carlo Sentim125532(^)^
EXHAUSTHOODWIDUC)
HOUSING MITI.A'1 ION FEE
HEAPING UNIT (To 110.000 BTU)
HEATING UNIT (OVER IOa.(N0 BTU)
VEN'III.ATIONFAN(SINGLE RESI D)
Yes ❑NoPAID
--
I Rcce #
Will the applicant or fume h^ilding rwvo,sad use esp'iPmatn or dcvico.which
e n:it numnlnus as conmm:nums as &Mauro by me Bay Area Air Quality Mmnmgcmmni
BOILER- COMPQHP OR 100,000131' U)
'I OI'AI.:
BOBJER - COMB' (OVER 100.0%) It'I LH
1111,1311';
❑Yr,, C] No,
AIR CONDI'IONER
ISSUANCE1)
nine p
I have rend me hanminuv ntteriaBm a under Chatter 6.95o1 the Car-
NEW HESIDIWI'IAh MECII. Sp, FI'.
fmmivgdoesreSafety Cak,ea tenat.that.25533and unJcrelanh that ifine
nsiali1
building does red currently have o ¢nanq that it is my mpansiMliry em nobly the r+ccurym
Of the requirements which must M met poor m issuance of a Ceniticute of (kcupancy.
'TOTAL:
ISSUED By:
Owner 11, amhorived agent Dom
OFFICE