S 1676 APPLICXtTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO HU I LDING-ELECI'R I CA I. ITI O"P NO.
BUILDING DIVISION APPLICATION/PERNUT PLUMBING-MECHANICAL 1676
RIMMING PROJECT1HENFIF'ICA'1'I0N
BUILDING ADURESS: SANITARY NO, APPLICNI'ION SURMI ITAI.DAIS
C . 95m-q-
OWNER'S NAME' FHON1!: )NTRACI( 'SW\ IE:� LIC NO:
' lK?. DIC,
NIC CON'IR(lhp
lalSCBII'IiCT/IiVGIN13EN; I CNO: Add UDRP C ❑
ta
'ON'TACE - PHONE BUILDING PERMIT'INFO
2 I ❑ Consultant Fces Paid by Applicant(Initial) IU.D(i ELIFCCI PLUMB MECCU
❑ (C ❑ yu
LICF.NS ID CONTRACT RS DEL.AHATION Q'py, ELECTRIC PERMIT FEE
I hereby afGrnt ilial limn licensed lmder provisions n(Chapter 9(ennm,enaing JOE DESCRIPTION
Z with Section JlNN))uf Do'ho.1inf the Ounivozund Prnfessionr Cudc.and my license is RF• .SIIJF T�IA�:
lypp In PERM IT ISSUA NCI? --{5
K0F fall Lrccomd clJ¢g��p2� n FUWI. ❑KHCHE RE ODEL
aUU Licence Class— LiC.M AI'PLIANCLS-ItESIL1iN'I'IAh ❑ADDITION El PLUMBING RC-PIPF
FZu] Dute Conwctnr
teas ARCHITECT' .ARA'1, PANELS ❑MULTI-UNIT CMODHTCURAL
F Z I undccq::nJ m plxm shall M1c ucc .PuMic nv. n s M(1DIIICA'rION
OZN� y UP T0In)AMPS CIN'rERIOR CCIIIMNHYRIiPAIR
�4,1"„W Licensed l'ruleesinnnl PBI-1000AMP5 IMPROVE:X11iNT CS\41MMING POOLS
OWNER PUILDEH DECLARATION
C Q 1 herby affirm lbw 1 am cumpl Bum the Convacmr's Licutse I.aw Ibr We OVER BX)0 AMPS ❑NnTll kEIpODPURE'AIR D tM .I ON
x11 p 1 V following name.(Section 7031.5.Business and 1'mfessions Gale:Any city or county SIGNS ELECTRICAL TI IF:R 1]
1+13 a y which requires a permit to construct,alter,improve,demolish,or repair any alucmre
FC-�•pa Four oitslnsaace.lik+r,q.ircxlheapplicant hulud,Cmtino file a,.,mdswcu,vrI SPECIAL CIRCUILMISC,
that he is licensed pursuant to the provisions of the Canonici-,License Law(Crane,9
WCpO lmmmcn,mg with Section 7IXI0)n(Division 3 of lire Rulbass and Profexsionc C:xfe)or 'I Emil MISI ER OR POLE INST R L.
66 c IY that he is exempt dontrum it the basis for the alleged exemption.Any violation of ❑NEW BLDGIADDITION C DEMOLITION
X^m Seaton9031.5 by try vp,l,.nl Gauttcmti(subjects Hcapplicant m v civil perahl of POWER DEVICES OTENANI' OFOODSERVICE
not mum than live hundred dollar.(5500). IMPROVEMENT
,Za❑ vc
E]Lmnwnerol'Ihep-,voy.ormy mnpluyees with wages acthcir sale compensation. SWIMMING POLL 1:LFCI'RIG
F• will do the work.and theo0ture is not imm�deJoroffcred forsale(Sec.70U.Business OTI IER
3 m and Professions Cute:Thu Comrinnr's License Law Ines nut apply m vu owns+of OUThI?TS-SWI'CCIIE$-IIX'TURIiS
prnpony who builds or improves thercon,and who does such work himmlf or through
his own uo pinyws,......Wild dial such hnpnrvenw7ns me.1111 iacnded a npemd 15n NEW It ESIUCN'11Ah I?LIiCTR SV 1'I'.
P L(IOR ARBA 5/SQ.I'1'
nsle.If,howc,Ir,the buildingor improvement is sold withinoneycarufcomple ion,the S . .
.rhuuder will hxsr We Imnlcu of proving that he dud not bald or improve lot put-
posenfsale.). '1'O'I' '
F1 I.its owner of the property,am exc 1-ively cmnraetiog with bcenscd contractors m ( 4
instruct the project(Sec.70aly Business and Prnfessiom Code)Hic Cordial Li. /
,rova l.aw dornm upply,o;muwner of property who buildxor hnproscs(hcnon.and QTY. PLUMBING PERMIT FEE
win s tmrma for such pnrieas wish n enmmctngs)IiccnseA par ualn to the Contractor's
Liccmc Low. PERMIT ISSUANCE
C l amesonpt ruder Sec ,B&P C far this reason
ALTER-DRAIN&V IiM'-WATER(tiA) VALUATION
Owner Doc
WORKER order
fi COMPENSATION FI TIQN DECLARATION RACK FLOW I' F. C' _ � /��
I hereby off nn under penalty of pvrurY one 11l die Following Jeclnmtinnc: s 1, -t, L.I
I have and will maintain a Certificate"cc...cut to self-insure for Worker's Conten- DRAINS-Il k N U. S'I"ORIGS TYPE CIINSTHUCUON
tion,as provided for fly Semina 37N)of the Lahor Code,Ga the Perfunnance of 1M1c I- I
w rk lot which this permit is issued. FIXTURES-PE �R+ s
i have and will nainwin Wmkcr's Cmnpcnsatinn In,mansc,as naryired by Seel... t_7
.)0(Ioflire"No Gds filefie Kdomance nobs work for x hick this permit is issued. GAS-EA.SYS" 'MPI 1�C.JOOT1.Ef' OCC.GROUP APN
My n
Worker'k�� tlnsurt
rance su rand l'oliuy iib
Correct na l Policy Nu.: GAS-I7A.SYSTIiM-OVFR4(EA)
CI?RI'IFICA'll?OF EXEMPTION FROM WORKERS' GREASFANDUS'I'RL WASTE IM'ERCEMOR
CONUTENSATION INSURANCE BUILDING DIVISION STEPS
(I'hixsecdomm,dold beculmdrt,J lthc urnlif I,hoormbunchIddollar,($1h)) GREASETHAP
PLANCiIIiCK fEli
less.)
Icettlfy thwln the aPedorny manner
luffic foe which this permit la,rsu Com uillm- Sli\VIB-SANITARY-STORM EA.200 ITT
mol employ any person many manner at as m hernme subjcm to the Workers C11opcn- ENERGY FEE
Z strum Laws of Caiflum. Late WATER HFATER WNI?NI'IELEC R
GRADING Ili
z O Applicant li '
to NOTICE 10 APPLICANT:It.after naking thin Ce oleate of H.vua,tion,you should WATER SYSTF,MICREATING
bee suh',cc,to the Worker"Comsovelion provisions of tLaboraf
e Lam Ce.You mm, SOILS FEE
n
W r hadwithcumply with such pnvicmm ort his gennitshall be deemed revoked WATER S17RVIC17
Q
p" CONSTHUCI'ION LIiNDING AGENCY NEW RISIULM'IAL PLbtll. SQ.ITT. PAIL [)ate Rcociplk
U OI h...hy affrnl(hat there in a cnnawnctinn lending agency tot the serhmnmac of
F the work file which this permit is issued(See3(X17.Ci,C.)
OTAL
Lcndcr's una 'TO
N :
U Lender's Address 'IOTA I:
LU I Teddy dot I h;nc,cad tltis:ytplicmiun and aline Ort oho above iofn ration is
BUILDING FEE
LU
F-' rn correct.l agree to comply with all city and county ordinance and state laws relating to QTY. MECIIANICALPER1,7IT r'Br: SEISMIC IBB:
UZ build inga.uIncli ,and herchy au,botim rupreuoumvesoftIn,city lucatel up()"[Ile
al.we.mentioned propeoy for inspection purfarec> PERMIT'ISSUANCEJ.VCI'RIC,Ilii
(We)xgne u,xr,x,inden my and keep h:melees the City of Culawinn agaimt
liatudities,judgnaoa,costs and,,pens'%which may in any wary accrue against said City ALTER OR ADD'TO MSCI I. PLUMBING 19ili
to
cn...em"nce of the gmnling ul this prior,.
APPLICAN'I'UNDEHSI'ANUS AND WII.I.COMPLY WI'rII ALL NON-POINT AIR HANDLING UNIT(TU I(,INX)CFM)
SOURCE REGULATIONS.
AIR HANDLING UNIT(DVI?R III,IXNI CPM) CONS'IRUCHON']AS
Signammul Applicanl/Cntnnart Dae EXHAUST 11001)(WMLJCqWI.QC`Mfl'IGA'HON FEE
HAllARDOUS MATERIALS DISCLOSURE ( _
Will lhaipplican(nr futunhuildingoecnpaut shtnorhandlehvanrdoucmvlerial HHAIING UNIT('r)100.00 R'IIJ)
as alined by the Cupenina Municipal Cala Chapter 9.12,and the Health and Safely HEATING UNIT(OVER 100,001 RTI))
Calc,Sc,ion 25532(x)'!
E)Yes CNo VENT)IATION FAN(SINGLE R ITS]D) PAID
[)arc Heceip a
Will the applicant nr future buHiring:Kcupam use equipment or devices which BOILER-COMP(31111 OR 100.00013'1'U)
ni1h:la.duus air cooloolincntaas darned by,he Bay Arca Air Quality Manageole"I TOT L:
ixtricf' fall I'R-COMP(OVER 100,000 RTU)
❑Ycc ❑No
I have rend the ltwadnuc nam:Wenqui.cu:cal sunder Chapter(195 of the Cali- AIR CONDI'HONI?R ISSUANCE DAZE
fnmia Health&Safely Code.Sections 8505,25533 and 2594.1 undentand that if the NEW RESIDEIVI'[A].MSCI I. SQ.ITT ^ Lb l
hm1ding,i—not Immody hove n antra,@x,it is my resp:n+sibil'ay,n nudity @e a,cors m lll2,�
of1be rtgldnnientn which mast he met poor at issuance of a CenMeate or Occapaney.
Owner or amhuriaedage d Ibae 1': ISSUED IIP: O
OFFICE �! e