S 1707 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-BLKC'fRICAL pld(flI No
BUILDING DIVISION APPLICATIONFPF.RMIT PLUMBING-MECHANIC L J 1707
HA� BUILDING PROJECT PICT IItENr11FICATION
ILDING ADDRESS: - SANITARY N(L APPLICATION SURMITI'AI,D61'E
1,933?
OWNEH'S NAME: PHONE: CONTRACTORS NAME: LIC NO:
NIC CONTROL#
,RCHHECDENGINHEk: LIC NO: AUDRCSS: ❑
CONTACT: PHONE: BUILDING PERMIT INFO'
❑ Consultant Fees Paid by Applicant(Initial) ELECT' PLUMB MECII
❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY. EI.EOTRIC PERMIT FEE
I nanny omam mal I a�tt lice ed aides p.nvieinm of Chase,v(cnmmemuing J013 DESCRIPTION
cwz with Section]IXNI)ol DivisionJll lM1e BuxinezwnJ Prnlevnions Coale,and myliccnne is RESIDENTIAL:
ki wPERMITISSUANCE
F� full force and effect. 0SEHEVI, O KITCHEN REMODEL
aUV License Clava Lie# APPLIANCES-RLS IDEN'HAI,
F-Z W Date Ctanm tar OAUDU'ION ❑PLUNKING RIiPIPE
tn6aOMUI.1'1-UNIT OSTRUCI'URAL
ARCHITECT'S DECLARATION PANELS
z C).z Iundc...i dmy car,,haf bemml:a Plmlic raanls MODIFICATION
O L N
U111 0 200 AMPS
❑INTERIOR 0 sIM
OIMPROVIMENT OSWIMMINGPOOLS PTnfessi...I 201-1000AMPS
Qy�J OWNER-BUILUHR UECLARA'TION
C J OVER 1000 AMPS 08ATII HI3MODI?IJRBPAIR ?M TION
xCCG IM1 by'ffmimol pot ,h Concrete"1 I for 3WF following (Safi NIJIS Business dI f Cade:e 5 IY nmy SIGNS ELECTRICAL ❑(TTHEk
olid y p II I f 1 lit P Y-t num
F"LL'U�' prior f - I. y :,happlicantI suchpc 'n II 6 'J.an ncno SPI CIAL CIRCUII'IMISC.
< y this h licensedpursuant 1 In p fin C I t 1 La ICh poa9 COMMEI2CIA1:
00 (cniuu n6wim Su.tm]INNpnfUvis atJot theBor:ssuuod lrklooloCll6or fl:Ml'.MI3'IER OR PULL INST.
6 6 e C that he is exempt Ihcrefnrm and the bWdn for the alleged exemption.Any violation of 0 NEW BLDG/AUDITION 0 GrAC LITTON
XmLL Station Al3l S by any applicant for a permit subjects the applicant In acmlpenally'd POWER DEVICES
h of more Than five hardmd drlla,l WI. OIMPROV ❑FOGD SERVICE
F=< Lus owner of the rt.orm employees with saes as their one cam tion. SWIMMING POOL[LECI'RIC IMI'BOVIiMEN'1'
f trope Y Ycmp > g Penna 0(y THER
F will Jo the work,and ihaswcmreis not imcnJcJoroRcmlfo sale(Sec.](11J,Business
L3 m and Pmfsoaa,Code: 111a C...um is Licen,vr I.aw duax not apply to an owner oI OU'TI,R'I;S-SWITCHI_IEN r
his own who bail..nr.mprovcs r such i and who does wch wotA deed oaf offered f
Ma own owc000cz pnwiJeJ ohm such inprovanenv arc not imcn(it or oRered Inc NI?N'R65NEN'1'IAL ELGC:R
sole.IL hlwemr,fhc huiloling ur intprovcnmm in sold wilhln one year of cnnhplcliom mu Sat P11' L O ,ARI?A F/Sp.PI'.
owner-holder will have the burden of proving that he did not build or improve for pur- e-
, ofsale,. TOTAL: AY 26 1'
O 1,an owner of the property.nm isel.l vely crone......wino Ilren,ttd avnbaetoo m QryQ•0
commute the project(Sec.9(X14.Business and Professions Calc:)The Contractors Li-
cense
i- / �N
r se Low does no apply it)an owner of proterty who builds or improves thereon,and QTY. PLUMBING PERMIT PEE b
vi rnI'aenmrsuntpmleeiscathamnfmena{a)hcorwdo'stanaomeConnanrra �� (.UYthII/YU
License Law. PERMIT ISSUANCE4
0 1 am exempt under Sec. .It A,P C for chis reason
Gw.n DateACO?H-DRAIN Ar VENT-WA'ILIE(EA) - VALUATION
�
WOHK13R'ti COMPI?NSATION DECLARATION RACK FLOW PROTECT,DEVICE
I hereby alllrm om ilw pcnnity of ofCon nnc of the hollowing decWorker's C•:
lhaco and will for byneCion 37()of Garmentr aebinwmfer Worker's Geopen- DRAINS-IlOOR.RWIo,AREA,GOND. STORIES 'I'YPF.CONSTRUCTION
.worn,its s od, his
far by Seaton 3](X1 of the Labor Calc,for Inc pertommnce nI hM1c
work In,which ibisannif In issued, FIX'I'URES-PER'I'RAI'
0 1 have and will Code.
maintain Workers unmpanaw,w rk I. whince.ch
h hisretacoo by Section
J](Nl of ohc LaWr Coaly tribe perfmmuncc nOhe work for which chis pcnuit is isnued, GAS-EA.SYSTI3M-1INC.i OUT[.as OCC.GROUP APN
My Worker's C'ompenwoon Imurat¢v carrier ant]Policy anther arc:
Cartier: Policy Na.: GAS-EA.SYSTEM-OVER A(EA)
CER I'11yCATE OP EXEMPTION FROM WORKERS' GRLASI%INDUS'IRI.\VAS'I'Ii1Nl'IeHCI?PIOR
COMI'I?NSA'I'ION INSURANCE BUILDING DEV ), FEES
.it Icad
1'I'Msacalem need mol be completed Una.permit is fill ane hundred dollars($1any GREASETRAP PLANCHI!CK FEIi —
I ,city that in theprnannarecofine link for whichthis pcona isil,mod.I shall SEWER-SANITARY-S'FORM IA.200 FI'.
t not employ my pecan in my manner so m to become subjecOo the Worker%'Coogan- ENERGY FEE
Z sotto Lows of California.Dao WAI BEE H13ATEH WIVF,NrIELECIN
OQ Appliaum \ GRADING 1:171:'z.J N N(HTCH TO APPLICANT:If,after making this Cenificaa of Exemption.you should WATER SYSTEM/1'BEATING
(~ bovine object I,,the Worker's Carol ...n pnoi,ions of Ina Labor Cade,you mus, SOILS FEE
R,nhwhh comply with such pmvivions or this pennio shall be domed related. WATER S17RVIC13
o
= z CONSIRCCT10N],ENDING AG12NCY NEW RESIDENT IAL PLMIL SO.Fp, PAID 1lecclptp
U O wereny afprm don mem vocalist nio„mndiogagency to, pernnmmee of
W 1- the work for wnichohis pc man is issued St 30v],Ci,C.)
O U bIOTA L:
end...Name 'rOPAI:
Lead...Address '
} O. I certify that 1 have read this application and state that the above information is BUILDING ITE
correct.I agree to comply with an city and county on im,nces ten•rote laws relating to QI'Y MECHANICAL PERMIT' FITE
SEISMIC
II
U z building cahsu'u¢tion,and hervny autbnriee rcprca<nativex of fhi•ciry hmn¢r uqm,he Ri
aMv mentioned pre,ady for inspection pectorals. PERMIT ISSUANCE ELECT RICE ill
(Ws.)agree m ante,Indenmify and keep hanalcen dict City of Capsicum,agninw
lianiliiles.judymene•,costs and expenses which may in city way ucemeo&most said City ALTER OR ADD TOMECH. PLU%1BIN FEF.
in consequence of the gmniing of this permit.
APPLICANNIII IJNI),,S'TANDS AND WILL COMPLY WITH ALL NON-POINTAlli HANDLING UNIT l'I'(1 IO,gNI CPM) III I?GRAN :AI.FEE.
SOL j(" iGULAi'IONS.
- AIH HANDLING UNIT(OVER 10.000 CFM) CONSTRU T'ION'TA%
4
Stiriffmine of ApplicantsConl nor Oat EXHAUST HOOD W/DUCT HOUSING MI ,ATION Fl9?
HAZARDOUS MATERIALS DISCLOSURE
Will ohc alluic:ml or fumm htildioga'apmistun nr handle hamnlons mammal HEATING UNI T(10100,000 If'I'U)
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safely
Code.Semicon 25532bP BEATING UNIT(OVER 10X1.000 RTU)
❑Yrs [:1 No N-LRA'1'ION FAN(SINGLE BESIDE PAID --
Dam Bmcipo a
Will the applicant nr future Wilding occupant use equipment or devices BO
which COMP OHP OR IOB000 RTU)
till hanndnuv:t]1"I'm linantsn•definedbythe]try Area Air Octal try M anagemcal 'H)I'AL'
Uis,Hct]
BOILER-CONI P(OVER IW."BTU)
❑Yea ON.
l hovereed the hoeanloun mmcdalsreymatmenN tinder Chapter A95 of the Cali- AIR CONDI'lION1?N ISSUA CEDATE
h,miu Ilcahb k Safety Code.Sections 25505.295JJ and 2553J.I aalcmand that it the NEW RIiSIOEM'IAI.MliCll. SO.lT.
bnilJing Jut•ten Safety Co haunt octant,that a is my and V 52 ,1 m nodly Iheocagmnf
of the requirements which must be met prior h+iawance of n Certificate of Occupancy.
Ownenmamhorival agmu Date 'IO'FAI,: Isco-11.1-
OFFICE
sco-DHY:OFFICE
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