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B 0648 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO IIl11LDING-F,hN:CI'RICAI. PERMIT NQ. /1 r /� n BUILDING PERTIN APPLICATION/PERMIT PLOMWN'G-MECHANIC-A 'S � !Z IOC(/ Liu NL1})0-U BUILDING PROJECt'IDENTIe11:,CIlON l� \I BUR DING�iRFSSSANITARY N(1. AI'I'LIC.1I'IO�U-1MI�Ah DATE OW E 'S 9 P ) s� I 00 CONTRACIOR:SNAME LIC NO: . 29 NIC CONI'R/Oh a ^IUTFLT F. GI C LIC NO: ADDRESS: ❑ y/ 'ONrACT: PBONE: —/ / BUIWING PERMIT'INFO ,/n#N,/,1 —/ ❑ Consultant Fees Paid by Applicant(initial) Hl.lr� ELECT PLIf- boli IrrYYYll11YJv1+ LICENSED CONTRACTORS DECLARPXI-MON QTY ELEC'rRICPERMI'I' FEE YJ JOBDDESCRIIYPION fJ I hemby affirm that 1 am Iicc osd under provisions of Chapter 9(commencing DSO with Su'tion9(XX)of Divi,ion J of the litomesxand Prvlcssinns Code.md,q hcennc is PERMIT ISSUANCE RESIDENTIAL Fly_ in full force and cffcn. SFDWL ❑KI'IC1113N RIiMOUIiI. cul- cun LiLac# APPLIANCES-BF.SIDENTIN, []ADDITION ❑PLUMBING RE-PINI? HZW Dole�/ - - forma, pMU1.TI-UNIT ❑S'I'RUCURAL ARCHITECTS DECLARATION PANELS MODIFICATION =Zy Z IeNerstand my plamxhall be tordnx public mcordx UI'T020IAMI'S ❑IN'IERICH ❑CHIMNEY REPAIR p 4L,Mj Ileenxnl fond stomal 1111-IIXM]AMPS IMPROVEMENT ❑SWIMMI NG POOLS ai,f j OWNER-BUILDER DECLARATION OVER 1000 AMPS ❑RA'I'11 REMODEIJREPAIR ❑DEMOLIT[ON Ga, =W7 1 hereby affirm that I am exempt from the Contractor'sLicense Law for the OWL tollnwany -ono.sr,linn TOES.Btwincss and Pmovsinm Cade:Any city or county SIGNS ELELTRICAL ❑OTUER NELE- which requites a permit to conuron,alma improve,demolish,or repair any.manure ��o j priormin isstmnce.also requires thenpplicam forsach pemtanofile a sagnedsmmmcnt SPECIAL � } that he i.v licenced punuannnlhe provisions of the Gmvannr's License hew lChapm'') 001 COMMERCIAL, �yQQ (commencing with Sect Division 3 ofthe Business and Professions Code) 'TEMP.METER OR it SI'. 1 L ty o C that he is uxrn pt tn heEen and the ham s far the alleged exemption.Any violation of ❑NEW BLDG/ADOI'I'ION Q DEMOLITION ^y Secretor 71H L5 by any vpplicanl fora permit mhjeos the applicaniin a civil penalty of POWER DEVICE. ❑TENANT 01'GGD SIiRVICIi n mom than five hundred dollars($Spry. IMI'ROVF,MENT ESQ pl.as owner of the property,or my coldoycex with wagexns their sole compensation, SWIMMING PO01 ' C p., willdothe work.and themmaure is not intended or offered fia.mle see-/61d.Business ❑OTIIIiR ac ..ad:mJ Prnlixsiomms Code'Due Cnnlmcl,,6 License Law docs not apply to an owner of OUTLETS-SWIT i -1'1%'1 ORES property who hold,or improves thetcon,and who does such work hmself n,through NEW RESIUENfIAI.ELEC'1'K SQ PI'. his own employees,provided that.such improvements are not intended or offered for SQ FE FLOOR AREA S.SQ.T-n sine.ll,however.the huildmy-r impmvemcnl iv sold within one year of completion,the T- : wncrbmbhT will have the harden of proving that he did not build or Improve far par- S z.9 3 2 8 L�9$ paworxme), I���t� �'ot�`t-d� of the prupeny,am exclusively contracting with licensed commnnms et x�f Clan Ethicvproject(Sec.]bat.Business and 0ofccsioos CWe:)'De Commove,Li- C ecse Law d,x not apply hat an owner of property who builds or improves thereon.and QTY, PLUMBING PERMIT FEE �f� © ,-x asp f who contracts for such Projects with xromracnmr(s)IicenseJ pursuam mthe Cnneucmr's /7y ({ 00 I.iccnsc law. PERMIT ISSUANCE p I ant exempt ander Sec. ,R&P C far thus mason ALTER-DR &VENT-WA'I ER(EA) VALUA'1'1(IN . Uwncr Dam WORKER'S COMPENSATION DLCLARAHON {ACK RR. W I' IiCi'.DIiVICIi //� 9 I herehy amm under penalty of perjury one of the(athero,dad-ration L �\ hoe and will noinunin aCenificatc nt Gmscm 11116-insure for Walker.'Carol'- DRAINS Iq.00R.ROOF,AREA.CND. STORIES TYPECONS1$UMION tion,as Emoided for by Section 3]1X1 of the labor Code.for Ne perfnrmmoce of the 2- work fur which this permit is issued. FI%TUKIS-I'E p 1 have and will maintain Workers Comiwnsalion Insnraec,as required by Section 390Dofthe Lahr Cede.fe,he petfnnnance of Ne work fur which this per mit n issued. GAS-IiA.SYS'fEM- l!.J OU'I'LIiTS OCC.GRf111P Q Ai�Nh(J My Wad 'aC�nmy'S^,y�uopp��sf urunce carter and Ynliq (!.� OAS-1?A.SYSTEM-OVLIF4 AE /J �/ •7 lib CartierQ'.ph Ynlicy No. .�- /C '✓l CERTIFICATE OP E%EMPTION FROM WORK'RS' GREASEANDUSTRLWASTE 1'ERCEPIOR COMPENSATION INSURANCE BUILDING DIVISION FEES (This ecromareed no hccompleacJ ifthe permit is fortune hundred dollars(SIM) GREASETRAP 1' t1:AN. Eft Or levx) lanify That inthe pcNrrm c(if 0c work lin which this permilis ssueJ,lehall SEWIiR-SANITARY-STORM IiA.21XIIT' IiN1iG --X IIV� nation) employ any Canoninany m ncr. as ty bcegmgsobypm Ne workeri Cumpen- fat V c O z 'attar haws of Cal'J'orga.D._�[JL� (I O WATIiR HIiAI'F;R W/VENT?:LF.CIR -( ) hili II Z Q Applicata sr.L, 1 �- r NODCE'1'OAPPLICANT.If,after making lbix Certificate of Exemption.you should WATER SYSTENNREATING gOI (I 9oO abecome vobject to the Worker's Conmpcnsalion lowixinns at'he I.abor Gale,you ama #7 L W forthwith comply'with such provision or this perrou"fall be deemed revoked. WATER SERVICE Q f PAID ES' CONSTRUCTION LENDING ACIiNCY NEW RESIUIiNI'IAI.1'LMB. SQ.lei'. =) z tY� Dam Bcceiptp U Q (hereby affirm that is a consnunion lending agency for the performance of -� 16 F. the work farwhich this permit is i oned see.31197,Civ.C.) _ CUU Lender's Name TOTAL: UW Lender,Addrrw BUILDING FEE G 1 certify that 1 have read this application and vote that the above admonition is ,... rp came'.I agree).comply with all city and county ordinances and same Inas minting to QTY. MECIIANICAL PERMIT FEE SEISMIC IT U Z huildingcnnswnlnn,and hereby:mmhorivn reprevenmdves of this city m cone,-pun'he ahovodamom ed property for inspection Paryoscs. PERMIT ISSUANCE 1.1-C'I RIC ' (We)-gree to save.indemnify and keep harmless the City of Cupertino against liahilitics.judgmems.coos and expenses which may in any way accrvc against said City ALTER ORADDTO MECIL PLO I �E in con.mquence of the granting of this Permit. �2�g APPLICAN'I'UNDIRS'I'ANDS AND WILL COMPLY WFIH ALL NON-1'OIN'T AIR HANDIANGUNITflO IBJXIOCFM) MI AN 'AL ITT SOURCE REGUI`TIONS. AIR HANDLING UNIT(OVER 10,000 CI'M) CONS UCII N 'ION'IAX .,11Z s � ,�gi EXHAUST ofAplicarousntmctor Date E% AUST I{OOD(W/)UC'q HO 'ENG MITIGATION FIiIi BAZARDOUS MATERIALS DISCLOSURE Will the applicant nt future building Occupant stem or handle hazardous material HEA'UNG ON I'f(10100.000 II'FU) as defined by the Cupertino Municipal CsMp,Chapter 9.12.and the Health and Safety HEATING UNIT(OVER I(p.IXXI BTU) Cada,Section 25532(a), I C]Yes on VENTILATION FAN(SINGLG BESIDE PAID Umc Receipt p ',II the applicant or future building occupant use equipment or devious which BOILER-COMP CHP OR 100.000 BE adme,air conmmiall vs efined by the Bay Area Aar Quality Management 'I OI'AI-: �1 BOILER-COMP(OVI',K If(I,1XXI BTU) _p Yes L-1 no AIR CONDITIONER ISSUANCE DATE [have mad the Cure. a tiosr S 5.2553 etas under Chxpler nal al bacCal'. ' feria Ilcahb&gafay Grade,Scetiuns 255115.25513 and 25534.1 unJcmmuJ that if the NEW REtiIDEMIAL MIiCH. SG.PE 7 Zv,Q p huilding d ncrat cunendy must a met p that it is my rcspmto Cl ity r nmify the occupam e mequiren¢ms which moll tc mel prim m iss nee of a Certificate of 'enp cy. �^ umhn'zaJ ager 'Date ew TOTAL: ISSUED BY: y OFFICE