S 1232 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY Tye CUPERTINO II.UMOIN1: NI.E ANIC\6 I'13`(�lIT NO
BUILDING DIVISION APPLICNHON/PERMIT' BUMRN'C..ELCI RILL J 1232
BUILDING PROJEC T IDEYI'IFIC 1 RON
BUILDING ADDRESS: jSNIARY NO. AI'I'LICA ION SUBFIII'TAL DADi 112OWNER:S NAME: PHONE: CONTRACTOR'S NAME: LIC NOCUN L p
CI11'I', IENGINIi13R: LIC NO: ADDRESS:
CONIACI` ' p1�'HONIi: Q, BUILDING PERMIT'INFO
13-VM I k� `-0�J 1 T N✓ ❑ Consutlanl Fe"Pail by Applicata(Initial) BLDG CI' PLUMB cu
zti6
IJCCNSIiU CONTRACTOR'S OEChARAI'IONQTY. ELECTRIC PERMIT FEE JOB DE$CRII'I'ION
1 hereby anon that 1 am licensed under provisions of Chapter 9(commencing
DAC, with Scc(i,,.70 ))of Ulvision3ofthc Business and Profc"am,Cult,andmy liaenva is RE�JDF.NTIAI:
i n full love and alien. 1'F.RM11I'1'ISSUANCIi Wh ❑KI'TCHIiN RI?MODE(.
aVV License Class Llan APPLIANCES-RESIDENTLid, ADDITION ❑1E.UMBING RE-1'll'li
Q G Date Commcmr
nRCH]IECI"S UCCLARKI'[ON ❑M11UIT1-UNIT ❑STRUCTURAL
IANhIb MODIFICATION
I andcdnry plain.hall Ise unednspWlic records
Omm�
Z=c UP TO 2W AMPS _ ❑IN]I:RIOR ❑CHIMNEY REPAIR
1-.-_tW Licensed Professional 1111-100AMIS - IMPROVEMENT E]SWIMMING POOIS
a V following ereby cion that I al.i exempt
Rand he Conionx G•License Law for the UV]31t IpIXI AMPS ❑HATH REMOUEfJR1iPAIR DIiM01,ITION
a4 OWNCIt-RUILDER DECLARATION
C y d P - ❑OTHER
Nc:Any city or county SIGNS ELECTRICAL
3 W y which requires a permit to con.amct alter.improve,demalkh,or repair any suuemm
......in it, , I: ac"de,m PPI' It h,crati(to fila 'k iv taco SPLCIAL 111111111ISC, -
��y-J hmhc] I dP tl ]h P Oh C I I rsi W (Ch Pmn9 N F
(.oro mnngxlh Scce vpxD fD vtxm 3 ❑h B : J Pr f_. .Cadet nr TEMP M11HfER OR TOLE INST. 'cI C�'YMERCIAL:
It
W. o a Ih,hen excn,,I,m,no,and the hasix bathe alleged exon Ii,,,Any vndmioa of — '0 NEW BLUGIADDITION ❑Urmo rm
�w Section 70315 by any applicant for a pemulsubjects the applicant a civil penally of IIOW17R DEVICES ❑'[FNAN'I' ❑FOOD SERVICE
FZ} urn more than five handled doll.($5010).
IMI'ROVIiM1iN'1'
�MO (] 1.an owner of the pmpeny,or my employees with wages as their sale cnmlamsmion. SWIMMING POOL ELECTRIC
6 0
will 01 HER
III,thew,ak,and the lmemm is not rotatided.....t tared forsale(See.7m14,Millar'"
a,3 m
and Yndezaons Cal The Cnnlmctor's Liaensc Ww does no apply lu an,owner of OU'I'LII S-SWITCIIIiS-FI%l'UkliS _ _-
,ropeny who builds or improve.thereon,and who dries such work himself ar through
his own cnT'Ioyces,provided that such Iommovalunts am not intended or..Tared for NEW RESIDENTIAL ELEiC1'R SQ PT.
sale.It.I r.the building ur im"o ant iv sold within nuc yca of no,lrtion,11h, 5Q.IT.Il.00k AREA bISQ-IT.
oismar-builde,will have thb rJ fp rc ,lia,he Jd I,,tm lJ or improvefor par.vorc,a
LI )
fi r pr p ty 'I_lis ly I ct y with licensed t tints m
I theP 1 rise 7044. 1 1 l"Idellftell Cal )TI C t risetors l'
ave Law due not apply I n fP property h h Ids improves thereon.and QTY PLUMBING PER, PEE
who contracts for such projects with a commons)Iiccmpursuant ed pursuano the Caremcu rs
h1
Li,envc Law. 1'E1'I
R 'ISSl1ANCli
❑ Iron exempt radar Sec. .H&1'C l orbs,leaven
ALTER-DRAIN&VENT-WA'TCR(UM yALUATION
` n] Dale 3 0S ®�Eli ''
WOItKEN'SCOMI'CI SA'I'I UI,CLARAlR BACK MAW I'HIIIECI'.
I hands,will ince uadtr penally afperja t al the following daclaratiene
0,]W[huvc and will maima:n aCcnifcam of Conwnuo elf-insu¢for NSnkcr's Gamlen- DRAINS-FLOOR.ROOK AREA.0 $'TORIES 'TVI'E CONS'(RUCTION
sution,as provided Ibr by Suction 39(X]of he Lahor Code,lin the w ammnee of the
work tar which Ibis,triol]is i...ad. Il X'I'l1kliS-PIiR'(RAI'
1 have and will unionism Wnrkcrs Cotn,toisminn Insurance,as minimal by Station GAS-Ids.SYSTESI-
3VIXc
l of the lahor CtNfor the,,donarnce of the work for which this permit is issued. (INCA OCI'1.1?"fS OCC.GROW' MIS
My W..ker's Cnn:pndatlnu lnnumnc,carrier mrd lleicvnnmbcr am: GAS-IA.SYS'I'HM OVER4(EA)
ID
Canicr. 1'nlicY No..
CHRD FICA'TE(IF EXEMPTION FROM WORKERS' GRI:ASMNDUSTRL WASTE INTI:RCI""0R
COM1IPENSAHON INSURANCE BUI. INE DIVISION FIiP_ti
(Ihissenion need not nucnmpleted it the pcnnil is be ntchwNmd dollms(bHX]) GREASE[RAI'
I'LANCIIK I'hli
or less.)
I cenify that in the perfnmlancc of the sear&lin xhich his Permit is issued.)shall SEWER-S - M1'A.2 F'.
all employ any person in any manner so us to becontu cuhjmt to the Wnrkcrs'O an- ENERC Lli
.Z x dion Lawsol'Culiformil,Dam WA'IPR II '1 WIVI d_ 'R GRADING HE
N NOTICIi TO APPLICANT:If.mwa n akin,this Ccnificmc of Ever ion.you should WATER S i /IREA'I'IN
hu'ontc xobjecl m the W..kcrk C'n:npms:ninn Pro,kil nI he LlhurCode,Yom
u nsl SOI(ti 'E
�
d+ lonoviln comply with such provisions or this(wood shall he deemed revoked. WATER SE _
0. Q
CONSTRUCTION LENDING AGENCY NEW RESID IAL PI.MB. SR ET. PAID
Dam kaaip]M
I hereby anfr:]t that roam ix a mo.o-an;..a Im]ning ngnmy Tonna nary rnatna..r
{UL O the work Ior which Icn
his pnil is issued(Sc,31X)9.Cr,C.) 'ID'ITL:
Landis Name
U
trhcnJcra AAJress BUILDING I';:
I ecnify(hal I have read this applkatio,and luno tha the above Iufom.alion Ip
E-' N Co."l agrttm comply with all city and county ordinances and stale laws relining to Y. MI:CHANICAL PI7RMIT FEE SCISNE 7
U boldingmnstmcdan,and hereby authorize mpresemmivcxof]his city tocnrar upon the
above,...at..n ed ptopcdy In,iaowltiun pug:oses PERM)(ISSUANCE [1.17-1 C IE
t (We)agme msave,'mJcnmify and lose,hannlcxs]he City ti]'Cape' again"'
liabilities,judgments.casts and expenses which nsayinany wavarnrueagain.,said City All(:101 ADD TO MECH. PLUMB( -ITE
tcequcnce of the gmnnng of this permit.
API'LICAN'1'UNDIiRS'I'ANDS AND WILL CUMPhV WITH A1.1,NON-POINT A I k I IANDLI NG ON I'I'(101 Oj XX)CFM) MECIIANI LIBC
SOURCE REGULATIONS.
AIR HANDLING UNIT(OVER I0,00)CFM) CONSTRUCTION TAX
:ignmur' p it oat t C) , `7 1/)nm IIXIIAUS'f IIUOD(VIDUCI) III IIISING MI'fIGA'I']ON FEE,
HA%ARDOUf/1s1A .RIAIS DISCLOSURE O
Will mta,plicam orfunne nand Bcecupan'smre or handle hacaNuusnmmrial HEiATING UNI'I'(TO IIXLINq BTIO
tie dufmW by the I naninu NJ pal bdc,Chapmi 9,I2,and the llcullh and Safety li'I'
IIIiA'I'INC UNI (OVlIIt I(NI,IllNl lJ)
Gude,Section 25532N)p
❑Yes [I No VESNTI I.ATION PAN(SINGLE BE SID) )'AID
Date P
Will the:y: ntort'u am mildingacctt,attl use eptipmmu or lwviecx which I30ILIiR-COMP(311I'OIt I(N),IXIOIfTU)
mi]namrdaun air con undrum.s as defined by the Bay Arca Air Quality Management 'f
Di,oic''! BOILER-C(MIP(OVER 100.INN)BTU)
Vcs ❑No
Alit CONDI'I IONEH ISSUANCE DATE
I have rust the Cash,S s mann,255als 5.1i 533 a tinder Chapin.understand
0l the Cali
forma,doth&Sfey Gula,Sminns 255(15,2s ,,and,,S iIj 1 o,nied b thin if the NEW RESIDIiNT1A1.MECH. SV.FT.
buildingduo"notcurrentlyhove nmama,that'n is my rollout Cann mnotifycuancy.
a(We regaircmcn(v which nmd he nml prior In issvnncc al n Ccnificum nfOccup:uny.
Owner nr uulhnrired agent Oma H ISSUED BY:
OFFICE
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