S 2433 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT Na.
BUILDING DIVISION APPLICATION/PERMIT PLUNIBING-MECHANICAL 3rj
-3 IIUIhDINC I'RO.DiG'I'IUEN'1'IFICA'I'ION
P.C]LUNG ADDRESS: EIARYAPPLICAI]ON SUHMI']'ITL DAPI
ia A s v6fRo - o rzOWNI! 'S NAME:AV�� I'IIUNE: /(',r` COt'.,RACI'f)k'S NAME:,/l LIC NU'.257- 320 SFS=Z KrTc//[ S �(.5�4� CONTROL#
�CIIITECII!NGINF:ER: LIC NO: ADDRES
k
CON'T'ACT: PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLIH'i ELECT. PLUMB MECH
N 4 1cm*XQa4 - a- 1�e 2- Q" Q`
LICENSED CON'IVACTOR:S UGCIARAI'ION QTY FI.EC'I'RIC PERMrr FEE
1 hereby infirm ma,I nth licensed under nowilior,of Carl9 Uommenrmg JOB DESCRIPI'ION
C=Z with Smi..700(Bot'DiWshm 3 ofthe Resines and Prefe.sions Codcandmy license i. !� RESIDENTIAL:
WOO .f PI3RAlITISSLANCE SV
F io bill lbrccunJeEect ❑SFDWI, CKITCHENRENIODEL
�UU License C,hsr Lic.p b APPLIANCES-R INIDEN'I'IAI. ❑ADDITION ❑PLUMHING RC-PIPIT
FZW UmeGmrmnor
vsQp, ❑MULTI-UNIT ❑sIODIFICAT16
ARCHIII: DITLARATION
ZOOOZ I understand my plans shall be used us Public records UP TO
CHIMNEY REPA
O Z En UV'TO 200 AMPS
❑INTERIOR CHIMNEY HIiPNR
licensed l'm!sionul 201-1000AMPS IMI'ROVEMEN'IE]SWIMMING POOLS
OWNIiR-MJILDER DECLARAI ION OVER IIXOAMI'S �i�ATH KWODELIREPAIR ❑DIiMOLGION
C C Q I bamby aIT,.that I ion esemp,four the Cnmraur s Licens Law fur tM1e
2 p W U ❑OTIII:R
X a following reams(crouton]03,5.Business and Ise.den
Cede:Any city or county SIGNS ELECTRICAL
W 3 W h which require,a permit m mmnucr,ol¢r,impmvc.Jcr,olixh,or,,tura any.rreum
�W�-5 print t alx..ucciture,J 'spits I' Ip tit, II g lacunar SPECIAL CIRCIII'DMISC.
'he,he licensed pmsu tlI,theplost'.ton f he Ctionaclue,l Low(Chapter 9
may'<0 Rionatencmg with Section]INXII of Division 3 of the Business and Profession.Carter r TEMP.X=iR OR POLL INST. FR AI'
t1 a e C that he is exempt thcrcGam and the basis for the alleged exemption.Any violation of ❑h /ADDITION ❑UEMOLI"TION
W- Sralion 7031.5 by any applicant I'll apennil subject-,the upplieran lon 61d punnity of POW17R DEVICES TP AN'T FOODSERVICE
H. Vat not nmre than live hundred dollars($500).
.r'.=Q I.a,owneruf,he n SW I MM INC,I.00I.ELECT IC 1'RUV EMIiN'I'
O ❑ trope y,r mYcmntendedintNwagcws,nle((Sec.
utmpensiresw ❑ 111?k
F. will Je uhewud..and,M1c Late
nnotlmendiva,La doesed .ul reply ]t u4,Bus
tail�m .hnA I t..' ( nlc: Ih C t t ',L - L does...t reply in, owner of (IOILFTS SWI'ICHFS 19 X'FQRE9
tat. property who buildv or morove,thercon,jund windoe,:dr k hun,ofttr hou.,li
his own arployces,provideci pal such unproverricars are notintended or offered or NEW RLSIIII:N'I'I Al,CLEC'!'R SQ I-C SQ,ET.FLOOR AREA SJSQ.F1'.
sale.IL however.the building or inprnvement is sold within one year ofn,mplstiun,the
nerhuilder will have the thankn of proving that he did not build or Improve for put.
,-v It alai '1'0 ( O
E] Lax owner of the propuay,ant es,lusivaly aonlrimling"Ili lcrn
Ised ennvucatr nh
,...true,the prolve,(See.](144,Ravines,and Profr.sionn Chen TLe Contractor's Li-
nseLaw does not apply to an owner of Propeny who build,or improves thereon.and QTY. PLUMBING PERMIT FEE
ebb,rearm.,fuser projects with a romrnods)licensed pursuanuo the Contractors
Licence Leu'. 11ERMI'r ISSUANCE. g
I ant eneohp,noula Sec. ,B K P C fill hI,reason
AI:I ITR-DRAIN&VENT-WA'fF.R(EA) VALUATION
wncr
Dau,IO n
WORKER'S
wan for Ilia'I or DECLARA'T'ION RACK FLOW 1'ROTF,CF.DEVICE 7
IhandIs nllie underpenhlteatoolCouscu ,set inor,on,dmrker', ran¢ DO O
❑ Ihnvennd will mainrainu Cenilinnw,fC'onwnno nclf-in,u¢l9r Wndcr's Crmpem DRAINS-FLOOR.Ii001'.ARRA,CONI, YI(lR1ES 'TYPE CONS'I'kUCT10N
salon.as provided for by Scotian 3700 of the Labour Code.for the perf rreance of the r /
tura
k in,,which this permit is issued. FIX'T'URES-E'ER TRAP
'lliIIII have and will ode.fan Worker's anue olstire w rk bor in h ,%pe 11
by Section
pfNlul tM1c hhM1ur Code far tire lwr0nm:meenfthe seed l'nrwhicb thin pemti,is:,surd. GAS-EA.SYS'll?M-1 INC.J OUTLITIS OCC.CROIII' 5Y5, 6
AiSY�
pe t J PoII,Y u�ayberate� ' (� l�
Carrier: I)�'tIS:T ioiln Spyra Policy No.: V7��r1� CAS-EA.SYS'IdM-OVER4(HA)
CIiRTIRCATEOFC/ffXENINIPTION FROM WORKERS' GRIiASF/ �Z
COMPENSATION INSURANCE BUILDING DIVISION FEES
Ilhi,seclinnnesloor be..mtp1led lit he pemtlr m fnrone huidad dollar.($1 NA GIXI!ASC' RAI'
or less.) PL\NCHECK FEE
I renify,hal in the psuformame of the wells for which this permit is issued,l shall SEWER TRY-STURM EA.2(X1 F7.
not anpluy any sentry in any m:mner so as h,become svbjsw,m the Worker.,Coupon- ENERGY IIiE
ZZ svion Laws of California Dem WAI ER H 'I' TLETU3 GRADING EEE
Applicunl
= NOT ICE TO APPLICANT:If,after making'his Cenili,areof Exemption.You should WATIik$ OREA'1'ING
[-� be ome tri ecu m the Workers Com ,inn f the labor Cede,you must SOII ti Igili
penia provisions 0
Wforthwith comply with such provisions or permit shall be JmmeJ revoked. WAI'IiR S li
d PND
CONSTRUCTION LENDINGAGENCY NhW REST DIi 'PIAL PI. 3. SQ.tN'. pis Reeripl p
V01 Ina fly allinndundre,is aconotr ion lending agency for the perfoarrowad
,he work for which this permit is issued(See.3097,Civ.Cd
lsndar's Name TOTAL:
L) bender's AJJru,,s 'rayl' 1
I ecni,aha,I have read dik appheadon and.,are that the serve int rmmion is SEISMIliulldd :I ?le 3 p o
F' h
contest,l agree to comply with all city and county ordinances and sm,e laws willing in QTY. MECHANICAL PERMIT FEF, SF.ISh11C IliE 0
V Z buildingeu'roution,and hereby authomc representatives ofthis city to enter upon the
nhovc,nesioned 11,11ey far in,pac,ion Fulloses. I 1'I?HMIT ISSUANCE 1'LLCIRIC iE
Is
(We)u,,,c m wva,Indrnndfy and keep humdesu the City of Linn.....n ug0imt
Iianilitic,.juJgmenrs,cns,s unA expenses which may in any w,sy acerae ugains,suit City ALIERORADD'I'OMECII. PLUMBI 'FEE
..sequence of,he gnn,ing of,his perm,. F
APPLICANIUNDERSTANDS AND WILL COMPLY WLITIALLNON-POINT AIR HANDLING UNIT(To 10,010 CFM) MEC11 ICA,PIiIi O
SOURCEREGUI.ATIONS
AIR IfANULIN(I11N1'I'(UVEIi If1,INX)ChM) CO 'UR CIION'I'AX
/ t I
"'nature ofApir ra/Cnntrmm, I F.AIAUST HOOD GYMUCT) HOUSING ITIGATION FEE
HAZARDOUS I A'I'ERIAL,S DISCLOSURE
Will Thu applicant or Inrnr building necepnnl store or handle hamrduus material 1117ATING UNI',(TO pinjig)B'TO)
as defined by due Cupcnina Mwhicipal Code.Crepe,9.12,and the Ilunldt old Salcey 1113ATING 11N1'r(OVER IfMh,IXX)B'T'U)
Code.Section 25532(0)? p/e,��
[3 Yes tW'0 ' VE?N'TI TATION PAN(SINGLE RESID) PAID
Date Rcceip,X
Will tbanpplinnn-tuna holding nut..p an,Iso aquipmcm ordeviccs w rich mus BOILER-CI1MP(3HP ON Virgin JI'IL)
,nit nardnus air curtailment, defned by the Ray Arca Air Qonlhy Manugunenl 'TOTAL:
Dixuic,! BOILER-COMP(OVER 100,000131U)
❑Yes . 7
I ha,c read Ilse humalou,nl'alerinl,rcq arenls under Chapter 195 of the Call- Alk CONDI'IIf INCH ISSUANCE DATE
4 0hmiu Hwhh h S:drt Cock,Sections 2555,2553and 25534 E. i ndcomod thou If ac
Y 03 NEW RESIDIiNI1AI"A11iCll. SQ.FT 2 — J9 — a
huilAingJ .nr,curreealy hareamnant.Dna i,is my mfh mibili,y hh nosily the occupant r
olthe m rams jaw theinnernpoor earissu0If a Cenificale If:�e�uJPa/n,y.- ��//�
Owner i�rd- c DGte— 'ITYfAL I ISSUED BY: C
OFFICE
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