S 1348 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.PD.IiCTRICAI. Pl:yyrl'Nn �� � �
BUILDING DIVISION APPLICATIONAPERMIT PLUMBING-MECHANICAL 'ES
"NO
PROJECTIDI?Nflh'ICA'rION
BUILDINGN)DRESS: SAN["LARY NO, AVVIACAI'ION SUBMITTAL DATE
` OW I�nL. N4?.MCL YI{ONF,: C(�N'OACTO
MTCf'NAMEl� /ybIQI.S 14) ) IQI NIC CONTROLa
ARCHITECT7Cf:N UNEER: LIC NO: �1)`DHI°CSO Gr, ❑
CONTACT. PHONE: (t Jf'�[ BUILDING PERMITINFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG BI 'C' 1'L TMH MFCH
L[CENSED CONTRACT OR'S DECLARATION QTY ELECTRIC PERMIT FEE El ek
1 hereby intima that I am licensed under Provisions of Chapter 9(commencing 10D DESCRIPFION
�0Z with Seniors70111Bof Divisiontof live Busincssanll rofcs.inn.Code.and my license is RESIDENTIAL
00 n' PERMII'ISSUANCIi
F_.- full force suite t. Ll 3741 ❑SPDWh ❑KITCI{ITN REMODEL
<—U Llcen:,Class G Lica AI'PLTANCIiS-HESIDIiN1'IAI. El AUDITION C]PLUMBING RE-PIPIT
f..Z W Dwe Cunlmclnr
Nod ARCI111ECI':S DECLARATION ElMULTI-UNIT ❑Sr RAL
~-Z I understand in h II M u,ed nx padde records P,\NIA,S MODII9CA'f10N
OZ YPunsv a UI"Dl21Nl Am
❑IN'[1iRIOR ❑CHIMNEY REPAIR
���qqZ 11crnwJ 1'm(caxannnl UW NIIIi-If IIIhDIJt IHiChAItA'f10N MNX)I.
MtI'g IMPR(lVl?MIiN"f SWIMMING POOLS
OVERDI AMT'S El BATH RIiM(I1�R71<Ytl IV4 1NSQ
C Q hcfchy ullirnt had tun xumpt R t the RAT( lot,hicdroc how for the
'LX�YU followings 't.I Salina 70315clhni,w, unit Prefcs ss Code^.Any cilyn county ECI'111('AI. ❑O'I'lllik
LL3LLy whlsl 4 II .a' l h demolish. p Ya name
^, -1 pmt I alsoal Ipl' II such It fl b d:ftcmcnl CIRCIT'I IMISC. J
FWy Ihatl Jp tt Ili p : Itl Contractor,1 La (Chpetro
W he g with5 t 7000) IU 3 (Ili Business JP f:' Celc)or EIER OR VOLE INST COMMERCIAL
Lao 5 that he s exec ,l therefrom and the hasis lir live alleged exempoon.Any siolafon of ❑NEW BLDGIADDITION ❑UFMOLI'1'ION
X m_LL
Section 7D3I S by mayapplicant❑.r.a permit vuqu'rc the upplicam m a civil Penalty of IIIiVICES ( ❑TENANT ❑POOL,SE VICE
W N olnuac than live lm idued mill...($500). IMPKOVhMHNT
t DLas owner of the propenY•nnnycanployccs with wages as lhcirsole cmnpcminum. NGMNl1.IzIA:CIRICwiIIJothew . ❑OTHER
13 m and Pmfessions CMG:The Contractr's Eieenw Law Jens not apply m an owner of '$-SWITCIIIiS-19XTURIi.S
Prnpeny who builds nr inspmvn thereon.and who Jses such work himself ar through
his own employers,provided that such improvements arc not intended or offered for NEW HESIDIeNI'IAI.ELECTR SQ IT.
sale.If,however,the building or impmvcmcm is sold within one year of completion.the
SQ.1.11 FLOOR AREA SISQ.FT.
er-tamidOr will have the burden of proving that he did nut Wild or improve for put-
Prove m sale.). TOTAL:
1,as owner of the property,am exclusively contracting with licensed contactors to i
construct the pmjca(Sea 7044.Basilicas and Professions Cale:)The ComactoLs Li"
cense Law does not apply in an owner of pro,eny who builds or improves thereon,and QTY. PLUMBING PERMIT FEE
who centmtls for such pmjeccs with a contractnr(s)licenced purwant m the Contractor's
License Law. PERMIT ISSUANCii � /J '
I]I am exempt under See. .B k P C far this reason 4
AU1 ER-DRA[N&V177NT-ci1iR(EAT A� VALU ' (lN
�Owncr Dam F�
WORKERS COMPENSATION DECLARM'ION RACK FLOW PR(YI'I:CT.DEVICE
I herchY off ism umWr penalty of penury one"I he following declarations Cr L
have unitwill maintuinection icnm MComcntto Ccd,nmrdie Wnurnm Comp en- DRAINS-PLOOR,ROOD.ARRA.COND. ,'D)Ii11iS fVl'BCON5'I'klJCT10N
su,,,k t, providedktdii fm hY Section 3AN1(A the lathrn Cndc,birdie pdr4xannnw of sive
' warkl 'I' I Ili;p t':......J FIX I'11R1ti I'I'R'lltAl' Q/y�
I have aud vill ownlain W A CoulpOnsub0a nNarance.as requiredhySectiot
370[lol l he Labor CnOr.l nbNxrhrn.esu d the wi.I, eM1tlispunit is i swOepll CAS-IA SYS'117M.I INC.d Oil LEIN OCC.GROUP MIN
CMy nrz Work and Y3yupnsxli�lnn a:r�cecpie Policy Nay.tnktb ell/17��000 GAS-HA.SYS'I FM OVER a(PAT
CRRLH'I'ITICAfIi llP li%li. PITON I:ROM(WORKERS' GRI?ASI%INUUS'IXL WAI"TIi IN'I'IiHCIPIY)R
CtIMPENSM ION INSURANCE NUIhDINC UIVI8IUN IEI6
G I,i c,iunnccdnm hecnmplctedll lhcpennil is furonclamulmddollam(SIOI) GREASE'IRAI'
PLANCHHCK 11717
orle".)
Ilenity thmin the perfmm:mce of the work for which this Permit is issued,I%ball S17WER-SAN)'VARY-SORM EA 200 FT.
not employ any person m any manner so as es became subject us The Worker.'Compen- ENERGY FEE
ISI oZ 4aliou lawsof California.Dam WATER I IEL\TER WNI:N1 Ild-ECIR GRAVING IEE
Z C) Applicant
N N(TI'ICE TO APPLICANT.11,acidulating this Certificate of Exemption,you should WATER SYSItiMITRENI-ING SOILS IEC
become subject to the Wallas Contpeuwtlon provisions of the Wbur Cade,...mu.0
forthwith comply with such onswo.,or this permit shall be deemed me.lo . WATERSERVICE
y PAID
CONhemiSaI'[ON LENDING AGENCY N13W'RESIDEM'[A1.PLM[IF SQ.IT. Dmc Receipt#
i U O (hereby aflinn that isattmstmninn lending agency for the pednmmnce of
(k. F' the work for which this perms is issued(Sec.3097.Civ.C.)
Tomei%NameTOTAL:
O
V Tandems TOTAL
Address :
I cenlly that I have read this application and stem that the above infomtmion is BUILDING FEF,
0.
Fr to cddrullagnremeonsply were allathand countyntativ%ofand city Taws relating us QTY MECIANICAI,PERMIT FEE SEISMIC FEE
U Z huilJing umumaion,and hereby awhnrire repmenwtives nrthis city menses upon the
alawe"nwmioned mo,yrtY lin inspection morrows. PERMIT'ISSUANCE ELECTRIC FEE
(we)ague to save,indemnify nn'l kids hantre"the City of Cupertino against
hadul'aiea,pulgomnu,co.I,let uxltenuc whidnnvya any way accrue vgeimuoid Cuy ACI'ER OR A DID 10 MECH. PLUMBING FEE
in conmqucncc oI'the grunting of This Irennll.
APPLICANT'II 'llik5'ANDS 1 IA,CO 1111,Y WITH AL1,NON-POINT AIR HANDLING UNI'['(TO IO.um CFM)) MECHANICAL FRIT
S(IUHCI' ��
�IZ^ C AIR IIANULING UNIT(OVER 10.000 CFM) CONS]RUCIION'TAX
Slgmmlrcuf ApplicanllCmnrnnur / Dom 1:%IIAUSI'HOOD(W/Dl1Ql') HOUSING MITIGA'I'ION FEE
HAZARDOUS MAI'EItIM S DISCLOSURE
Will The n,Ii,mr aTatum bnJding,l1alenl stem orhandl,hazardousmaterial HEATING UNIT I'(TO I00.01fl 11'TO)
as delincd by The Cultenino htunlcipal Cndc.Chapter 9.12,and the Health and Safety BEAT INC,GNI I'(OVERIINLIXNI RTU)
Corte.Sudo.255320)?
❑Yes E]No VEN'I'B,AION VAN(SINGLE RESID) PAI[)
Dmc kvleipta
Will the a,E,,,ant or home,e,Willing wmpant uw eyuipmem or device,which BOII.ER-COMECOTT-OR 1INLOIN)BTO)
mit hrrms ai
achr csmn
ndninanas JefinN by the Be,Asea Air Quality Management TOI'M,:
Diamitll BO[LGR-C0IMP(OVER I00,I00BTU)
❑Yes Fl No
I have mad the haxillarxmemdals is amk:r Chapter 6,95 ofilm Cali- , AI R CONDI I'ION12R ISSUANCI?DATE,
m,11111,
fnmia Huhh k gumry Csxlc,Smions 255115,35533 and 25514.1 undentanJ that if the NEW RESIDWI'[AL MECH, SV FT
of The re ima of cunumly haveh niam,INme,tenant.tem o is my responsibility to unity the Bealoccupied V
none nyuies act c which must be met it To es issuance ora Cenificuu of Occupancy.
Owner or authorized agent Dow TOTAL: ISSUED BY:
OFFICE