S 2186 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING..ELECTRICAL ...I rr No.
BUILDINC DIVISION APPLICATIONIPERMFP PLUMBING-MF,CIANICAL
2186
BUILDING PROJECT IDEN'I IF'ICA'I'ION
NUILDINGAUIVV�l'S: � ,r � SANT I'AHV NU. AI`1/'17,�hC�AI'ION SU11M1'19yAAI,DAU'li
( i 'SNA p. ' �/yH-)Nl+y CI P RAC OR S NAME: LIC N('
G Sf/r GJ• NIC CON'rliOl,p
• ARCHITECUENGINEER: LIC NO AIDRE'05
i+ �� ❑
CO N'I'ACT. PHONE. 4'"vA BUILDING PERMIT INFO
��� /•� ❑ Consultant Fees Paid by Applicant(Initial) III DO ELECT' PLUMB MECCH
LICENSED that iU CONTRd under$DECL s of Chap]ON QTY CLEC TRIC PERMIT' FEE
1 hereby mann that 1 ant licensed under provisions or Chapter 9(commencing JOB DESCRIF''I'ION
pel�Z with 9lXla)nf Dlviahm Jaime lima ''end PmaWans Colla.and my hearrw i' RESIDENTIAL
Ilpp wt I'F.RMTT ISSUANCIi
lull hnec and Wfmt. 4 OSFUWI. [:1 KITCHEN REMODEL
4VU LiccnscC -r lJa4 APPLIANCIS-RESIDEN'T'IAL ❑ADDITION ❑PLUMBING BE
vFi6i Dmc Cnnwcmr Dh1UCTI.UNIT DSTRUCTURAL
ARCIIITF.CI-S DECLARATION PANFI S
f-H Z 1 undersand my plana shall ce mcA ns public record. MODIFICATION
Ozv,)Q IIP TO 200 AMPS DINTERIOR OCHIMNEV HIiI'AIR
F-z.F.4] Limn'W Prnl'usinnal 201-1(XX)AMPS IMPROVEMENT D SWIMMING TOOLS
:z--i OWNER-BUILDER DECLARATION OVER IIXX)AMPS ❑BATH REM I/J2 P 1 Ublyt II'ION
yC Q 1 hereby affirm that Ian exempt from the Contmcme,Lima Law fnr he v% 4
Li
X C'W F fullawin8 m m.fgneainn 911315,Bu,inus unf Prates m Calc'.ABY city n manly SIGNS ELECTRICAL S
WCall whlah require'a"'.I ut c n.ntruct.ahm,,improve.demolish or reRtir any smmmuc
F_' Prior o it,iawance.aEoreyairestne applicant fnr such permit m life a liar eecmem SPECIAL CIRCUIVMISC.
s,My,- that he is licensed punaanuo the pm.maons Ill Contractor,I.imaw Law(Chapter 9 COMMERCIAL'
W C, (canuneneing with Section]IXXgofDivisina 3ofthc liwimessamd l'ndes,wo,Gtdeptr TEMP.MITER OR MOLE INSP.
Y Ilan he is cecmpl Ihsreb and the hast'fur the alll umnption.Any violminn or ❑NEW BLDG/AUDITION ❑D17MOLITION
x m ee Section 9(131 5 by any applicant fa a prem'lmfmis he upahemo mo a civil penaky of POWER DEVICES ❑"TENANT C root SERVICE
of mote than Ilya hundred dollars(8501). IMPROVI3MHN'1'
f'=0D1.as owner ofthe property.of my employees x ith wages as their sell,mmpcnraina. SWIMMING PO(OL .I IC
F willdodse.,ok,tmdme,l..mmrc is not inmoded...fared bn,af,lSm.9044 Business OTHER
G 3 and Prefep'iun'Code:'1'he Cnn raeo r',Ljmu lsa 1 use docs nm apply na am owner of OUTI-P I'S-SWITCHES-FI
property who builds m notimvas hereon,and who does.such work himself or through
his own employees,provided that such immrc
pmvcents anot intended or offered In, NEW RESIDENTIAL.ELECfR Q FI'.
sale.If.however,hatsuilding or imprvement is sold within one year of completion.the SQ.1.7.Il(1nH RHEA 3/SQ.FI.
owI er-builder will huvc mho her lenal prying mut Ite did not build nr improve for pur-
ry"e oLwley '1 fYl'Al,:
D I,as weer of the property,am exclusively dommeting wits hennaed contractors to
coromvm the police,(Sec.91144.Business and Professions Code:)Tha CwtractoF I LI-
c wLaw does nm"Ply at are,acrid ,,,cdy who holds ar lntptor,thereon,and QTY. PLUMBING PEZRN41T FEE
xlnm ortowslin such project,with licensed Pun'aam wthe Cn a te,lofn
Umnac law. PERM1'I'ISSUANCE
D 1 am exempt under Sm. .B&PC for this mason
ALTER-TRAIN&VIiNI'-WATER ICA) sewn VALUATION
Owner Dwc
• WORKIiR:S COMI'IiNSAI'ION DIiC1,ARA'1'ION LACK FLOW Yk(B IiCI'.UI3VICIi -17-
I hereby difee runder penalty of per a,one of the following federation' (/
D l hammal will armaujinaCedifiearnnfCnwuw
nnowlf-inrefnr H'nrker's Camper- DRAINS-FLOOR.RUDE,AREA,CONK. STORIES 1'YVE CONST RUCTION
saner,as poMi ed IF r by Seeinn 3701 ol'mhe LUMn Code,fur the lerf-macto a of,he
work lin whleh This pennil e i,aned. FIX'1'l1HliF-PIiN'1'kAl'
D 1 have and will maintain Worker's Compensmion I...ram e.us required by Seeder
39(0af the baton Cale.for the performance of he went,for whichhis pennil is Lam ad. GAS-IiA.SYSTEM-I INC.i OU T"LETS OCC.GROUP APN
My Worker's Compensation Insolence center and Policy number am! GAS-IiA.SYSTEM-OVER i(IA)
Curries Policy No: 9t
CER'll FICA IE Op E%EM PEON FROM WOR KERN GREASE/INDUSTR I.WASTE I N'I'ERCEPI OR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(This section necdont he completed ifthe permit is fornne hundreddolers 181110) GRFASHIRAP
YLANCHIiCK FF,I:
I' y .o.ttil work bar,I' nh . LI'hall SEWERSANITARY STORM PA.LX)FI'.
nm pI Y any
nY ,.,I
Y m t be hJedt I f Wor k Carrillo ERGY I tai
Z afin.Law,of California [)am WA I;R HEALER W/VENT I 'CI'R ADING FIE
Z C) Applicant
NOTICI i0 AI PLICANI' II alar n.lk 6th'Cenil unc f 1 dnmpt ren.Ynu should WAT17R SYSTEMn RIATI
a > is FEE.become moms am the W..me,Compco,minn pow sines of the Labor Cadc.Ynu Built
wI'anhwith comply with such pmvisinna or this permit shall be deemed revoked. WATER SERVICE
DZ CONS"FRUCfI(ON LENDING AGENCY NEW RESIDENTIAL PLM . SQ,FT. Dat Receipt
U 0 l herebyaffnn than there is u ae
mameon lembngageney 0n the pcdarmunce of
the work bar which his perm,is issmal(Sm.31X)7,Co,.C.O
O I(YIAL:
Lender's Name '
U Lendeds Addm,, ItUILDING FF.
W 1 eenly the I have read this appllcation; I oma the rhe shove Information is
Iyh os
amca l agree to comply with all city and County ordinances and%lute laws relming to Q'I'Y. MSCI IANICAL PER MIT FEE SEISMIC HE
U Z building mn,cal,ion,and heebyumi rim mpo,,ambm,.f this city mareerurym me
above-mentioned property for inspection purpeea PERMIT ISSUANCE ELECTRIC FEE
(We)agree m save,indemnify and keep h,ml he City of Cupeninn against
Iwini ae,judgmenu,uon an 1a,ensea wh,chno,y n any way lmcme ugail,l said Cay ALI'HE OR ADD 10 MECH. PLUMBING FEE
in om cipenscof time smmia,nf his permh.
APPLICANT'INDERS'I'ANDS AND>WqCOMPLY WI'OI ALL NON-POINT AIR HANDLING UNIVIO 10.000CF14) MECHANICALFEE,
SOUR , X11' TION
p / AIR HANDLING UNIT(OVER Io,l100 CIM) CONSTRUCTION TAX
Signmmaof ApPlicanUComra a C /Dae EXHAUS'FHOOD IW/DUCT) I ROUSING MI'i'IGAI'ION pili
HNA )OUS MATERIAL N DISCLOSURE,
Will the applicant rfutumbulldimgmell,n.aran,handle haunfnusmamrial HEAT]NG UNIT(TO IOBJMM)BTU)
us 11efnW l the Cup' ren Munlclpal Code,Chapter 9.12,mal he Heahh and Safety
Coble.Section 255321 )'! IIIiA'1'ING UNIT'(OVER 1m),000 BTU)
D Yes [-I No VEN'11LATION PAN(SINGLE RESID) PAID Date Receipt#
. Will me applicant or name huilding occupant use equipment nr devices which BOILER-COMB'(3HP OR IS).000 BTU)
emit hervNnu,air,non, s nfam as doomed hY nhc Bay A.Air Ql fity Managcmcta TOTAL:
Disricl.' BOILER-COMB'(OVER I011,I nBTU)
E)Yes E]No
Lova read the Mvumln
nloa,nalcrinl, 'ryircenis under Chabot 6.95 ofthe CA- AIR CONDITIONER ISSUANCE ATB
htria Heolth&Safety Code.Sm6or,255115,25533 and 25534 1 mnderoand that If the NEN'BESIDES [A].MECII. SQ PC 2 f C'rf
building docs not curtcnfyhavcatcnanh mm it in mY mlxmsibilimytn notify hcoecupam l/J
of the myuimments which nest be met boom to issuance ofa Cenificme of OecuPam* �o�/...1
Owner'nautllon".gint Use TOTAL: ISSUED BY�-
OFFICE