S 2978 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
C1TY OF CUPERTINO BUILDING.ELECT RICAL PERMIT NO.
DLIII,HNG DIVISION APPLICKPIONIPERMIT
PLUMBING
ING RODE bT IDEA NIOAI.
WILDING 1'ROJ Y:CT IDF.N'I'IN'ICATION 2978
RUIhDING ADDRESS: SANI'1'AHY NO. AI'I'LIGCTION SUI{F11TIA1.DAT[
r. ' h
OWN[RS NAMES; HONE: CONTRACIOk;S NAME: LIC NO:
SiON NIC GDNTRGI.X
AIXCHT ECTIENG EER: LIC NU'. AUDRE ❑
CONTACT: PHONE. BUII.DING PERMIT INFO
❑ Consultant Fees Paid by Applican((Initial) IILDG ELECTPLUMB MECH
a J-whCS 377- 7- ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY EI.E(:PRIC PERMIT FEE
I fairly affirIan 1 nob rontx licensed mmr nrn.i.imOf chapter 9(ed
nmincnng JOB DESCRIPTION
m
C rLZ with Sochi 7finfol Divieiun Sof the Hoone„a.d l'nrI r,,mns Code,vnd myliccn.c is — RESIDENTIAL,
W O PERMIT ISSUANCE?
l-,=0 in full farce and effect D�3f9)WI. ❑KITCHEN REh10DIi1.
C
<ul- License Class G�7-9 Lic.p G
a. U APPLIANCE RESIUF.NIIAI. CADDITIGN ❑PLUMBING RIbI'IPIi
t.L� Dara C S opL
T-ZU AHC((I?CI"S Oalur t 'IION ❑MIjLU-UNIT' ❑S'FItUC'NRAI.
PANlihs MODIFICATION
OO_Z unJcntlnJ my plan.,shall M:mol as puBlic recoNs UPT02(p AMPS
I ❑IM'I:RIORHIhIN1:Y REPAIR
t- F•W Licensed Pmfcssional 201-UIMPROVILMENT ❑NX)AMPS
v. SWIMMINGPOOLS
�afE; OWNER-BIJILDER DECLAtAHON Ovl?It lafN)AMI'S\ ❑ISAHIREMODEI/RF,I'AI}t L1 )LITION
C K a 1 nereM1Y uflinn IM1nt 1 am exenhpt form the Co dhavha's License Law liter he R l(In'1 C y.M N CK_
X3c.0 followingteama(Section 7031.5,Business and Pndessions Calc:Any city a,thirdly nSPECIAI.
AI, ❑O�T3FILR
LL1 LL N which repaint,a permit m construct,alter,improve,demolish,or repair any somewm T f L('M�—�o n-P L;-7 P.'— 410.
F ; priorI t I: y ' n ppl tf hpc 'n M -s 1: a.nmal T IMI,SC.S�+ p"r, uhf I dl u flP no fth ( duY I 1 f(I peer)mn�7 (eommenamywth Sectio 7000)ofD'vson 3 of the Bhsm.cs and lrotrusi nsCole)or RPOLLINSI'. COMMERCIALdMe C that he i,excmph therefrom and the basis for the alleg]exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
X..+ Section?031.5 by any applicant lira permit subjects the applicant u)a civil penalty of S \ ❑TENANT ❑FOODSERVICE:I,vs owner of them n L ELECTRIC I1 HER
E RVEMEN'1'
G O ❑ I pc rionnycmntende.with Bred for
reel.ctnn,Hu%idon' ❑UTHF:R
t. will Ao the work.and the<trucmre is not intended of offered for salt(Sec.'IHYt,Husmess
W 3 m and Iknfe,ne,Ca]e The Comrscto(c Licence law does not apply to an owner of OUTLEH'S-SWITCHES-IIX'TURFS
propcny who builds a nopu vc,marehm.and PI'
won dhwx,ucM1 wOrc himself fail.rohen
his own emNOyee,,pruvid.d fruit such iohprovencm,rat u9t imcuded oT Offered hhr NEW ResIDENTIAL ELF-CI R SQ FT
sale.ILhowo¢Ihu lanihngor lmpmvencm issnld wahinonuymr Of completion.the SU.FT.II,OGR ARBA 5/SQ. .
smut will have the burden of proving that he did am Build or improve for pur-
m,�or mala.). 'TOTAL;
O I,as owner of the pmpvay,am cm,blovely contracting with licensed eomra von Or
cnrovuct the porno(See.9144,B.onre,,teed Profession,C<xle:)'the Contramer's LI-
seLaw does not apply it)an Owner Of progeny who builds or improves thereon.had QTY. PLUMBING PERMIT FEE
who cnmruchs for such pn?iecs with a cnmrecmns)Beefs]pursuant o the Contractors
1 teem.law. PERM I'ISSUANCE
❑ Ism emauld oder See .H st 1'C Tor thl.mason
ACT 17R-DRAIN Ar VENT-WATER Us) VALUATION
Owner Doc
WORKIiN;S COMPENSATION DECLARATION BACK FLOW`PRRII!LT DEVICE
I hereby of Ornh under lnmally of perinry hire el the following Juclurutiunv •/
❑Floss and will mainwin uCenifeme of Consenunselr-insure for Worker's Cnmpcn- WINC.40UILFIS
FLO k.koOF.ARI:A.COND. STORIES TYPE CONSTRUCTION
vii p J J for by Section 3100of hM1 lab Code.f to peal ncc f IM1e
Vk 1 '<h this pc t d. PG TkAP
1 dins I W k",Lo 1 Y I .m I ' dI,S Yon
o
M11yXµftnpT�lyl NIf art}IY YlBry,w9�l /hH 'pe it a':. cit gYSTI: INC 40UI'Lt9S OCC GRrIUP 6 n 1-N
z1 I.yN IVWIy O Z-C' �� �� SYl'I I:M )VPR4(hA) 3-
CE III*) or FXEMI('ION I ROM WORK(RS' NDUS'I'III, SIT 191 ERCEPTORCOMPENSAIION INSURANCE RUIUINC DI ISIO 1II:S
(Tbo.,cetion readout beecmdenalft ciatrmil is forces,hundrcddnllan(SRIO) HAI'or lessI cenily that in thearfforce of the work for which this pannit is issued,l shut] SANI'ITRY-STG MEA 21X1 PI'.hol employ any pen any he mux,usuh Becnnemdjceuodhe A kers'Campc.,_ BNIiROV II?IinpR 4f $nn in fin Z satin.Lbw,of Culroais.Dvfe ATER W/VEbU`n.E R
C)
Q GRADIN
Applicant --4GGOili
h NOT ICE TO APPLICANT':IL after mating this Ccnificale of Exemption,you should WATER SYSTENORFATING SOILS J:
n
F her s,,hbjecd do lhu W hkcr'm Cnn,penxaliu l provision,A the labor Cale.yth dodo \
fanhwith comply with such proviuion.onhin permit shall h.dl revoked WATER SERVICIi �I
y PAID
7 z Cat hereUCcut, LENDING AGENCY NEW I'LMI;. SQ.FT' Daly RcceiplN
I hcrchy nEinn That Item:is v mn"n"'h n lending agency for the per(mn.:mce of
CUL. O the work far which This perm..is j,,ned(Sec.3(X)1,Co.C.) TUTAh
UIcnddz Nama
1<ndcr'..Ad TOLL:
6i 1 ecniiy that I have read Ihls.pphibru,vnd Nam dust TO,abate inlinmation is
BUILDING
N
......ct.l agree in"onply will,all oily and e,,f ly...timate,and n',mc lawvrclmingm Q'rY. MECHANICAL PERMIT FEF. SEISMIC I 'F
V Z hnilJing connmction.vM hereby vmhinic representatives of this city m enter the
above-mentioned pmpuny for impec ion purposes. PERNIN'ISSUANCE BUT
IT.
(We)agree m save,indmnmfy and re,hamdr,v the City of C-hill agemN
hahil...v,judgmcnAuats undcxpc+hsu which rally in any way accrue against said City ATTER ZIA)'I'OMI?CI. PLUMBING PE
.....eghence,al the granting of this pe,,aid.APPLICANT UNDERSTANDS AND WILL CU!s1PL\'WTffi ALL NON POINT Nj
GUNIT(TORI,000CFM) MECIIANICAL113.
SOURCE REGULATIONS. /�
A/ h NIT(OVER I OJXNI CFM) CONSIRUCHON'TAX
ti lure of ApphaaunContrMmr Dat. OD(W OUT) HOUSING MITIGATION FEE
HAZARDOUS MWI ER1ALS DISCLOSURE
Will Ifslkanl nr math,buildinguccupum more or handle hmaNmunm¢rial IT('IT)10W BTU)Gulof S anon by life
)rylno Municipal L xle,Chopmr 9.12,andThe II'althand salcty
IT(OVER IN).(N ITU)❑Yrs No FAN(SINGLE REST PAID
Date Receipt IT
Will the npplimmt or futureholding occupant use cqulpnsnl ur Jcvinw which
BOILER-COMP(3111'OR 10 0,0M)BTU),
amid hararJnus air contunrinunfs aydellneJ by the Bay Arca Air Quality
Yes Nn blunagnnem
Di.t6ct? GJ/ B011.liR-COb1I'(OVER 100.000100.000I)TU)
❑
I nay.reed the ha,r...hionasurnal,usquireach,under Chaser 6,95 of the Cali- AIR CONN TIONER ISSUANCI:DST I,
lamia Health Outcemy centrally
have
Sections SSoS.25533 unJ 25534.1 unne¢IanJ that if IM1e NEW RESIDENT IAL MECH. SQ.FT. 1 /� CIJ
hu19
d"i"does not carmntly haveatensor,thatiI i.fly.r'col. M1ilitymnmify Inc wcupanh o
of hhc myuirenmme whit nustMmn Pdnrmismuunac nfvC nrlirnc of Occupmcy.
Own umhoriveJ agent Datc TOTAL: ISSUED 1{Y:
OFFICE