S 1993 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY -
CITYOFCUPERTINO - HUILDNG-ELECTRICAL ^ - PESII"NO.
1993
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL `V
ii 1 HUILDING PROJECT IDENTIFICATION "
BUILDING ADDRESS: SANITARY NO. APPIACA'1'[ON SUBMITTAL DATE
5.
/2-78
N 'S NAMF: PHONE'.. - CO RACTOR'S NAM E.- AC No
1 ,� ! Ik0 �R NIC CONTROL#
ARC TELT iNGINEBk: [ AC NO: ADDR :S' ❑
o F 7 S, JaA4-11 ISIUA I _
CONTACT: ' PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG I!LECI PLUMB• MECH
LICENSED CONI RACIOR S DECLARATION
ARATION QTY' F;LhCTRIC PERMIT, EE8-'
I henry affirm In I I I d d 1 f CI m )oc b _ - t. JOB DESCRIPTION
w00PIRMII ISSUANCE t
2 with Seelon 9nW)ofD 'an t 9nfthe Bus .. tel ProfessionsCle,ttdny because is RESIDENTIAL
N� inhdlfowe:ndeffed. ❑SFDWl, ❑KITCHEN REMODEL
-
1UU License Class Cula APPLIANCES-RESHAN'[JAL ❑'ADDITION_ 92LLUU@ING RE-PIPE
y G Dam CanDECL _
ARCUll be
DECLARATION El MULTI-UNIT �Sl MODIFICATION'ZOy� Iundc�tnnJ lay plans shall be uacd ac public recoMs PANELS - _ MODIFICATION _
UP 102P)AMPS�z"'O INTERIOR ❑SWIMMYREPAIR
OOL
Lieenvd Prnfessfmml 201-I000AMPS IMPROVIiMI:N'1' SWIMMING POOLS
aa W, -
OWNER-BUILDER DECLARATION
C
C Q 1 hemby nRnn ithat I am exempt tram the CommcmPs L¢ense Low is,,the OVER IIXq AMPS El BATH RP,MODLLIRCPAIR [I DEMOLITION
C WU followinb whoon.(Section 7031.5,Business anti Perfusions Con,Any cily nrmunty SIGNS ELECTRICAL- ❑OTHER
m whleh I'.....at,a permit In construct,alter,improve,dumnlhh,or repair any saumure
an Friction,insuunm,also courts the alThourlror such permit m file a signed aeronaut SoCIRCUITIMISC.
j'-4 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter J
(contractual,,al,section 7P)O)ofD Isi 3 offhe H : ass anti1 f:: :Coas)or 'I"M C M L IF R OR POLE INST. COMMERCIAL:
d IY a eG that lie is excipt therefirson and the bacas for the II g 1 exeriparre.Any violation of ❑NEW BLDG/ADDITION ❑UEM01.1'1 ION
m W Section 9031.5 by any ppl t l pen t.anneals the applicant t l penalty of POWER DEVICES
cel^m ❑TENANT ❑FOOU SIi
W RVICIi _
�p not mote than five hundred things($500). IMPROVEMENT
2,R0 1,as nwncr ofthe h
2, ❑ pmpe y.or my empinyeer with wogeemlheirynle uempenxation. SWIMMING POOL ELECTRIC
p. wdl do thewofk.anithcnmeutrea not intended mnfceini for sale(Sce.9041.Bu sines, - - El OTHER
Gm and Professions Code:The Contractor's License Law([nes not apply it,an owner of OF 11.171'S-SWITCHES-FIXTURES
property who builds or improves star earn,and who does such work himself or,Ibrough
his own camployeac,provided that such improvements aro not intended or offered for NEW RESIDEN'T'IAL EIj SQFI.
sale.lFhoweveq the Nuilding nrinlpmvemem is sold within one ycvnt(mntpletinn,the SQ FT.FLOOR ARCA S/SQ.Fr
awn
er-Failte.will have the bunlen of proving tont redid not M1 led...ltnperve fnr par-
,.So efosale). _ "
E]I f p1P ly t i b lb E' d t t t t DOTAL
oi't 111 c .70 .project 9044 Business ad Professions C1 )The Contractor. L • - - . r i" -
I d t plYt e fpnp 1
to, 1 od QTY. '/,PLOMISINC PPRMIT• „)AFL^E
who taco for such ens with vcontractors)hcensed pat 'mnmlbe Contractor - r
License Lnw. PERMIT ISSUANCE.
[] lam exempt undo.Sea' ,B&PCfor lhls uum
3S 6-0
Owner Data ALTER-DRAIN&VENT-WAI'ERBEA) - VALUATION
WORKER'S COMPENSATION DECLARATION HACK FLOW PROF ECT DEVICE
• 1 hereby Storm under penalty of perjury one of the IDllowmg dmlamrtonv:
❑Ihavevndwill maintain rCenifmale of Conserv to SCIFIFmre for Worker's Croton- DRAINS-FLOOR,POOP,AREA,COND. STORIES TYPE CONSTRUCI ION
anion,as Provided for by Section 3900 at the Lotus Code,fof the prdian once of the
work for which this permit is issued. ' FIX'I'FEES-PER'I'RAF'
❑I have Ind will maintain Worker's Compcnan en Insurance,as nature.by Section -
3900althc ober Codcf tl p lxman' ftl rk forwh 'I Ih'.p it is Issued- GAS LASYS'IEMI INCACUI'LE'TS OCC.GROUP APE
My Wer Comp f p ec addyIcyn I�
Cu Wo f y N t... GAS-I A SYS'fLM 0V LR 4(EA)
CEall ll All OF EXE ION FROM WORKFI2N
COMPENSATION INSURANCE? GREASEENUUSTRL WASTE INTERCEPTOR
_ H 1UINO DIVISION hliliS _
('Ih::re'mnwlmmliewmplened'f0 1 lis l"ern h d dl lh,rs($lee) GRI3ASETI2AI'
or le ) PLA 0111 K HER
I hfy that in the pufnnnaare offine kf Lich lh.pe .t' d,Ishall I -
not cmployvryperson inany mannersoasmnwnm,subjecne the Workers'CoSIiWLR-$ANTPARY-S'IOIIM L'A.21111fT. ENERGY,,
Z vision Lros,al California D t WAI ER IHAI ER W/VFN'BELEC'I'R
2 Appl t G PEE 1IVV
(/ri NOTICE TO APPIICANI 1 11 after harkint,Ih Carlefical,of E.act.lion,you should WATER SYSTEMITREATING - t
H beessubjectt theta k C 1 t provisions NaLabor Cdc yet hu yt SOVILSPF t- UV
fonhwlb coapt)wish each pmvso..inFs permuehull bedeemnl revoked. WA'FF.R SERV ICP. r
n
Q
CONS'1'kUCI'ION LENDING AGENCY iNEW RESIDENTIAL.PLM F. SQ,PC PAID
UC) t
IEatery at re
nn that is a amsction tenth n8 agency for l he nmanwol Oete p
CL Fthcworkfor which thin perish is Issu d(Sao 3097,Co..C) _
Lender's Name TOTAL:
O U Lenders Addrens YI
1 ononlydidII read this ppl t d hit the b 1 n : - �- ) F BUILDING FEI
rr rn corms I agat to counionly with all city and y 1' e t t r 1 f st 'QTY. o•MECHANICAEP-PERMIT �'I' FDF,
U Z mild' g tnslncfon S dhembyauthtrie 1 nadvwofJuicly toatofuponthr t d" SEISMICFEB
above anti Bred pmpeny for hoins,ion purposes. PERMIT ISSUANCE
(We)egtez in save,Indemnify and keep hit class the City of Caper iso aeries, - ELECTRIC Pf
Iirbilitieslydgntents,A,e,ant expenses which nifty in mtywaYaumve against said City ALTER OR ADD TO MF.CH.
in tmeyuence of thegmnting of this Penni. PLUMBING FP. fl v
APPLICANT UND NDS AND VILL COMPLY WITH ALL NON-POINT AER HANDLING UNIT(1013dMEB CPM)
MECHANICAL h'G'
PP,lL/q-(�, AIR I IANDLING ON 11(OV HR 10,000 CPM) CONSTRUCTION'I'AX -
Signstrait pplicanhComnmmr - Data EXHAUST HOOD(W/DUCT) I IOUSING Son FIGATION FEE
// HAZARDOUS MATERIALS DISCLOSURE
Will theuppbcnt or future Funding arvpnnl store or handle hawnlnus material HEATING UNIT(TO 100,000111 U)
it,defined byline Cupertino Municipal Code,Chapter 9.12,and the Ilenllh and Safety
Chile.Section 25532(a)'f IHA'1'ING UNITLOVER 100.000 If IU) - -
❑Yes E]No PAID
_ VENTILATION FAN(SINGLE ItESID) Date Raria#
WEII the applicant or future building ocaTanl use equipment or devices which
�Ivisith,quilc,.air cnmamintmu as defined by the Ray Arca Ai.Quality blanagomm�t BOILER-COME(31IF OR 100000IT]'U)
Doldol^, 'r E:
F-1 Yea, E]No BOILER-COME(OVER 100,000 BTU)
I have reed the Founders hiscrials refractories- under Cha mr 695 of the Call- AER CON[)It]ONER _ ISSUANCE DATE
p
rondo buildingHealth does&Safety Cada a Sections 25505,°5533 and nsfula I to nota yid that it onoire NEW RESI1l[?N'DAL MBCfI. SQ.ITC ^ ^ /J
ofthedum rents s ndynuvc blenan4lhmt)is manceorscOupmnotifytbeoancy. 'r L CIX
of the rcgnimmonb whicL moat be,net poor it)issuance of a G�niliw,e of Occupancy.
Owner.,uutitofieed aguvt Disc 'PO'TAI.: IS$I]ED NY:
OFFICE