27448 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
) rran1r r4n.CITY OF CUPERTINO /PERMIT PLUMI1NG-AEC1ANICAI
BUILDING DIVISION APJaLICATION
27448
WARI,�SMSANITARY NI. APPLICATION SUIINIGAL DAIS
UNIT N LOT N
PIIUNIi: ) i Mlb i�MLIC No/K& N/C CONIROLN
LIC NO: R n�WW ❑
oNIACT: PHONE: , 'lye ?I`�LEC 3�VEf� IIT
-,s•c i ; w IPEIdTNFO
f
BLIM I:LCCT PLUMS MGCiI
PERMITISSUANCE El
LICENSED CON I RACTOR'S TX:CIARA DON APPLIANCES-RES I DEN FIAT,
Diaz Ihembynffirm Oral)an 0censedunder prwiaiumOCImprer 0(commencing with
POO❑ Section 7000)a(Diddlort Sof the Buainma and Prnfe"mrs,C rand my!!erre Ta in PANEIS
fullfn.ceril UPTO 1fMIAMPS
1k'L.7y) Licca 'Ins I.it.p
Us?y Ilam Customer, 201-1180 AMPS EI' S/SV.19.
zFyZ Rholl ati,ed DECLARATION OVER IUIO AMPS
O OZ— linnlmtand my Plans mallMuseJ as indictments.
SIGNS LI,ELTRICAI.
9NE Licensed Pon e.asionel
OWNER BUILDER he ARAimelm SPr:C1Al.CIRCUIT/MIS
Xo � 1 hereby archm tier 1.m attempt erase me hamractora License Taw ser the
w3LLy following mason.ISection 7031.5,Bminess and Professions Cods:Any city mrnunry TGMP.MGI'ER OR LE INS r.
..mien r-luhca a pemail m con.ma,neer,improve,demolish,m m,mi,any anmctare
>� pdarinisaisxmme,vlsnrequireathcvpplicntfanucnp innRleaaigneJamtameen POWERDrvi
Oaprc IM1m hs is Iicen.mA purawm m the pmviaiona of the Cnmmnur'a License Law(Chapter
d eW 9(mnuu,mm,with Section 70XB.f Division l of the 9usirmssod frufemiun^CWe) SWIMMING OL ELIiCI RIC VALUATION
yxJ_N m that he is eaanM therefrom and the basis for the alleged exemption.Any violation a! OOTLrrS-SWTfCIiIS-ITXTURIS
z G Section 1031 S by any applicam for a Permit subjects the applicam to a civil penalty o!
TD
or mare then five hundred dMlara 135181). NIiW ftE51UIiN'flAL rl.IiCIR g .1'1.
5Cp$ n❑ LavnwnnnlOx rmpcdy.mmycmployccs with wages aalbcirvdecomixnmdon, Q STORIES UPECONSIRUCIION
a will do he work,und lheemncmre is not hnendedorofkreJ for set,(Sec.744,Bminess
and Professions Code:The Contractor'a License lAw dues not apply to as owner Or
property who builds or impurities thereon,rsoM who dme such work himself or domain his
I I dllmtsuchim t ti I A 1 lfcrcd lire mlc.If. OCC.GROUT' RES.DINT'1'
bWear a heea,rravhe rravemaneamna men tiara
wwa.dx have
t eg errden ofpman is hath a didr one......rim rovefin,roe Owe or To rnL:
nnahle.will Awe me mm�en err rm.mg mm he did hat nada or impress un purpose or
581e") QTY. FLUWINO aEAMitlhsMIN
❑ I,mnwmrnf the prnpeny,emexcbwivdymnvectingwiTblianudrnmrucmrsm I'LOOU ZONE 'N
Lianatruct m�project(gee.ltw4,Business and Professions orale:)The Contractors ...,.
cense law Aocaean^rplyprnperlrwbn butdaarinnnprovaa teaant.anA PERMIT SSUANCE:
who convects formcn projects with a mnvvcteahl licensed ParmanUr Inc Cmmactar'a
License law. ALTER.DRAIN&VENT-WATER(PAT n FERSOMMARY
❑ 1^mu
cmin under Sec. .R&P C fonhis mason BACK Fl.OW PROI'1?CT.DLVICP. S 11
SANITARY YN
Owner— Dam 5FJlNDirLR
R,RWI.ARCA,GOND, RUCUIPI'p
WORKMAN COMPENSATION DECLARATION SCIIOOLIAX Y N
❑ Iherehy ef0rm inmlhaveecmi0cme nf<unumto ullimure,orecertircme of R TRAP RECEIPT as
Workeri CmnRasatinn lmamnccore cervi ocapy thereof(See,3RW.l.ob C.)which PARK FIA! Y N
Purlis Alla I TEM-I INC.40UTLIiTS RliCiillsl'N
l iryp BUILDING DIVISION PEES
Compun EMOVGR (GI PIANCIIIiCK FCC
.-tired copy la hereby famished.
❑ CerviOeAappy is EleJ with the airy inspmiinn Aivisiva L 1 INERCETOR GRADING FEE
C12RI I19CA'I'rs 01;EXEMPTION FROM WORKERS' SOIISFEE
COMPINSATION INSURANCEAR -STOR R ENERGY Anti
m less.)
Is-tify that la the pin a.,aen er i,a,for er.m @h remail is i.amW,iahell ER IIIiAT /s .NTAiLECI'0.
nm e�nnrmy say peri any r .t as e.Ixeame.��njeoi ver n:e wager.: rare
Z C'ompennatitm Lowe of Culifamia, Dem v IiN SYS'fliM/1'RIiA'rING U:ne fteceiptN
Applicant
z�7P0 NOT ICE TO APPLICANT:If,aOcr making tine Certificate of laemryion,yon should NEW R ESI DENTIAI.I'LMB.
SQ.FT. TOTAL:
hmoinewbjeamhe WOom,aCan.ren,.Iiun Timsidun^nf The l.RMo Core,yomaile, u mail
!!� , forthwith comply with such provisions or this penE.
ult^hall be decreed revoked. BUILDING FE
W z CONSTRUCTION LENDING AGENCY SEISMIC TFC
ort Ihaebyafrrmthal them is a construction unding.prcy for the Pcdmmvnce of
L) O the work for which ilia permit is Issued(Sec.31191,Civ.C.) T l ELECTRIC IEE
Ir I,cml Name 4 y
O [v Lenaaa Atmmaa QTY. :,.`: _. CIidN�CdL PER I'}: a `"t. 'E;'4`hL+ii 'i"�,; PLUMRING TFTs
I cemfy that I have read!this^rplicuion end slate that the.Nave information is - s
Lit correct,l agree m ish comply wall city and county collimates and time laws relating To PERMIT ISSUANCE. MECIIANICAL FIR
Qj building cmdmction.Real hereby authorize represmlallves ollhia city income Aran the CONS IRIICITON'I'AS
U 7 aMtvcmemioned proproy for inspection purpn^es. ALTUR OR ADD TO MECIi.
C (We)agree ,,save,indemnify and keep Tameless the City of Cupamim vg^ima
Iiabilitio.JuJgmema.cab andeapensea which may horsey w^yaceme^geinaT and City AIR I TANGLING UNI I'(1010,1809,�
in cnnseyuenerof The gaming n!this permit.
AIR I IANDLING UNIT"(OVIi 60 CFM)
Signature of APnl mo/Convnam Date EXHAUST UOOG(WA)u )
PAID
HAZARDOUS MATCRIAISDISCLOSURIi IWAI'INGUNIrit ),(NO GNI Date Rmeipi0
Will the applicant no future building occupant than or handle hnnmaan.s mmerivl IIF.ATINC UNIT' VIiR 100.0110 111 '1' A .
as JefncJ by the Cupertino Mu ll' vl Code,Chapter 9.12,anti the ilealih and Safety
Center.Section 25532ay? VENI'ILA'I'IG hAN(SINGLE RIiSIDI 1. �_
❑Yea
ISSUANCE DATE
Will the applicam nr lummnuilJingexcupem use equipmemmJevices which emit I)OILGR-C MI'plll'OR IW.gN)RIU)
rations air comaminvnu n^Wined by The Bay Area Air Quality Managemem
A.V.T/'/ BOILER-COMP(OVER 100,000 R"fU)
Dimlal ❑YesA
NEW RESIUIiN11Al.MliCll. SQ.Fr. g�� `i
1 hate rend Inc bmnrdoua no'clula regnimallna under Chopmr 6.95 of The
California Drills&Svfny da Senium 25505,25533
rf iwnhl nhlJ35505,25N3and5 1unAcm/vm/nadro that
u ent.Ihatitismymsptiiibilitylonotifythe (Va
JUL I12 19elidNdoeancacehum unge mwHe,to i,s. y/a mcl
OneOrn ImmAgGiveh
-�
OFFICE