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25574 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO PLUMBING.M1115CIIANIC-AI. PIiRh11I'NO. BUILDING DIVISION APPLICATION/PERMIT 25574 _Y,tF! UILBNO ROJE 1 NT FICA ION.*ssnsp.{a.;,;•' BUILDING AE RES( SANITARY NO. APPI-ICAIION^SUBMITTA1.DA'IT III.LZ (TMJ \✓✓ T VWPo �lJou LOTto OWNERS NAME: PIETIF. � CO TRACTOR'S ML� f / LIC?t Nrc CON'1'ROLN CHITECI'/ENWNEER: WC NU: ADDRESS: 1•/LY4 ❑ ONTAFl� PHONE: QTY. 1 w I,P�•pRIC PEBMR' # 'T I FBB � ) i' ?r .`;1.BUB,DINO PERMIT INFO 97S;2 Y 9a f, r T"'a`"rrlt w xp f far aa� P vtt LOO ELECT PLUMB MLCII PERMIT ISSUANCE E] 1:1 0 LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL JOB DPSCRIPIIO t0w9Z Ihereby alfiw that am licensed underpmvisionsof Chapter9(commencing with FJVICfull Sectioon cee A)ofevissiioonn Sof the Business and Professions Code,and my license is in PANELS �. �, p0o2 C7 A0 ¢ZUZ Luh License class_fL_Lic.N �• i0d 1000AMPS rrFs<a Contionor PI'.FLOOR AREA S/SQ.FI'. Gin ARCHITECT'S DECLARATION OVER I W AMPS S Q Z—A I undersmnd my plans shall he used as public records. I{ y'-f Pi\V, kd LiccnuJ Pruluseional SIGNS ELECTRICAL y OWNER BUILDER DECLARATION SPECIAL CIRCUIT/MISC. /y O 1 ngreas affirm that I am exempt from the CosionsCode: s Licensee Law for the Sal�¢"n following reason,(Section lUJLS,Business and Professions CW e:Any city or county TEMP.METER OR POLE I � �m..l which requires a Penni,to condom,him,improve,demolish,or repair any animateY� prior to its issuance,also requires the applicant forsuch pewit to Ne a signed statement POWER DEVICES Q p that he is licensed pursuant to the Provisions of the Contractors License Law(Chapter, SWIMMING POOL[ELECTRIC VALUATION 0�4 9(rnmmencexemjob therefrom and Division the eed exess mend.Any violation of �w Seor ction 7031.5 by applicant for the baspenisforbe is the,ppi tea In. elvilonsion of OUTLLTS�SWITCIIliS- 2-(c, F-y T - Y cT- nmum do. v hundred undre dollars(11500).Permit subjects the applicantto.doll penalty of FIX V tel/ nm morethan Bveill dpM dldlarmyemp. KK ❑ Lesnwnernldre propeny,ormy empleyeeswi,h wegamtheimolecompensation. NF.W RFSIUFNTIAI.F.LCCfIt _SQ.f?. STORIES '1'YI'Ii CIINSTRUCIION y3� will do the work,and the swcture is not intended or offered for sale(Sec."/044.Business and I'mfosinm Code:The Contractor's License Low does nm apply In an owner of properly who builds or improver thereon,and who does such woo Is himself or loorigh bis OCC.GROUP RF-S.UNI IS son employees,providad that such improvements are not intended conflicted forsake If, however,the building or improvenetn is sold within one yeorolcompletion,the owner. TOTAL: builder will have the burden of proving that he did not build or improve for purpose of '�dd sale.). QTY njr}'+•V aI PLUMBING PBRMIT 'Epnz aa d�+ 9a FEE zJ ❑ 1,as nwnerafthe pmpeny,am exclusively commcoing with licensed contractors, ,y, Aa, {-;x,tv,. e,s n. .r e,eki,n,(Yr# IF' �.. ate ` F(•OOD ZONE AI'N ensiruat the police,(Sec.70144,Business and Professions 7oI The Commctora s Licensclawdcexnnupplyman nwnerof properly who huildsorimproves,hereon,anA PERMII'ISSUANCE whocnmmmx for such projects with ecnnvemot(s)licensed pursuanl to the Cenuamors ALTER-DRAIN&VENT-WATER(PA) EBB$UMM License Law. AR Yo i ❑ O . , S BACK FLOW PROTECT.DEVICESANITARY Y N tuner Date DRAINS-FLOOR,ROOF,ARFv1,COND. RECEIP`p# WORKMAN COMPENSATION DECLARATION SCIIOOLTAX Y N I hereby off rro that l have.cent feme of consenuo set f-imus,or a ceni0cato of PIXTIIRE.S-PP.R TRAP RECEII'F# Worker,'Compensation Insurance or 0.cent fed coy thereof(Sec.38tH),LebC)which PARK PIiE Y_N IPI If cove,,all P. ye wed h' ,. _ GAS PA.SYSTEM-I INC.4 OUTLETS RCCT:SION PulicyN lC��/--r�r7-- BUILDING DIVISION FI!lig Co ny [rTaF Q A� GAS EA.SYSTFM-OVER 4 PA) PLANCHECK FEE LJI Codified copy is hereby famished. enified copy is fled with the city impectinn division. GRBASUNDUSTRI.WASTF.INTT:RCBPTOR GRADING ITE CERTIRCATFOFEXEMPTION PROM WORKERS' GREASE TRAP SOILS FEE COMPENSATION INSURANCE (This action need nm he completed ifthe permit is for one hundred dollars IS IIIc) SEWER-SANITARY-STORM EA.20011. FNIERGY PER or less.) I cenify that to the amfowence of the work for which this permit is issued.I shall WATER IIF.ATER W/VENT/ELECIR an, and,any pcovm in any manner so as to become subject to the Worker, PAID Compe...linnlawsnf Cnlifomio, Date WA'1'IiRSYS,1iM/TRFAI'ING [),are Receip,N Q Z Applicata 7O NOTICETO APPLICANT:IL after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: y bermne subject o the Worker's Compensation provisions of the Labor Gate,you must BUILDING PEE /N LLLL� > forthwith comply with such provisions or this p mait shall he deemed revoked. W ASEISMIC ITE CONSIRU(TION LENDING AGENCY I hereby alfrrn Ilia, here ue nmrucuon lerdmgagcncy for the perfommore f O IDI AI ELECTRIC FEE the work for which this permit Is L. ed(Sec 7091,Civ C.) ILLI Under Nome EC••Is LemET,Address QTY ur;( ' MBCHANICALPERMIT,x r E;^u 'o� E3',�W' MAIMING FT:F read mi.,application sad mate that the al.we mferm C I certify that 1 have emanation Ila correct legree tocomply with ell city and county nNinmmex end stare laws relating to PERMIT ISSUANCE MECHANICAL FEE building construction,and hereby amhorrim representatives of,his cloy to ant upon the CONS'IRUCI'ION TAX V 7 eMve-mentioned pmpeny for inspection pu5ph.rrh o. ALTER OR ADD TO MECIL ^-i (We)agree I so ,indemnify sod ke ,he Ci,yof C rfno agsin.vl. Iiabilities,jmig n 'mtam,despen manywsy againt said City AIR IIANDLI NG LIN I"I IT 010.(X10 CIT)in cmarche of egmming f % AIR HANDLING UNIT(OVER III,WXI CFM) Signature of ppdcanl/Contmnor t EXIIAUS'IF HOOD OVIDUCT') PAID HAZARDOUS MATERIALS DISCLOSURE IIEA'ito fINC,UNITTTO.100,IXX)BI UI Ua,e. Receip,q Will the.pplicam or future building accupein mare sir handle hazardous meeftal T on defined by the Cupentnn Municipal CWe,Chapter 9.12,end the Health and Safety HEATING UNI I'(OVER Ilkl,ll(NI B TU) Code.Section 25532(¢)? VENTILATION I7AN(SINGLE RFSID) �• ❑Yes ❑No ISSUANCE DATE OWill the applicant or future buildognscrprm usecyuipmenmrdevices which emit BOILER-COMFORT OR 100,000 BTU) azardou.,air contaminand as defined by the flay Arc.Air Quality Management BOILER-COMPLOVER I4g0,000 BTII) P A 1 ado? ❑Ye., ❑No NEW RESIDENTIAL.MECIf. SQ.FT. 1 have read the hazardous Core. minion., 5505.25533 under Chapter understand or the SEP 2 2 Cotif have email t e hoz CWe.Seater 25equire ent end 25534. I understand the, if the building Jces not conically have a¢rent,ohm it is my rmpo sibili,y to notify the Occ upon sir the rcgnirmnena which meat he me prim m ixrvance of a Cenifeme of Mt\`I�ov ccupancy. - Owner sir imli imd;i"ra Date TOTAL: ISSUED 9Y: OFFICE