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S 1874 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-EIA{CI'RICAL I'I[RppIT NO. 1874 HIl11.DING DIVISION APPLICATION/PERMIT PLUMnINc.-MECHANICAL l`J BUILDING I'ROJI?CT IDFNT'IFIGk'1'111N BU1LOINGADIDItIiSS: - SANITARY NO. APPLICATION SUBMITTAL DATE 2 /8-0,,F- R&6/V4 k > e-u Pc/Lr�h/D (IWNIRS NAMIi: PIIONCE CON'IRACIOR'S NAMIE LIC NO Ro 2� �}tG` 4'z$-7 Z.5-07z- - ' N/C CON IRDI.0 �SID pECTIC�C`NN �c.�d6 u oGNO y3a t� ADDRESS: . _ ❑ O CONTAC: PHONE: BUILDING PEIiN11T INPO �Oq CYANO �Q Z� ' Z ; ❑ Consultant Fees Paid by Applicant(initial) HLUG ELI b/ PLl1h1P I ; ,7 LICENSED CON TRACTOR S DECLARATION ARATION QTY 1 LGC TRIC PERNII`F " FEE I hereby ntGll dart :d 1 1 IChEFI )1 ' g - -v - ..JOB DESCRIPTION ZoIZ F+ 00 PERMIT ISSUANCE RESIDENTIAL in full force and effect rQ : ❑sErm. ❑KITCHEN REMODEL GVU Lmenvc Clnl hicN APPLIANCES-Ii RSInENT1A1. ❑AUUIIIGN ❑PLUMIIING RI?-PIPE [-ZM Date Convenor Na,E• ARCOTFCFS DECLARATION ❑MULTI-UNIT ❑$TRUCTURAI. 4-p N PANELS MODIFICATION N Z 1 understand my phms shall be used its public records OZ�`� _ UI"Iu 21N1AMl'SI'HR10R ❑Cl]PANTY REPAIR F BF--Ed Limmul l'mfewourill 201-1000AMPS IMPROVEMENT - ❑SWIMA1INGP0(lIS OWNER-BUILDER DECLARATION OVER IINII]AhIPS ❑BATH RY:MOnI?IJRI?PAIR DEMOLITION �J C�a 1 herehy of rra(I'd 1 an summa Goan the Cunoneou n Licen,eu Lnw It,,Ile 3 m U following inaction]031.5.Business and Pnd'essions Cotln An t t ❑01'1{lili g recant.( yciyor cnunY SIGNS[LF.CI RICAL F 0 N which requires a permit ut construct,alter,improve,demolish,or repnir any structure f y� tic or hs isxtarn,t,also l.....lotslbsu"licanlfor such"moa n flea nignalelat"at l SPECIAL CIItCUIDMISC. Ihathe is licensed pursuant m the provi.vinns of th,Centnclors License Law(Chapter 9 I+1�00 (OOmmcncing with Seninn]fN)B7 of Divisinn3ofthe Business and Pafevionz Gdcl nr TEMP.METER OR POLE 1NS9L COMMERCIAL' d p�o t•L IMn he is exrntpl therefrom=it the basis for the illegal cxcmptina.Any violation of - ❑NEW BLDG/ADDITION ❑DEMOLITION ISN, Section 7031.5 city any aPPllcam fill a pennn oinces the applicant Ina civil penally of POW17R DEVICES > not more than five hundred dollars($500). ❑TENANT L3 FOOD SIIRVICI: �Fd Los nwner it miss nt I11res with wages as dmf,sole el ulceration, S IMMINGPOOLEIECfRIC IMI'ROVEMIiNT ❑ PrnPu Y YmnP Y acs pcava dolhewnns Code TheConnectors on e hots License La this. of appu.]fan owner (if 63 m and Pdy'he co Code The C its the.rs License law dre.not apply e f owner of OUl'LI FS-SWI'I'CIE?S-FIXTIIIt F.S 3 OTHER prnpeny who bullJs or innpnvev thereon,std who does Hoch work himself nr tM1rnugh hiswa entployws,provided Far.inch ingnnvenanNu wnal immadnl or offend or NE RESO)1?NTIAI.Ii1.EC'FR SQ F-F sale�If,howcvcu the build'mgor improvement is add withinoneyeoridic, EPletimt,the SQ.FI'.FLOOR AREA S/SQ.En cr-builder will have the burden of paving Lha he did not build or improve for pur- e rl h'ale.). - is nwner of One pro,E ant exclusively nmvacling will IkenseJ enNractors In TAI: 1 construct the project(Sec.](M-1.Btuia.,cold PmRssions Coo the Contarm(a Li- wew, awdws nntupply loan ownerof property who buddsnrimpaves thereon,and 'QTY. 1 ISItA11T• ,r FEE; n...mails bu...It Project,wins a contraction,)Iwilool l Pmstmnt to do G,ubanor's 1-ircnse Law. PERMIT ISSI' NC ❑lam tpnJ .If do P C for this 1.111. AIAER-DRAIVAkHNT- A'FI?R(1? VN.UA'FION O run C. WORKER:SCOMPENSAI'ION DI?CLARAT ION BACK FLOW PROTECT DEVICE I l ereby auirm trader remdly of penury one m ole following ardirmiate, d L3 1 have and will manudna CenillcateofGmcoad1. lbin,urc for Wn kcr'e C...... DRAINS-FLOOR,RIIOF,ANIIA.�N S'f(1121L 'I'YPI?CONS'IRUCTION ration,as pruviderl for by Section 3700 of the labor Gide,for the performance of the work far which Ibis permit is issued. FIXTURES-PER TIE ❑ I have and will mninhlln Worker's Cca,s na i l,.Oco cc,as oeyuirnl Ery Srrllon 370(l of the Labor Code.fm the witurmanec of the work for,rush lhk%psua as issued. GAS-EA.SYSTEM-I INC.d OUTLETS (ICC.GROUP APN My Workers Contp.nsation Inaummsc wilier and Policy anther are: Carrlur: Iblicy FROM GAS-EA.SYSTEM OVER d OFA) CERTIFICATE Oil SAI ION RAht WORKERS' COMI'IiNSAI'ION INSURANCE. GRIiASFl1NDUSTRL WASTP.INTERCEPTOR BUILDING DIVISION FEES fThlx eenien Dud nm becnnmlual II Ile pennn Ix fonmc hundad Jnllnra($IIXD or Ens.) G-WER 'S N' PLANCIIECK FI',li 3 T (x� Icenify hot in in pedomtanecnfthe wmk Rte whichhisIn permit is issueA,lshall SEWIiR-SANITARY-SNNM LiA.21NIIT nounpdoy any person in any manner solabecomc.vnhjacnn the Wurkers'Cnmpen. 'NERDY FF.I? /2. / Z� Oz action Lnw..ill Calilnrnlx.IJote WAI'1ilt HI3Al'I?R W/VIiN'I'll?LEC'FR GRAVING PEP .Z-a Applicant .�.a NOTICE?TO APPLICANT':If,after making this Cenlfwre of Exclnptinn,you should WATT?R SYS'FEM/fBEATING - F leasntaa%ubjea Ra its woatars Gtmpen,xtal E pmvidntsol he Labor Gale,yna angst I'EE forthwith comply with...It ponvmor nr this penal Shull be deco edrevoked. WAI'IiR SI?RVICE aQ CONSTRIJCI'ION LIiNDINO AGENCY NIiW I2ESIDIiNT1A1.I'I.M13. S Ur V•V�-r PAID UQ I hereby alEmubaulere is.c...cunin.lending agoncy kadepedouncruo of Illk(,J' Lha RecoiplN the walk for which this .it is issued(Sec,3097,Civ.C.) Lender,Naane TOTAL: L) Leadcr'.AJJr1s - 'I ODV„ '� y 1 renily Thal I ha c J Ih'. ppl I' J.t t that Ih M fsmml nn is BUILDING HE 0 e rF-a rot coned logical to comply with all city and counly I' I state I r"Ironical ttlhe eaming et OIY MECHANICAL PER MIT �' FEES Zl O U baiW O geo stnon, rd heichy null - el Tn esofll city I FUPSEISMIC El: l abnvnmcnllonM pmpcny for inslrmion pupxsres. PERMIT ISSUANCE O (We)agree t.save,indemnify and kccp hnnnlu..v the City of Cupertino agains ELECTR0. E U Enbiline,.judganenl...... and exycnses whluh any in any way uceaenguival suiJcily AlAIRORAOI)TOMIiCIT in consequence of granting of pemd6 rLUMInrvc 4'E •3 s/J APPLICANT UNDERSTANDS AND WILL COMPLY will It AL1.NON-POINT AIR HANDLING UNII ETD I0E)0ICFM) MECIIANICAh P SOURCE REGULATIONS / V 'AIRRANULING UNI'I'(OVER FlFp)C17M) CONS'I'RUCTION'LAX Signumm ofAppliwMCnmrnctnr Date EXHAusTH00D(W/DUCFI HOUSINGMI'FIGATIONFEE IIA%ARUOIJS MA'1'I:RIALS OISCLOS(JRli Will the applicant or future building nTupanl%lore or handle Introduces tnulcrial iA I ING ON I],(TO I 00.00c)It FU) as dclined by the Cupertino Municipal Coal,Chapter 9.12,.and the IIcurh and Safety Cady Scott n i 25532(u)? trial[NO UNIT(OVER 100,11011 BTU) ❑Yn 7 N VEN'I'LLATI ON FAN(SINGLE RESH)) PAID Vine be q Willdun EPPllaaa..r IRoaa building by the ..use..Air tentmdaviel which BOILI?R-COMP(3111'OR 100.NIO BT U) emit baveNow Dir wmaminamu us define)by the by Area Air Qm'ny Manogcane'tt 'O OiwrinP ❑Yee 0 N BOILI?R-COST(OVER I00.0g)BTU) AIR CONOI'I'I ONEIt S have wildlife Cask,Serious 25505,25533 5,2553 annts u2553 .l eine mann that6u5 of the Cali- ISSUANCE IJATI% is forma'do &Safety Gds,ca rental, a po2553),I unJcntamd thatifthe NIiW RESIDENTIAL.MECf{, SQ.Irl'. ntnMiltgdae.m"I cry hnvenlellom.don ltMntr lem11nainillty to..eaify ille nerapaatt e quire ns Minh mus I poor rot lssuancc of a Gen rode of Occupancy ,- Owl cOaou(Iari,cJ agc d Date TOTAL: ISSUED BY. OFFICE