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28656 �- "APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL.POINT:PEN ONLY, ` -"4 a . CITY OFCUPERTINO BUILDINGELECTRICAL - �yPERMIT NO. MFexANICAL BUILDINGDIVISIO -APPLICATIONPERMIT PLUMBING ^ ^ VJ ,IVB t BUII.DIN(:PROJECTIDENTIFILATION " - _ ' ' BUILDING AUURP.SS ++ ^+ '� �i - n ^. y " SANITARY NO. I APPLICATION SUBMITTAL DATI qj OWNERS NAME: - �` H/ ONE CONTRACTORS N+ � *',LIC NO 1 a _ e I NIC - CONTROL N ARCHI TF.C, GII E: IC NO ADD,RE+SS: 06��W. p/ '� ""' :ACJ - , 'CONTACT - ' PHONE' •+ BUILDING PERMIT INFO W r ' ^' 21-2-:74 '`❑ Consultant Fees Paid by.Applicant(Initial Lr10. ELECT, 'PLUMB -i MECH ' r oa ❑ o LICENSEDCONFRACTORS DECLARATION na QTY. ' ELECTRIC PERMIT FEE l I eny Item in t{ f d d v : r charter 9(1. g _ _ JOB DESCRIPTION awith Section](MIO) [D 3 fOeens .ad Cdeand tylcenses 00 RESIDENTIAL: License yQIPPRMITISSUANCE 's' tulle deffaL - ' ❑SFDWI. ^I D KITCHEN REMODEL' FUU Date Class. Ce. cinr APPLIANCES-RESIDENTIAL, _ i<. •N" _ ❑ADDITION -1 0PIAMBING RE-PIPE had' HITS DECLARATION v,e - - •o - -❑MULTI-UNIT ❑STRUCTURAL 02nd 1 PANELS' ,V:" I dt built a�KL bl' N t MODIFICATION J �� UPT02lN1AMP8 ine d P 1 Y _ - 171 INTERIOR El CHIMNEY RGPAIRt�: L 2111 IOW AMPS IMPROVEMENT'� - OWNER BUIL DLR OFCI)RATION OVFRd000AMPS BATH REMODEUREPAIR^ElDEMOLITION p I h ff by that l are exempt front the Contractor,I en Ethic O c {iisS5..O V falloWngrea n (Sect a?0315B .in. edP f .Cod Ay ty ty SIGNS CLF.CTRICAL ] ❑OTHER which ' q res a permit t t 2 11 r improve demolish, r ren any someone - f s- �0 prior to t e also'eiluires the ppl t for suchr tiofle stogrod.et mens S PECIAL CIRC U I I'/MISC. _ - yThai he licensed prt the pros isionsofth Coul for,Li,etoc L (Chapter 9 _ '(coo g with Section 7000)of Division 3 of the Boone.,, d P C'.i .Code)., - TEMP METER OR POLE INST. fCOMMERCIAL:- •� 0.fa m a' that h mol therefroma J theba ._' f Ih Ileg J e pt Any violation of El NEW BLDG/ADDITION ❑DBMOI ITION �"y Sect ]o3156y nny PPl moot ap rnet objects me ap,plicath,n a civil penalty of. POWERDEVICES t „0TENANT L FOOD SERVICE ^�, GI reih fivehund edd 11 :(SSW) 1 of p pry myempl y with g ih al ren t' SWIMMING POOL ELECTRIC IMPROVEMENT 1 will dolhewa k andmest whefan t mended r rfe df 1 (S c TUD Bu ss -- ❑OTHER and Professions Code:Th C t t Lcense Law does r apply to'a u'n of - OUTLETS-SWITCHES FIXTURES '... prop ty who bills;r impbries therem,and who does such workhimself or moragh - ♦ Yn his own employees,pe8vided that such' prove vents Ire not intended or offered for NEW RESIDENTIAL ELECTR SQ FT. + sale if,however,the building miniprovements sold within oneyearofcoidplet mi theSQ.Fr..MOOR AREA v $/SQ.FL.:P owner4milder will hue the huulen of proving that he did not build or lgnefar pun ' - '•° ` PrOse of EP 27 1995 r ❑I )z f thep p nY exclusively ing th I ce W c nuacmra to TOTAL: / s cont uh p ) t(S ]1114 B d P .t Col )Th C t r L' s crea,Lawd e: t ,l,Iran ncr rP p ny 1 Wild p ,l co and QTY PLUMBINC.PERMIT ,FEE �y I.UYt1���I� ho t t f nauehp 1 cos wim uu nt t rOI'cenecd Pumua ti the Comm tors ;��'I s �C ') q License Law + t PERMITISSUANCE, r ,I ° - ❑ImnesemptunderSne B&P C for this reason q @. +owner Data ALTER-DRAIN&VFN 1'-WATER,(CA) - VALUATION - WORKERS COMPENSATION DECLARATION. I BACK PLOW PROTECT )HVICE y - Is Ih rehy orf le tK Wty of pep Yo fth f II ng Je I t ns - -6 Ip ' .❑ l have and will maintain aC Certificate ofCoussumto self-insum for Workers Co pson- v DRAINS'-FIAOR,R EARFA,COND. STORIES TYPE CONSTRUCT ION ashen as provided for by Suction 9]00 of ih'L b Cade,fo the per urmance f the' ,. - workforwhichohisper t' 'sued' FIXTURES-PER AP E I have and will mamom Worker s Coarpmeadion insurance, required by Section - I]WoftheLabor Code for penton nonce of the wort for wh I Ih:p - lisi issued x GAS F.A.SY. M-I INC.4 OUTLETS - MyWorker's Compensation lneumececarrier and Policy mmberare t - uOCC.GROUP t. AEN' Career Policy No. GAS-EA YSTEM-OVER4(EA) CERTIFICATE.OF EXEMPTION FROM WORKERS' +•- COMPENSATIONINSURANCE i G : SFINDUSTRL WASTE INTERCEP'T'OR^ Ul . Dion need tiro completediethe pennulsfnrn ehu dr ddnllary(SIM) - BUILDING DAT 9ION FHP. or le s) - ORBASE TRAP -. a � '- - -'� PLANCIiLCK PER 1 contrition fit the pnilmonateridolue weakf which this permit is issdleall SEWER SANITARY • RMFA.200 mot npl y h y p n y t h bj t t U, W li C open - ENERGY FEE e Z Ration Laws of Califofn .Dat WAfFR III. TNR + R st 0 'Applicant - GRADING FEE �S NOTICE IO APPLICAN T.If,after making this Certificate of Ebrumquima yon should WATFRSYS . .)TING ,a ems+ beembe subject to the Worker 0 Compensation p v sins of the Labor Code,you must - .SOILS PEE forthwith emrply with suchp o,this spprout shotlh d d revoked. F R EA'i :. Z CONSTRUCTION LENDING AGENCY N 'IUENTI L SQ.PT. PAID 1 h by B' Ih t tl t i I dig age i.y I ,h pcnf.nn.ce of � - D 'Re ipt M 'u thewokor,wbichmes Permit is issued(Sea 3097Civ.C). _ U Lend Namer v •, '' TOTAL: Ixndere Address 'TOTAL: W y ]a unity that 1 have rad this applleau n and tate that the above C information on is BUIL fn amret I g 1.comply with all ity and ry k' a •e d.ot la elagt uno QTY' MECH) ALPERMIT FEE p UZbuilding .veauthorize construction,and hereby tives represmaofthis city to enter upon the SBI9 P - 'abov honed pilot for inspection ptrawas r PLRMI'TI CE (We)agree to save,lades ly and keep harmless the C ty ur capelion ag oro ELECTRIC ohil ie. judgme t nets and expenses which may in wit,,uhhou.,aiest said City pISER OR ADO TO MECH, ` in consequence ofthe granting ofthis permit. e ' PLUMBIN /FRH - APPLICANTUNDB NDS WILL PLY WIT 1LI,NONPOINTAIRHANDLINGUND(TO (L"CPM) MECHANICAL PEC SOURCE REGULA 0 .'. AIk IIANDLINO 11NH'(OVER 10,000 CFM) .r 1. ' !, CONSTRU ION TAX natureof 'cant/ & actor Da EXHAUST HOOD(WHUCT) a, ,'-HAZA DWS MATERIALS DISCLOS F _ ` HOUSING MIT TION HE xst. Will the o It future buildingoccupantmori store or handle hazardous aal HEATING UNIT(0100,000 BTU) . gas defined by the Cupertino Municipal Codc.Chapter 9.12,and the Health and Safety Code,Section 25592(.)7 . HEATING UNIT 100,00013 U). - , ❑Yes .DN VENT ILATION FAN(SINGLE RESID) PAID - a ' Will the appHdram future building p' t isse equipareal,or devices*which I u•emit h b I ,.M out s dod by therea Bay AA Quality ManagmnenBOILER-COMP(3HP OR W,OW 6TU) t ._ 1 n Dm'm' "r' ', ❑Yes ON BOILER-COMP(OVER 100,000 BTU)p �+ t S _ .. _ MRC ONDITIONER I h rve'read the h zadous materials req remems under Ch pt 6.95 of mit Cul _ _ _ SS CE ATH forme Health @ Safety Coda Sections 25505 25533 and 25534 1 ndensond ohvt of the Q. NEW RESIDENTIAL MECH, SQ FT ;a, building doe.nut cunentlyh t Beni Kant my n:Ia s'b'4.1t Yfythe occurs unt' - anusfaCeruf t f0 mpancy. ' '• of the re9u rene na wh ch sob eeipdo t '.. - �,. ,a ' Owner or au I -Date _ - authorized em - - Date' e TOTAL: I% € � ' iSSUGU BY: