S 1961 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO WILDING-MECHT MECHANICAL
PER�71TNo. -1961
BUILDING DIVISION APPLICATION/PERMI'I' rLUSInING.Nn;C,xANICnI.
• - ,I4lIILI1INO 1'RO,Ib:C'I'II11iN'fIIICA'TIUN `
BUILDINGADDRESS: SANITARY NO. AI'1'I.ICAI'IONStJIINIIIT'AI,DAIdi
ON I✓ 9-106Ill L71-S Vi -S�
OWNS fS AMI:( � P-HHOON�Al COMI'RACTOR'S 11:1 �(� LIC NO N/C CON I'ROL 11
CER - l n J o
ARCH)'IT:CT/Eim)lIi R: ` LIC : AUDHES'S:-'/ VIf10eI S� ❑ 7
CONTACT: - l PHONE ,51 [ILL NG PERM IT INFO'
.-f qq ��^� ❑ Consultant Ft Paid by Applicant BLDG ELF❑.CT 1-1-UMB ME
(-`V
LICENSED NSW CONTRACTORS DISCI ARATION / QTY. ELECTRIC PERMIT;.
���d Fy winitf II foCrcn leauu)sbnbyitwepnrelctD d t�I nr en.LaicI.NJ p
" - -
IEE
GJOB
DESCRIPTIONTION
OC) ... HI'LItMITISSUANCE Rj7SIDENTIAI
3369 C1 SFU0.L KITCH
IiN REMODEL
QVUDL., CamA'LLANCES-RESIDENTIAL ❑ADIITION C)PLUMBING REPIPE
F-ZL ❑MULTI-0NI' 11 STRUCTURAL DFCLAR LON IANFLS
F"rn Z, I nnderswn l my phlos resell be used as puhlic accords MODIFICATION
O [Ili'I0200 AMPS O rn^
OZ-a ❑IMPROV 12 ❑SWIMMIN POMC
[FNC4] LicemcJ l'mtessinnxl 2{11-IIXIB AMPS IMPROVIi!1fIiN1' SWIMMING POOLS
IR
OWNER PIRELLI DECLARATION OVER 1000 AMPS ❑BATH REMODFLMEPAIR ❑DEMOLITION
C yay11 Q I hereby affnn that 1 and exempt from the Conlracmr-r License Law for the
5.U bulawimg reason.(Section 7031 S,@®incl,and pool assions Cndu:Aay city or nmmY SIGNS EI.EC'I'RICAI. []OTHER
til a W h which atmares a permit in carr ,uel,alter,impnrvu,di,amI h,aep
ler any.tmm
vlc
-meq pr I I''.. eat 9 rc.0applicantf such a 11 signed Term SPECIAL,CIRCUIT/h1ISC.
f�}; that be is licensed pr tt the provisions fm Contractork,License LiOw(Chapter9
W`xC0 (cog with Section]BW) l)fin t fiheBusiness 11 1 Court or TEMP MITER OR POLE POST
COMMERCIAL:
L o C man l Pt then d II basis f tl d II g x pt A y la n r I El NEW BLDG/ADDITION DEMOLITION
I 44y. Sulo ]0215byt......PPhcan le t permit.tbcvl s rhwppdwm t:aivl Px ally of ❑
POWER DEVICES 'TENANT ❑ ODD SERVICE
mol nave Ihan five handled dollen IS500).
F.Z Y IMPROVEMENT
Fl SWIMMING the pmpeny.onnyot intended with wagesasthei(Sec.coepcnsinen, SNIh1MING IYR]LF.LECfRIC
�p.to will(lathe stock,and the structure
eContrators Licersed e Lawddfarm O,,Iy 1.4a Business ❑UfHER
3mand.ruwill, eC leld"o,mut Caurnena's Licensehaw,aanm apply..lfowner n1 OUTLETS-SW'ITCfInS-I'IX'I'UkES 9gry Q
Pmpedy who bunds nr intpmve.Otnran,anJ who Jnes such writ hlnnalf or ill ruugh
Ili,own ansployees, ,,aided that well ilnprovelnenls are not intended or offered for NI1W RESIDEN'HAL F.1,17 it SQ PIT1
sale ll:however the builJing orimpmvcnrcnt is Hold within nneymr of mmpletinn,the SQ.IT.FLOOR AREA S/SQ.1"r.
miner-builder will have the burden of proving that he did not build of improve for par-
. ryuuofmle),
I,its owner of the Properly,am exclusively canlmcdng,olt Iluvr.ed vain auwm do
- 'I'OT'A L:
met the pr,,jc,,Sac.7044.Burines,and I'mfuasions Code)I'he Collimator',Li-
sela,ldnl,notxpply loanowne,ofpn'peny who builds or improves thereon,laid QTY. PLUMPING PERMIT FEE.
who contracts for such pmjab with a conwnor(s)licensed pursuant to the Comercaors
License Law PERMIT ISSUANCE
❑ Iamexemptrmdcr Scc. ,13&PCfonhiumasan
Owner Dmc At:[ER-DRAIN&VENT'-WKI'Elt'(EA) - VALVA PION
WORKERS Cally of SAT(an DECLARATION RACK FLOW 1'R(JTECr.DIiVICI! D^ 0^
(herebyoff nntainorder Certificate
eomltyof titConeneofthefnllow'ingWrkersC.s: O QIJ TYPE
❑ Ihava and pooll"meinl Se't'ml Bamen(Ce Lai oselflunare(or WOder's Cathryn- UHAINS-FLOOR.ROON,AHIiA,COAD.
S'I OIYIn, TYPO CIINS'I1RUCTION
w...,f'Lou"',;" owth ElJ lues by Susia:3]00 ul Lha Lubar Code,for the perhrmwnm al the
wnrh lar which Jit,pcnnit is jawed, FIX'I'ORES-PCH TRAY
have and will maintain Warkers Compensation Insurance.Or,required by Sttlinn
� unit he Labor Cale,far the perfmmencenfthe work far whichlhispe.it isiouul. GAS-Eq.SYSllihl-1 INCA(lI1TLETS OCC GROUP AI'N
h1Y WnrAer', et-Ili
Hzjan r I OJ Policy
Carl!,, - 7 Poli,No GAS-EA.SYSTEM.OVEkJ(13A)
C.IfI INICATCOE SAiMP INS RAN WOk EItS'
COMI'IiNSAl10N INSURANCE GREASE/INDUS'IEd,WAS 1'17.INI?RCEI'IDN
lit_111,DING_I11V I51(lN hliliti_ _
(This section used not he completed ifthe permit is fornne hundred dollars(511X) GREASETRAP
or Lem-) 1'LANCHECK Rin
ccaify that in the parfunnwecorme work for whleh this unit N,Ia.d.Wall SEWER-SANITARY-S ORM EA.210 FEE
nm em ploy any at, no in any as u, o,msmbean..omelc In.d ie Wnrkcrs'Cumlwm ENERGY PEE
07, satins laws of Caliomia.Dale WATER IIEAI'ER W/VENr/FLECTRGkgpING FIREApplicum
.Z".I h NOT ICETO APPLICANT:If,after ranking this Certificate of Exemption,yam should WATER SYSTEMUT REATING ilin ILS FEF.
a ? bec me subjal m oro Walker's Compensation motional of the Lm G
ahale,you nndt
w fnnhwof,council with such Pnrvimun.ser dIli.Imamal varl bedecmedrevoked. WWI'ERSERVICIi
4 0
CONSTe isRUCTION
acost LENDING AGENCY N1iW'RESIIl1iNTIAL PLh11{. $ PAID\
7 Z IhcrebY animt that there isnamstmclinn lending agency for the performance of � IINJ Date RccciplN
U O the walk for which dda perrah is issued(Sec.3097,Civ.C.) V l
u' (~ Lender' m
s Nue p1 'I)TAL:
C) U Lcndcr's Addles 'I'0 Id
r y I certify that 1 have mad this application and state that the above elimination is BUILDING PER 0 O
F (A correct.(agree to comply with all city and county ordinamms and arae laws relating to QTY. MECHANICAL PERMFf PEE
V z handing cnmaterimn,and hereby andancie representatives of dais city nr enter upon the SEISMIC FEE
abnvwnentimned fa toy far Inspection pulp", PI!RMTT ISSUANCIi
(We)agree losuvo,indenmlly and keep hm'mlcss the City o1'Coil action,
FF:
behilon-,judgmems.costsand etipeucswhielt ay in anyw.ayacameagajma,mdCity ALTER OR ADD10 MECH.
sequence of the granting of this permit. PLUMBING I;];]:.APPin LICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT G`0 1I,00OC M)
SOURCE REGUI.A'I'IONS. MECHANICAL PRI:
AIR II ANDIANO UNIT OVER 10,000 CFM) CONS'ERUCTION'I'AX
Signalurcof ApplicantrCommnor Date EXHAUSTHOOD(W/DUCT HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE:
Willthe applwl or future handling ocenpunt.mmor handle hw.abia,nmmriul I(EATING UNIT TTG IgdfNlll IT U)
as dcfmcd by Lha Cuportino M orallDd Coda,Chapter 9,12,unit the Ilc:dlh and S:dety -
Cada Section 255321:0^ HIIATING UNI T(OVER W,000I{'TU)
❑Yet -I No - PAID -
VENI'ILATION FAN(SINGLE RESID) Data Receipt N
Will the applicant or furore building occupant use equipment or devices ,Lich BOLI FR-COMP(311POR IlN1,0011 BTU)
raiz Iraiardous air cnohiminants a.dclined Lydia Iiny Aran Air Qmality Menapontat 'IOTA],
Dlevlm? BOILER-COMPDIVER INO.000 LITE)
❑Ye.s E]No
I have read the hazardous materials requiremmn Is under Chapter 6.95 of the Cali AIR CONDITIONER ISSUANCE?DATE
fnntia Ilaalth&Safety Calc,Sarah,,,25.505,255)3 and 25531 I understand dict it the NEW RESIDES I'[A),MECIL SQ.FI'. `
budding too,nod...randyhave amnam,thatoismy rcponobility local.1,ill,air, 0,
of the requirements which med M nuct Her to issuance of a Coudiaaln of Occupana, /rye
Gwner or uuthorizcd agent Date TOTAL: ISSUED BY: �O • l l O
I OFFICE