S 2832APPLICANTTO FILL IN INFORMATION WITHIN RED LINES • USE BALL POINT PEN ONLY
CITY OF CUPERTINO BHlld)ING - EI,EC7I'RICU.
BUILDING DIVISION APPLICATION/PERMIT PLIINiItING-MECIIANICAL
I41)1fJBN(: 1'ROJI:CT II)LN'1'IF'ICA'1'IUN
PERMIT NO.
� �O
o 32
BUILDING ADDRESS
a
SANUARY NO.
AI'PI.ICATIONSULIMI'1.1'ALDAIIi
OWNER'S NAME: PHONE:
e
CO RACION'S NAME: LIC NO:
YmHe qs. N Q 3
NIC
❑
CONTROLp
l ARCIII'I'HC VI NGINEER; LIC 0:
ADDRESS:
O Dellove-_ a heti
CONTACT. PHONE:
Ne '3 77—
❑ Consultant Fees Paid by Applicant (Initial)
13UILDINC PC•RMI'I' INFO
BIJ FLPCI' PLUME MECH
U❑ ❑ ❑
LICENSED CONTRACTORS DECLARATION
I hereby.from Inas 1 am Iammxd ander,rosNior. art Chapter e (ermtmencing
Scdian]fNNI)nf Dlvisian3 of rM1C ltuxinexs anJ Pmlessinns Cade, xnA any licenel's
WE
in full lulma Ieffycl. _ _ 0 ry
License Chis. Licb
Dale U-7 J� a o Cantmdnr N
ARCHITLGI-SDECLARATION
I understand my plans shall be used as public records
QTy ELECTRIC PERMIT FEE
JOB DESCRIPTION
RESIDENTIAL:
E�TFDWI- ❑ KITCHEN REMODEL
❑ADDITION ❑PLUMBING RE -PIPE
❑MULTI -UNIT ❑STRUCTURAL
MODIFICATION
❑INTERIOR ;�FCHIMNEY REPAIR
IMPROVEMENT [DSWIMMING POOLS
El BATH 1213MOUEURI3PAIR DEMOLITION
WTHER IgIa a e.
'I
PERMIT ISSUANCE
APPLIANCE-NISIDENT1AL
PANES
UPT0200AM
Ltmas.1 l'ndcsvional
OWNER BUILDER DECLAItAI'[ON
I hereby affronted I .m x,ca pt from the Can ...... s License Law for the
following reason (Section 7031.5, nosiness and Professions Code: Any city or county
which requires a permit to consumer, alter, improve, demolish, or repair no, structure
pda.,,it, isaammem.a...... am the applicant for ,ch permit to filen xigmce shnemem
that heixh� wa purstaim to the preaisonx of the%ammo%., Lleensc Law(Chapter o
(commencing with Sedion]OBO)of Dividoo 3rd the liminess and Prof cions Cash)or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7131.5 by a, applicant for a permit subjects lhe.applicart ,, a civil penalty of
nal nem than five hwtdred not... ($AXI).
I,nsmnczarthu pct peny, or my cnnpluyon with watts as lhehaole annpxmation,
do the work, vnd the xlru rros N not intended andrured for sole (Sec. ](004, Bminem
and , Fenian Code: 'I m Carousemis License law dues net apply to an owner of
property who builds or improves thereon, and who dues such work himself or through
his own employees, provided that such improvements arc not intended or offered far
nude.11; howevemthe building orimprovement hold wleoklonc year ofcon.pletion.the
or-btdlder will leave the burden ol'prnving Wm he did nm bond or improve for pur-
pose oI sale.),
L] L m owner of the p,,,,.y, am exdnsively comeacting with licensed enntmemes to
construct the project (Su. 7(H4, Business and Professions Gde.)'to, _ a, ... ..i -
cense Law does not apply to an owncrof property who builds or improves theram, and
wene tham,I xmhprnjul.withacomructo(%) liccnsul Tolmnl at let Cnnlle"aI
Limme law.
❑ I am exempt under Sec. ,d&P C for this reason
201-10WAMPS
OVER IINNIAMP'
SIGNS ELECTR1 1,
SPl!CIALCLRCUIP ISC.
TE.MP.ME'FERORIN EINS'r.
COMMERCIAL:
❑ NEW BLDG/ADDI'11ION ❑ DEMOLITION
El TENANT [I FOOD S17RVICE
IMPROVEMENTwill
El OTHER
POWER DEVICES
SWI M M I NO POOL EI.I1C'I'RIC
DO] 'I.ErS-SWITCHES -IIxT,Ls
NEW RESIDENTIAL ELECTS SQ ET.
SQ. Irl. FLOOR AREA
$ISQ. IT
TOTAL:
QTY PLUMBING PERMIT FEF.
PERMIT ISSUANCE
^�
AL'OiR - DRAIN VENT - WATER (.AI \ ��_
Owner DateWORKER'S
VALUA7l_N
COMI-17NSATION DECLARATION
I hereby .Eu'T under penalty of Ierjury one nl'the f lluwing declerminnx.
❑Ihuvc andwillmuintuineCenifenlanfConcent In>dGi...actnr Wmdets Compen-
moan, az provldW for by Section 3900of the Labor Cxlc, for the perfamem. of the
..,k far which this permit is issued
)�nd will mainmin Werkee, Companati a Inumore, as mquired by Section
3718 oI'the Labor Code, l art the erfonn;u¢cul'the coati fur which Ibis penni(e, u.urd,
My Wor is Capt coxal m rancp r and P m
Carier�Polie a,.n 0//-0
CERTIFICATE OF EXEMPTION (MOM WORKERS'
COMPENSAI'[ON INSURANCE
('Phis section need Full he completed if the permit Is I'ar (me hundred dollars ($ HNB
or Ice..)
I cenify that in the performance ofmc work for which this permit is Issued, I shall
not employ any Fenno in any manner sn;as m become abject m the Worker.' Compen-
sation Laws of California. Damv
Applicant
BACK I'I OW PR ECT. DEVICIi
DRAINS -I;L00 ROOF.AREA.0 )NI3. A r
ORIES
I '7
JJ j //
TYPEI CONSTRUCTION
// N
V
r r
FI%TURES- PERI' APU Inn
GAS-IIA.SYSTId0- INC.40U'rLE: S
:C. GNOUP
�
APhL fa
G V
w
V Z---
GAS-I?n.SYSTEM.tI dR4fEA)'r_
GRHASEdNDUSTRI. WA TE INTERCEPTOR
BUILDING DIVISION Flits
GREASG'BAY
I'LANCI IIiCK FIIII
SEWER -SANITARY-STORM EA. 21X1 FT.
ENERGY FHH
WATER HIIATER WNF.NT/EL[
GRADING Pit[
NUTICII'1'O APPLICAN'L IL atter, nmking this Cerifute of Evenynlan, you sleomd
become .,,hirer to the Water's Cnm,ru,lflon provisions .1 the Labor Code, you must
forthwith comply with .such provisions or this pconor shall he deemed mvnked.
CONS'FRUCIION LENDING AGENCY
I hereby affirm tett there is a construction lending agency for the perratimme of
mewurk fur which this,%unit Ne -tel (Sec, 3097, Cit. C.)
Lender's Name
WAI'171K SYSTEM/IBE6IING
WATER SERVICE
SOILS PEI(
PAID N
NEW RESIDCN'I'I Al. ('LMH. SQ. p..
fie R2dpI»
TOTAL.:
Nader, Addles.
TOTAL:
BUILDING
I unify that I have mad this application and slate that the above information is
correct. l agree m comply with all city and county mdinanex, and ,are laws rearing to
buildingconstruction,and herebysadaim rec,creels"of an cityroemu.uponhe
abovo-nem toned prgwrty ler Inspenlan Pnrpa.e.'
(We) agrethe e to save, indemnify anti kap bora City or Cul'eNno against
liabilines.judgmems, costs and expenses which may in any wayamme against said City
in consequence of the grunting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH At.[. NON -POINT
SOURCE RISULnl3(1�5,
(
QTY. MECHANICAL. PERMIT FEE
SEISMIC Fi
i
Pf?RMI'(' ISSUANCE
BI.EC'I'RIC V17
ALTHRORADDTO ECH.
PLUMBING PIPE
AIR HANDLING UNI' (TO HH.00 CF.)
MECHANICAL PEE
AIR IIANDLINO UNIT OVER IB,IMNI CPM)
CONSTRUCTION TAX
Si re ofApplicmt/Commewr Dare
HAZARDOUS MAIERIALS DISCLOSURE
Will the applicant orfumre bnildtngoccupunr%lore orhundle M1unrtdomneacnal
m defined try Na
CnC2(a).' o Munldpal Cade, Chupmr u.12, and aha I Ienith trod S.fdy
dc, Section 25Z32W)q
E] ye,
Will the lotc.m firhome on,abuilding bwcup.nlyAequipmentordeviceswhine
emit humNous air enle, nimm�s us AdincA by he Ilny Area Air QnNity Management
Iliprial ,�_,//
�Ycs a1Vo
I have & S, the h udc. S Tieraml, 2 505. 2 rements under4,1 mad emard6.95othethat Cali.
buildHoon al Safety Cade, Section ,Ica i, 25533 and 25534.1 to ourshmd that if rhe
bnllBing dorsal), curenrly M1.vcamount,@m it Is my msdamsihlliry mami Itheoccupant
arae Fgrthcmemlx come% �nta.t be pdmrmfc.aannm arae' ireere art (xeawpanay,ay.
EXHAUST HOOD(WID CO
HOUSING MITIGATION ITE
IIHAI'INO UNITOO 001( OH'I'O)
HEA'I'INC UNIT (()VER I(NI. B'I'U1
PAID
VEM'NATION FAN(SINGLE FSIU)
Date Reuipt»
BOILER- COM('(3HP OR I (10, (1110 BTU)
fllT
BOILER- COME, (OVER Ina" H'llt)
AIR CONDITIONER
/— IS 'UANCfi DATEFann�s
Y ABS yC.
ISSUED BY:
NI1W RIiSIDLN'rlAl. MliCll. SQ, PT.
Q
TOTAL:
Ow rauthonzed agnn Dam
OFFICE