S 1498 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PE181'1'NO
BUILDING DIVISION APPLICA'T'ION/1aERM IT PLUMBING-NB?cunnB.AL J 1498
J IIr111,I1IN'1:1'ROJ4:CT IIIENI'IFICA'1'ION'
BUILDINGADDRISS: SANITARY NO. APPLICATION SUBMITTAL DAT13
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YI IfINI?: S• CON'I'1(ACTUIt'S NAMIi: LIC NO',
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CONTAC I': PHONE: HUII-DING PEkMI'f INFO
JGs --+2-9'2J%osue / ID O ❑ Consultant Fees Paid byApplicant(Inikiap BI ' 'LFC
with Se I lyOAof Division hdraised nderpUF,C1,ARA ION QTY ELIiC'I'kIC PERMIT' EGI3
I,ICENSIiI)CON'
herebya nrnyi,drn.or cmmmte(commencing J 13 DESCRIPTION
OCZ and Profession,Cale.lad my lkcnx is RESIDENTIAL �Kll'CHGN REMODEI.
F�•�B in fill toreeneddla,l, 1q� � ' I'IiRMIT ISSUANCL r O
F Z LLVI Uulemw •--1 C+ O (.icl �
APPLIANCES-RESIDENTIAL ❑ADDIT ❑
ION PLUMBING RIs-PITT;
I,,;
Na4• • nHCHI'fECT$DECLARATION ❑MULTI-UNIF ❑STRUCTURAL
F P{n PANELS MODIFICATION
OZ— Iunderstand my plans shall be used a„public record„ UPT0200AMPS
2 CJ ❑IN I HkIOR El CHIMNEY REPAIR
Licensed Prole,anams l 201-vXX)AMPS IMPROVEMENT E]SWIA1MINGPOOIS
W
UW3H IgM)AMPS ❑BATH REMEIIRFI'AIR L1DEMOLI'I'ION
OWNER-BUILDER DECLARATION
ON
C C 1 herebyMithat 1.,it cam
ept from Cfie the ann Ulcnw Law tiro he
(7,50 a.Q U fellmwingrea.na.(Seen n 17031.5,Businc,s and P...fcs„ions Cale:Any city tar county SIGNS ELECI'RICA], ❑01'IIEk
97'3 e y which requires a permit 10 congrvnm
,alter,improve,demolish or repair any st enure
F"LL'�< pr...lon,isoaaava,al y ' knetchpannan,filea,landomernam SI'FCIALCIRCUIT/MISC.
that he licensed p : to the p .Ilith CountLicense Lno,'(Chapter 9
Ra }_1t 00 (nommws ng w'Ih Sscl nn llXllpr 111 vsrr3old alisvn...and ll)4.: :Crde)o, TITsip MI na ORI ST. COMMFRGIAI'
d d c C that he is exempt therefrom and the basis fila the alleged exemption,Any violation of ❑NIiW BLDG/ADDITION ❑DIiMO1,ITION
ILI Scelon 7031.5hyany applicant turn pernih,Ajeels the aPplicaut loa,villtcnaltymf POWER DEVICES ENANr ❑1'GODSE VICE
N out mare than fire hundred doll...S50KUk
F-SGLa,owncnof0c n locc,will warasa that, cnnmm�valin i. SWIMMING POOL HI,ECfRIC MPROVI3MEN'I'
O Ornpc y.tar my corp Y b I ❑OTHER
p. will dolhe work and thea1mcture Lsnml intended o uttered fmrsalc(Sce.JOl-I,Business
3 c and Professions Gmde:'She Contractor,License Law docs itm apply m on owner u' 7 oull.1?T$-SWI'rC11E5-FIxrUHI'S'
property will)build%m hematites Ihe,am,and who date%such work himselfur through
his owe employees,provided that such improvement,all not intended or vieved tai NI?W RESIDENTIAL ELECFR SQ Er
side It.howevoq the holding or lntpmvcment is sold within one year ofcomplction.the SQ.FI'.PLOON ARI7A is J°l'.
owma,builder will have the burden of Proving that he did not build or improve One put- �05 0 OO
p...c of sale.). T r l:
I f the p pray am ,clunively contracting with I' al comovites to
encolruct Ih p J l(See7094 B ' ”; it Prefe,sians Coda:)*Me C t t r la- —
clause
i-
se Ioes m,.,,Iy,o anowroofpr Perry no h ild,, improve,there and QTY. PL G PERMIT' FEE
whoumwus lorsuclt pnp.us II ttt l,)li".1,1011111-al the Intr'
I.iccn,c Law, I PERMIT ' ANC: D
Iomeaem,laoder Sec, -B&PClnrlhele'lln
ALTI!R- AVEN'I'-WA
(Iwnc, Uafc
d WORKIIRSCOM1'ENSNITON DECLARATION RACK F1.
VII 11: lH E
I hachyaff n under peralklefpe,myore oldie following dedamtions:
l haves If.i11 maintain',Certs finaeol Consent to wlf-insum for Wnrker'e Cnmpen DRAINS-FLOOR.RW AR C I STORK 'I'YVE C11NS'I'RUCfION
n,ns provided for by Section 3100 of the Labor Calc,for on,Irlimrmme of fhuI/ t /b O '^ 05(l
A
work forwhich ll,spennil is swcA IIxFURBS-1'I3H'I'RAI' C`yf V
I have and will mainmin Workers Compensation Insurance,u,m"mcall by Station
37000 he Lahur Cielc,he tficperlir....sa til the w...4 lbr which this terror is issued. GAS-EA.SYSTEM-1 INC.a OLD LETS -GROUP MIN
My Werlsds Caratetion lmumnce carp' JRIicY�lt�crgq
Cartier: lNDU�TILs�4 i+be•M4�11 i1'IicY Nn,; �11.a�'4L r3�ry GAS-IiA.SYSTEM1LOV1iRAIEA)
CF.RI'IPICAIE OF EXIT ION ON PRAM WORKIiRS' GREASITNDUSTRL WASTE INFERCEPPOR
•COMI'ENSAI'111N INSURANCE HUILDI IV1$ NFE&S
(Thisseaionneadna bee.andesed iflhcpermit is roronchundeaddallms($11X)) GREASE TRAY
PLANCIIECK PF:1i
kgs.)
1«nify
Oatllthe
anofthe
work fwhich tn 'd,l shill SEWER-SANITAI'-STORM EA,201 FF.
IiNIiHGV FEF
not employ any Ncrsan Iran,matner sur.,in McmnswajeatudieNlkar,(ontpmt-
Z
roti....Laws of Culilorniu.Data f WATER I MAIEA1'NENIELECFR Q 00 GRADING FEE
z Applicant
Not ICE to APPLICANT.IL after snaking Ni,fe,tilwan,of Execution,you%hold WATER SY�fEM/FRE
y $OILS IIi1S
[-' Mcotne sahjrel y the Workers CnmP,or pmvit qual of the de LnMa Qde,you moat J
limlwith anngily with well pnrvisiun%unbi,Iwrmit slnJl RAeen¢A rcnWJ, N'A'rlik%F.RVICK
UJ
Q PAID [/ O
CONS,,is it'IONIJiNDINGAG1geCV NEW RIs. TAI.I'hMlJa> SQ.FII Ilma rept • 7
U OIhvwhy off nn lhauM1crc is azomwmion lending agency for perlmnancc of J
' the weak l'or which fin,permit i,issued(See 3097.Civ.C.)
O f-U lenders Name V
Under,Address r X 9( r
0. 1lenity that I have mail this applicminn and pale that the above information is �•
F" 0 comet,l agave us conmply with all city and county initiatives and stale law,relallug m' QTY. MECIIANICAI-PIiRMI'f IFIi SIT" P CAD `I•
U Z nalding eon„unciiam.aml ne,nny awhaLe,opre,enmtiyas Doli,.city,.%mer atnn me
.Nor-mentioned pclpa,fill impreams.Putprrses. / PIZRbut,ISSUANCE Ii1.liC1'RIC 1:1217D
(We).,a,,o s,,c,indcmmfy.,it keep hrou les,the City o1Cupoeino against /•�
liabilities,judgments,corns and expenses which mayinany way aam<againa said City , ALT ER OR ADD'TOM, [Iin (� V
On, i I'Ilis 1. 2 PLUMItI ' I I
mmqucncco ySrAND tenni
APPIJCANT fIRDERS'L\NDS AND WILL COMPLY WIT[ALLNON-POINT AIR HANDLING ON]T'(lY)I(,XNICFM) p1EC_4 1.FEE
/ 4p UCI'ION'1'A
%
/ AIR HANDLING UNII(OVER 10.00B F41
tiign:n 'ofnpplicunVCnmr.'en flaw EXHAUSTHOODIW/DUCT) OL SING Mir FIGAI'ION FEE
HAZARI OUS MAI ERIALS DISCLOSURE
Will the aTlicumor future It dingocsltpanaumeo,handle hwardom material HEATING UsiT(10 I00,000 B'I'U)
as defined by the Cupeninm Municipal Code.Chapter 9,12,and the health and S'usely
Cnir.Seen 25532(x)1 BEATING UNIT(OVER 100.000BTU1 U
0Ye, F)No VENTILATION I'I\N(SINGLE HI'_SIDI PAID Uate Rtti Ip
Will the applicant or future building rcwpant use equipment or devices which BOILER-COMP(31111 OR 100,000 B I'U)
mil h trandaus air eom nnmanl%as defined by the Buy Area Air Quality Mmmgcment
DuanctI]Ycs ❑Nn l BOTER-COMP(OVER 100.0I0BTU)
I have read dre hara,lom nsmerlaN requirements tinder Chapter 405 ml tic Gdl- AIR COND[HONER ISSUANCE DATR
p
fumiu llcllb,4 Safety Cole,Suctions 25505,25533 and 25.514.1 undemlual that if the NEW RESIDENTIAL MECII. SQ.FF. ��_�gy
building decision rumored,have a fenanl,that i1 is my ra,nri ua,m nilly the oseup:ml �O•/�� Pof the mgnimmmas which must be nmt pdonn..... c of a Certificate ofOccnpar, V V /
47"
Donator amhorind.,an( Ilam T07Y• ISSUED BY:
OFFICE