S 1999 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-FILRCI'HICAL Pli H NO.
RUR,DINC DIVISION APPLICA'1'ION/PERMIT PLUMBING.MECHANICAL 1999
HIALIHNG PROJECT IDEs'1'1FICA'1'ION'
IfIJILUIN(1 ADIIHf5S1 SANI'T'ARY NO, APPLICATION.I It DATI!
106 00 z -
UW//digg.'ti NAM17 I'10 �`� CONI'H/` 1)R'S NAML IG IC NO:• V��1 /� � (IlA 1 NIC ��bII'' (� CON'1'ROLp
AI{G14TIiCr/ENGI EH: LIC,I� ADURIiS4 II ❑ y �Q
(`-/ 1
CONTA'I: - PHONE: HUILDING PERMIT INFO
�12 I O^ -L ❑ Co a ullaN Fecs Paid by Applicant(Initial) III,)G ELE(T PLUMB MLCH
GG Il CZl� Br-
LICENSED 0�
CON'DAM OR;S DECLARATIONQTY Ii1,FC'IRIC PERMIT FEE
I hereby affirm mal 1 all,licensed under 1,n,vixi,ms of Cha b,,9 mnntmencing JOB DE5CRIP'I'ION
`-2ZZ with Sminn](NN))nf DivisinnJof[M1c Hmine,Ond Profession,Code and my license'11 RFSIDFNTIAI'
-100 PERMIT ISSUANCE
CWF in full Ions and rare 7��96� ❑tiFUWL ❑KITCHEN REMODEL
aUU I,icen.m Clxss Lien o APPLIANCES-RESIDENTAL ❑ADDITION ❑PLUMBING RE-PHIE
iM1 ZW Date comms /-94 sYi7usf.?i. 5_
ARCHITECT'S UIiCLARAr]ON 1'ANIJ.S ❑ h1'1-UNIT' ❑STRUMURAL
hIODIFlCATION
Z O'er 7_ I understand my plans Shull be,i sM ac public records
UP TO 21X1 AM15
IiRIOk 0 CHIMNEY REPAIR
I:•��W hiamsed l'rnicxsinnal 201-1001 )VEMENI ❑SWIMMEROPIOLS
OW'NCR.IiUll.1l11RD1icL RA'1'IUN OVER 1'9 ❑BA' REMODEIJRF.PAIk ❑DF,MOLI'r10N
C W Q 1 hereby,odors that I am exeptpl Ram the Convacmu's License I,we for the
{xyI 3 LL F li,llnwing¢,rens ISmliun]0315,Bmincss send I'mlexsions Gxle:AnY city ar awnY SIGNS CLEC'I C,1. Illi[.
y which myuirc a Mnnit n.copspnel,elle,'nngnve,dcmoliuh,nr repoir any,memrc is
OsC prior-:its issuance,aha requires the applicant forsuch permit,File a signed watcmm�t SI'ECIA CU1'1 SC.
E }, ma he i,IlcenseJ murcwnuuthe povisinnsof the GmtraeuK.x license La,v(Ch;"f"q
111ap0 lmm�ncncing with Scninn]INNq of Uivisianlol me Husinesa and l'rofesinm Calelnr EMR ME OLEHON
,. .
EE o C that he is exemptm there mand the lebis Jon rw.Ile,rd exaln,I I,.Any ,ipl cion o[ ❑NEW RI. /A ION ❑DF.MOLI'
X-mSeNon]031,5byany appli,am furapcn:dl bbicO,lhca"icannnacivil pc.alIy.f POWER ICES 1ENAN'I' ❑Fool)SERVICE
aI more man rise hundred dollars(451X11. MI'ROVIiM1iNT
❑ L.,nwner of lire prl,sm,.or.ory aloPloyerl with writ-es their sale cnmpetwnian, SWIMMING .ELECIRIC
�S0 soilldndw wnrk,and the Odeare is nm imendeJoralrered forsd.(Sce.]1Xl-1,Business ❑OI'llliR
Cf o
Ladd pofcasinm G,de:'fhe Con-helm's L nd w Law Joe,rod apply s un nwner a OIff1.CP5_SWI'fG IKTURHS
his p.,Is ho tuilJn or improves l .ell-,and who d:ws a rail
work himself ur IhnmgM1
his own employee,,pmvideJ Ihal such impr�vemenra arc nal imrnJal.r allcrcJ Inr NEW RIiSIDIiNTIAL EIEC! SQ IT.
sale if.bnwever.the hniliing or nipmvcnteni is sold within ane Yc:nnle-mplelinn,the SQ.19',i'LDDIIANCA $I5Q.PI'.
wn
cr-milder will have the harden of moving that he did not buil)or improve fur par-
pmeafmle.). Tt h /^Y /X•��
❑ 1,a,nwner d the prnpcny,um exclusively c-:nracdng with licensed contmaors it)
nrhuet the project(See TW.Hmsinexs and I'mmslnn,C:xlc)'I'Ite Cbtnracor's,On
scJ,aweoc.nm amplymm,,,rvr of pr),eny whn builds or imprnves thereon,and QTY. PLUMBING PERMIT FEE
whncommets for such pn,jcan wimucnntraellm)licensed pursuant lotbc Conlraclnr',
Ldcep.,e IWw, FERMI I'ISSUANCE
❑ 1 ren exempt under Sec. .H A P C for this rwmn
AI:I'EN-TRAIN A,VIING-WArER(EA) VALUATION
Uwnm Date
WORK12R'S COMPENSATION DECIARA'1ION (SACK FLOW PROI ECT.DEVICE a , ® 000
I bereb,alfint ander Penalty.d Palury nuc of the Lflarre gJcelumtions: Q //�
❑Ihavc and will m.inlama Cenifcate of CImwm osell-insure fur Worked',G'mpcm DRAB S-FLODR,RIR)P,AREA,C.ONU. J 'V S'I ORiES 'fYl'E C'IINS'I'RU6TI(lN
m[i: p 'JJI I,S f 3]1X1 IIb I M-C 1 1 II p l of Nc ' II
o.kl '1''hR pril A0 ii
isEf
❑Ihave J will maintain W Ice,CM -I i ,y Jby Stu nt
3700.4 fle,Limit Code fIrm,...rnpan, f he work lir hiclpemti isissueJ GAS IA.SYS fiS'dd INC.4 OUI LET'S OCC GR(IIJ I' MIN AIN
31y Worker' Compensanon ins[pec carricrund Pettey pre his, y /\
Comte, AM �o Iblicy Nn,: l,•�w/R J4 ,T'GI GAS-li).SYSTEM"OV13N 41EA) - \
CERTIFICATE OF EXEMPTION FROM WORKERS' GREASIVINDUSTRI.WASTE IN ERCLFB)k
COMPENSAI HIS INSURANC17 tlUll GDIVISION ILI!S
or
['fbl,smiorneed not hucnmpleted if the permit is fo one hundred duPLANCHIi K ll.,1$1001 GREASETRAP '4 / 2_0lcsnJ � c
1 c1l if,[Joel in lhalelfilp ace of the wnrk lar which this Permit is ix,uaA.1,hal l SEWER-SA N I'IARY-STORM EA.201 FE .�
w[ip yany M^"n in any manner.-as to becomesubject,[Joe Workers'C."".. ENISRG
nanan Io a
O ,� nn laws of California.Ualc ' WAItiR III!ATEIi WIVIiN'r/EI,IiCI'H GRADING ai
Ampllcnnl
z NOTICE"ICJ APPLICANT:If,after making Itis Ccnifcam nl Emprininn,you xh,,.Jd WA'1117It SYSrEMOREAHNG O
(~ ; be,,no,subject m the Worker:,Coni inion an s of the Labor Grote,you must SOILS
hwi[M1 rnYl:,
1 Mus pmvi
funmply with real pmvisionc-nM1is pemsilshall be deenleJ revoked. WATER SERVICE
H
5z CONSTRUCTION LENDING AGENCY NEW RFS1D1?N'fIAl.P1.MB. SQ.Pp. PAID
Receq[#
I hereby affirm that there is a c.nsavelinn lending agency lbr the periormmace of U,
� - the viols fur w hieh this crinit U issued(See.Pn],Civ,C.) TOTAL:
O lcnJei,Name )TA
Lend-Lc Adir,x e
U 3
I cenlfy hill I have real thin-pylic.ion and ,are ma[me above inlommlin: , Fit I1.D1 G Ii1S
pao.il Sal I ago.In eoloply with all city and comply nrdbn and state laws lording TY. EC ICA I P MIT FEE SEISnu
UZ !f:
tendiltgenmlmc[iall.and temby aumndw isprewntadve,nlmi,city to enter-pent
uixwe"ntenlianed properly for inspalmor purgrscs. 1'IiRiv 1'1' SSU N ( tk„/ 1iL1:'1'RIC iii S Sr
(We)agree,,,nme,indemnity and kccp harmless the City of Cupertino again
Iiahilities,judgments,costs and expenses which may in anywayicerue againsnaiJCi A ) IMECH. Z PLUMBING 217C ( C
in onw,ucnce of gmaring of Mrmit.
API'IACANT UNOT IN UWDS AND WILT.COMPLY WITH ALL NON-POIN' AIR HANDLING 11(HO it).mNI 'FM) M[CHANICA ITEC
SOURCE RFGULA'I'IONS. ff
/ i AIR HANDLIj{l)LSEFtt&=M.f ICFM) CONS'FRUCf[ON'1'AK
Sig n APPlieunt/Cnnt en,r Dab IIXHAUST HOOD(W/DUCI) I IOUSI NO M ITIGKFION FEE
HAZARDOUS MAIT,RIAI S DISCLOSURE
Will the applicant or future Ni ding omcupant more or handle humrdnux material IMAI INC,UNIT GO 1kf0k)RTU)
us Jetined by me C'npen!no NE-11119,11 Calc,Chapter 9.12,and the Health.ad Safety IIEAI'ING I]NI'f[OVER 100.000 RTO)Seen..2553200.'
❑Yes V1iN'I'H,A'I'[ON FAN IS I NG LE RISS IDI PAID
I lac Re'ripin
Will the applicant or pa
future building:weent use equipment or Jevicas which HOIIXR-COMP 13HP OR 100JN10 BTU1 Vv
ntit haanrd-m air conunp inams as lomed by the Bay Arca Air Quality Management 'f
16
binricl] If01LER-C(lMP IIOVER III)ad,lf1'UI
❑Yeso
Ihavc uaJthe hmand"r,`naledals .,..other Chun,,6.95-I rho Cul- AIR CONDI'fl(INIiR ISSUANCE DAI (,
m,25r Sen 1 / 7 VX
111 1,Ilullih h Sudety C'ak,Scmi.m 255115,2553)and 255.00.1 unJcrsmtW that if IM! NEW RGSIDIiNI'IAL MliCll. SQ,IT. l/
building rete,nod cur,endyhNcuanu )i,nry resgmsibililymnodly mc:xv'upam
ofcite res ane which ins I be l -of.cedifeaem O;xapaney.
O.ar,lu m mosealN u I Dam T 1 ISSUED tlY:
OFFICE