S 1931 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PE 11T NO. //��^ q
KV,l(.UING DIVISION APPLICATION/PERMIT PLUMBING.NIECIIANICAL 193 1
-1. BUILDING PROJECT IDFNTIFICA'NON ...LLL VV 1
BUILDING ADDRESS'. SANITARY NO. APPLICATION SUBMI'T'TAL DAT 1:
g 7- 2,f - `l9
OW NAN PHONE' CONBACTOR'S NAME: LIC NO:
-
NIC CUNTROL#
Ate \Y C ENGI it?R; LIC NO ADDRESS; ❑
V
CONTACT': PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BI UG ELECTTEAM❑ MHCH
❑ KZ ❑
I.ICI?NSEDCONTRAC'IOR'SDITCI.ARATION Qpy. ELECTRIC PERMIT' FEE
1 herchy afrrtti slat 1 ani licensed mmler provi.aanx of Chapter 9(emi.....o nag JOB DESCRIPTION
MD Z with Seclion
OO PF:kMITISSUANCH RESIDENTIAL]tg0)afDivision3ofOre Business and Professions Code,and my license is r �O RFSIDENTIA
Fin full force land affeO.
W� ❑SIUWL ❑KITCHEN RF.A1ODIi1.
�UV Idccnsa Class Lic.#
QL APPLIANCES-RESIDENTIAL CADDIUON [I PLUMBING RI;-PIPE
yDol¢ Contractor
(.,7w ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT El STRUCTURAL
Z O in rZ. I understand inY Plans shall be used as public records MODIFICATION
OZ-� UP 1'O 200 AMPS El TNT 17RIOR ❑CHIMNEY R17PAIR
F-��F-ul Licensed Professional 201-100OAMI'S IMPROVENIIiISP [j SWIMMING POOLS
Q E_J UWNERBl11LDER DECLARATION
C -9 OVER 1ON)AMPS ❑BATH RFN: I R )E IO
OCU herchy affirm that 1 pm exempt i i thea,,a Contractors License Law for dhe
�WW�S5O�U li loation muxoa ermiio,, 031.5,candoull.t er. and se.d..ioux Cod,:Any city arcuumY SIGNS BLI?C'I'ItICAL ❑DTEER
t++3 m m which reyuires a permit m cnn.wa,alter,Improves Jnnolinh,nr repair any nwment L.
ap
prix t I ': Irequireslbapplicantf suchpc 'n fl .6 ll
GLT mnem S19.CIAL CIHCIIIT/MISC.
� that he licensedp a Th provisions of the Contractor's I 1 Ut npmr9
(eon Bari i6w lh Sul nn]IN)I1L rD'vis'it 9nfihelhnn...o Alnifess'rns Cade)" f1,Ml'.Mi?'I'lilt ORpm."t"ST. ER
CIAL
a a K Nm he is cssmPl Ihemfmm and The basis fur Ise alleged ex¢niplion.Any violation of ❑NI?W BLDG/ADDITION ❑DISMOLITION
KILL. Section 7031,5 by any applicant for a permit subjects the applicant ter a civil Penalty of IY)WF.R DIeVICES
ga-,', ❑TIiNANT ❑FOOD SERVICE
m than lire hundred dollnrn(SSfNB.
F� Ian IMPROVEMENT
,z do I,as nwnerof the prnpeny,nr my employees wlN wugex as lhail'nnlecnmpenrmhm, SWIMMING POOL I?Lf?C'rklC
L., mate work,and the mruGum is not imm�dcd uroOereJ for side 'ow
Handles, O ❑OTHER
L 3 m and Professions Code:The Contractors License Law does nod apply to an owner of OUTLETS-SWITCIITS-PI%'ILR[S
property who builds ar improves therein.and who Tali,%nab work himself or through
his own anp.oyees,provide)Ihm Inch impl'nvemenlx are not blinded or olf+cd fol' NEW RESIOC TIAL ELFCTR RQ Fr
w1c.If.however,the building or improvenrtml is within one year ofeumplalinn,the SQ.FL FLOOR AREA YSQ.FT.
Der-builder will have the burden of proving that he did not build nr improve for par,-
ptso of sola.).
El 1,as owner of the moperl um exclusively canmacl.ng wish licensed comtmcron ant AL:
construct the project(Sec.701A.Business and Professions Code.)'na,Contractors Li-
closeL..does me apply rmanownaraf property who builds or inipmvolhcrcon.and QTY. PLUMBING PERMIT FEE
who c,"Rh.uch phipals with o conbkctnr(s)licensed pursuant it)the Contractor's
License Law. FERMI']'ISSUANCE
Iameeemp primc,Sec ,B&I'Cfanhisreaon
Owner Dom ALTER-DRAIN&VENT-WATT?R THAT VALUATION
WORKERS COMPEN Burry ora DI?CLARAI'ION BACK PLOW I'R(YI'FC'I'.DEVICI?
1 herebyill hats under penaltyte perjuryoneofthefollowingorkiaedeclarations:Co
Thew and will nisi omineCerti ofComern Ill LaftoCode. ordwr Workers Cc of Il, DRAINS-Iy.00R,kO(IP,AREA.COND. STORIES 'TVPE CONSTRUCTION
duties hick this
fpr by is issued,
37000'the LaMir Crxle,for the p'(oI'manm of the
work for which Ibis pemtai is is rkJ. 19%"TURES-I'ER'fltAl'
1 have and will maintain Workers Compd.no,o salfon Insurance forh;as reehis par by Section
M,W.the,Car Cchollurlheperfnmwne¢na Ne work larwhiah this permit is rescued GAS-EA.SYSTEM-1 INCA Uf1T1.E1'S UCC GROUP MIN
Ca Wprker6 Cotnlx7istnlnn bauntna currier and Policy nkmMr arc'.
Gartree Policy Na,: GAS-EA.SYS'rHM-OV ER 4 TEA)
CURT TFICATF OF EXEMPTION MOM WORKERS'
COMI,ENSAUON INSURANCE GREASFIINDUSTRL WASTE IMIERCEPD)R
BUILDING DIVISION ffiP.S
('Thin secdnn need nal he amiplGnl if the parmil is lomtell undred Jallnln($I(N) GRI?ASE'fItAP
or less) PLANCITFAK FI?C
I mnify than epennnnanceofil, ark for which this permit is issued,I shall
Ey
person nanyt anne" P Sf:WEk-SANITARY-STORM EA.21X1 PT.
Bol em u u 9 O the Workery Cnm en" ENERGY FEE
O ,z NpilicawsoVia its.Dm WA'I'Ek HliAfl?RW/VIiNT/F.LUC'IR GRADING FITE
z Q Applicant �-
? NOl'ICIi T A I A T:IL after making this Certificate of lixempmon,you shoulA WA'TEk SYS'IEM/1'RIiATING SOILS FEE
scram¢su eG n the Worker's CompedOcas h pmvinipns of the Lubar Coda you nmsl
I'oHhw,lha Is wlthsuchprovisions nr Odx permit shall be JeetneJ revakcd. WA'TERSHItVICE
a0
CONS'I'RUCTION LENDING AGENCY NEW RESIDENTIAL 1'LA1R. 5O.1'r. PAID
U '
z I harehy uffnre
nllnl The .,aeon'traction le ingngonay for lha perhvmDam wrap,m�ec of Da ,X
. the walk for which this permit is issued(Sec.3097,Civ.C.)
l-' Lenders Name T(1'I'AL:
L) Lender'x Address 10 AI'
Lti W BUILDING PE
po i ectree.a.I hone ud Thisty and coup Iced stem Thal the shove ipbmnuann Is
rH. Z building xgrcetoco.hiplyand herh all byanityamd eepresntative ofthises and statcity to evudmin the QTY. MECHANICAL PF:RM19' FEE
V z building ronstivaion,and hereby authove representatives of thin citymenmr upon ib¢ SEISMIC FEE
abosc-tha Bakal property for inspection purposes. PERMIT ISSUANCE
(We)agnv m.ova,indmnnify and ko,a n ow,the City of Cup¢ninn against ELECTRIC FEE
.iabililics,judgmenle,costs and expenses which may in anyway acerae agaiml said City ALTER OR ADD TO MECH.
in sequence of the granting of this permit. PLUMPING PEE X40
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1.NON-POINT AIR HANDLING UNIT(TO MOTO CFM) .�
SOURCE REGULA'I'TONS. MECHANICAL.FEE
AIR HANDLING ON]f(OVER 10,000 CFM) CONS'FRUCI'I AX
Signature of Applicun/CommGm Data 17XIIAUSI'I IOOD(W/DUCT) HOLES ING MI'TIG ATION IEE
I I AZARDOUS MArITR IALS DI SCIAS[THE
Will the applicant or future hulls ing occupant done or handles hamaNnus mutadal I iVATING UNIT(TO 100.0 m 111 U)
as refined by the C.Fri iso Municipal Code,Chapter 9.12,and The Health and Safety
Cade.Section 8532007 HEATING UNIT(OVER 1011,010 BTU)
r
� e o VI?NTIhAI'ION PAN(SINGLC ItI?SID) PAID #
Will the applicant ar it uilding occupant use oyuipmem ordevices which pQILER-COMP(3HI'OR I IXI,(0X1 BTU) Dare Receipt
,,it llr hdous air cnntamimnal vi de11oal by the Boy Area Air Quality Managerial, OTAL:
,trial MOILER-COMP(OVER 100.10O BTIL
❑Y¢s n 3
I Lava read the ha,rJuu.v nuterilds r opiradia s ender Chepmr 5.95 of The Cull- AIR CONDITIONER ISSUANCE DATE
f. fit IfeallhSaf•ly Code, actions 25505,25533 and 25594.1 understand that if the NEW RESIDENTIAL.MECH. SQ.17
,
ncndnan
yha tad.fiend is my raffmaihra i lyimtifyl eoccupam —7� G� 4
of e r qui to Is which mus te met prior to issnan tificn @F
r Ownr gent Wine 'TOTAL: ISSUED BY: UfNS P 1 A
OFFICE
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ICE VCR �t bC IR JUL 28 1998
VCu p�A-n Nb Cil
BLDG. INSPECTION DEPAt;i imuu i
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