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S 2969 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO IIUILDINI:-P.LEC'I RICA], PERMIT NU. CIIANICAL BUILDING DIVISION APPLICATION/PERMIT PLUM IROJ CI IDENIIFIC It1111.DING 1'k(IJ N:CB'IDENPIkICA'I'IUN a S: SANITARY NO. A'I'LICAUR) :1 iMIMPI)SUi �/ 34 jdj& PIIONH' C(lNB CrUR'S NAM)!: LICNo�V Li # NEER: LIC NO: ADDRESS� 0CONTACT: PUONE. BUILDING PERMIT INTO / ?87 ,9_ ❑ Consultant Fees Paid by Applicant pniliep- NLUG _ ELL©li PLUMS-, MEC Ii LICENSEDCON'1'RACTOR'S DECLARA'f1GN QTY. ELECTRICPERMIT FEE ©/- LJ I Inarby her on ma 1 ran licensed Under pawisitna of Chapter 9led mreach, JOB DF,SCRIPTION WQ� with Scdiun 910)Ip nlDvlsinn3ufthc Eusincvcand Pm lessons Ctxle.;nndmy license is p1iRM11'ISSl1ANCl? RESIDENTIAL' FW in full force ct'fect. [I SEEM. ❑KII'CHEN REMODEL CUF Liccme Clots I,ic# Q U APPLIANCES-RESH)EN'II Al, DOITION ❑PLUMBING RE-PIPE FZW Ilse Convaaor m60. MUL'['1-UNIT ❑STRUCIORA[, AltClll'IT,C'PS UECLARAI ION PANELS MODI[CA'1'ION ZO vi.+ 1X1 ZInnderslw,d my plana shall he used uv puMle rcmMe UP AMPS OZ�-O ❑INTERIOR ❑CHIMNIiY REPAIR r'4(rW Licensed plot gsaional ]01-If0111AMPS IMPROVF,MRN'I' E]SWIMMING POOLS �•l'�.�.1 OWNIiR-EUILIIITR UECLARATION )VER IgNIAMPS El BATH RFMODEIJREPAIR ❑DEMOLIT]ON C C Q I hereby alliin that I and exon,Earn the Contractors License Law for the O Iodowin ..lNcaion]0315.13nsincsn and Pmfmsimu Cods,'.Any city ar counI ty SIGNS ITLECRICAL '❑ER g Ewan W 3 W vFi wblch rcer ervira neon,to con,gruct,re,hat,hos,demohnh,ar repair say factum cQ Peter to its . . alsd retillites the applicantI perhatt II ,gone'treated SPECIAL CHICO rr/MISC. )ball I rip tl ' I r1 Coll"1 .l r (Chapter9 1�+1Li Lli(coluncrc ngw'thSectio,7000)oflSvdo,3tl the Fuorne,ld l refer_.ox Code)ur TCMP.M El ER OR POLE 'T. MMFR I L. a a 11 that h is pt thirst and d k sic r theII g d cxa pl A 6111,1 I lV id FG/ADDU'ION ❑I ,)TION MIE sect 90319 by any applicantI Pinot: hi n he apply II "1 penalty of POWER DEVICES oIlI 1^��� )( SERVICE not re thanf handledrill '($51Hp. IMPRILVE a l� ❑ I ': fthe po,ardy.I,,try caliployses%allagesus Care sole ciallpinsittivin. SWIMMING POOL EI LCI'kIC r.. wild Ila k dthe st 't liinsettedfI df r: (See.7044 pint ❑O'rH13k w3,. and Professions Code:The Contractors Lacus,Law does not apply la an twee'of OUTLETS-SWITCHES PIX'I'URE. li pmpefty who huilds tar mlprovys thereon,had who loss such work hineelf or through J his own employes,provided that such i,npmvements are ant ineaded ,I offered for NEW RI!$I DICNTIALELLC'IR SQ P p Is.II h Ila l II f g 1 lac l e Ia id rah r f, pl Ilea the SQ.En PI, SIS'Q,FI', I I xll h I Igoe ,that l of oth'Id 1 rorpur �wt11 a,as wit fsM1 Ir I IY' I by 1, t' line with l - dcontractor,to 'rOl'A ;ovals the pntfecl(See.9044,Buri;cs,and Profess ret Cam:)'mc Convacmrfs Li- 6 ,e Law docsnotapplytonnI—enarpmpcny who builds er iapmve,mLYcon.and QTY. PI,UMBING PER FEE who .nvuct,for act,p Jtt 110,a umvactor(s)licensed norsennat to loc Contrhaor'e Lteauc Luw, PERMIT'ISSUANCE ] 111111 except under Sec .11 6,P C Gra his reason ALTER-DRAIN A VENT-WAI' iAl VALl1A1'ION r Date WORKER'S COMPHIENFION DECLARATION 13ACK FLOW PRO[6C'K DEVICE O O© I hereby ukimn ander penally or pcgufy m¢of the following declarations: I laws and wdllnainain 11 CeniGhac III Comcuuo 111plene for Worker's Com n- DRAINS-FLUOR,ROOF.AREA,CONI). 1 STORIIT; IYEECONS"IROGI[ON utiu 1'..sj&df IySection 3700 l he Labor Code.,lio,In,ocol lhe wort) I' I Ih:p t I. FIX I URLS PER I RAI' 2 v A / 011 ,act"Hart t W ter,C I 0 ' I . 4 A dhy5 l 49101f the Left,Calif Ila rforlall I'the wtrk for whentl .penal is mace. CAN LA SYS'I'I:M IINC.40UTLE'I'S OCC.GRUUP My Workers Compen,efed Imoranee carrel and Polar, .,,,be,arc: - i C ononr Policy No GAS-EA.SYSTEM-OVER 4 WA) 0 GER'I'IFlCATE OPI;XI;MNfION PROM WORKERS' GREASUINDUSTRI,WA.S'I'1T INTERCEPTOR v COMILVIM I'IIDN INSUkANCP. BUILDING DIVISION[TPS (I his eel be cony.lacdifthc pernat is toren hundred dol litrelSlthp GREASETRAP or Iuv.) PLANCIJXX FEL I amity sem in the lsrfommaccofthewark lorwhlch this permit is issued.I shall SF,WLR-SAN[TARY-S'IORM PA.200 Ell not mnploY any person in any earlier Noes to bec.nnc mhjcn to the Workers Connote- ENlik�FLL Z Refine Lnwsol Califon ia.Due WATER HEATER W/VITNT/ELLCIR0C) A,,I,,r I zNO]V 1:70 APPLICANT.11,uRcr lrLE.,an,Cendwalc A Jesse,tinq you should WATITR SYS'IITMTFREATING a`0 bees n.blerl e,the Workers Conn,l,p,.on pre .ismorthe Labor Cody yon nail' SNS/ .S -- Wfarldwiin comply with-such prevision—, his pcmlit Aall be damM revoked. WA'rFlR SERVICE � Z CONSTRUCTION LENDING AGENCY NEW RE.SIDENI'IAL PLMB. SQ.FL PAI Ibuchy ufErm Mal finers,isacnnMmmto,,leach,agency kadre,e*In...al Car Dale Rmcipl# wr P the work for which this permit is isound Net,3097,Civ.C) / p U I<11ds,,Nmnc W Lender',Address =AN (YI fy tM1t11 fflea 111 t daI k th b t tnt1113UII,DINC 9rZ roc t 6 t r, t1 11 ity I ly d d.rt P Lngm QIYHANICAL PERMIT FEE Z buildingconstnaitn,and reohy aahoizc«pre,eriflIe.af be,inlym enlerepnn theSIJSMIC ahovcancnllned pmpcny farhh,e,,, Ipapal', CII9Z4 III)(Wr)agreem saves,indenmlty and keep hart ,e,the City of Curator)againstELEC' l:liabilities,judgmusco,C; d eenses which reayln any way III a,aimteaid City 'IO MF,CH. PLyIM G2nmeyuenecof the grantingor tlal.oarmit.APPLICANT UNDERSTANDS AND WILL COMPLY WIIII AI.L NON-POINT UNI'I'('IO IQ(E0CIbU ME.(: IE LFEE SOIIRCiiRE(IULA'I'IONS. I t /qp.(-�`("�� UNIT(OVI?k 10,1010 CI*M) CONS'fkUCTION TAX cars,of ApplicanOConvncmr � EXHAUS'CHOOD(W/DUCT) HOUSINGMI'CA'NONFEE HAZARDOUS MATERIALS DISCLOSURE Wlllthcappleal nr tawshaddingocce,enn Mom ur handle hm.anlarl oaeriA I I HAI'I NG ON 11(T0100,01011TU) 1.1 dclired by the Cupentno Mehicipal Gds Clegnsr 212,and the Health and S,E, Code.SCGien 255i2(a)? HEAPING UNIT(OVER 1110,0110 111 Or ❑Ys,, ]No VENTILATION FAN(SINGLE RES ID) PAID )lase Rccs,ipt# Wdl the1.pplicrn or Iuare handing oe:nmnnt enc uqulpmcnl or devices which BGILER-C'OMP(3HP OR II01,f001 H'N) it b1.uvdous air cvnanniaatsas dclincd by Inc bay Arca At,Quality Mana,caent f AI. 1 .trey H01LER-C(1MP(OVER 1101.1100BTU) ` F-1 Yet E]No I h�ve reudthc hnnahn,nvacnal is under Chamr6.95af the Cal.- AIR CONIII'I'IONEIt ISSUANCE DATE ,2 533 tennis Ilellth&Su(my Cmlq Swl.nm 255(15.25533 and 255.34. undcrnenal than it the NEW IEESIDITN'I'IAL MECII. 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