29531 CITYOF CUPERPINO .rs ^••v••••••••••••`r`•••` "• BUILDING'F.LDLTRICAL PERti INO.
BUILDING DIVISION APPIJCATIONIPERMIT PLUMPING-MF.CIIANICAL 2 9 5 3 1
BIT]LDING PROJECT IDDN IIFICATION
BUILDING ADIIRP�. r3 �� Lc,y.S ✓�l SANITARY ND. APPLICAlI11N 5Ullnll'19TLUAIF.
OWNERS NII [I [ill^ I'IR)N 1^ ,k � CON I'RAC Dat;Y NAME LIC.NOoff Z�
l� O{7 N/C CON I Rol.If
kRO111TF�CENOINELR: LIC NO ADDRESS: ❑
killc eo Ott, Co- 1► :10 0
CIINTACI: POONU. BUof ILDING PCRMIT INPU
15`µ / /_Itk -7 _O y Q / ❑ Cnnsaltnnl Pecx Pail by Applicnnl(initial) nLDU PL MFc'n
LICENSED CCONTRACTOR'S DF:CLARA'l ION
o / QTY ELECTRIC PERMIT FP,B
I nerery effrm Ilmt I ear licensed neder pm i'Qui,of droller 9 R:nnnmmdns JOB DESCRIPTION
O f)GZ wirn Section 9lXM)O nl Uivifian hdthe lfusincfs scot l'ndn,innlCNc.nnA mylme'eis
{Y OO in full fnc<anl e(fccr. PERMIT ISSUANCE CNTIAL:
t � I'DWI. ❑KITCHEN RFMFODEL
�U�j Licence flail Lie. APPLIANCES-RESIDEN I IAL ❑ DIIION ❑PCILMIIINO RE PIPE
Fll=)NZ,Zj6 Ilse Commit"'
VVI- ARC]11C'S DECLARATION No ❑SMOCTURAL
Z8024 I nnJeramN my,Inns 1 Lshall br used it pnhlic remrda PANELS ❑ OI:F6 UMODIFICATION
OZ , UP"10200AMP3 ❑INTERIOR ❑CIIIMNCY REPAIR
Llcaned l'mfes,ion^I ]R6RXRrAh111S IMPROVEMENT
F Ice{ OWNER-BUILDER UnCLARNION OVER Inco AMPS ❑DM'II RFF,OUCIJRFPAIR ❑DEMOLITION
yy o I herehy affirm enol 11. exempt from me Cm orfs;C s :Anne Lnw fm Inc
W O a U fallowing reawn.(Sminn 9(111..5,nu,inal and Pudc,inm Gyle:Any wiry or nvnty SIGNS ELECTRICAL ❑OTT HIR
LLLL77 W O�j which rr9^irea er pennil In o"'il"'ed,alcor,improve,Jenxdish ur repair mry on clam
spn^nuiniasuamie,ali^rnryirex llrcapplianl know,prmrino flenni,crdimumnenl SPECIAL CIRCUIT/MISC.
that he is licensed painful in life pmvieion,of life Conrtmrf License Law(Chapter 9
OOO Le.mouencing with Section 80(Xpnf Div kine 3,400 Ruainese end 11 mooinna Code)for FLM P,MET HR OR MOLE INS'I'. COMMERCIAL;
I],;it he in nand twerhom and Ine For fill the alleged rumplin1 Any violation of ❑NEW RLDWADDITION ❑DEMOIJ TION
YXI"9W
So-linn 701 1,5 by if,ar"' enl0n a permit subjects the npplicnnt to a civil pennny of POWER DEVICES
notmorc Iran Five ho ndmddollars(35mD. ❑1'FNAN'T ❑FIGO SERVICE
❑I,ua owner of be pmpeny.urn loee.v with woes Its Fheirsrde cont lion, SWIMMING POLL ELF.CI W OTBER
IMPROVEMENT,
c enp r s er¢a
will do the wo.Ic and me sFmenrc is n l inanded or offered for ode(See.104.Dreinr,v ❑Or11ER
and Professions Cmle:'I he Cnnm ulf'a Licnra Law dews nm apply I^air owner of ()ITT LEIS-SWI ICIIES-PI%TORE
R' y progeny who builds or mtp'nves Thereon,and won dna such work bim,elf,I fl rnldo
his own employees.provided Ifni such hou,nmuer,am con inmadeF on offered for NEW RESIDENTIAL ELECI'R SQ FT, a
ole If,hneeeer.the huilJingnr mponemet is sold within one year ufenmpleion.LieSQ 19',FLOORA :A SQ.IT.
crhnildcr will Imve the hnnkn of,coving Fond he did nm build for improve In aur- too 61
x�k
N',ornate.).
❑I,niler of the property,not exclusively cre a rding with licensed nmtracnea w A LLL �+q vL
unslruct rise project(Sec.9Mt Ifmines,end P..fesviona Cc—,I-- t
,e Low dos not apply to an owner of properly who builds or improves limon,and Qty- PLUMBING PERMIT PER k1J
who r^ntmae for Inch projects with a womraeor(s)licenced pueuanen The Cnnmacbda
Li...w law. PERMIT ISSUANCE
❑I nmesnnpnmkr .See ,RR PCfnrthiI rens..
Owner Bum Ald'IiR-URAINk VENT-WAilili(IiAI VALUATION
WORKER'S COMPUNSADON DECLARATION HACK FLOW PRUIECF DEVICE
I hereby aflrrm under penalty of pe any one of elm Tuition,need nrndians: I 1I.
❑ IhavenW wilM1nnimxine Cenihcme of C'9nscrnnsd4in,umfor Worker's Camlrcm ORAINS-1;1.(X)R,RCOF.AR17A.COND' STOItIEt 'TYI'I?CONS'fNUCIION
sntium.ea provided Ine by Section 1200 of The Lento Code,fofm
r the po mamea fit I
work for which Thi,permit is limed. FIX I ORES-PER TRAP
❑ 1 lt,,aml will maintain Wnrme,Campensminn Frontier,ea no,nimd by Section
3700ofdhe Labor Crak.for the performs^ceef The work For%iich this permit i,kurd. OAS-HA.SYS FTM I INC.4OUTLET LS OCC,GROUP APN
My Wittier I Compemminn ltornnwe cooler real Policy inn to am:
Carrier: Policy No.: GAS-IIA.SYS TTM OVER 4(CA)
C17RI I TCAI V OF LXEMPI'ION FROM WOR KERS'
COMPENSATION INSURANCE OR EAST 91 N DUS'TRL WAS Ili IN I ERCEITDR
or tried
1'fhie sewtinn need a".he compltnd if the permit i,four,hundmd dC)NIiASC'IRAI'rdlars 011m) BUILDING DIVISION FEES
,
trendy First in lie wrfonntrceufrhe work forwhich lhia permit is bored.Isnnll PLANCIMCK ITC 6 �-+
and employ any Peron in try ruminator m as ur beer SH W ITN-SANI I'ARY-STORM ITA.lap FT.
ince auhjra Tn The N'orkeri Comp�m ENERGY 191! �
Z amino Ca—dr Ce itamin.Lane
7O7 �
Applicant WAI CII REAL Hot WrvfN9'/IiLT:L'1'R GRADING LEE
q ljy NOIICETOAPPLICANI':If.afermnkingtnis Cetifcete of Esemuirn.yob.,unto] WAIIiR SYSIENORCAIING
ai iwcorrro solrjcd to The Worker'.v ConPenmdion pumionns of the Labor Came,yon nroo SOILS FEE
bmhwidb comply with.onto pinviaioour Ihiv Iwouil fhnll he droned revoked. WAI'pit SERVICE
Q
CON31re i%a cIONuclion NOAGIiNCY NEW RESIDENTIALPLMO, SQ II'. PAID
Uz Thresh ffinn that lacer isvcnnnruaian knAln Unm
(� hereby g agency for the prrbmn:nte ofce
Ito tp'.'I [lie xonk fnr Which Chia permiF is isancJ(Sec.1121,Co.C.)
Q U leader's Name TOTAL:
{Ll lewlrr'1 re d y t l' 1.: y
I cmify FImF I have rad this application and Ilam FM1nt the aMsve infrtmntiun i.e FU
r FE 6
N correct.I agree mrunt'l,wirn all city end county Folio nnref nod forte laws relating In QTY, A1ECHANICAL PERMIT PEE
U7- huildingasnametion.and lmeo nuthorim represanmivef ofthis city in enter ulxt the SEI. FEE Z Zn
nhnve-rentianal prc,"y for impectinn purixta.e' PERMIT T ISSUANCELam.
IWcl agree mems.inJnnniky onJ keep hmndess lM City of Cupcninn ugninsd ELE 1 TC j s
linhililiea,judgments,ono and expenses which may in anyway accom.againa,aid City
in nnequenee of the granting of this pemtit. Al l'IiR OR ADU TO AILCII. PLIIMRINO FE ro Ifr
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIN IIANULINO UNI ry'10 IIhgX)CFM) �.g
SOURCE REGULATIONS MSCI IANICA1, F go
AIR IIANDLINO UNIT(OVER IRdXX)CFM) CONS I R IIC'1OAA X
UAUSI
SiF^adOWill Incappl Icanno,future n LAZARDOUS Ir'ILIngce—,am on cm hon FIc lmtrlnn nmm,rd IIP.AI]NO UNIT I(10 I1XUXro 11 OFF ST RIAS DISCLOSURE IIOLISINU MI"TI(iAl'I FEE
n defined by rbc Cupertino Mm.kipal Cocc,('M1:gnrr 1).12.cool Ira Henhh mal Su el,
Carle,Scotto 23312^1' THAI INC(INTI(OVER l(R.0a)ILL)
❑Ye, ❑No
VCNTILNION PAN fSINGI.F:RESIDI PAR)
Dam Remip
Wohm,l The applicant or mral,ie buildid1flarg oytirepytipant A aAit tumor Morar xhidt BOILER-COMP(31 if OR 100.000 RTO)
Dikhhneerduus air umhlminnnll of ArOnnl by the Ploy Aren Air Quality klnnagcmmal
Uiorirdn U)IAI:
❑Yes ❑Nn If011.lilt-COM I'(OVER I(X),IXx1 n'fU)
I lave mail Ore Fortuitous materials muirnnenu tinder Oraterfins of the Cad i- A I R CONDI I'ION HR
1 P ISSUANCE.DA'I'li
moria Healgdoe;A Safety G.k.t,ame.s 2551),3.23311 nN 25514.I undefeated Few ik tie NEW RCSIDCNI'IAI.MIiCIi. SQ.FT.
building Arne ioomrntlyconea no prior
ismym,'of.Ciliryroreify Ira rtwetry.nl
of the rnptir,nrcnn which mull M neF prier m issuance of.a Croifame of Fact try.
O.,m,o,ferhun ied Igen Oat A ISSUED DY'. _ 1I
OFFICE