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S 2101APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILI11NG FLECTRICAI, RIIILDING DIVISION APPLICATION/PERMIT PLUME NG MECHANICAL BUILDING, PROJECTIDENTIFICATION PEgp11T No 2101 1O1 �`J BUILDING ADDRESS: j©�h9 Vo'>e-rC,c.LryS CuPttoo SANITARY NO. APPLICATION SUBMITTAL DATE OWN�'S NAM '. `1 Al G�-t. PHONE', :l( ry 1`(IIiyP- p ONTRACfORS NAME:. LIC NO: �Y'�:- CIJNS ZIpS NIC ❑ CONTROL# � lJ TIRC1111TECTENGINEER: LIC NO: ADDRESS: 745 cne.T eQwo A. it ;.T CONTACT: PHONE: ` 1 �-�;�p./"C �g �J�� �'� V •C,ONNTTRAyC'I ❑ ConsWtnnt Fees Paid by Applicant (Initial) BUILDING PERMIT INFO BLDG ELECT/ PLUMB MF�.C{'� Ih-4✓ FT � L LICENSED OICS DECLARATIONY 1 hereby affiort 111.11 an, licensed under provisions of Chapter 9 (eninda ncing QTELECTRIC PERMIT FEE JOB DESCRIPTION PERMI'1'ISSUANCE S-y� with Searle. 7000)nf ....ao3ollhe Busine.a snit PmtBsYca, Code, inti my licence is in full force and of t. LicaI Class Liss#Z'�'s Contractor ``mv�� n�l- ARCHITECTS DECLARATION 1 understood my plans shall be used as public regrds RESIDENTIAL' ❑SFDWL El KITCHEN REMODEL El ADDITION [D PLUMBING RE -PIPE. ❑MULTI -UNIT ❑STRUCTURAL. MODIFICATION ❑INTERIOR ❑CHIMNEYREPAIR IMPROVEMENT E]SWIMMING POOLS APPLIANCES - RESIIIEN'IIAL PANELS UP TO 4110 AMPS Licensed Profoaionol 201-I000AMPS OWNER -BUILDER DECLARATION 1 hereby Idfum that I .n, ese npt Ban the Cocaine, s Lance, I.ow for the thieving r ,.a (Seninn 90315, Binnow. s and Professions Crile Any city or musty El BATH REM0I HIARBPAIR ❑DEMGLITIDN C3 OTHER �% Q ' OVER 1000 AMPS SIGNS EI.HC'TRICAL which n aima a permit In consmn,.lmr, Impreve, demolish, or repair any smnane SPECIAL CIRCO /MISC. prior mitslssuance,slaore,... cob. npplicvm forsuchpermfl In lila o signed statement that he is Iieensdd purauna no the pmvisinns of the Con n e ef, License Law (Chapter 9 (commeceem,with Section 7fIDOofDivision3ofthe Bdainessand Defeanions Cedc)or TENIRMETER RP .FINS k COMMERCIAL: Ont he Is exempt therefrom and nhc basis far the alleged exemption. Any v,olation al ❑ NEW BLDG/ADDITION ❑ DEMOLITION POWER DP.VI Section 70315 by any applicant for a,nuoh cabjed, the appllcsnf n u civil penally of ❑ TI?NAN'F ❑ FOOD SERVICE not mare than live hundred dollars ($500). ❑I, ae novae, ofthe propedy,army employees with wages as bei - ale campesation. will do the work, and ilio structure Is not intended orodened far. a nit (Sec.7044. Biomass and Prnfcssions Code: The Contractors License Law does not apply to an owner al ,nearly who builds nr improves Iheresm, and who does each wad hitmdf or tln'oogh IMPROV(?MBNT ❑ OTHER SWIMMING POOL ELE r OUTLETS-SWITC >S -FI TES J I disown coodoyesu provided thnt such impmvemems ani intended or offered for rade. IL hnwevcr. the building orimpiovement in sold within one year of wmpl,linn, the NEW RESIDENTIAL E SQ FT. SQ. FT. FLOOR AREA $/SQ.Ur conodubuilder will have the burden of prming that he did not build or improve lin pur- Ite a ol'ala). as owner of the propedy, am exclusively contracting with Ifcennesl contractors to construct the project (See 7(A4, Business and Pmlvvengs Code) ON Contra don', Li- / i L� t TTOTAL:[:]1, erne Law does not apply to an owner of property who builds or lmpmvr,lhereon, and QTY, PLUMBING PERMIT' - FEE who contracts for such projects with a cinummgil lfano l pursuant m the Contractor's Lic area%crept under Sec. ,B&PC`ni tuacrea 1'� t PERMI'I'ISSUANCS - D OVAV AIAHR-TRAIN &VENT -WA'T'ER CA) VALUA'T'ION /^ \ p� NJ UQ 'V ( WORKER'S COMPENSATION DECLARAf10N I hurt,rrfmn under pennhy pajuryon, .1 @d following Aedoratinnx: RACK FLOW PRUIHCT. DEVICE - 47 ❑IhnvccoldwillmsimninnCetlifiwleofCunsemmself-insure for Worked Ct syroo notion, m provided far by Section 3700 of the LohnrCode for the perrormmnce of the DRAINS- FLOOR ROOF, AREA, COZZ 5I'ORIP.. TYPE CONSTRUCTION work for which tho. permit is issued. 1 hove and will roue in Worker's Carried to Insurance, as rd)uhed by Section 3700 of the Lvbor Coda, far the performance of the work for which l hi s Krd it is issued. FIXTURES -PER TRAP If GAS-FA.SYSTEM-I INC.4OUTI.ETS OCC. GROUP APN . MyWnd,daCompensadonInsurtmce carrier and Entry numberare Cornea Policy No: v GAS- HA. SYSTEM -OVER 4 HUG GREASOINDUSTRI. WASTE INTERCEPP(l CERTIFICATE OF EXEMPTION FROM WORKERS'kl COMPENSATION INSURANCE PELZS (Thiesenion neednolhemmphted if permit is foronshunddedddlafs($I011) in lessJ GREASETRAP _ _DIVISION ANCHEC F i I wtify that in lire performnncedf the work for which thio permit is issnad, I shall so as to hoo oe subject to the Workers' Cooper- not employ any person in any mannerd ,noon Laws ofCaifna. Data Applfcna SEWER - SANITARY -S FORM HA. 200 FT. ENERGY WAI FR HEATER W/VENT/ELECTR - GRADING E NOTICE TO APPLICANT. If, site, making this Crnifiette of Exennption, you should became ablcet m the Workers Cnmponaation p rueon sof the [,,barCodeyou must WATER SYSTEMG READING SOILS F E WATER SRRVICP, forthwith wmply with such pmvisiam onhis permit ,hull be tlacmeti revoked CONSTRUCTION LENDING AGENCY I hereby notion that thele is a conxWclion lending agency forthe performance of NEW RESIDENTIAL PLMB. SQ. FF. PAID Dnte Roc ipl# of the work far which this permit is issued (See 3097, Cfv. C) Lender's Nome (PAL Landes Address TOTAL: EDILD 1 gnify that 1 have read this application and stand that the above infirtmution Is _ covect.I agree ¢, uouly with mlditymul eoomyorditnmces national, lnwsrcladngm building construction, and hereby authorize represemnives ofthln city to dnoroponthe QrY. MECHANICAL PERMIT. SrlMIC F • SQ above-mentio nit! property for inspection purposes. (We) agree to cave, fail gnany and keep harmless IheCity of Cupertino against PERMIT' ISSUANCE ELECTRIC rL ALTER OR ADD TO MECH. liabilfdes,ludgmema. costa and expemes which tray in any wiry secure optimal said City in of the Pending of this permit. consequence APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS. P G AdA AIR HANDLING UNIT (TO 10,000 CFM) Cj MECHANICA AIR HANDLING UNIT (OVER 10000 CFM CONST RUC'I ION IX /IIJlA Signature of Applicanl/Ctmm¢mr Date HAZARDOUS MATERIALS DISCLOSURE EXI IAUST HOOD OVIDUCT) IGATIFEE HEATING ON IT (TO 100,000 B'I'U Will the applfenm or found building occupant store or handle hazardous material as defined by the Cuperino Municipal Cuda Chapter 9.12, and the Health and Sal my Gide, Seddon 25532(a)'! E] Yes E] No HEAT] NO UNIT OV ER 100,000 BTU) PAID���!>''<i0 0/��{1 /�!PI-l0 Dan Receipt # VP.NTILATION FAN (SINGLE RESIU) BOILER- COME CHP Oil 10(1,(410 BTLD Will ilia applioer, or future building occnpanl use equipment or devices which anon hazardous air cannminams as defined by the Bay Area Air Quality Managenart TOTAL: BOILER - COMP(OVP.R 10q(11109TU) Dishier^. ❑Yea E] No AIR CONDITIONER ' 1 M1eve rgd Ilio ho<.ardouo materials requlremems ..our Chapter fi95 of Ili, Cnli- fore' Ificith & Safety C le Seel us 25505 25533 add 25534 I understand that f she ISSUANCE DATE NEW RCSIDE?,U JAL MECH. SQ. pit. buildingdous not currentlyl tanart,in t tr,rhyne,santalityl tilyth occupam ofthc I' r. I'I tc Ipri t nfnC dl I Oa . i�1 � 014��'k ISSUED BY: T�e�h"%O I(,tiCG TOTAL: vandr Owner or m thnriznd agate Ilald OFFICE