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S 2008 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO Runnmr. F.LecrRlcAl, PER flf No 2008 BUILDING DIVISION API'LICA'FION/PERMIT PLUM BING-MECHANICAI' BUILDING PROJECBIDENTIF'ICA'TION BUILDING ADDDRRESS: SANITARY NO. 1ACCXIION SUBMITTAL DATE 2©G / /T Gl �S G't c (� �l —IT OWN S N r'll(NC: C NI'kACTOIfS NAME: LIC NO: it R 4A. Ss-I w, f ` NIC CONTROL p ARCHITECTIENGIN EER: t,7 1.11 so-, ADDRESS: ❑ 5^ CONTACT: PUUNe; IJIIILUING PERMIT'INFO STal_z✓f�`'AQ147�� �yeL3'/`'��/ ❑ Consultant Fees Paid by Applicant(Initial) BLDG IiLECf PLUMB MECH ��Lcf ZSrON ( E .tNE 63 - FfPlGd l( ❑ ❑ ❑ LICENSE CCMAI fTR DIiCLARAI 10N QTY ELECTRIC PERMIT FEE 1 hereby affirm that I am licensed under previsions of Chapter 9(commencing JOB DESCRIPTION "ZwilhSmtion]OINl7 of Division3 of aha❑usinesa and Professions Cnde,and my llcatsc ie RESIDENTIAL: LLI 00 P17RMI F ISSUANCE FWUin:-rte fr,mc unci offcu ❑ADWL ❑KITCHEN REMODEL PUZU LicenseC c Lic.M r I s I'hIANCIiS-RESIDEN'IIAI. []ADDITION [I PLUMBING RE-PIPIT F.Om ARCHTfLCI'S DECLARATION PANELS ❑hfULTI-UNIT ❑STRUCTURAL Z,O'^Z 1 understand my plans shall M u.cer e,public remrda MODIFICATION Oyr?Q UP'f02M AMPS C3 INTERIOR E3 CHIMNEY REPAIR F. u1 Licensed Prnl'cccionul 201-11X0AMPS IMPROVEMENT SWIMMING POOLS •] OWNER-BUILDER DECLARATION OVER 00()AMPS E]BAT] RNMODIiLBHPNR ❑I]IiM01.1'fION I funny afl'ion(bat I all,escran bon,(he C-11111-11111-1 LICemC Law let Ilve xLx d U f(lowing 1'elnon (Sectio 7031 5,Bmincss and P...Fealal5 Cala:Any clay or cvllnly SIGNS ELECTRICAL ❑01HF.R W 3 LL N which requires a permit In connrum,mlteq improve,denudish,or repair any slracmrc _ __2 0 pmanivissuuncc also mquimelhe uplli.am for such Mmlinn aleasignal xtammcm SPECIAL CIRCUITIMISC. If re �y that he is licetoed pustanuolhe pdo,woroof the Comracmrc license U.(Chapter 9 I;M'0�a (commencing with Section 7000)of division 3 afore nosiness and Professions Code)or 'TEMPINTI'ERORPOLEINST. COMMERCIAL: F e LL that he is exempt directional and the hasis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ]DEMOLITION ^m Section?031.5 hyanyapplievnl Porn parralsubj.ets die applicant sen civil penalty of POWER DEVICES ❑TENANT ❑FOODSERVICE. not more than live hundred dollars($Solt). 7,. Y IMPROVENIHN'f SO O Lasmuncrollheprnevery.many cniployces with wapcsnc lheirsole colnlwo,dion. SWIMMING POOL IJJiC'I'RIC �H wit l do the work,vnd diromcmre is nal intended proffered for sale lSec.7(W.Business ❑OTHER 6'3 and Rofcainns Code:The Contractor's License Law does not apply to an owner of OIITIAN S-SWITCHES-FIXTURES property Is ho Luilds or improvers thereon,and who docs such work himself or lhrougM1 his own employees,provided that such improvements are not intended or ott.md for NEW RESIDENTIAL.ELECTR SQ FC sale.If.however,the building or lnprovcmenl is sold within one yearefcouddedon,'he SO.P.FLOOR AREA $/SQ.ET. ponerbuilder will have Bre hunlen of proving mat ha did ual build m improve III lur- -saof w1c.). F7 1.1, r of the property,and exclusively conlfacdng with licenced actua oR at 'TOI'n L: construct the pmjeel(See.]044.Busme,cv and Profession,CuAi The Contractors Li- ceLaw does not apply toanowner of property who build,or improves thereon,and QTY. PLUMBING PERMIT FEE Li- cause contracts liar such pra is with a cnmmemr(s)licensed pursuant to the Contractors License Law. PERMIT ISSUANCE ❑ lam exert,i dr Sea. ,H&P C ford,,nason f1W11G DYIC NJ lilt-DRAIN&V HNT-WA LER(EA) VALUA'I ION • WORKER'S natty o COMPENSATION DECLARATION BACK PLOW PROI'ECI'.DEVICE 1 hereby anion under Candid to perjury one of the Rdlowlng dedaces Coc: (have and will far by eCion 37m ofComaddLabor Cord or the Workers Cumpen- DRAINS-PLOOR.ROOF,AREA,COND. STORIES '1'YI'Ii CONSTRUCTION ,o,kf as provided for by Section 37!X1 of the Terror Cale,Iia me peRnrmance of me work for which this permit is fissured. FIX lINCS-PER TRA(' 1 have unci will and Worker's.atottheCompensation Imuranchi as fequir,d by Section J'100r,f mclaubnrCndc,for the pcHmm�mucr,flhework l'ur which his pemhil is isxucol, GAS-ITA,SYSTEM-I LNG 4OIJ'I'hP.TS OCC GROUP APN Cameork Cnmpcns/atp-inn"+nsurryce cunic�unic 1al nldY Noym o- / GAS-ITA.SYSTEM.OVHR 41EA) //99//CERRTIFICATCGG'O/h li%IiM/ Pf10N FROM WORKERS' COMI'ENSKI'[ON INSURANCE GREASHIiNDUSBRL WASTE INTERCEPTOR It1111.DING DIVISION PIifS (B'hia srminn need not he annpletwl the permit is lot one hundreddnllurs($100) GRI'ASP'TRAP or lecsJ i'LANCHECK FEE I ecodyfloaa is peffonal vol he work l'orwhlch lois permit.......,,. sluJl SEWER-SANITARY-S'IOItM EA.200 PI'. ®V not employ any poison in any mann...n as to become nahjea tome Wo13.ri Cnmpcn. ENERGY FEE O Z amima Taws of Califnmia.Date WA'I'12R HEATER WIVE r1'/IlECI'R iili Z O Applicant GRADING F NOTICE TO APPLICANFE If,mall making oris Cenifcxle of Exemption,you should WATER SYSTE,MfTRFA'I'ING F' ^ SOILS FEEhecme to th r, object e Workers Ciar,ma tint previsions of rhe Labor Cal,you Inuit Wforthwith comply wim such provoionu or this permit dull bedecmetl revoked. WAf1iR SERVICE. P G CONSTIII)C'I[ONdual LI3NDINGAOENCV NEW RIiSIDEN IlAI.I'LMI1. SQ.I'1'. PAIL U O - Dice Reoeinl a I hereny ith thi that seas E s ad(Sri.30 lending agancy rnr the perlbnn:mac of the work for which this permit is knuttl(See.31N)],Civ-CJ W �­ Lenders Name TOTAL U Lenders Address 10B } WR(JILDIN iP rr I certify that 1 have read this application and state than the above infatuation is L. III wrzaet.I agree to comply with all city and county ordinances and state laws rclaing to QTY, MECHANICAL PERMIT FEE U z building conamcdnn,and hereby aulbnti,nature xenlntivex of Ibis erymentrrupnn the above mentioned pmlIw cdy far i® adon pugwscx' PERMIT ISSUANCE (We)agree to stove.uncannily and keel,honnless me City of Cupertinn against habilitin,judgmenrs,costs and expenses which may in any way III against said City ALTER OR ADD TO MHCI I. in consequence of the granting of this permit. CII PL 1(wRI.G Ffa; t O APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,000CFM) SOURC RF.GULA'DO MECHANICAL FEE. _ AIR HANDLING UNI'I'IOVER IIkIXO CPM) CONSTRUC'I']ON'I'AX Signamreo[App et] r,immclor Date EXHAUSTHOOD(W/DUC]) I IOUSINGMITIGATION FEE HAZARDOUS SIM ER1ALS DISCLOSURE Will the vpplicam or future building occupant store or handle formal mmarial HEN)INC,UNIT(TO 100,000 BTU) as defined by the Calendar,Municipal Cnd,Chapter 9.12,and Inc Health and Safety Curie,Semina 25572(x)? !{HATING UNIT(OVER H10,00I BTU) ❑Yes E]No PAID VENTILATION PAN(SIN[:LIT I<HSID) Dam Recap, Will the e,applicant or future building owaeam use e.Air Qu or devices which emit hazardnu.c air ennremimm.0 as def neJ by the Ray Arca Air Quality Manugemenl BOlhlili-CONI'(Jf{P OIi IINI,IHIO BTU) District! T A.. (]Yes E]No BOILER-COME(OVER 100.000BTU) I have maul the hazardous mmeiaN rem yuimcros muter Chapter 6.95 of the Cnii- AIR CONDITIONER ISSUANCE:DATE; forma Hcaab&Safely Cada,Sections 255059 255371md 255311 understand mol If d'c NEW RESIDEM'IALMECH. SQ.FC hniliing lines not cummly have a tenant,don't is my respnmihhty ah no.ilylhe...Ilam / �( of he"idnanents which must rte mel,aiol'to i o surrof it Cenilicmcof Occupancy. Owner or aumound!agent dam TOTAL: ISSUED BY: OFFICE