S 1826 H,MLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
' CITY OF CUPFRTINO II1111.DING.MEC'ANIC L I'IiR�11T N0.
.+ ' UILDING DIVISION APPLICATION/PERMFF 1'LfIh1BING�MIiC11ANICAI,
IIUILIN NG PRO•IRCT IDEN'TIF'ICATION
1826
RJILDINC AUUREtiS: SANITARY NO. AI'PLICAI'ION SUBMITTAL DATE
IOb, a SANrA LLtJ2'4A (Z LuPCrZT1110
OWNE 'S NAME' P iDNL: CONTRACTOR'S NAME: LIC NO:
LA
1 , NIC CON'TROt,p
�CH IiCT/ENGINIiEko K L LLiC NO: _C Lrj A'} ADDRESS: ❑
CONTACT': PHONE: R11ILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
❑ ❑ ❑ ❑
LICENSED CONTRAC'TOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby affirm that 1 am Ieemed under provisions mf Chapter 9(commencing JOB DESCRIPTION
BOZO with Seclion]010)ol Divisica Sof the Huvincss and l'mfessimnx Calad m
any license is PF:RMI'I'ISSUANCE RF )
o,w F in full force and elect. ill L1KITCH17N REMODEL
QUU License Class fico APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PII'li
S Q L Dam Commit.,
AI<Cill'TF.CT'S DECLARATION ❑MLIU'I-UNIT ❑STRUCI'UkAI.
F y Z I undersand mY plans shall be toed e,public records PANELS MODIFICATION
OZ40 UP 10201 AMPS ❑INTERIOR ❑CHIMNEY R17PAIR
C•��W Licemed Preevsimal - 201-10,10 AMPS IMPROVEMENT 0SWIMMING POOLS
OWNER 13UILDIiI1 DECLARATION OVER IINN)AMI'S ❑RA'TiI RP:MODHLIREI'AIR DEMOLITION
C I hereby affirm'he,1 am exempt from the Contractors License Law Ino Om
Xa U fallawin•mason.(Section 7011.5.Business and Pmfessions Code:An t count ❑O'I'HHR���O 0
ul b y ci y or Y SIGNS til-ECI'ItICAI.
3 LL H
which myomas a,amnia m cmnsuum,otter,improve,demolish,or repair any smaure
�'�� prinrro its l�summe,,plan reyuircv the vppliurm fnr.vncIt,ennir to file a aigneJtalcmcn SPECIAL CIRCUIT/MISC. �/�
fey that he is licensed pursuant lire provisions of Ne Cuntracmr'.s License Law(Chapter 9 ss#`�/Y
W�pO (commencing with Section 7000)of Division l of the Business and Professions Calc r COMMERCIA
)n TEA1P.METER OR I'OhE INST.
d y m of Sfreec io is exempt iburefmm am,aha Mrciv lino the ol,the ex fi,,nd .Any viPetir,of ❑I HN BLDGIADDI'DON ❑DEMOLITION
IR H Section 9NL5 by any upptlnim forn,crmit suhjccpn lire applluum touelvll penulry nl' WWEI<DEVICES ❑TI?NANT ❑FLOOD SIiItVICP.
rot more than five hundred dollars y raid.
I.•zi IMPROVEMIENT W
Sp ❑ I,mto,ncrnf thc,mpeny,nr myentployceswithwagesas put rsolecnmpem,iore, SWIMMING P(NO.ELECTRIC T
$y� will Professions
sions Coale: N,Contivnm iaacense Law does not
to an owner xs ❑O'fI�ER
and Prolcssions Cade:The Commclor's License Law does not apply to an owner nl 011'I'IJSTS-SWITCHES-FIXTURES
6 3 property who builds in improves thereon,and who docs such work himself or through
his own employees,Provided that such improvements arc not intended or offered for NEW RESIDENTIAL ELECTS SQ FI'.
nrele.It.however,ammilding orim,mo,carmc,,old w,minun,yswufcnmplmimi,the S IAt1R//gl!dI11SIfn $ISQ.FI'.
e�_hssyyl1der will have the human of,covic,Ila,he did not huild or improve for par- 11 VV ANST
Llc.).
o ,as owner of the property,a n exclusively contracting with licensed cemrvmnrs m AL' y)(Y Lir
compact the project(Sec]044,i{minenx and PrnI..on,Code:)'the Compactor's I, 44(CR l IIVI�
seLaw does not apply to an owner of pr,sny who milds or imperics thereon,and QTY PLUMPING PERMIT EEE
who contracts for such projects with a commnaro)licensed pum art to the Contractor's
Llacnnv;I 1 — /, FERMI'I'ISSUANCE
Tam +c �d Sec. ^' .._L_.�.li&PCr+r thiiwus
( ---
ALTER-DRAIN&VENT-WATIiN(IiA) VALUATION
WORKER'S COly o'pSATION DECLAIIA'DDN BACK FLOW I'ROl'ECL DEVICIi &IT O
1 herehy al rnntainaCenifi ofpejuryoneofthefallowingdeclarations:
L]Ihnas andwilcio,i, eCmificmeof Comethr Code,I... for Workers Compen- DRAINS TLOOR.ROOT'.AREA,COND. STORIES TYPE CONSTRUCTION
nation, t provided I'mrby$salon 1]INI of the Ishnr Coda for the perlirtmvnce nl phc
work fnsw hick ill permitin issued. FIX'1'UItIiS-I'IiR'1 RAI'
❑ 1 have and will maintain for Worker's eoteCompensation work
ce.which
h hisresperm by Rection
t]W nl the LaMm Coale,for performance of the cork for whichthis permit is issued GAS-EA.SYSTIiM-I INC.4OUTLETS OCC CHOIR' AI'N
My Wnpy� :Popp andnn Inxufancc culria, d I'nlicy n
My Win � dmnI fk.p 0:1 No.: Log1tp__ ` GAS-EA.SYS'I'FM-OVIiR4(EA)
CarCERTIFTCAIii OF F.%IiMlTION FROM W'ORKF.RS'
COMPENSATION INSURANCE GR17ASMNDUS'TRL WAS'IE INTERCEPTOR BUILDING DIVISION FEES
'fII...section need not he cumplcteddhe,nnhh krone hundrxldefice,$100) GREASE TRAP
or les) PLANCI{ECK PEE .�
I cenify that in the Performance ol'thc work Inr Inch this coal is issued.l shall SEW17R-SAN]TARY-STORM EA.200 FT.
nal eny+luy p iia ynnnnera uvmhcenn:c hy'yI lm phe WnrMM{�rx'C:11fd�0,+m: ENEHOY Ff31i
Z section La ) WATER HFA'(lilt WIVENI'/IiLECI'11
N(t ruled i l GRADING PIiE
s.. NOTIt,subject lot ANT,1•Curoconking thin Cenihcme of FLabor C l You should WA'I'IiR SYSTEMRREnTING SOILS FFE
WF Icconm acmna the Wadurk visions tun is pentad shal of Ode Lobo Lode., ,mord
� fmhwiOh comply with such provisions or this pentad shall h:Aeemed revoked, WATER SERVICE
Q
O CONS'I'NUCTION LENDING AGENCY NEW RESIDP.N'I'IAI.PLMH. SQ.17. PAID Date Receipt#
U
hereby nl'lirpn That Thera is a mnMruction Icndin6 u8omy for Ihc,urfornancc nl
the walk to,,which this aerial is issued(Sec.1($)7,Ci,C.)
Lender's Name '1 O'I'AL:
U Lender',AAdrFs T(YI'AL: _
I certify Ohio I hive read this i,iicanan red store that the some infnnmion Is, BUILDING PTH
correct.l agree a,comply want all city and county mrdlnamr,and sate laws tnlmine m QTY. MECHANICAL PERMIT FEE
U Z building construction,and herehy comerine representatives of this city m enter upon the SEISMIC FEB
abuse Onend ancd property in vomit nn purpmcs. PERMITISSUANCE
(We)agree mave,sindemnify and keep haonless the City of Cupenino against ELIIGI'RIC THE
habil itien.judgments,costs and expenses which may in any way accrue against said City AITER OR ADD TO MEC-H.
um
, ance of the gr
eating of this permit. PLUMBING FEE
In
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1.NON-POINT gll<IIANOTING UNI'I'(TO IQOOO(PM)
SOURCE REGULATIONS. MECHANICAL FEE
AIR HANDLING UNIT(OVER 1I,000 CENT) CONSTRUCT ION TAX
S,,mImcof A,pli,mWContmcmr Dam EXHAUST HOOT) W/DUCT)
HOUSING MI'T'IGATION I+IiE
HAZARDOUS RIA1l DISCLOSURE
Will the�applievo or Ennre huilJiilding ng dccupum sore or handle h:0amous mammal HP.AfING UNI'1'(TO I(p,(Nq BTU)
as defined by the Cupertino Municipal Code,Chapter 9,12,and the Health and S:dny
Codd,Section 25512mT1 HEATING UNIT'(OVER 10,000 It I U)
E3 Yes No VENT'[LAI'ION PAN IS I NGLE RES IDI PAID • 'O^ Ofr!-(�C
Dutc Reap,p H
•Will the appliesm nr Tut building by the
ave e.Air em nr devices which 0A)IITU
.nil hanrdous air ummmiwms as defined by the Bny Amo Air Quality ManaSa'ment BOILER-COMP[THP Ok 1116, )
DOTAL
DistricR BOILER-COMP(OVER I00.010 IITU)
❑acs
I have mad thea nationals Is under Chapter 6.95 of the Call- AIR CONDITIONER ISSUANCE DATE
m,255 fo '+1 at & "em Calc,Sections 25505,I, and 25514,f undenr//////nd that if the NEW IIESIDIiNTIAL MECi1. SQ.FT.
hail IO • nnlanrion0yl rvcu mnunhphalllxm rc 2l"11.lugsdc t ddl pont
y` of me r+ 1, k n. te, ,r u r a,Cenificmy
V O ncrnnmthari"I"tt !.` 7 aDate TO'T'AL: ISSUED BY:
OFFICE
PLOT
:
• CHEMEpD $ B
�
DATEJUL 13 1998
'
oLUG. SPP�ION DEPARTMENT
.t�f„�;v,\.•;,-- p , e ���I� CI '�0Ecy1PERTIN0
DATE
FLDr . DEPT_ \ /
G
ski
I
!APPFZ8VELa6Cn f / i
IN ACCORDANCE WITH THE CITY Ot
CUPERTINO CODES AND ORDINANCES SUE(L HAf�E1 I cn
�y o(LeH rn
SATE —/0!9.15 _ a
SIGNED_
MUST seof_ � 3
be kept un the io a. , { times and it is Un ?
lawful to make an; i •grass or alterations I cL j
on same wrthUdl ,,nuxti permission from
the building Deht., City of Cupertino.
The stamping of this pian and specifications
SHALL NOT be held to permit or to be an
appiraal of the violation of any provision!
of any City Ordinatrce or State Law.
i
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