S 2786 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.ELECTRICAL PERMfr NO.
BUILDING DIVISION APPLICATIONIPIERAIIT TING PROJEBING-hD!CEANIFIC S 2786
It1I11.1)ING 1'ROJECI'IDEN'1'IfIG\'1'{{led lJ UT
SAN]'R\NY NO. APVLICAI'1(1N S1111N1'ITAI.DATC
11UILDING ADDRESS:
SC,F_ 3/- 9
OWNER'S NAMEPIIONI?:��'So CON'IRACIOR'S NAME. LIC NO.
�� =SELL NIC CONI'HUI.a
t ❑
-AI(CIII'fHCI'/IiNGINIIUN: LIC N(1: ADDRESS:
CONTACT: PHONE: BUILDING PF,RMI'P INI'G
❑ Consultant Fees Paid by Applicant(Initial) HUNG IiLECII'LUh11t MECH
CJS ❑ ❑ ❑
LICENSFY)CONTRACT'OR'S DECLARATION QTY EI.I:CI'RIC PERMIT FEE JOB DESCRIPTION
1 hal arrmr mol I nm)cenXed ower prnaismn,nr chapter 9(vorimanemg
WOO wish Serlioe]WI)ofDIVlslon]offle Businessland Profession.Csslo.ond my license n is RSIDEN'PIAL:
WOO FERMI I'ISSUANCE
CSF in hill force effect. CSFIIWI. CKI'I'CIIIiN RIiMOUISL
aUU Liccn.ac Class hicft APPLIANCES-RESIDENT IAL ❑ADDITION C1'I.UMHING RI PIPE,
N a i D:I,e Cmnmetm CMUhI'hUNI'I ❑S' rlllt N.
ANCIII'I'ECI':S UECLAIt ATION PANELS ' DIF'
FX I uok
n icod my plan.,shall he used us pnhlle m,ords MOUIIICA'I'ION
O'Z'`^� UPT0200AMPS CINIFREOR CCHIMNHYREPAIR
F 4t:M hicc.wd Prof.'ionto 201-HXXIAMI'S IMPROVEMENT ❑SWIMMING POOLS
A;a4 OWNEWBUILIIER DECLARATION OVER 1000AMIS C HATH RI-MODEUREPAIR CDIiMOLITION
C W Q I herch'ti fimt mat 1 am exempt from the Contractor's License law to,me
x�Ct follows ing reason.Section 7031.5.Business and Pmfc.sions Cwe:Any city or county SIGNS ELECTRICAL COTIIIiR C
W 3 a H which requires a pecord to conshmer,alter,impose.demolish,or repair any stamen
C6,' prop I ':. het muim,the pplic t for suchpermit l file signed samurai SPECIAL CIRCLE I'I'/NI1SC.
� }
that lie is Icousedpursuant the pi ofth Committees L [.;I.'(Chapter9
� �_� tix�lthin i�m1]IIJISh)Ihny�upplinnn lnr,� ut l (m H su JI f -' :C.Md eta fEMI'MI"I hH OH 1'(ILE INS'❑ COMMP,RCIAh
�a0� I,to 6 mS Yi ]0X0 ID is
Task tar the alleged esentpunn.Any volution of ❑NEW It1,UGlADDITION ❑DI?MULIIION
W pennil suhjcas the ampllcunl ns a visit III of POWER DEVICES C l'1',NAN'1 C PUOU SERVICE
otnxtm than five hundred dollars(150). IMI'It(lViiMliN'I
ASG Q L us owner of the propcny,or my employees with wages as their auk ean:pciesman, SWIMMING POOL ELECTRIC
N will it,,the work.am
ndme,tclum is nal intamdcdornlfered for,ale(See 7094.Bu,inc2r CD'I'HER
6 3 m and proms ions Code The Cantmetoh -icen,e law da¢not apply to un owner of OU'I'LIiTs-SWI'I C,I{ES-PIXTUR6S
propcny who)builds or improves thereon,and who dues such work himself or though
his awn employees,provided that such improvements am not intended or oRertvl for NEW RETSIDEN'TIAI,ELECTS SQ PI'.
site,If.hnw'eannhe Iniliingnr improvement is sold within one vear of completion.the $Q.14.FLOOR AREA $ISQ.II'.
owner-builder will base the burden of proving that he did not build or improve far par-
M to,oew.l. 'r[YIA1:
uX t weer of the ec.7(y,an cxctmivdy commeting with )Lbslicensed contrao,%]In
construct a the project[Sac.a,
an l liminess mol Poleny.1.... uX CoT,im,ece,Ja mr'X nd
w Law",I.nolapply man ownerofluiLcony wccosedd,or imp to the mcrcon.nod QTY. PhUMHING PF,RMIT FEE
who nuninX fnrsuch Pmjuaswilh acumm�etor(s)IicunsM par nonuuthu Cununnor'a
I.-o'le I.aw. 1'IRMU ISSUANCE
Cl
.,it camnpt under Sm. ,it k PC for till'lesson
AIA IiR-IINNN X VENT-WATER IIiAI VALUA'1'1(IN
Dnlu l d
WORKER'S nal Js'SAIION DECLARATION HACK FLOW I'HOTECI'.DEVICE - 0�
Fl
have
and will mai ower Penalty of Coneryneofthefnlmwing declamatWorker's
C lmwe and will maintain aCcnifcatcol'CmLsenuoscl4inmmfor Worker's Cumpcn- DRAINS-FLOOR.HIX)P.AREA,COND. S'1' 11!S TYPli C0Y5T�tUCfRIN
sant n p dW f by Sea 3]1X1 f tl Lab Code,f theperformance f the _ J
world ti .ch this pc t FIXTURES PER TRAP N
M I have,and will maintain Worker's Conaperiation Insurance, 1 I l)Section
371X1 ofII L;jfsar Code,for the1ert,oranne,c timework or hot, h 'fn t':I:: cd. GAS EA SYSI'HM I INCTa )l21J IS,- ,^ (ICG GROUP , AP6
My Wtdax Umpev' lan It i,,and loteyumM Tons GAS-ITA, -OVhR4EA) V or
Carrier: Polley No.: 2.
CRRTIPICA'1'1;OF IffiI71,1I11'ION PROM WORKERS' CREASE%INIOUS'I RCWAS'IE INTERCIEPIOII
(His"flm newt CItth`tiNlSleteditNhe pcmkiANfrom hundred dollen ISIWI GREASE(RAI' r•nR 31 99 PIANCI IECK 11?EILDING])]VISION R:hS
tans.)
I eenify that in the performance of tire work for which this permit is iswiIshmlt 'SEWER-SANITARY-STORM IEA.200 PI'.
not employ any person in any manner set as to become subject to the Workent Carrico-
C)
arrico- GNIiNGY FEE:
smion Imws of California.Dam WATER IIEA'1'IN WNENTELECIR GKAUING FRIT
z 0 Applicant - honlA ..
NOTICH TO APPLICANT:It,after making this Certificate of Esmanion,you s WADER SYSTEM/rREATING:�.;- 5011 ti 17Ii17
F hmmte subject m the Worker's Cumpervv;eion pmvi,ina,of the Labor Cods,You most
t'anhwull,....gtly with such pro, inn,nr lhispernat h1II be deltoid revoked. WA'F'ER SERVICE
PAID
z CONS'IRUCIION U NDING AGENCY NPI'
EW RESIDEN'I'I AL PLMB. SQ. ' fe Rcccipl0
U O1 hcrchyafirolda hoc is a comtruninn lcndingaguncy I fw,vrfnrmmnccaf
I^ the work fix which this permit is issued(Sae.91109,Civ.C) 'Dll'AL:
0 Lendeis Name TOTAL:
} U Lcndce,Addre,s _ RUILD.'CTHE
CL I certify that 1 have mad this application and state that the xMme information rs
,F. ret coi l agree I. ua y with all city and cumy ordinances and,tate tawsrelmin,to QTY. MECHANICAL PERMIT FEE SEISMIC 'Illi
U building conncelf.n,nnd hereby umhorim mpreenmtiveso!thin city menmrupanthe
abovomcmioned pmperm for inspersion puyvsee PERMIT ISSUANCE ELECT' Cplili
(We)agree m save,indetnnily and keep fomales the Chy of Cupertino ugainu
liubilll is„Iudgmenls,aa,OanAexpcnws wFlch may in unY wnY ueen¢a8:dnst suiA Ciry AMER ORADD'1'0 MECIL PLUMB1 GIBE
to ......nee nro'egmmins slob,pelma.
APPEICAN'1'UNDL'RS'I'ANUS ANI)WILL COMPLY WE 111 AEI.NUN-POINT' AIR HANDLING CNH'(TO 0.00 iTO MECHANIC I.ITEE
S11UEJJ�REGU1,Aq'Ifl� � �
O/' AIR I IANOLING UNI'PIOVGR IOIXXICIM) CONS'I'RUCHON TAX
Iy
:i8nomrc of ApplicxnVCnmty n EXHAUST HOOD(W/DUCT') IIllU51N0 MITIGATION FEE
HAL\R S MATENIAI S DISCLOSURE
Will the applicant or future building occupant%rare
or handle hostdous material HEAI'I NO ON IT(to 101.000 BTU)
as defined by the Cupertino Municipal End' Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 101,001 BTU)
Code,Sr 25532(x)”
kyr, RAI, V ENI ILA'I'ION FAN NI NGLE RESIDE PAID
Dane Rect,N
n Ail
Will me applicant nr fwure I ldingorcurymt use aluipment in devices which BOILER-COMP Gilt-OR IW,00)HTIf)
iouTU
h huaunlnu,air ronlnntinunt,u,dclincd by the Itay Amu ATI'Qunlily Male gmnon 'Air
U nu cl]
❑Yes HOILIFIR-COM to(OV ER I000fil IITID
�e
NR CONDITIONER ISSUANCE DA]1,
I have read the h ode.S ...null 5.a 53 encs 2553 ,1 and rou o1'he tithe
t/ ��8y'
lomiu Health A Safety Csvle,$salons 25505.25533 and 255311 undcrsmnJ that if the NEW RISIUI:,Y1'IAI.\TECH. $Q,IT. 3— 3 1 ^- ` T
building does but currently have a tenant,that it is my responsibility to ratify the twcupmn
off Ittc which Mm prinOoittuan¢ofa CcnifcaRo kcuP ncY. if
Ow cr nr aumnmoJ uBcm j Duc T(YfAL: ISSUED BY: R�y
OFFICE