S 2443-,-APPLICANTTO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELECTRICAL
BUILDING DIVISION APPLICATION/PERMIT PLUMB NG -MECHANICAL
BUILDING PROJECT IDENTIFICATION
P17RMII' NO.
2443
BUILDING ADDRESS:
_2Q(b13 s���«l� �2-
SANITARY NO.
APPLICATION SUBMITTAL DATE:
:3-2-y-9
O ER'SN MEL'. itJPHONES
CO 4IRAC'{OR' N E: Mai�jLIC NO:
{/
N/C
❑
CONTROL#
ARCI III EC'I (ENGINEER: LIC NO:
fxU1 SS: - � � �,n
/K'7 ✓/
adjaCONTACT
- PHONE:
BUILDING PERMIT (NPO
❑ Consultant Fees Paid by Applicant (Initial)
BLDG ELECT PLUMB MFCH
❑ ❑ ❑ ❑
LICENSED CON 'rRAC'I'OR'S DECLARATION
1 hereby affirm mot 1 am licensed nation provisions of chapter 9 (eommeneing
QTY. ELECTRIC PERMIT NEE
JOB DESCRIPTION
PERMITISSUANCE
with Section 9000)ufErvision301 We Business and P^r-o-o�ssimnv)C de it ylicenmis
in roll Coax and docIC /7i/%��/
License Close LicA i� 1
DoneARCHll
RESIDENTIAL:
1IAFDWL El KITCHEN REMODEL
❑ AUDI TION El PLUMBING RF, -PIPE
El MULTI -UNIT ❑STRUCTURAL
MODIPICAI'ION
APYLIANCF.S-RPSIDENTIAI,
he use DECLacmaARA IONl!fM
1 undemm�d my plans shall he used as public records
PANELS
UP TO 200 AMPS
[_1 INTERIOR El CHIMNEY REPAIR
IMPROVEMENT E] SWIMMING POOLS
Licensed Profeoi'mW
201-I000AMPS
OWNER -BUILDER DBCe ContRAIractor's
1 hereby ,(Sena Ihm 1 am ,xcmpl Cram Wm onsC License Law for the
Code: Any cityor comity
t following rears (Section t 90315. Rosiness and improve. den
Which rnlairea n permit m sea ,«a ,. Ober, inner..vee ennel'Inn. or r,,air any ntmmnre
❑ BATH REMODEURF'AIR (] DEMOLITION
❑ OTHER ._
OVER 1000 AMPS
SIGNS ELHC'1'ItICAI.
SPECIAL CIRCUIT/MISC.
proem: in Issuance, also requiter the apPlicunl Conoco Pennine file asigneJ slnlemenL
(nal he is licenecd puouunum me pmvulmns of lbs Cnmrvdnrs License
(emmmcncng with SceUon70IXp ofDivlsion3 oflhc Busines-s unJ MofessinnsCwle)or
or,Coal,)
11MR MH'1'HR OR YOLH INS'1'.
COMMERCIAL:
Ihill he is exempt Ihereame and the buil for th0 alleges mxempfion. Any veteran Of
❑ NEW BLDG/ADDITION ❑ DEMOLITION
POWER DEVICES
Section 7031.5 by any applicant for a permit subject, the applicant to a civil penalty of
merman than five hunemcl dollar, ($503).
E] 1, as owner ofthe property, or my employees with wages as their sale compensation,
will do the work, and the structure is nal intended.,efface farad, (Sea .7044, Busin„e
and Professions Code: Th: Contractors License Law does not apply to on owner or
El TENANT ❑ FOOD SERVICE
IMPROVEMENT
❑ OTHER
SWIMMINGPOOLELECTRIC
OUTLETS -SWITCHES -PI STORES
property who builds ear improves there...., and who does such work himself ortnnugh
his own employees. Provided that such improvements ec om intended or offered Sof
NEW RESIDENTIAL ELECFR SQ PT.
SQ. HI'. FLOOR AREA
$/SQ. IIT.
sale. If,however, the building or lmprovenect is sold within one year afcomplaeom,lhe
nenhuilder will have the buNen of paving that he did not hails or improve far pro-
pose of sale). -
0 1, as owner of the pmpedr, am exclusively comrt¢:ing with licensed contractors to
TOTAL:
consumer the prosect (Sec. 7044, Business and Pro@ssinns Code:) The Contractors Li-
-
..seLawdoes not apply to an owner of papally who modds or loneness meson,and
QTY, -- PLUMBING PERMIT- FEE
who contracts for such projects with a emnvacmr(,) hire ..sed mroar, e me G,mme..ra
PERMIT ISSUANCE.
License Law.
n I an exempt under Sec B & P C far his meson
ALTER -DRAIN & VENT -WATER (EA)
Owner Date
VALUATION
_
WORKER'S COM PENSAIION DI3CLA RAIlON
BACK FLOW PROTECT. DEVICE
r I hereby affirm under soalkyof,ejtary onceffhe following eeclamtimns:
Q I have and will maintain a Cervi lime of Ccurwin to self -insure for Worker's Compen-
amuse, as provided fur by Section 3700 of flue Labor Code, forme penhareares of the
DRAINS- FLOOR, ROOF, AREA, COND,
STORIES
TYPE CONSTRUCTION
FIX 'I'IRES -P17 rIRAP
workt which thisp,mR is issued.
� end will maintain Worke/, Compensation hou rare, a, uuired by Senlon
3700reffie Labor G,ve,for me IN I mann ofIheworrkyroye�wfhich this pp,.,,illl, iissssssuueedd.�
Caner 'aO:JBeA lye. 3y.L nA. i Policy No.11 )ff1'-'•?•-"
Cvmce (-(Y/(A. KII iXr FUUI
CIiKI'IPICCO Oil EXEMPTION FROM WORKERS
GAS-EA.SYSTEM-I INC. 4 OUTLETS
O GRO
GAS-H1-OVHR4(HA)
COMPENSATION INSURANCE
need not becnmplewlifthe pennil is rnnmehundrnt J..Ilars ($IIp
less.)
GREASFIINIJUSTRL WASTE INTERCEPTORUENFRGYFFE
u
JAB' )(VISION
IVIES
GRHASETIAP
-rn
NCHPAK FHH
LJel
_ _(This,muon
SHWHR-SANI'1ARV-STORM HA 2UU FI'.
Ioy anythat inthe an co mon o a sIwork for subject topanni(i,irs'Compn0
emplsy any person in any maneran ar w become suM1jeel m the Wnrkerv' Compen-
HEATER WNENTELECTRNOT
Afien Lown of Cnlirrnin. DoeWATER
Applicant
become no r TO APPLICANT. If, afar mvking this okiCanifirstoof of Exemption, you should
busmu subject m the Workers Cmmpenr provisions of the Labor Coke, you count
WA'CBR SYS 'CBM/IRF;A't ING
SOILS FHP.
las
fnrlM1with comply with such provisions soils permit shall be reamed evnkW.
WA'CHR SERVICE
CONS IRUM ION LENDING AGENCY
I hereby nfiirm drat mere is it construction lending agency forhe perfourrese OC
NEW RESIDENTIAL PLMR. SQ, FT.
PAID
D e Receipt If
the week nor Which this permit is issued (See 3097, Civ. C.)
Landed, Name
TOTAL:
Lenders Address
TOTAL.
1
1 ecnify that I have read this application and store ohm the above information Is
13UILDI E
I I
-FEE
mct.l agrm mcompty with au city and a,amy..minunens ora sem wwa rclming fo
haildingcon,wnie., and hereby authorise representatives N' this any m: emerupon the
QTY. MECHANICAL PERMIT
SE I S Milk PEE
aAove-meationed propony fur inspection purposes.
(We) agree to save, indemnify and keep harmless Ib, City of Cupeninm ngaln t
PERMIT ISSUANCE
ELEG'TRI
ALTERORADDTOMECH.
PLUMBING'
Iiteilitirs,judgmenls, costs, expanses which any in any way accrue against sold City
e efm granfin of this permit.APP
AIR (CANDLING UNI'I'('I'010,000 CFMJ
MECHANICAL F
I ND "I'AN )S AND WILL COMPLY WITH ALL NON -POINT
A l N.
R
AIR HANDLING UNIT (OVER III,WOCFM)
CONSTRUCTION TAX
•`I
3%159
Sign,tu Moran ommemr I*v s
HAZARDOUS MATERIALS DISCLOSURE
EXHAUST HOOD(W/DUCT)
HOUSING MITI C.NI ION PEE
HEATING UNIT (TO 100,000 BE U)
Will moapplicmn,a, more buildinguccapant source, handle hazardmusmafedal
a, counted by It,, Ca,mo loo Municipal Code, Chapter 9.12, and the Healthiest Safety
Cole, Section 25532(..)?HEATING
❑Yes �
j' ,malre, applic ut or Warranwure building Occupantuse ,Ae, Ao ent or Quality Mieagement
mil hwanlnus air at Warrant, as defined by oho Boy Arcu Air Quality Manngemutf
Gold.?
Yes
UNIT (OVER 100,000 B U)
PAID
-
VENT( LATION FANS INGLE REMD)
Date Receipt#
BOILER- COST DHP OR 100,00) BTU)
"1'QfA L:
BOILER - COME P (OV Hk IOQfgU ITI'U7
AIR CONDITIONER
I have real the hamresn,materials rccuirctnmm, under Chapter 695 or the Call-
ISSUANCE DATE
NEW RESIDENTIAL SUCH. SQ. I, r
feria li,a u, & ' in Code Sections 25505, 25533 and 25534. 1 intensional shut if the
bnllangd ,I cu ly a e a lemml. that it is my reap erabiNyt ifythe .at
._
Otherc n 1n nnpri.r. isnaneeur. co,�ye ,ter
J 60
ISSUED BY.
Owner M,mrs,imd agent ate
TOTAL:
OFFICE