S 1316 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES.USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.ELEcrRICALPE ITND
]BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL 1316
BUILDING PROJECT IDENI'IF'ICAY'ION
BUILDINGADDRESS: SANITARY NO. AI'I'IJCA'I'IONSU9MI"I'IAI.DATIi
i I Sre ' �fS t�
O NE 'S NAME: �� NFA—. CONTRACTOR'S NAME. LIC NO:
C ll NIC CONTROhM
'<CI IIT /ENG( •R. LIC NO: ADDRESS: ❑
�.
CON'1'ACD PHONE: BUILDING PERMIT INFO
A/In*95
q— SO Ij30-TL/ ❑ Consultant Fees Paid by Applicant(initial) BLDG ELECT PLUMB MIiCI
LICENSED CONfRAC'I ORIS DECLARATION QTY. ELECTRIC PC PEI$
I been,tiff n.that 1 am rcensrd tinder provisions of chapter 9 feommmacing JOB'DESCRIPTION
�aZ lb Section 700buf D,min Soo the B.eincss and P fiesoior Cde.vnd my license is RESIDENTIAL:
40, wt PPRMITISSUANCH
F�.. in till lbrce,mddlia ❑SI'DWI. ❑KITCIII3N REMODEL.
�U~ License Class Licp
Q U APPLIANCES-RESIDEN-TIA1. ADDITION C1 PLUMBING RliI'IPE
NCL Dam Contractor
NeCHI'ITCI"S UECLARATIOry ❑MUEN-UNIT ❑S'rRUC[URAL
F.p w PANELS
y Z L understand my plans shall M umd as puhlic fecords MODIFICATION
OZ4UPTO200AMPS ❑INTERIOR C1 CHIMNEY REPAIR
F W Licen.ved 11..test oil 2111-IggIAMYS IMPROVEMENTSWIMMING POOLS
QXf� OWNER-BUILDER DECLARATION icense Law for the
I hereny rrm OVER 1000 AMPS ❑NA'rH RIiA10DISUREPAIR �DEM01.1'I'ION
CLC afWm I am coelom In,m he Co
tn narion v L
c. fnoovin (Section]0315,Business and Profession.,Code An citlar ❑Ofl{ER
❑ '
X13 LLI grove,. y ci y n y SIGNS lil.l?CI'RICAL
m which rcoptires n Termil In emswm,vl¢r,improve,demolish,,r repair any swaurc
thatheslPuerto iensedprsuant to the lhexisiosofthe Contract"alor's
Law(Chaphrt) SI'13CIAI.CIRCIII'P/MISC.
y'� Ihmheislicensedpursuannmheprovisi�nsnftheCnmmnnr'aLicereLnw(Chupmr9
W gQp (commencing with Seth 7001 of Division 3 ofthe Business and Prorevsions Cede)or TFMP.MFIER OR POLE INST. COMMERCIAL:
d ct,X Qo 5 mat he is cxmnpl mcrefmm vnd lbc hams Inns the ollcgc l c..'abe n.Any veAd on of ❑NI?W BLDG/AIJUI'1'ION ❑OIiMO1.IT10N
W^y Section 7031.5 by any applicant fur a prand subjects the applicant In a civil penally of POWER DEVICES
.H. nm mmelhan rive hardeddellars(99W). ❑TENANT L1 FOOD SIiRVICIi
fS� (] hva owner of the pmpcny,or my ompinyces wish wvgcy us theisxole mm�pmhsutlnn, SWIMMING POOL HLEC'I RIC IMPROVI:MBNPAI
D
F.
will do w
the link,anJmsl
ervcmre is not imilded,rnffered for sale(See E44.Business 11 OTHER Y
W vnd Pn I ..on,Calc The C,nm,nnr's L eCoNe Ldw does not apply to an owner of OUTLFI:S—SWI'FCHHS-FIX'I USES
propcny who builds or improves Rumor.and who does such work himself or through
his own employees,provided that ouch improvanen¢an nm intended or offered for NEW RISIDL•NTIAL ELECTR SQ PC
sola 11,however,the huildingm i,np,oven,a,no,old within ane yin,,ofamnplaian.the SQ.IT FLOOR AREA S/SQ,FT,
poreowner-builder will have the burden of proving that he did not build or improve far par- "
nus,o . C /r t,urenw V2�d
❑I,as ower of the Sm.70y a,n excessively unmeaning with licensedlowcnnlmctnrx In
mdme thee,not (Sec.o ar Business and professions who but Code:)The er,wetePs and
carve lLw Aocanmltpplymvn nes ti,ina arlou who,,,i I...improves menlia,loJ Q'PY. PLUMBING PERMIT PEki
who amin¢ta for such projects with u e,nvemorfe)IicereA pu¢unm to the C'onlruchn'x
Littre L v. PERMIT ISSUANC'
❑lame n Jw Sw.� .BSPCInr this renam
U ter Dalc AIIFER-DRAIN JVE 'l'EIt(FA) VALUATION
WORKER'S COMPENSATION DECLARATION HACK FLOWi'ItOFECr.DP,
I herehy of firm under penally of perjury one of the following deelamlion,: �+1
C] I have road willmainmin a Cenifroorm Consent loself-inwre for Workers Conten- DRAINS-FLOOR,ROOF,AREA CO
salon,as provided for by Scotia 3700W th .
e[.it Code,for the,ditmnma:of the STORIES PTFE CONSTRUCTIO
'
work for which this permit is issued. FIXTURES-P• A1' 1,
I have and will maintain Workers Counpensation Insurance,as required by Section k If
3](I0 at Labor Cade.ba-the Perinrmanec of he work for wbid,ihls permit is lxnucd, OAS-13A .YS'tli -1 INC.40U'ILHI'S •,C OUP APN
My Workers Compensation Insurance artier and Policy number arc: qq�-
Currier. Pnllcy No.: OAS-li,.SYS J(EA) qsVest
C13RTIIrIC OP IIINN PROM WORKIiRS'
COMPENSATION INSURANCE GRFASL%L DUSTRL WAS - 'rF.R iPFUR
BUILDING DIVISION FOES
fOhis senlon need nal bon„npktnlifthe Prmti(is fnrono lnmJral dollars lS 100) GREA,SE'I'RAI'tins ItP C ECK PEIi I lO
I certify morin the perfnmhanceoflM work fmwhich this pennitis ismed,
ru,n- SEWER-SANITARY-S'roaM EA.219)FT
nal employ any person in tiny man.N,,o us to bacon soh,vet to Ih,Work,,,Cmngmn- EN, TY 121713 ISI e
zz scion Laws of C.I faidu Dare WATER HEATER W/VEINDULECTR
Q Applicant GR 1 NO 19iE
y
NO]'Cir'f0 APPLICAN'E IL Idler making oris Cer iGcam of Exemption,yn.should WATER SYSTIIMORHA'FING
abeeone,subject to the WoUr's C,nnpenati,n pmvisions of the Labor Cale,you and SOILS F F,
LT1 turthwilhcmnply with such pmvidnns ordiNpennit shall bedecmalrevoked. WATER SERVICE
0. 0
CONSTRUCTION LENDING ACIWCV NEW RISIDF.MITAI.('LMR. SQ.PC PAID
UC) i Uroby infirm that three is a,indructi,n lending ngancy l or the pertunnnmeof Dan, caiptM
V the work far which this permit is issued(Set.3097,Cie C.)
�' 1"•' lenders Name TOTALL rig
wIcnders AJdreoa TO D
y I certify that I have read this api licaion road ,are That the aleme nationalits BUILDING 13E
conical.l agree to comply with all city and county ordinances and state laws relating to QJ•Y, MECHANICAL PERMIT PCC e�p
U huildingemxlmelnmentl herehy authnrirc reprenemetivcx tins this city tocnmrupnn the SEISMIC FEE
aMrve-mentioned pmpcny for inspection purpuras. PHRMD'ISSUANCE:
(We)ogre,to save,irdannify and keep harmless the City of Glpenino vganno ELECTRIC FF
Iishilitic,judgments,costs and expenses which jury in any way nectar agvin.et said City ALTER OR ADD TO MIKE.
in c n.crtience of the grantingof this permit PLUMBING hE D .SJR
APPLICANT IINDP,RS'LANDS AND WILL COMPLY WITH ALL NONPOINTAIRHANDLING UNIT'GO 10,000CF10)
MECIIAN 'AL FEIi
SOGUI.A
AIR HANDLING UNIT(OVER 10,000 CFM) CONSTR TAX
S hfrplican/Coutwcto Dam AIH
IAUST IIOOD(W/DUCT) HOUSING MITIGATI FEIi
�p
HAZARDOUS MATERIALS DISCLOSURE
Will the applicanl or fetus building accup.nt store or handle han,oker,nectial I(EATING UNIT'TO 1010,0q It G)
us defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safely
Code,Section 25532(a)'! HEATING UNI'['(OVER 100.000 BTU)
(]Ycs F7 No VENTILATION FAN(SINOLL'RPSID) PAID
WdI he rpliwnt or filters,building (use tai meal m'devices which Date Reeeipl4
Ip gbytheB e. P TOILER-COMP(3HP OR IBO,WO BI'IN
anis hvmd,us sir comaminama as Jerncd by the Hay Oma Air Quality Alunagenhem
Districts 'TOTAL:
(]Vas ]N B(IIL13R-COMP(OVI3R IW Iqp BTU)
I have real the hvnrdous Inararivk requiremcros tinder Chapter 695 of the Cali- AIR CONDITIONER ISSUANCE DATE
fomia Health A Sulety CosE•,Sectinnc 25505,^_5533 uad 25534.1 uadwaund that II'he NEW RI3MDEN'I IAL MECI I. SQ.IT,
building does not currently have a breca.that it is my resptmoibilay in notify the occulunt
of the mrylreencre,which mud Iw has print,,iasu:ntce of a Centrale of0ceuptincy.
Ownerormthmiled agent Date w4t- ISSUED BY:
OFFICE