S 2262 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUHDING-ELECTRICAL PHUT NO. w
BUILDING DIVISION APPLICATION/PERMIT PLUAUHNG-Su
HECnmcAl, b
BUILDING PROJECT' DEN'IIFICA'TION
BUILDING ADDRESS: SANITARY NO. AI'PLICAI'ION SURMI'TTAL DATI
I le�Co �.C)T LArj D & 2 r 49
OWNER'S NAME: I'IIONIi: CONTRACTORS NAME LI NO:
COS —255—?i vSTwA Hr=,l g132g "" CONTHO1p
ARCHITKT/ENGINEER: LIC No: ADDRESS: ❑
6 n211Tlan/hL hv6-Nva- WAJZD CA
CONTACT: PHONE: C,L-{$4 BUILDING PERMIT INFO
❑ Consultant Fces Paid by Applicant(Initial) BLDG ELECT vL,uM MECH
LICENSED coN'rRAC'TOR'S DECLARAIION QTY. ELECTRIC PERMITCWZ FIiE
I hereby affirm that 1 am Rnmsad under provisions of chapter 9 commencing JOB DESCRIPTION
n 'n lfudfor u7s"nnf Divlslnn3 oftho Businessland Pmfesslnns Code,nndmyliccmc is RESIDENTIAL,
6100 wa I'IiRMI'I'ISSUANCIi
force and 11c rr(• p ❑SI'DWI. ❑PLUMBJG 'MODI'.
(—U Licca lass Lic." J 1f 1
<—U s5S-1__�_, APPLIANCES-RFSIDENTIAI. ❑ADDITION ❑PLUMBING RE-Pill'.
F W Dale Gntmnm 7�r I-u���P p
FOy ARCHITECTS DECLARATION He(,dEId I'nNF.14 ❑MULThIINIT ❑STRIICTUNAh
z p y^ T understand my plans shall be mwd as public mmWs MODIFICA'T'ION
Oz— UPTO200AMPS ❑INTERIOR [I CHIMNEY REPAIR
P 4F"W Littmcd Podo"i'ud 201-11610AMPS IMPROVEMI?NT (]SWIMMING POOLS
Oat lam
OWNER-BUILDER RATIO" OVER I(IN)AMT'S ❑HATH REMODF.UREPAIR [I DEMOLITION
r� �U 1 herahy nOUm thus and cemnpt Iran the Comraclnac License Law lin the
K 6 U lollnwin6 rcvwn(Section 7031.5.Itusiness end 1'rnfessium Code Any city lir nnunrySIGNS ELECTRICAL ❑OTHERK
36,� which requires a permn m construct,aher,impnwc,demolish,or repair any stricture
I'15� prior In its uan ,also,,unu,lbe applicant finsnch pnrntiuo the a signedd,nonnt SPECIAL CIRCUITIMISC.
� wmmat he in licensed pnnaam to me provisions of the Contmcrors License law Whader9 -"L M`-
H'�¢'E (cnanenOng with Seaton l0001ofDivision 3of the Bu.vino,md Podo mm,Gxlc COMMERCIAL:
Jof 'TIiMP.METEk OR P(11,E(NST.
6 a o C that he n6 exempt any applicant
and me hash for the alleged exemption,imaAny it Faulty
of ❑NEW BIAC/ADDITI(IN ❑FOOD .ERV(
_W
Section 7031.5 by any applicam forapermit wbjeaalhn applicanlma civil penalty of POWER DEVICES
nal more Onm Eve hundred dollam($50n), [I TENANT ❑FOODSERVICE
�_< Las owner of the Prnpeny,onny employee.with wagesulhcir sole mmPeneation, SWIMMING POOLHIJiCTRIC IMPROVEA11iN'I'
�f..� will Jo the work,and the structure is not intended oroffercd fofsale(Sec.]DW,Business Or HR
I�l m and Profexsiam Code:The Contractor's License Law cines not ilpply m an owuclof OVfLl3'IS-SWITCHES-FIX'I'URILY
L property wM1u builds or improves therms,and who as rich work himself or through
his own owever li providal mut such Intprovenmnn are not intended or nHernd for NEW RESIDENTIAL ELECT If SQ FI:
owne LM1nweveeme buil the bur en ofnovinlisat he
none yetWild or
forthe SQ.II'.FLOOR AREA $ISQ.FI'.
owner builder will M1arc the burden of Proving that he did not(wild or imprms for pur-
poso of sided,
❑ 1,as owner of The properly,am exclusively contracting with licensed contractors to NUAL,
metrud the Projml Neu.]DW,Hudnus and Professions Code:)the Contractors Li-
ucLuwdnevnolT,1,Inanowa®rul vaopeny who hal ms or inapmve,mcram,and QTY. PLUMBING PERMIT FEE
m anconuaels for such projems with a commumos)licensed puraianl to the Contractor's
License law. PERMIT'ISSUANCE
I am exnnpt under Sec, ,B&P C fnr This reason
Owner Date ALTER-DRAIN&VENT-WATER(EA) VALUATION
WORK12R'S COMPENSATION DECLARATION RACK FLOW IIRU117CL DEVICE L O
1 hereby offirm under penalty of perjury line of the following declarations: `7
I hvvn and will nmintuinnCunlOcem nl Coavcnmsclf-Insum fnr Wnrker'a Cnnapen- DRAINS-FLOOR,ROUP,ARTA,COND. STORIES TYPE CONSTRUCT ION
satin,as provided for by Section 3900 of the Labor Coda,for the Nal null of the
work for which this permit is issued. 19XTURES-1113R TRAP
IQ I hoc nand will anoinmin Waekar',Cunipemnlion hounmce,as required by Section
371X1 ofthe lads Code,for the pedtnmance of The work for which this permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLIUS OCC.GROUP APN
My Wor 'sFyu F IHatlyp lnvurance curie P.ld Py .,tp�It p"
MyWoo lfcr' t�nn_ 1R -Palleyolicy yJ,�, CAS-ISA$YS'I'EM-OVER J G?AI
CERTIFICATE OF EXEM17ION FROM WORKERS'
COMPENSATE ION INSURANCE. GREASPIINDUSTRI,WASTE INTERCEPTOR
N1111.DING DIVISION PIPS
f1'his section need not he completed if the Pemtit is l in one bu dualdollar,is 100) GREASETRAP
lir less.) PIANCHECK FEE
I eefily data lhelmrfanmmneef the work farwhich this permit is issued,Idull SEWHIt-SANITARY-STORM EA.200 l)1'.
not employ any percnn in any manner so us m Mcylne suhjecuo Ibc Workcri Cnminm ENERGY FEE
Z smian Lvws C I turn t Unte IC WAf1iN tIEATEk WNL'NT/IiLECPH
7O� Applicam J r-1,11 7 -��TF y�ld�` GRADING I7EE
NOTICE TO APPLICANT':If,after making rias Centfiaate of Exch poo ,you ehould WATER SYSI'IIMaREATING SOILS FEE:ai L� haeme subject m the Worker's Compensation prnvi .v of the hatanr Crede,yuo oris(
a� ord,vilh comply with such provisions on his permit died Ise Jecancd rcvnked. WATER SERVI r
0. 0
CONSTRUCTION LENDING A 'oney NEW It ESIDIi IA.PLMH. PATO
L) 0 Ihcrcby alBm Wnthere isacnnswrlinn lending egcncy funhe perfnmmncenf Dsm cciptN
the work for which this Permit is issued(Sea 31X1].Civ.CJ
u' F Lender',Name n V TOTAL:
QG Lendoe,Address TOTALFE
BUILDING FF.F.1 certify that 1 have readthis appli.ti ofand sine that the above information ix 'f(Icnarecl.Iagree In comply with all city and runtnY nN nno,ex and doe luwsmbalng to QTY. CHANICALP T 1998UZ building conslmcliaq and hereby amhorrzcre,marotmives ofthix citym ether upon theahova-mcntienel properly Eu insPmlino Pnrposos. FERMI'I 1. 'Lai E(We)agree to save,indemnify and keep harmless Tho City of Cupeninm ELECTRIC I'GIIIiablities.juit s.ar iconALTF,ROR, TOsgaenm ahat n6 nl lhispnJL CPLUMPING FF..
APPLICANT N tS AND .CO. PLY WITH AL1.NON-POINT' AIR HANDLING UNIT(TD 1111X10 CFM)
SO
URC f10 S. p MECHANICAL PIiE
I'1 1— I(Y AIR HANDLING UNIT(OVER HIIN111CPM) CONSTRUCHON'I'AX
nnmrenfA licat Dale a 17XHAEJST HOOD IWmucr) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store orhandle hazallous material HEATING UNIT(TO 100,0013'111)
as dafined by the Cuv,ifi, MuniciP01 Cade,Chapter 9,12,and the Heulm and Safety
Code,Scclion 25532(0):' HEATING UNIT(OVER 100]610 HE Of
❑Yes C]No VENT]I,ATION FAN(SI NO I.E RES I D) PAID
iDate Recipl N
Will the futue buildingpant me eq i memlir desres which emit hazardous air cnm:uninamx as dehncd by the Bay Area Air Quality Mawgcmem BOILER-COMP(31111 OR loll")IIT U)
District!
0Yes E]No BOILER-COMP(OVER 100.000 ITT'U)
1 have real the hmtrdnus materials reyuimmenn AIR CO NDE'I'IONER under Chapter b.95 of the Cali- ISSUANCE DATE.
fnmia Health&Safety Code,Satins 25505,25533 and 25534.1 nndentund that if the NEW RISIDENTUAL MECH. SQ.FT.
huilh.,UI, ,uoacurnllyhuvenlcnanlOil,it only to.Ponsibiliryw iaify We nknpam
of the ob,tim nems which must Is,met poor to Issuance ofal Cenifcale td Occupancy.
OwneroraumoriuJ agar Date 9OTA L: ISSUED BY:
OFFICE