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S 1776 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO RIIII DING.ELECI'R ICA I, PI!tTT NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL' l`7 (6 RU I LDING PROJECT IDENLI FICATION BUIIAIN4 ADDRESS: SANITARY NO, APPLICATION SUI3M1'1'1'AI.DATE L0370 S. �.e l G WNER'S NAME: 1--Lj- 3 VHON ��� CONrfRACfO�.5-NAME S LIC N(), HCHII': /ENC F.:R: LIL Na: AD KESS: r21��V ❑ {,/�V IIU QCx 13.8 5 t,A CON'I'ACC PHONE:/ ! 0/4 BUILDING PERMIT INFO qR�/ Vu 'L/�13�a ❑ Consultant Fees Paid by Applicant(Initial) DLDG ELECT PL MUCH V r LICENSE[)CONTRACTOR'S DECLARATION QTY BLIiCTRIC PERMIT .'FEF I herehy aRrm thin 1 am licensed under Pr,isian.of Chapar 9(commencing JOB DESCRIPTION Fra+Z wan secI....n)ofDivision3 onbe n.,ine,,:tnd Pmfwndo sc::de.und.ny liean,e ix RNID .NTIA1.: FOO in BEl force nnJ I. PERMIT ISSUANCI! IA- / WI, ❑KH'CHBNREMDDEL aUE' License Cl: au"n - AI'PLIANCIiS-It1!SIDIiN'I'IAI. ADDI'T'ION ❑PLUMHIURAL PIPE FZ Rmc Cnnvanor _ ARCHITECTS DECLARATION PANELS ❑AfULTI-0NIT ❑$'I'kI1CTURAL Z O Z I un summed my Plnne,uml be-.u:d as puhhe nvmM, MODIFICATION OZ-- UP O2010AMPS El INTERIOR [D CHIMNEY REPAIR W Licensed ProPovssional 201.1"AMPS IMPROVEMENT SWIMMING POOLS Cedi� OWNER-BUILDER DI!GLARATION OVER 100o AMPS ElBATH REMODEL/REPAIR ❑DEMOLITION Ex�f�y�yII Q I hereby affn Loin I.,it woan mEnm the Cantrad.6 License Ulm,far the i�5dy U following odds n.(Scmin 0]031 5,Bmincv's a:nl bodrasions Code Any city o,county SIGNS ELECTRICAL ❑OTHER u]a a N which requires a lawmin to con.cund,alien,improve,demolish or repair any stmdulr C) SPECIAL miminir isao.nce,also requires aeapplicatn toroidal pemullo fit...truldsaamenl 31'I!CIAL CIRCUIT/MISC. y�y'� than lhois licensed pursuanlu.lhwpmvisiomofthe Conlrumor's l.icauc LawlChtmmr 9 �© a �C�Q (commencing with$arinn]Oq))nf Division 3ofthe Hu,inea and ProfessionsCWe)nr / TEMP.MEHIROR POLEINST COMMERCIAL: L p,o y Ihat he Ix exempt there Gn a and the Iseis for the alleged eamumirm Any violation of ❑NEW HLDG/ADDITION ❑DEMOLITION W_m Section]8.11.5 by any applicant for a Wrout subjects tae applicant m u civil penally nl' POWER DEVICLS ❑'f13NAN'I' ❑FOOD SERVICE PF.. nil mc¢than five handled dollars(8500). Igad 22 n IMPROVEMIiNT E:1 SWIMMING POOL ELECTRIC wildohewrk.andtesmcamfirm intionhornHledfosule(Sec.7014Business ❑Ol'HEk W�'� and Professions Code:TM10 Contractor's License Law does not apply r)an owner of OUTLETS-SWI'ICUES-FIXTURES properly who build,or improves nucleon,and who dice such work rel,elf nr through his own nnployees,provided that such improvements are not intended or offered for NEW RIiSIDENT IAL ELECTR SQ IT. s:de.IL however,(he building or improvement is sold withinote year ofcontpletion,me SQ ITT FLOOR AREA LSQ,FT. ryrbuilds,will have the burden oI ra,ir,that he did unl build or Improve lo,par- •w , of sown. 1, f owner of(M1c pmpcny,um exdusivdy cnnirndGng with limnsed anu'ncrars comwm the pntjat(Sec.901 busbies,and Professions Cale:)The C,nlmears IJ- censa Luw does not upply to air owner of profanity who builds or improves thercre,and QTY. PLUMBING PF;RMIT FEE ��Q who conhods for such prnl ojects with u mracluds)licensed pursuno nnthee...tmnt'a is Licenm Law. P,RMI'T ISSUANCE ❑ Ilen cxempr under Set. - ,R&P C for taster.nn Owner Date ALTER-DRAIN&VENT-WA'I'F ) VALUATION WOIIKL'k'S CUMPIiNSATION DIiChN1A'IION RACK FLOW Pk(JI'ECI'.U ;li 1. IM1emby aRrm mtder penally of perjury one of the foluwing detlarations: �� 2 O --- C1 and will inaimninaCenifcatc of Conscm m,df-insure fir Worker's Campo..- DRAINS-FLOOR,ROOF,ARL,C(11 ,.tion,as provided fir by Section 3]1X1 of the Leber Code,lit,the action........wf the STORIES T Iti WNSTRUCI'ION work for which this permit is issued. FIXTURCS-PER TRAP ❑ 1 have uud will mainwin Worker',C....per,a en bhwmocw,ax ognind by Sermon 3700tifthe lsMrt Cale.fortbc wrfo..mrs,ot the work for which this permit is is wed, GAS-17A.SYS'IENTI INCAOUTLEI'S OCC.GNOUI' AI'N My Wor Con e-Iti I- .nap n 4YCan A� or.numhprly qu,',79�2 GAS_P.A.SYSTIiM-OVI?R4(1iA) ((( --- CE TII:IC COMPENSATION INN FROM WORKERS' COMPENSATION INSURANCE GHF.ASUINDUSTRL N'ASTI rRCIJ'10 _ :1 DIVISION FEES(Thissatiun need nm he eomalc¢Ail'the pent.it is for nuc hundred dollars(811X1) GREAMPTRAP or less.) CHIeCK IrHE l oenifyrbm In the perliemanceW nhework(nr which laiepennil is iaxned,l,hull SIiWER-SANITARY-STO .2 na employ any person in any manner sit as m Mame subject lathe Worker,Commit.- E GY FEE _y O z .curio,Law,of Cedifomia.Datc WATER 111!ATER WNENT/ 1�oCEN z Applicanl ` DING FEE N NOTICE TO APPLICAIfl%If.afar making this Ccrificme of Exemplum,you should WATER SYSTENUTRHATIN; abecome nable,,m he Worker's Compcusmiun Pm,i,io,s of be Labor CoAe.you..nat SU S GEF: hLl forthwith comply with such provision,or this permit shall be dcemW necked. WATER SERVICE Y L1 Q RUCI kile.ONL;ion lending ENCYagency NI!W RIiSIDEN'I'IAL I'LMR. SQ IT. 'Z Ihemb ffirm lhauhem isaamswminn lendin for the performance of Doe kueipt# yes ,agency U O Id,eiA for which lois ae I Ica.309],civ.cit 4' F" Lender.Name SnY.ih u� Tarnl.: 0 L) Lc..dcr,Addres ts— f aI comity that I bttve thaN.hie upplicrat n and state that the naive inlimnanimt is BUILDING FEE sill". r� fq re cmcl.I a .greecomply with all city and minty nNlnances and are laws relating m QTY. MECHANICAL PERMIT FEE 7 U G budding comuuction,and hereby authorize rgnesem:ni.es ofthk city to enter upon the SEISMIC FIVE ubovoinentioned to sae fmimnifyan Inept I_e. 1 PERMIT'ISSUANCE 1 We)agree m save,indemnify and keep hannlcsz the City of Cupcnino against ELECTRIC PEI, febiliriae,judgtncuts,c' pond expenseswhi.h may in any wary recrve agoing said City MITER OR ADD TO MITCH. in cnmcquenm of the granting of Ibis Permit. PLUMBING FEE a APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,003 CFM) MECHANICAL PGE O IOU RCIi REOUL TIONS. D l AIR HANDLING UNITIOVER 10,000CPM) CONSTRUCTION TAX Sign alurc ofA lie, t ]onuuder IJ e l 1!XHAUS'I'HODD IW/DUCI'1 DOUSING MITIGATION FEE J 7 RDOUS MATERIALS DISCLOSURE Wilhl, rel orfimtre building nccupnm smremhanAlc hnzvnlwnn m;acriul BEATING UNIT(TO 100,000 B'fU) as defined by the Cupertino Municipal Cade,Chapter 9.12.and tire Health and Safety Code,Section 25532(6)1 ABATING USE T(OVER 100,0010 If ❑Yc.c ❑Nn VIiNTILAI ION FAN ISINGLIi RES]D) PAID Date Reccipl# Will the air comm or d,.building by the nu use co Air Qui k devices which emir,hmallous air asmuminums as JcfneJ by the Pay Arca Air Quirky Management IIOILEII-COMP(3HP OR 100,000 HT1]) rin'1 TOTAL: Dig ❑Yes 0N BOILER-COh11'(OVER 1011.000 BTU) AIR CONDITIONER v I Hove real rhe h:vaNnus mnariub mgnircmcnr,under Gloater h95 of rhe Culi- ISSUAN9DA7E resect.[Icahn&Sunny Calc,Section,15505,25539 and 25534.1 understand but if me NEW RESIDENTIAL MI!CH, SQ.FT. - building does non eurmmly h.vc a m..am,that it is my mxrymxibility,,notify the occupant rel thercquornin,which moa he mot Priormimuan.,da Cendinunof O,O.plrOy, /'� fill, Iiiii Owner mem l,tole,cnl Dam Tf� .0 ISSUED BY: OFFICE