S 0596 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPRRTINO RUILDING-E,LRC'I'RICA L PE 11'1'NO.
BUILDING DIVISION APPLICATION/PERMIT PING PROJEM'ICEANICAL 0596
BUILDING 1'ROdF.CI'IDENTIFICA'1'IU:V
SANITARY NO. APPLIC PION SUBMITTAL DAH!
ItU11.DIN0 ADDRESS:
low
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NP 'S NAME: PHONE: C N'IRACfUR'S N E: I LIC NO: NIC CUN'TROI.p
CH TEC'/ENC N12:R: LIC NO: AUDEP_S, ❑ ,
CONTACT. PHONE: cruZ BUILDING PERMIT INFO
WdMY�IN M �. 335_ ❑ CDnsBltanl Fuel;Paid by Applicant(Initial) BLDG e ' r PLI❑Nul Me❑cH
LICENSED CONI'RAM ON;S DECLARATION Ty ELECTRIC PERMIT FE, JOB DES IPI'ION
1 hereby uBinn(hat I an licensed milk,prnvisinns of Chapter 1)(con;mncing
Z. with SCclion 9190)of Divisinn 3 of the Business and l'mfesions G.3e,and my liccnsc is RESIDENTIAL
O m PERMIT ISSUANCE
�tyF full force and eRua. ❑Ml)WL _ ❑KITCHIiN REMOUIiI.
QUV liccnsc Clas Lic.a APPLIANCES-RESIDENTIAL DADDH'ION ❑I'LUMBING RE-PIPH
F Q 6 Date ConlfJclor
,- ARCHITEM;DECLARATION I,ANHIS ❑MULTI-UNIT ❑MODIFIVRAL
F u,Z I andersmnd my picnic shall be used as public record• MODIFICATION
ZOy,- UP 1021X1 AMPS OINTHRIOR OCHIMNEY REPAIR
OZ O
��.F.ul hittmscd Pro(csviunul 2ULIINNIAMPS IMPROVEMENT OSWIMMING POOLS
z wx,f OWNF,R-BUILDER DECIARATIUN UVIiR RXX)AMPS O BATH REMOUBUREPAIR 0DEMOIJRON
—,W< 1 hereby af0m1 thud I um exempt from the Comment,'.License Law for the
XO6 U following reawn.(Section]0315.Businessland Prof cssinns Cade:Any city or county SIGNS ELECTRICAL ❑OI'1113R
W 3 0 F" which requires a permit a,croonno,alter,improve,demolish,or repair any•ormo re
REu n prior to its issuance.alio requims the applicant for such permit to file a signed sla 'a SI'IiCIAL CIRCUITIMISC.
@.H that he is licensed purwanuo the provisions ofine Contractor'•Lactose Law(Ch ,T
�p�'�� (mmnml:ncing with Sectio 9(XXp of Division 3 ofthe Busincxs and Professions C Dor E ME k1riRTOuti IN
d e C that he is exempt Ihere(mot and The basis lir,Ice alleged mxemginn.Any viol m of ;I hUG/ADDITION 0 HEMOLITION
ySection 7031.5 by any applicant for a permit subjects the applicant m a civil pe lilt I EVICES r IIiNANT 0 FOOD SERVICE
oat more than five hundred dollars(8500), IMPROVEMENT
f=� ❑ I,as occurred the pnrpcny.or my employees with wages as their sole cont ation, IMM ' 4s00L EIECC I RIC .
❑OTHER
he work,and the ehncmnten
m is not ided oroffcmd file (Hi
r sale(Sec.I ,
will do t
F- O -SwITC r '-I'X'NR
W 3 m and Pmfaslons GNB:The Cnntracmrs Liccnm law Jas not apply ter an
r
pmpcnr who builds or improves thereon,tend who Joea such wmA himself or through NEW RILSIDENTIAL L' 'k
his own employees,provided that such improvements art not intended or offered Tor SQ P sA S/SQ,FT.
wle.If.however.the building err improvement is sold within one ywr of cnmplmian.1hc
aster-Milder — V_
will have the burden of proving thin he did not nuilJ color v e I'ur pur-
' of sale.). TOTAL: ,S NOV
I,as owner of the property,ant exclusively contracting wiln licensed canon cmrs I,) NOV
D
conerucl the pn,jat(tie.TW.Business moil Ymfnsions CNIC:)'ITc Contractor's Li- �{[�u
move law does not apply loan owner nfpropeny who builds or improves lineman.and QTY. PLUMBING PERMIT PEE
wnacnnmactsfnrsmch pmjens with a contmam(s)llmnwd pursuant Contmmnrs CITY Or GUrcNiINO
License law. PFRMI']'ISSUANCE
lam ext IunJerSce. .B&P C far thin reason
ALTER-DRAIN&VENT-WATER(EAI VALUATION
Ua1 n
n ;S NSA'fl DCCLARATION BACK 1'IGw PRDTEC I'.UI;VICI: /`�l/eb.
I Term,mbligaranda penalty ofperjnry oncof The followmgdccbnalnnx.
I nava and will maintain a Cenifcamuf Commano wlf-insure for Worker's Compcn- 1)RAINS-I1,00R.HOOF,ARBA.GOND. STORIES 'I'YPH CONS'I'RUCTIOF
wilocn,u provided loot by Section 3900 of the labor Code,for palonnance of'he
work for which this permit is issued. FIXTURES-PER TRAP
1 have and will Mountain Workers Com,enmtion Inwrame,as required by Section
37M of the Labile Cade,for Performance of the work for which this .it is issued QAti-IiA.SYSTEM-1 INC.i OUTLETSOCC.GROUP APN
My Worker,Comper,mion Insurance came,and Policy number um: GAS-ITA.SYSTEM-OVER J(H,G
Carrier: Policy Na.:
CERTIEICA'IEOP EXEMPT ION FROM WORKERS' GRIiASHANDUSTR.WAS'UIIN'I CEFICR
COMPENSATION INSURANCE; 11 G VISION FEES
Im,,eoam accJnm he complaedifthel mcnit is forone handled dollars IS 100) GREASE*1'RAP PLAN
err less.)
Toy any that in the any
nrof as
work for,objectch to The rtil Wisiss,c'C0 shall SEWL'R-SANITARY- OEM EA.2IXIIT. ENI: 0'1;
nm employ any fiction in any manner so as m heurmc suhjea m IM1e W'orkcri Compen-
O Z ,no.laws of Califomia.Date WATER[]EATER ENDTLECTR GRADIN
O Applicant
Z�+ NOTICE TO APPLICANT:It.after making this Cenilicute of Eamptinn,you should WRIER SYS M/rREATING )II s I''.Is
Fq bcantm la t Lar the Worker's CompcnsaJon previsions of the IaMa Code,you must
�s� IirrthwitM1 comply with such prnvisinns or lhle ln,mil shullhJeemcA revoked. WAI El !RVICE
W Q
Oki
CONS'IEUCIION LENDING AGENCY N' 'RESIDENTIAL PLMB, SQ.IT, PA U
Dom ueceilna
=) Z
U O InerehY affirm gnat them isaamstmnion lending agency rte tireperfnrmwv:e of
D. the work for which this permit is issued(Sec.3197.Civ.C.) TGI'AI,!
C) ULenders Name TOTAL:
U LendO'•Addreas BUILDING FE,
ff..yy fy I certify Inst I It.,. .it this applicutiou and smic Inauhe aMme information is
Fes. h amncd.l agrw mwnmply with ill city and arwuy nnlinunecs anJ.dmc lows rclmingm QTY. MECIIANICAI.PERMIT FEE SEISMIC FEE
U Z buildingumstmclion,and hereby aulhnri,cprv,c ativkx"otic ay to eal a, ithe
mauve. bond pnmpeny for inspection pmrprws. PERMIT r ISSUANCE IlLBC'I'RIC FE71
(We)agree to case indemnify and keep hanale,,the City of Cm1mml against
Iiabilities.judgmat,onetsand kxNd,c,,whichmay in any way accmcaguinsl said City ALIER OR ADD TO MECH. PLUMBING I'
in consequence of the grunting of Nis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT AIR HANDLING UNIT 0 O 10,000 CFM) MITCHANICAL FEE
SOURCE REGULATIONS.
AIH HANDLING UNIT IOVICE IU.IXIOCFM) CONSTRUCTION TAX
Signature of Applicunt/Condmcnnr Dam EXHAUST HOOD(W/DIICr1 I IOUMNOMITIGATIONI rF
IIA%ARDOUS MAI'lzRIAI,S DISCI,OSURB
Will the applicant or future buildingtecupanl,lore nr bundle huarJous mamriul HEAHNG UNIT(10 IWAI)B'1' el
as ddnm by Ibe Cupertino Municipal GNe.Chapter 9.12.and the Ile hn and Safay UIW INC UNIT(OVER HX X)RID)
Crede.Section 25512(x19
0Yc: ON. VENTILATION FAN IGI,RESIDI PAID
Receipt p
Will the applicant or future building¢cupant use equipment or devices which BOILER HP OR IIIBM)BTU)
nit haearJnus air anntunumants as defined by The Bay Arca Air Quality Maoagcowto 'IIYI'AI.
District! IBILEN- IT'(OVER OUAXNT Brut
E]Ye, 7N
AIR(' DI'HONER ISSUANC17 DATE
1 have read the h rde S um,1i5 5.2553mms ander Chapter 6J5 of the Cali-
Grmia Health&Safety Grade.Sections 255(15.is my si 25531.1 It)Mar tth that twaMeatrim NEW RIi51UENf1AL MECH. SQ.Fr.
building Jars ce cmvcnlh have a tenant,that a is ua responsibility ter notify the pancY.
of the rvquiremmntx which mall M met pour m issuance of Ceni&ac o(Wcupancy.
Owner or annmireJ alcor
Dac TOTAL: ISSUED BY:
OFFICE