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S 3070
Baal 1CANT Tn FB I. IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO API'LICATION/F'F.RMIT BUILDING- KLV.CFRICAL BUILDING DIVISION PLUMBING - MEOIANICAL BUILDING PROJECT IDFNTIFICA'FION PHT'N0. 3070 J BUILDING ADDRESS: SANITARY No APPLICATION SUBMITTAL DATE �1 7 o S, iv Pesci Cwt vS1 el 2- OWNERS NAME: PHONE: CORI'RACIOR'S NAME: LICIS y,C alit ,.a WWC4 '�//(� CA „'4-,r 71 NIC ❑ CON'IROLN ARCHITEMIENGINC:ER: LIC NO: ADDRESS,: y �-�(} Z Lu11JL l+'vtYJ� CA. CONTACT: PHONE:� BUILDING PERMIT INFO .�• a� E:1 Consultant Fees Paid by Applicant (Initial) BI.DO IJ.1!G'I' PLUMB MECH i 10 -r ©o I ❑ ❑ ❑ %,. LICENSED CONTRACTOR'S DECLARATION I hereby aff)mt that 1 am licensed under provisions of chapter Q mnmmanaing withSeaalor,]UOU)af Uivisiao3 onM1e Rosiness ane l'nde..i: CJ,fl.andmylneenseis In full force and c0'ccl. 'I `� QTy ELECTRIC PERMIT FEE _ JOB DESCRIPTION RESIDENTIAL: ❑SFIIWI, ❑KI'T'CHEN RIiM01lIJ. PliItMIT ISSUANCI! APPLIANCES -RESIDENTIAL Licensc Class ia.Y Data trot tali []ADDITION ❑ I'I.UMBING RI; PIPE. ❑MUEN-UNIT ❑5'rRC=RAI. MODIFICATION ❑INTIIil012 ❑ Cl I IMNEY RITAIR IMPROVEMENT E] SWIMMING POOLS CH'! SI C A'1'ION unJers,an y a .h as pea is recnrJa PANIiIS Up 110200 AMPS Licensed Profs.. zona 201-IMOAMPS WNEUILDER DECLARATION R-0 I hereby f n ,hat 1 am axevnpt from the Contmaor, License Law dame following lieu. ection ]U315, Business and Prnfessinns COJe: Any city or cnun'Y ❑ BATA REMODRIJREPA1R ❑DEMOLITION ❑O7III:R OVER ]Bud AMPS SIGNS IiLECfRICA1. which "'arms o ..Bann m cans........Iter, improve, demolish, or repair airy slmemre SPECIAL CIRCUIDMISC. prions las issuance, also requiresme aPPlietmlfor numb permil to filen signed,0anena that he Is licensed pursuant to the provisions of the Contractor's License Law fChupmr 9 (eommeneingwith Setion7000)nfUiviolnn3 oflha Isminamand Pndcssi... Code) or TEMP. METER OR POLE INST. COMMERCIAL: ,bat he is exempt fherld a and the basis fm the alleged exemption. Any violation of ❑ NEW BLDG/ADDITION ❑ DEMOLITION Section 9031.5 by any applicant for a penmh subjects the sUdicam ma civil pennhy ar not nfan, Than five hundred diners ($5 W). I❑ ],;is owner of the primary, or my employees with wages as their onto compensation, will doing work. and thealracmm is no, imendednrnffered forsale(Sec](,4,Budness and Professions Code: The Contractors License I.me does not apply m an owner a( POWER DEVICES ❑ TENANT ❑ FOOD SERVICE IMPROVEMENT El OTHER I ri ar4- / rM.(jA/ SWIMMING POOL iI.ECTRIC OUTIArl S -SWI'I CHF_S-FI%TUN NEW RESIDENTIAL I!I.ECTR SQ I'I'. VI-- property who builds or improves,herean, and who doe, ouch work haunter or through his own annpioyees, pravided thatsuchimprovements me no, initiated it ofaed for rule.if. however, 'he building or impnrvamanl is sold wind, one year of completion, the— onerhuilder will have the tracer, of proving that heard no, build or improve for par - w SQ. FI HABIB AREA $/SQ. FI '. pose if sale.). I, as owner of the property, am exclusively contracting with licensed contmeom to TOTAL consa unn the pmjecl Nov. 90,4, 13 arms, and Post ..into Code:) Ilio Contromnrx Li- .al...wdnasnu,appfy mlmnwocr of property who huilds or lnnpmvcv,hereon.aml QTY. PLUMBING PERMIT' FE. who conducts for such projects with it condactarfs) licensed pursuant m the Cnntraem's - PERMIT ISSUANCE License WIN. l nm exanpt under Sec. ,B&P C for this revwn Owner Done AM HR - DRAIN & VENT- WATER (EA) VALUATION WORKER'S COMPll SATION DIiCI.ARATION BACK FLOW PRGTRCI'. DEVICE I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent it) for Workers Cnmpcm salion, as provided for by Section 3710 of the Labor Code, for the performance of the DRAINS- FLOOR. ROOP, AREA, COND. STORIES '1YPE CONSIRUCI'ION walk for which this permit is Issued. FIX] ORES - PER TRAP ❑ I hive and will beinmin Worker's Confponva,ion Insurance, as rttryhed by Section 3700nfahe Farm Cade, farthe performance oflhe work Ravemeh this pa.,It is issued. FICC. GROUP AIN GAS - EA. SYS TEm- I INC. 4f FILETS My Workers Compensation Insurance comer and Policy number are: Cndict: Policy No.: GAS - EA. SYSITM OVER 4 (TIM IIASEII S kh WAS ! N'TER R CERTIFICATE OF EXEMPTION FROM WORKERS' COMP17NSAI ION INSURANCE BUILDING DIVISION PI„H$ CITi carmen need not hecon,doled iOhe permit lx frn nnehundrcd dnllms($IlNll or less.) EASE AP PLANCIIIiCK FEE 1 canifyRal in the performance offhe work for %Inch this Permit is issued, [,]on not employ any penin in any manner so as to hecnme subject to the Workers'Compar. IT S 1 Alltrllli ENERGY FEE cation Laws of Cadhoma. Data Appliaua WA'IE HEAfEIi W/VIiNT/EI I'll GRADI , FEE NOTICE rFO APPLICANT: If, aver making This CcnilieNe n( Exengninn, you should hwmans inbjee m fhc Workers Comlxm mion p,nvislom of the Labor Code. you mon WATER SYSTEMO RHATING SOILS Iia! 'Ifjr' 9.Ef TFF forthwith comply with ouch pmviouroor this pcania,hell he deemed revalL CONSI'RUCI'ION LENDING AGENCY I woolryalfdothut shoreiaacnnnruginn lending agency finthe perfmm�nnee of N1oVRESIDENDAI.PLMU SQ. FI', PAI Date Recelp,K ,be work lit which this permit is issued (Sec. 3097. Civ. C.) lenders Name IGIAL' TOTAU Lender's Address is I )INCITE I today that 1 h: ad ... art annual l and slate Ilmuhe above infarmalinn mTl. I agree ,o cam y w th II airy rot county anlimuncev and state laws relaling to buildingcnrvnmco, ad r ymlbod, represennni e,oflhkoify m emeruponfhc tio ve-mentioned for as p es abotos s the Cay of Cullmaagainst (We)ag. is in n do .,to c ham en Q'fY MEC, IANICAL PERMIT FEF. SP.I MIC D3P. r PERMIT l 3✓ r E 'CIRICFEE PLUM TNG PEE liabil'ities,'udgmems ossa xpens ihat. anywayacameugains,said City ecal gruff flhis l'r nit APPLIG T D .It, N S AN LL (' L PLY WITH ALL NON -POINT' SOURCE LA I ALTERORADD'IIMECH. ��//yy AIR HANDLING UNIT (TO 10,000 CFM) C;,1 MECHA AL FEE AIR HANDLING UNIT (OVER 10,IXXICFM) CON$TRIILTION TA% Signaltenf p nanVCnnwetor Data 11ALARDOUSMATER LSUISCLOSURE IIXHAUS'1' HOOD(W/DUCT) HOUSING MITIGAI ION THE II EATING UNIT J 0 100.000 11 DID Will the northeast or made M:illim, rc span,..ore or handle h reanlau,. material as defined by ,he Cupertino Municipal Gale. Chapter 9, 12, and ,he IIcahh and Safety Code. Section 25532(..):' HEAPING UNIT (OVER 100,000 H'I'U) Ya, rvo VI3N'I'IhAT(ON PAN (SINChli 1l1ISI U) PAID Data Rcacipt p BOILIiR-COMP DI{P OR 100,000 BTU) Will the applicant or futon building by The B y A equipment or devices Management emit hazardous air contaminants v Jcfinel by the tluy Area Art Quality Management TO'T'AL: ROI LER-COMP (OVER 100,000 BTU) Dindcll' E3 too, ❑Nn AIR CONDITIONER I hove read the huavdaus malen'inls requirenrenly,mJer Chapter fi:JS of One Culi ISSUANCE DNFE NEW RESIDENTIAL. MECH. SQ. FI� form. Health & Safety Code, Su,imf.8505, 25533 add 25534. 1 understand fhaf if Ibe building does not currently have a mnanf. that it is my mxprmsibilay to notify the occupant of the requirements which mus, he met prior in issuance of a Ceni Bate of Occupancy. III ISSUCDBY: 'A L: O Owner or loodaizeJ..genl [).,aT 1. OFFICE