S 1120 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY BUILDING-Ej,LClRICAL PISA]pNO.
PERTINPLUMBINC-MECIANIC L 1120
BUILr)1NG DIVISION APPLICATIONPFRMIT
111111.DING'PROJIA;I'11)ENI'IF'ICNI'I()N
SANITARY NO. AI'I'I.ICA'I'IONSUHMII'1'AI.DATB
BUILDINGADDIi ESS:
07-01ocS �- L vim L vP 1�T rrn .
'
OWNER'S NAME: PHONE: CONTKAClOR'S NAME: LI/N11 NIC CONTR L
w S rn IU
2H ITEC'DINGINEER: LIC NO. - AD 5: ❑
fol CJ/lkl/WZJ
CONTAC'1: PHONE: +,'• " BUILDING PERMIT INFO '
• �.1 SIG V'si (2,L - [� ❑ Consultant Fees Paid by Applicant(Initial) RrrL-DyyG ELECT' PLUMB MUCH
A
I
LICENSED CON TRACTOR S ARAGONpQTY s _ rfLETRIC PERMIT; Ifln,mny nrrmin lne 1 provisionsrchamr9aemma„mg rt I t•rr a•� ' FEL -
JOB DESCRIPTION
HOZwith 71NXl)ofDivision 3offe Thic eemind Profession,Code.and my l'cense s pERMI11SSL1ANCE RESIDENTIAL
, in full forecasts]effect. - (-
' 7r,S _ OSPDWI. O KITCHEN REM
ODEL
License LichoOPLUMNING RE-PIPEU Carlow g APPLIANC17S-RESIDENT'IAl. OADDRION
QL -UNIT ❑STRUCTURAL
ARCIIlFCPSDECLARATION PANELSI
MODIFICATION
_ I understand my plans shall he used as public mmrds
O ZIJP T02IXIAMI'9
❑INTERIOR OCHIMNF REPAIR
�i1 LicensW l'rolkvcional 20I-IINN)AMPS IMI'ROVIiMENT 0SWIMMING POOIS
�J OWNER-BUILDIR DECLOVER IWMI AMPS
DECLARATION OVER BATH RENIODEIIREPAIR ODEMOLI'I'ION
6 1 henry,shouted I ate exempt front the Common',License Law for the O urnER
iq5 O L U following reason(Section]011.5,Business and Professions Code:Any City or county SIGNS ELECTRICAL
lit WO y which mouires a permit to construct.alter.improve,demolish,or repair any suucwre
ffnn6 ,for ill its mars.-Ilse nismirw 1111 applicant lurmch pantie,,file usignedstatmnenl SPEC I AL C I RCUI'I MISC.
Msan
at he is licensed puuTo the provisions of dm
ie Conlctois License Law(Chapmr)
121 C (commencingwith Section 71X9duf Division3 oflhe Businessman Professions Code)or TEMP.MIIIT-R OR POLE TNS'1'. ZL
CIAL'
Q.d o K That he is exempt Ihemfmm and the basis for the alleged exemption.Any violation of G/ADDITION ❑DEMOLITION
ern Section 70315 by any applieant forapemiit suhjens he applicant tai a civil pered'yof POWER DEVICES OFOOD SERVICE
f❑❑„� not more tato five hundred dollars($500) EMENT
2 +❑ O1•ts owner offile prnpeny,ornty empb,cc,w llh wages Cs h,iraolc,uaOcCmaion, SWIMMING POOL ELECT RIC
will do the work•and lhestrunnia is nal intended as..n'ored for'sule(See.7044.Bu.in Cls
I+al a and Professions Code:The Carl,., r'.License law does not apply tai an owner of OUTAG FIX'I'GRE
�•3.. property who builds or improves theater,and who does such work lunrself or through -
his own rnlpinyees,provided thnt.,tach improvement,am not intended or oRerW far NEW RESIDENTIAL ELECBp psale.If,however.the building or improvement is sold within one year nfcomplelion,the ' �]T*y REA $1SQ.F.
wnerhudder will have the burden of proving that he did not build or improve for put- ld q
ID
pose.(auto)
1 f the progeny an,C.Cfml,cly contracting w N licensed coalition,
nm t f Ih p jest(Sec 21Ni Busines J IT f: CN )Th C I T t.LI ,f i s *7 ANSq
cense La 1 T apply m as ownerofp pony h builds t and QTY' iPLUMBINC PERMIT ". F IP
contractors)contracts for such projects with acontractors)licensedsmu
.ed punnthe Contractor+ •' ` ' I-
LicenNe law. Ur
LJ
OI um cxcmpt order Sec. ,B&P C for This mason PERMIT ISSl1ANCP. VVCCllllly
ALTER-DRAIN&VENT-WRIER(EA) VALUATION
r Date
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
I berchy aBirm under penally of perjury enc of the following dedwdtide s:
I have and will maintain a Certificate of Consent to self-insure for Workers Cooper- DRAINS-VLOOR,ROOF,AREA.GOND. STORIES - TYPE CONS'lRUCrION
Italian,as provided for by Section 37M of the lahir Ede,for The performance of the
k for doelt This permit is L"ned. FIXTLIKES-PER TRAP
10(1 have and will maintain Worker's Compensation Insurance,o,retuirod by Section
3700.f the Latin Code.far the pefformanecof the work for which his permit is issued GAS-VA.SYSTEM-1 INC.4 OUTLEF S OCC.GROUP AI'N
My Work,kC tin9,Ind ',c .��,�(�d Policynu
Cartier:sTNn�don 1- -'w�^ricy No.:[jgca1q-7 GAS-HA.SYSTEMOVER 4(PAT
CERTIFICA'I E OF EXEMPT ION FROM WORKERS' GRF.ASIVINDUSTRI.WAST Ir IN'I'9RCEPTOR
COMPENSATION INSURANCE I BUILDING DIVISION FEES
(I'hiNuccliannoednolhecnnipleled bite pount is fotnne hunlooddolbmv($IIID) GREASBTRAP '
PLANCfIIiCK FEE
or less.)
I teddy that in the pediammnce ofthe work forwhich This permit ix issnW,I shallSEWER-SANITARY-STORM F.A.200 FT.
not employ any person in any manne.......become on ccun the Workers'Compcn- ENERGY FEE
Z action Laws of Califomin Dam WATER 1117ATER WNWIIELECI'R
Q Applicant 1 GRADING FE-H
NOT RIC'IO APPLICANT If,aper making this Cerlifcme of 17cloption,you should WATIiR SYS'IRMiTREAI'INC, SOILS Id!li
f~ lavoom nubJceuo the Workers Cnmpensalien pro,kil n, title hirer Code,you nmst
UjforthIll with courply with such provisions or this Ishall redeemed revoked. WATER S13RVICE
0. Q
CONSTNIICI'ION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.PL PAID,
VQ I hereby affirm that there is a construction lending agency for The perommeneenf Date Be ipttl
UF he work for which this perniT is issued(Sea 3097,Civ.CJ 'f(YfAL'
� �
],end...N -
ULee Address H)TAL:
yLs, 1 cerify that I Imvt mad this application and ,are That dui cheep information is BUILDING]:
y
a
cmel all I agree to comply wall cityordinancesand county d:mi mTY
laws addi g Q . MECHANICAL:PERMIT SEISMIC IT
FLh
Z building Committed,and hereby amhurim representatives oflhis city us enter upon Cfile i' "
above-mentioned Property far inspemlon popposes. PERMIT'ISSUANCE
(We)agree lenave,indemnify and keep airlines,the City of Cope"...against ELECTRIC PEE
liahilitins,fudgratermmsm and aspens..which may In any way iueerue ugninst.ato City AI,TFRORADD'FDMHG H.
PLUMBING PI?li
in consequence of no granting Of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(To 111,000 CFM) MECHANICAL FEE
so ONS )
AIR HANDLING UNIT(OVER 10.000 CFM) CONSTRUCTION TAX
S uitimmul AppliamUConoccur 7 Q [)am _ EXHAUST HOOD(WIDUCI) HOUSING MIT I IGA'1'ION 17111
_ HAZARDOUS MAI'RRIAIN DISCLOSURE
Win fheaIsI heart or future building w.'cu,nmsmre m handle hveNousmatenul HEATING UNIT'T LO 100,10X113'1'1)
as defined by the Cupertino Municipal Cale.Chapter 9.12,and he Health and Safety BEATING UNIT(OVER 110,0X0 PTU)
Cade,Section 25532m)?
❑Yes 0 N VENfI1.A'I'ION PAN(SINGLE RESID) PAID
Dam Recoils w
Will the applicant or flour,holding occupant use.quipnfcul or devices which BOILER.-COMP(JHp OIt IlXl,01X19TU7 '
,mil bamrdous air conmmin Cls as defined by the TOY Area Air Quality Management TOTAL:
L
t BOILER-COMP(OVER 101,000 BTU)
ON.
read the he...utas mmerille requirememwude,Chaps,695 mmo Cali AIR CONDI"ITONER - ISSUANCE DATE
&Safely CedeSection 25505,255.11 and 25534.11 demand that if be NEW RESIDENTIAL.MI?C1. SQ.F!.
not curtemly hove a tenant,nun It hmyre,porwilil Ir,m nnlify the e,npanlmems whichmast be nta Ion,ni issuance of a Cmifieme of Occupancynrited agent Date TOTAL: ISSUED 11':
OFFICE