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24957APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY '- - A CITY OF CUPERTINOBUILDING BUILDING DIVISION 'APPLICATION/PERMIT PLUMBING -MECHANICAL 7UBUILDING PROJECP IDENPIFICATIONC:pw.,ni' PERMITNU 2-4957 BUILDING ADDRESS: > G"�OuNITa LOT SANITARY NO. APPLICATION SUBMITTAL DATE 6.t,,.8 -92? OWNERS NAME: PHONE:CONTRACTOR'S ass. NAME: LIC / / f .d '_��Ii.C��L-• N/C CON ,TSOL a V- 1 'RCHI CT GINGER: I LIC �yO; Lits ADDRESS: CONPA PHONE: if >.::++i3y�fs,',." Irx+•w.-a.ss+-r.+'. �x yr gv.�sr✓INF �pY s ,. m,EC1RIC PERMITA "f eb nef FEE a ih �uxlwx as P+r e aif$ w r, v," ,�BUILDING PERMIT BLD LEGGY PLUMB MI:CII PERMPPISSUANCE 17/�,l y / l /LiGJ�7 L LICENSED CON'PIIACfOR'S DECLARATION 1 herehyaffim N rei 1 em licensed underprovisionsof Chepter9 (commencing wit Safi 1000)of Division 3 of the Business and Professions Code, and my license is N furea end cB iccnu Clns - Lic.g OZ APPLIANCES -RESIDENTIAL pprypyq UP T0200 AMPS LOB DESCRIPTION !^w g Due Convaror 201 - IWO AMPS ARCHITECTS DE LARATI iN 1 undersand my plans shell he used as public records. OVER IOW AMPS SQ. FT. FLOOR AREA i M $/SQ. FP. as�� SIGNS ELECIBICAL - --' r. Licensed Prafessionl OWNER -BUILDER DECLARATION I Force, eRrm Net 1 am excmpr Ne Cceract License law for the gPECW.CBt4V1T/hDSC _ ' 'TEMP. 'OR POLE IN$T. t_ following esmr. (Nation 1031.3, ssfirma su sines end 9ofeaions Code: Any city are county Co u t. a perms( to con wet, alta, improve, demolish, ore. srr any ewcture its prior s its I. the eppllwlt fare permits RIC a eWeapter, in POWER DEVICES dust he tat to Co se Lad tet he ti Rangd pursuant m Ne) fDivid of the Cc Basis. 9(commencing wish Section7")asis is License law ([hepar oro 3ofteedi c.cseend. ions Code) SWIMMINOPOOL VALUATION M\ W andhe bete, and the besisfmbjeescgedeaempti in. civil etion of Art are Nu he it 13 by my Section 703 13 by any appfiant fore pvmit subjects to eppliant rne rivllprnalry of SWITCIES FIXTURES • not maethen ve rofhundredy.dollars yempl ❑ I.mownerofNe propmy. ormyemveroodwitwage NEW RESD]ENML ELECIR _SQ FP STORIES PECONSTRUC TON .will do Ouwok, end Ne Formic 7044.Bwineu Formic(salecalnpcniness no Lawdofor end Profession;b. Code: Thc Contrecur's Ganse law due not lf an owner of hi pro mpihob,Mvi imp tsuchemon,end ntsmnotin odtoroffeorfw We.hf, imp ne earolcomplleered foo cmr. iar OCC. GROUP RFS. UNITS Otis however. Ne own r- tiebuthri ina,overs is sold item meteor improvement is Cold within one yw ofiprove cave builder wall Mv<Ne burden of proving Nu he did not build or improve for pur{pse of a far pa Post NS.R i 4 Nr GaCIn.J-YRW'Ia,�.. Mv- . . MtAWa:Wc2eaca+aeaFr ..'E•,i "' �t¢w�''.! � YOM= IN6 PERMITS FEE• sale.). ❑ I.mownaofrhepmpeny.emexcimivelymnt tingwiNlicermedconvecrmsto FLOOD ZONE APN Oa 1 to proXct (Sec. IOM, Busines end Pmfeaion Cade:) The Convectors PERMPP ISSUANCE License Lawdoanot epPlYuen ownaof propmywhobuildsorunprove Ntteon.and who commas for such projecu wit a contracur(s)IiamW Pursuant to the Contractors Inane Lew. ALTER-DRAIN&VENP-WATER (EA) ..y. a. `,�, yam, k FEE SUMMARY :_,..'`F�'i"'.na",�i.1 y ❑ 1 em exartpt undtt Sec. , B R P C for tis mason BACK FLf/1W PROTECT. DEVICE OMIDE 5 ABY Y N RECEIPTas Owner Dare DRAINSr ,R O D. - ` WORKMANCOMPENSATIONDECLARATION ❑ Ihaeby affirm dwlhavcaartifiwe o(congntuglf-inure, ore anifiweof Wakas'Compmsadim Ias.. me certified copy tereof(Sec. 3800, Lab C.) which SCH OLTAX Y_N RECEIPTM FIXTIIRFS P —1 P FEE Y N covers all anployee's under this perrNt.. , / n�� o �� n �I Policy as W ['t/ 7 GAS - EA. SYS .1 .4 �C a BUILDING D ISION PEGS �CeniBM GAS- '$YSIEA��E(FA) Ij P H[CK FEE copy is hereby fomishrd. GREAS DIISTRLWASTEINIERCEPPOR GRADING FEE ❑ Crnified copy ie RledwiN to ciry inpation divivion. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASETRAP SOILS FEE SEWER - SANITARY - STORM EA. 20017. ENERGY(EE (This section need notbc completed if Ne permit is for one hundred dollers(SIW) mics.) WATER HEATER W/VENP/ELECFR I certify that in to performance of the work for which tis permit is issued, l shell not employ any person in any marmtt w as u became subject to Ne Warlo s' PA{D WATER SYSTEMITREATING Compenurian Lawsof Califomiu. Date re Receipt# Applicant NOTICE TO APPLICANP:If. after making chis Cenifiwre of Eacmpdon. You should NEW RESIDENTIAL PLMB. SQ. FT. TOTAL: baame subjem in to Worker's Comperwtinn provisions; of the Labor Code, you man foMwit comply wit such provision M Ws North she]M domed cooked. BUILD] FEE Q CONSTRUCTION LENDING AGENCY Shust FEE O O )hereby aff than there is a construction lending agency for the performance of No wok for which his perm(Sec.M7, it ie issued (S. 1, Civ. CJ LaWei Name TOTAL: ELE IC FEE Z© L Lab's Address vset: an:svr::,s.ay.iw:�wr..••. >K"••,• QTYt-,- -urs -"�' •+ MECHANIGUPERMIT.: j, •s'S,. W -Y<-.. is PL MBING FEE 1 unify Nat I have read this application and sate that Ne above inmmation is wi yen ryo g nect. le mCom telleb dcoum Nimoceendsa¢lawe¢Imin ro "'P3e'...;'b, r'usw,,..•.vuC-.a.- m. =.os ;. w _T n.<. PERMIT ISSUANCE �s M IANICAI. ME nsmr Ny ivesof Nis city ro enar upon the abovomcntiomed propcm f r inspersion purposes. abaremgen cion. Jharebyrveam porpsci, ALTER OR ADD TO MECH. C .'S' UCTIONTAX In (WJ agree a save.' Jemnify and kap harmless to City of Cupertino against cos areal ci n which may in any wayaccrucagaimat said City in donuyuenee of tc gr tinro rues ldt /. j AIR HANDLING UNIT OTO IO.WO CFM) AIR HANDLI NO UNIT(OVER I Was) CRI) Si ciff i Sat/Com r /� aDa !- e iy IIAZARDOL'SAIATERIALSDISCLOSURF. EXHAUST HOOD MMUCTI PAID Dau' Rcrv'p.a HEATING UNIT (TO 1W,M1 BTUs I Mill IIIc appbcani Foe lumrc huilding rKap:mt sure etre handle harardnus mwerial ex defined byte Cupenino Municipal Cede, Chapter 9.12, and the Health and Safety Cade. Section 25532(e)?�,( ❑ Ya .81 No - HEA TING UNIT (OVER I W.000 Ii1' UI a VEN1IlAT10N FAN (SINGLE RESOD) Will the a pplicamtorfutum building«apanr usecquipmomordevienwhich emir BOILER -COMPUIHPOR 100,000 BTU) ISSUA C ATE ASI FD ,BTU) BOILER - COMP (OVER IWWO 4becoudes air wnumina`nts as defined by Ne Bay Ara Au Quality n Magemce, IN 1:1 Yes S9 Na AP 9 1993 NEW RESIDENTIAL MECH. - SQ. FT. 1 love read the hazardous materials nNuiremenu under Chapter 6.95 of to CaliforniaCode, Sermon 8505, 25533 and 25534. 1 undersand Nat atly have a anent. tel 11 is my responMiliry a as fy to /• r V Ur Cn L rkJ VIII V me h must be met prio u issuanon of Ceti es of , 3 em .. ISSUED DY' ' L: � U OFFICE