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S 1660 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CI TY OF CUPERTINO BUILDING-RIA%'RIOAL I'1i1�\1 H'No. BUILDING DIVISION APPIACATION/PERMIT PLUMPING-°II`'CIIANICAI' v 1660 BUILDING PROTECT IDEN'1'IF'ICA'I'ION ISUILUING AUDkliSS: ��� � SANI'IAKY N(1. AI'1'LICA'IION SUBMI'i'IAh UAL' 20 OWNER'. NAMI' ( I'110Nii: CON'IRACE OR'S NAME: LIC NO: NIC CONIROLX �/('1y' /0 l/ 11!Cr/HNGINI!i!R: � LIC NO: AI UlESS. coN'I'Ac'r: ��'Q�PHO,NIf RUII,DING PERMIT INFO l Bp,J'J1601/ ❑ Consultant Fecs Paid by Applicant(initial) IJ IiL�E�C/r` PLUMB M9C9 "f LICI!NSIiU CONTRACTOR'S DIiCLARATION QTY IILFCT'RIC PERMIT FEE H hereby mBrm[fiat Ham licensed under provision.of Chapter 9(commencing JOB DIiSCRIP'I'ION WOO mSarson TX10)ol )i 'Jm3oOlsv Imour,,an.utot'e,,ions Coda,andm RESIDENTIAL: i i'I!NMI'I'ISSUANCH ��� nfull lnrc and cdmt. �nwu ❑SFDWL ❑KITGIIIiN BIiMODIih zW Licen. Lic.p s API`LIANCES-RISIUI!NTIAL []ADDITION El PLUMBING BIi-PIPIT 9 F-Z W Uwe T'SCoutiactor tn6a � ❑MUI:11-UNIT ❑ti ODIF'ICAI I. ARCIIITI!CTS DECLARATION I,D y PANELS MODIFICATION -4- lunderetund my plans,hull be used republic records UP'T021XIAMPS ❑INTI!kIOR ❑CHIM1INI:Y REPAIR Licensed Perfesslonal 201-II00AMPS Ih11'BOVI!h1LNT E]SWIMMING POOLS �aa�; ON'NF.R-9UILDER DECLARATION OVILR 1000AMI'S ❑BATA RIiM0Dl!URIdIUR [I DEMOLITION a a¢ 1 Immhy altuo d,m I airs cxcmpf Ilion,the Co aruclor'x Liem,sc I,uw for[fn �3III F- fol6min&reason.ISection7031.5.Ru. s ineand professionle:s CoAny city nr county O SIGNS OLHCIRICAL ❑OI'lllik y which requires a permmre it to conaet,after,improve,demolish,or pair any ametme C JAI pram t '1. t y 11 „1' l It 'hp .I file ai,radonlonala O SPECIAL CIRCUI I/MISC. , ad that he I JBarmaid I t p . fd C I cl :L La (Chapter 1) W4 Icon, b withSeen o 700(a fD J of the Business-andl .f. .Cale), TE O THPIR MER OR M)LE IN.S`I'. COMMERCIAL. dyoa lhnb Luh Ii and h If [f 11g H ,pl AY lie Iott •:W Ii1DGIADDITION [I DEMOLITION Section 703 1.5 by any aFpl cam for a l'emm subjects the apps cent u,a asJ psnuhy of POWFR DIiV ICIeS at more than live hundred JnlLrs l55(0). D ]TENANT C1 FOOD SIikVICli FZQ Ln.owncrotthc n SWIMMING POOL OLI!CTRIC 011`BOVIiM INT Q ❑ hundred otlars cntpbryces win,wugc nu mea sole eon,penemin°' Q ❑IMPRO 1 ).. is l do the work.and the%fracmm is not upended or offwOuraale(Sse.]w4.Business in Wim and professions Calc:Thc Contractors Liceme Law dons not apply to an owner of OIfrLL-I'S-SWITCIIIS-PIX'rURGti F propmly who haddx o,improve thereon,and who does such work hilewlf or through D his own empinIh:n yccs,provided such improvclums are not intended or offered for NOW RPS IUON'rHAL HI.ECOR SQ FI'. sale,If,however.the nuildntgor improvement issoW within are yearafrompleamr.the SQ.PI'.I'LOOR AKIeA SISQ.Irf. ar.hoader will nave the burden of proving flim he did not build or improve for par. pawofmle.) :2S, d4O ❑ 1,us owner of the property,am esclusivelY contracting with license]contractors in n.snn.I lm,uveo(Sec.91144, tnsiness wW Pn le,,inm Codc:)the Claumll r,Li cause Law duos not apply ht an owner of property who buildsor impose,thereon,and QTY. PLUMBING PERMITFEF who contrac6 for such prolecn with a eontmctoB%)licensed pursuant to the Contrac'tor's Licmuu Law. PFIkMIT ISSUANCE! Cs,a0 ❑ 1 a exempt undergoes .H&1'C for his reason ALI HE-DRAIN&VENT-WATER(17A) VALUATION 5 Owner DatcT WORKER'S COMPHNSAI'[ON DECLARAION BACK FLOW Pan YI'I!C'I' IiVICIi r�. IM1L1O/ I hereby affirm under penalty of perjury one of Inc following declare ions RIS W I havcnnd will maintainn CaniOcmc ul Conwm msel4insurc far Worker's Compcm DRAINS-FLOG )OP.AKEA,COND' STOk15g T PIi CONg'1'RUCTIUt lion,vs pmvivW fur by S...lon J]ap of the Labor Code,tor,he pednnmupe el the rk for which rods permit is Toes]. FIXTURES- ' 'R w. I have unA will nwinfain Wndcr'x Compenvation Insurance,m repaired by Section J]l of thelather Coate.linihe perfnnnenecal the work lin'which fids Inti is'nened. GAS-IeA.SYSTI?MEIN 1'I' :'I'S OCC.GROUP AVN My W, Aers Compen,atiun lnzumneecamer and Policy numhr am: w Corrins. Policy No: GAS-HA.SYSTH. 4IF CORE'IiICATEOP1SSi PON INSURANCE,WORKIiIt5 GRHASI➢INUUSTRLW iIM'I!RCIi COMPENSATION INSURANCE UILUINC DIVISION fI!Ii5 1. suetTan ne-i not be completed irae permit is lin nuc hundred dollars I$In), O Illi CRhASC TRAP I'hA ICK mien ) I tht nth rf 0th work for whichth his '. -sued,l Quill I n 1 peSEWI!R SANITARY STORM �. I!NO YFEE un v, I Ylw 'vii 'nY ,[fent 0. object Ili N A n'Cnmwn O 1 Y W'A1'OR IIBAI'OR WIVFNTIILpCI'1l ORAUINOiI'I: ' z sot onl I(`Iloma, 'I Z Ap,1 I LICANT:Ili nfmr making mi<Cemficmc of laemption,you should D WA'I'1!RSYSTEMITIRLATHNG N(YI'IC9TU AI'. SOILS pp (•-' h heemne sabre,R, Worker's Colowelmion powkinns nl the IsId, Coda,you must � > f".all cnm,lYwif suchprovisionsnr this permit shallMdeemeJinvoked WXFI;R SERVICE ::)z LEE, S'I It LONDING AGBNCY NOW RESIDI!NTIAt,PLMIL SQ, PAID . 5 zis a contraction lcndingagency fur the penfirmanameof um le 1 herebyhathm,Innst 1e X �� ILe work for which ihlx Irc^^ Fs iswul(Sec.TN)],Co.CJ Lender s Name 9U , Lenders Address T I'M,: I cert!ly mat h:ne cad th s°Ppli,nion and,mm That the aba—mumormion is ItUI1.UIN,hili V F" y ntnwl.l apres•n.comply wionJ)a llY and conmy onllnanccs and sora laws rclming b, Q'I'Y. MIiCIIANICAh PERMIT FEE Nil P': kD V z hui.Jingmnslruaiun,and f in,a- a' r w-� c representatives ofmisenym eme,uptm the o• Q ahovc(We).al me all; fan innpemt 'n I keep lea I'I!RMII'ISSUANCii ITL Is,V.E •D J e 1 (We)agree In,ave,indemnify nd keep mlcxv me City III e...ru t s ugump Iiabilities.juJgt 'osn unit use Machin,manY way acc^'c agam.0 said City At:TCR OR ADD TOMECII. PIAS INGI J! ncquen .nfm Brat t ul Ix le,"mit. APPLICA ON :k' U ANO\ ILL COMPLY WI'r11 ALL NON AIR HANDLING UNI',ITU I0.INN)CIsMI © MEC IANIC ITE O C C SOURCE 1!G -1 N' , / f//e AIH HANDLING UNIT IOVr:R II),INXICPM) CO. 'TRUCDDN TAS `(� C ' UCommwsr Dat OXIIAUS'I'I IOODIWIDUCI) D HOUSE 'M I'I IGCDON PF:I! Si'mat or A,, HAZARDOUS MA IAI,S DISCLOSURO Will lheupplic'anl or future building, oatp:nn xlnm or 111 ;1,huuudousnwmrial Z IIHATINI UNIT(101110,1%X)BTU) Z a 20 as Jahned by IM Cupertino Municipal esdc. Chapter 9.12,and the Health and Satiny IIBArING UNIT LOVER 100.000 BTU) Club,Section 25532(a)'I Yes ❑No VIN'I ILA]ION AN R14 ED) PAHO ❑ IJwe Re-i'k p uipment or dcs;ccs which Wrdou,ll File ar,outaunaryliCall or it handing by it, Arco it Quality Manngcne.1 O BOILER-COMPQHPQR IIX),(XXIITIU) �N1 V .,,it naeunlnus air umlumin:nne acs A<lincd by the Bay Area s DlalrlGl? D BOILER-ED.MP(OVER IIXL(XfOIffU) ❑Ycs C]No ^5 a(Ihe Coli- AIR CONip'i'IONB12 SS NCE DATIi I have d ILK ns mateduB reyuimru nnunder Clioner lr. /N, A Forme Hca 's .Sections 25505.25511 mai 255:41.1 unJc ra )teei'fit he NI!W RESIDENTIAL MI:CII. 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