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S 1799 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO IUILDING-ELECT RICkL PE D"No BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECTANICAL 1799 BUILDING PROJECT IDEN'I IPICA'1'ION BUILDING ADDRESS: SANITARY NO. AI'I'LICAI'ION SIINMITTAI.DAII'. 45 5 SGI? Ut/ljGupwvf o Cliff 6-1; OWN ' N/A)�,1E: // 1r�1-' QQyNE:c.-�ryf�( CON/TRACIOR:S NAME LIC NO'. RI. a NBC CONI RIII.a MIITIi /ENGNItER: LICgNO', ADDRESS: ❑ � s 75as 6-- CONAAACL /�...fa c1/11O�:: //�/'_ BUILDING PERM ElIT'IMrO 09u,-K C f P&5 ('1©) ?5-3 3 Ccarairdna"t FersPaidbyApplicaRhee nl(IniliRl) C UMI Millin LICENSED CONTRACTOR'S DECLARATION Q'PY. ELECTRIC PERMIT PIiP: 1 nemby amrm That].'it Ikcnncd coda provision,of Cancer 9 Be uncaring I JOB DESCRIPTION O 1'Z with Section]BW)uf Division 3oftbe Busines,uml Profession,Coale,andmy license,, RESIDENTIAL W O PERMIT ISSUANCE Fwt in full force unJ dfecl. ❑ADWL ❑KITCHEN REMODFE aUF' Liemtse ' Licp l- U APPhin NCrs-RESIUEN I'IN. El ADDITION ]PLIIMRING RIs PIPE F Z W Dme Corona plop, ❑MDC'-0N I' ❑SIODIPfURN. • FU,� ARCIII I'f;CTS UIiCLARAI'ION PANELS ATI ION OZ�'� IunJemm�J my plans sM1ull he usN os public records Ul'TO 2W AMPS O CHIMNEY HIMN YREPA ❑INTERIOR ❑S IMMING REPAIR Q1 hi,,n-d l'mfeaviould ]III-I IXil AMTS IMI'ItOVF.MI!N'I' SWIMMING POOLS y F, OWNER-BUILDER DECLARATIONOVIiH IIXM)AMI:S ❑RAfll REM(DFUREPAIR ❑DEMOLITION 1 OW UfV 1 hereby affirm that 1 Bill exempt from the Contractors License Low for the f llo,c ng n ..(Ecalon 91131.5,if Be, nil l'mm, tv Cotc:Any city n unry SIGNS HLECI'RICAL ❑OT1{ITR of which requires a Penni)to construct,almq ingm,ve,Jannloh,of crianr any stmcmrc E'=Vat prior to its issuance.aEtu require%the applicant for such permit to file a signed statement SPECIAL CIRCUr,,MISC. ��}'� than he is licensed pursuant to the provisions oftbe Contractor's Lice a Law lChapmr9 ,C.11O famnincncing wnh Suclicn 9(IOnl of Dickiun3ol Il,Bovine"End l'rulcsvinns G,de)or TI!MI'.MF'TER OR POLE INST. COMMERCIAL: m a C C that he is exempt therefrom and lite basis Gm the alleged emntptio I.Any violation of ❑NI'.W HLUG/ADDITION ❑DIiM(ILITION Xaa Section 7031.5 by any applicant for a permit subjects the applicanno a civil penalty of POWER DEVICES CNANT ❑PWDSIiRVICIi �' nor I'm than five hundred della,,Wall). 11 fS0 1.us owner of the n MPROVENIIiKf pmso.con knoramaded un.rdfnr Ncirsulc contpcusiness SWIMMING I'UOI.ELECTRIC F. BudNNewark.Ertle: he Contractors License Low osEvalc(Smtono wnerOf OTIIIiR If.3 w and Proleuinnv Code:the Contractor's License law does urn apply to an owner of 011'ILIdfS-SWTfGHI!R-i'I%TUkOs property who builds or ilnproves threat,and who does such work himself or through his own employees.provided ihm such in,pr ocluent,nm nm intended nr tulRrnl for NEW RESIDIiN'fIAL ELIiCfR SQ PIl ,clft,,however.the building Or intpmvc:acnl k wid within one Y-ruflonaddiot,the SU. e .Iq.00R AREA SIgU.1-r. ter-Wilder rill have the burden of proving that be did not build or improve for puf- fan.of,ded Tal L: 1,us uwncr of tM1e Prnpeny,But rxdusivuly contracting wish IiccnncJ nmPncamc o-2 construct the pry Eel(See 9BW.Business Bad Timm'io ,Code.l'llte Catalano,s LI- se Law docs not apply to an owner ofpmpeny who builds or improves thereon.and QT)'. PLUMBING PERMIT PEE echo contracts for such project.with a contmcunM1)licensed pursuant to the Commetors Liccn,c Law. 11171ZMI I'ISSUANCE Q E]I am Ntenipt under Sec. ,It N I'C for this reason Owner DoleALTER-DRAIN&VHN1'-WATER IRA) VALUATION �/`^ ('� WUItKERS C'UMI'IiperjNSA'I'I(IN DI!CLARA'1'IUN HACK FLFLOWI'ROTLCI'.DEVICECI! DID 0 1 hereby a(finn under IcnEby ormy one OI the followUU following declumdoln: ��//�� I have and will maintain B Cctifeam ofCommu � a self-iuvute fur Walkers Co.'- DRAINS-FLOOR.ROOV.AREA.CONI. 1 / 0 STORIUS TYPE CONST R UCfION nation,;is provided for by Section 37M of the Labor Code,for the ltcrfom.coo,Of the work lin whkb this perntit In 7.111111. FIX'I'USES-PER"1'RAI' ❑1 have and will indite in Workers Clurfe-ation insurance,as required by Section 3700 office Labor Code.for the valontrance of the work lin wbichlhi,permit is issued. GAS-IiA.SYSrEM-I INC4OUILETS OCC.GROUP APN My Wnrk�[LofyfRenst oyou_Tyi neyr6 Au'ev utsI policy ttt all Z GAS-EA.SYS'T'EM-OVER4(EAI Carrier: (/, (L✓{rU'1. ir//�iT-1J(A pe /t5PPI , MCA Ili OF EXI7MprrION FRUI OM WOR KERS' I GRHASNDUSTRL WASTE 1M'IiRCEPf I V BUILDING DIVISION FEES V'L Gla J COMPENSA'I'[ON INSURANCE _ !This vxtiun need But heaneplemd it the t'c.air is fortune hundred Jnllun(S 100) GREASETRAP OC or less.) I'LANCIIECK Igili ccnify that in the farliontance ofthe work for which this permit;,Issued.I shall SEWER-SAN]'1'AR1'-S'I ORM EA.21X1! O O Bill employ any pem person in any manner so as In Wvoc subject m the Worker'Coined- 0 omped- ENERGY ILII Z s;,Iiun Law,of Calilonal,Drs¢ WATER HIAIER WNENI'/ELEMR r OQ Applicant GRADING FEEz' N NUTICE'10 APPLICANT.If,ullcr making this Rnifcme of lixcmption, on should , µ'A'1'IiR SYS'1IiMRRIix'I INC 10 SOII ti b i [-� become salbPthe Worker's Compensation pmvisionn of the labor Code you must ai ct m tonhwi th comply with such provisions or this pemtn shall IN,deentad revoked. WATER SERVICE a � oz CONSTRIIC'I ION LENDING AGENCY NEW RESIUI!N'I']AL PLNUL U.1°1'. Dam Hewifta I hereby aWmuhaldson I,.mmouction lenJingagemy for e petfoomunce of U ;fithe work lot which this perntit 1,iOood(Sri. Civ.CJ 1 C) �nn 1'PAI H Lender's Nn unt U Linder'sAddress YI' h W1 ready thatI have mail this application and stole 0e.the above information i, TO .DING Flili D ,F.aIn arrest,l a gree unvnnply withall city land county ordinances and%late laws relating to QTY. MECHANICAL PERMIT FEE S,ISMIC FEE Q 6 Q U budding comortuden,and hereby Bothnmc mpresuedaive-I mixuhy of enter upon the ahovonmationeJ pmpesy for inspection purpose.. PIiRMI'I'ISSUANCE :. OV.)agree m nave,indemnify and keep hamdem the City of Captain against Iiabilbi,.ludgmenta.cwts:mJe swbichmayo,any way accrue against said City ALTCRORN)DTOMECI{. w/1 en.e !• 'mrow c fns if' nmquceint ,,anti,, t tis permit. IOIN'P APPLICANT ITR 1 AND W I LL COKR',Y WITH ALL NON-' AIR HANDLING UNI'1'('1'0 I(L(XXI CIM) MECHANICAL FEE D SOURC, i Rr .A' 1 /� f �.( - AIR HANDLING UNIT(OVER 10,0X0 CPM) Sign retufApplica Co I-.' Dam 1!X1{AUSTHOOD(WIDIICI] HOUSING MI'HGATION I':: HAI RDOUS MAL S DISCLOSURE WIIIthe"",I,nmorfnlnmI...Jinga"e,to sort Or handle hanrdoev mwerial I HEATING UNIT(To la),(M.O IIID as defined by the Cnfenino Municipal Code,Chapter 9,12,End the Ileatb and Safety Code,Section 25532(x)'! UEAI ING UNI"P(OVER 100,000 It'1'U) [:J YE, Fl No V ENTILATION FAN(SINGLE RESID) PAID Dam Receipter Will the applicant or future building occupan no,equipacid nr devices which BOILER-COMP(311P OR I(10.(XXI BTU) BI hazardous air conmminanl,as defined by the[toy Arca Air Quality hlanagemcal TO'T'AL: Dklncl'! MOILER-COMP(OVER 100.0(X1 11110 E] r2 NO Y 10 Ihas id It hm aon%i55052i533ns uMer Chapmr6,95 rstadf her Cali ISCONN RHSREIEUTR /N IS'SUANC[�I� lomin Ilea Sad We 1 salon 255115.25533 and 25514.1 understand that if the Iia RILSIDI!NTIAI.MIiCH. SQ.f4. handing it, 1 11Y .n talent :a' , •sfunvibi111y e:softy the oantp:nn �y1yy JII L ufthc IN m trent be BEW iIs r -aC ili<:In 10aVp: s yn� Lill agont U:nc _ ISSUED BY: I�O n /Y / V OFFICE