S 2344 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.ELECT TICAL PERMI'Y NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL S 2344
II1111,U1NG 1'NDJECT IDEN'I'I F'ICATION'
RUI LDING ADDRESS, SANITARY NO. I APPLICATION SUBMIT I'AI. )ATB
S G� 774?e6gr- 101614
OWNS :S h',ME: PHONB: CQM'Fty\CIOIi'S NAMIi: ,{.IC O'.
O /WI (� L/fV 5 NIC CONTT�ROLg
HI ECD.NGINIiGRo LIC NO: D69 DHIS,' ?�❑ O V�
CONTACT` PHONE: / BUILDING PERMIT INFO
Ggraq;ali ❑ Consultant Fees paid by Applicant(Iniliappyc / ELECTUMy� MIiL'II
LICBNSBDCONTRAC'I()SR'SUf:CIARA'i'IDN QTY ELEC'IRICPERMIT PEE L-1 Irr�l/
1 hereby affirm that L am IiceumJ under provisions of Chapter 9(commercing JOB DESCRIPTION YJ
CCz rW SeGion 9000)of Dividon]ot,he Rl,irl and Po n,CI rima li,oaeris /1 RFSIDENEIA1.:
Blpp w' PERMIT ISSUANCE O/ ❑SFDWL ❑KIICHEN REMODEL
N ly 15111 sores unA Ilea.
aVV Limas• I Lich APPLIANCIS-RI?SIDEN1'IAi, ❑ADDITION ❑PLUMB WG RIid'IPIi
N d d I Conlmctnr
AR.IIrrECl`SDIiCLA ATI N PANELS _ ❑A1U1.9'6I1NIT ❑MODIFI MODIFICATION
F Z I undcolanJ my plan.chola he u.nl un puhliwurrds MODIFICATION
OZN� UL'T021HIAh1PS ❑IN' ERIOR ❑CHIMNEYREPAIR
1=41zu1 Licensed Professional 201-1000AMP5 IAII'NOVEt11iNf SWIMMING POOLS
OWNERBUILDER DECLARATION OVER 10M)AMPS ❑BATHREMODEUREPAIN ❑DEM
OLH'ION
C W d 1 hcehy action that I all.exempt Friar tile Ctu+wctur'x Ltcanw Law for We ❑OI'lllill
X R a W
V following reason.(Section 00.11.5.Business and Professions Ce:Any city or county SIGNS EI-ECTRICAL
t+13¢.N which require%a permit to c.mxlma,alter,improve.demolish,or repair any structure
.tq pr'at t '1: .t ppl' ' I forowthp 'II tile a,11ccdIma ..l SPECIAL CIRCUIT IMISC.
Ihathe is licensed ptt (lie positions f mcConniclorsI I (Chapter+) COMMERCIAL:
Ili n gommencngwill.Section 700(yofDiG,on J ofthe Business and Profe.:tn-Code)or liiMI'MIiIRORPOLEINSK
a.c.e IY that he is cxeop therefrom anti the basis For the alleged exemption.Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
X`^LL' Scdm1911.11,5 by any applicant lbl alwnnil xnhjcax the appl'maono a caval penullymf POWER DEVICES �AN'T 0 OOD SERVICE
y amore than Svc hundred dollars($500).
1-=¢ Las owncrofthe n IMPROVEMENT'
C Properly. or
for
their compensation. 5W1 MLNG P(XIh IiLECI'HIC ❑OTIIIiR
F. wall do work.and Wextrvaure lxnolimcnAGl nr offered for xalu(SCL."ILDJ., t,'Ix
W 3 and Prolwooms Code.The Cantraamrx U-isc Law does not uPPly m un owner of TLIl1'S-SW ITCIIliS-Il%'rUR1i5
property who build,or improves thereon,and who doss such work hill'or Ihmugl. :W RISIDENTLAl.ELECTS SQ ff.
his awn en.ployms,provided thin such in.pmvem a,am mol intended or oOereJ Ila
stale.IL however the hnildingor improvement issold within one yearof campl,tion.lie SQ.fT.FLOOR AREA ASQFT.
,
cr-hulldr,will havethe burdenof proving that be did IN I i ld ter in+pnrve br par
ptwe of dc.). 'I
1,as owner of the property.run exclusively eommcting with licensed contexclor m
n,a a,Ibc Prcjccl(Sec.9044,Itucinmxv InA foil u.oi a,Cndc:)Tb,Cmnlmmor'xIl-
seLaw dox.'snot a
h apply .an owner al'property who builds or improcs lhcrenn.and QTY. BIN PERM[P F17H
Wn
hes comma forsuch prokcp wish a nmwmor(p liwnmd pumuum m the Co.nracmr's �
hicens law. PRN T'I..0 CIT. a��//
1 run umnpl andel Sec. ,It ar PC I'or this reaxon 1
ALTF-H
Owner Doc - AI &VENT'-WATER(I?A) VALt1A PION
WORKERS COMPENSATION DECLARATION HACK PLOW I' "Cp :NIGH
I I by i under imandly Ill ImPty ('film followan,iltelanal
Ib n�.
L] d 'll I Crif fL Ifinw 1 \V A Con.pc.- DRAINFLOOR, IT .CON]. STORIES T'YPHCONS'rRUO'DON
xatiu p 'J J f by S t 37M f Ih LZM Code.4thepert a of the
urA 1 h II pu 'I d I'I U Yf.R'I'RAP
"Ih I 'll silt ' W k . Cop.. I' .I 'IncrequiredhySttloh
9]00 OM1 1 bo Cale f Ih pert re fW kf rwl hIn QIF pe Ocnc eJ. GAS-CAS 1'I' I INC.40UTA,. OCC.GROUP MIN
MyW �: e l Policy Nand e� -p- GAS I:A SYSTE70FR IlL
i CE I'IF+ICAIL'Oh Lxl:m$'IIONITRUMW K ERS '' WASI'L'I NTP CHI'rOR N G'D
COMPENSATORf?n51/INDUSIHIT ION INSURANCE LDINIVISION FEES
(LTicxcetinn need notiecompteted it )cont is forma,hundred dollaa($1010 GREASETRAYZD O
nr Icu.l 1'fANCII�-K ' '
Ic,nifylht,in the pe binnacle Ill he work for which this permit as isxurd.l shall SEWER-SANITARY-S'IDKM EA.200 ITT ENERG I
not emptily any perms in any manner so us to became subjmt to the Worker'Compen. Z�
Oz hOon Lawxof Califnmi.a.Date WATER HEA'ritR FEB
- GRA 1 r
z O Apphr..m
TICE TO APPLICANT:If,after making this Cenihcmc ill Exemption.You should AT. TI MIT P PING SOI 'EE
a ; become.chject it,the Wa km`%Compensation pm sions of Labor Code.you r
Qorth alb mn.ply wish web Prov'' n+r Ihix permit shall be dee red rev od, hes W SE ICI?
z CONSTRUCTION LENDING AGENCY NLW RISE IA SQ,PI'. I'N
I hereby allirm that is a cnstrction lending for the performance of
Dam Heceiptp
V O ga.) pe
0 H 0mwank l ter whish Ihix pcmlit lx iaxumA 15u.909).civ.cel T(n'A
O V Lender's Num, 'I'D'EAL:
r W lenders Address BUILDING Bili _
fy cnie that 1.PI, rend Ihis application and,'late that the above infonuaeon is `I
Ua,lZ unreel. on,t weminply bereall cityand uontyomli'rwx and oratelawnrelating Iu 'S) Al.PERMIT FI:1: SEISMIC' iL
U Z buildin6<nnumclinn,mW hereby and hnrim mproanativea of Wis city to enter up.m the J
abovcommianed property for inspection puri PERMIT'ISSUANCE 0 EEC' CP 1: 2
(We)agree to save,indemnify unit keep hanNess Ibe Cit,M Cupcnim)against a T
liahilitins'.judgmm�a,cotta,nA expcnvux which nary in ashy way uecme ugnhsl xaiJ Cily ACIPRORADD'O)MECIL PLU IN MH?
inconsequemeoflhcgmntingc)fthispeTniit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO KOSK CFM) M A ICALFEB 1 O
SOURCE I+ ULAI'IONS. AAA
!w Jrrn �� AIR HANDLING UNIT LOVER 10,00X)CPM) CONS ❑CI'If1N'IAX
Signature of rlGnnmCtt� Date EXHAUST HOOD OV/DUCT) NOUS 'GMIDGAHON19ili
IIAZAItDOUS MA'1'1?RIALS IIISCI,OSORE
Will We+.pplicam nr linurc Building.Ccupunl xurtc or bundle hmanlnus mntcnal HEAPING UNI PHO 100,010 OTU)
a.JdncJ by the Cupcnino M1lunicipal Gale.Chapter 9.12,and the Iicahh and Sulny HEATING UNIT'(OVER HOn.(100 DTU)
Coate,Section 25591(:)?
El Yee VRN'I'ILATION I-AN(SINGLE RIiSID) PAID Doc lirecipta
Will the applicant or furore building.rcupant use equipment or devices which BOILIIR-COMP CUP OR 100.000 It WO
mit harandone air conuaninan".Itched by the Huy Are.Air Quality Munugancol '1'e.T'AL:
cultist? ,V,!/ HOILRIt-COM1'(OVIR 00,000 lffUt ,�
❑Ye. 76 t
I havunt Web us mnmrialx reynirenmnts 26.95 of It"Cul- AIR CONDITIONER _ISSUANCE�DA
TE
fLu Health N Safety Code.Scdiuns 25505.25533 and 25534.1 andentunJ
labra lathe NEW RESIDES'I'[AL MI'CIi. Sp,IrIr
bvilJingdoesnm a Cly h:neamnanl.Wail6nov.,rym,,bI to. 'I'th .caufvlm
of0cre ��,nust rte tech nano ixxu ce nice/'IBw guuwa(,`�Ca
Owner or aaWmn SLI/ ��ly>a�i,. T(n L: y Issup,D BY:
OFFICE