S 1734APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - ELF,CI'RIGAL
BUILDING DIVISION APPLICATIONWERMIT PLUMnING-MRCIIANICAL
BUILDING PROJE,CIIDEN'FIFICAA ION.
PETS IT NO. �X
J 1/ 3
BUILIANGADDIt1iS5' (/���/
SANITARY NO.
AI'1'LICA"TION SIIHMITT-AALL DATE
' PHONE.
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,BUILDWG PERMITINFO
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Cnncnitant Fees Paid by Applicant (Initial)
RU1G :LO PLUMB ME❑CU
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LICENSED D CONTRACTORS DI I I ARAI ION
I hereby affirm Aou Is. l .sed code, p I Chupmr 9(.o:nnr g
with section 70HBoDv.on3 Ohc Buinca'�M�5�� Emylcc.
fene nmol vhf t • ����nn
(�'��
License Claw Lica
Date ContractorE
QI-Y, l," 'I 1 I C9RICY I RMIT7 PGC'
f -
J013 DESCRIPTION
RESIDENTIAL
❑AIDIII`VL ❑ KITCHENREMODEL
❑ADDI'I'IOY ❑I'LUMRING µIi-I'll'li
OMDLI'I-UNIT ❑STRUCTURAL
MODIFICATION
❑INTERIOR [I Cl IMMING POOL
IMPROVEMENT 0SWIMA7ING POOLS
❑RATH NILMODIPJREPAIR'❑ DEMOLI'I ION
,
❑OTH1.R
1.17RMIT ISSUANCE:
APPLIANCES- RESIDENTIAL
y L
Z FO y1
OZ-
ARCH] "1'ECTS DECLARATION
e J land ter plunsA+cll be used as public record,PANELS
�
UI"T021X1 AMPS -
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OWNER-BUIL-DER DECI,ARATION
Ay uffirne the I an, exempt from from the Comment's License Lew far the
following reason ,(Section 7031.5,Business and Professions Code: Any city or county
2111-1000 AMI'.S
OVER IINIIIAMPS
SIGNS ELECTRICAL
�C,a
wli y l I anal, o1r mines, defish, p i y:t Uum
poor u, it,' Lse w,aimsfir ,plc.. I for suchpermit I fle . signed slenere
SPECIAL C I RCIrIT/At ISC.
J
W O(
d m Iy
thin he I' I proarturn the pairs kiomofth Cormai License I(CRq.er9
...... neotagwth Scoo 7000) of Di J of the HInnevi,al Professions or
and Elm basis E'or the Any viPen lty of
that he is exempt1.5
'rLMP. MhTIiR OR POLE INST.
COMMERCIAL
❑ NEW HIAGIAUDI'PION )I?OD
W^vi
SSC❑Luwnwncrol
F-
w
3
casthalleged applicant.
Section 7031.5 by any applicant Grrapemeit wM1jeas the applicant nranvil Penalty of
bIany applicant
noinaau than Hoc lmadeal thelws(3500)
the pmpcny, nrnryemployucswithwagesuslhcinnlecourycn.vntlnn,
will do the work, and the structure is not intended cambered for .vale(SecAOU, Business
and Pronasion. Code: The Contractors License Law dons not apply to an owner of
empeny wha milds nr irnpmv.r ducton, and who does such work ono'cif or It a
his own employees, pm,idcd that .arch impmvemmns area., intended or offered far
sale. IL however. the building or improvement is sold within one year ofcompletion.,he
POWER DEVICES
SERVE
❑TENANT [I FOOD SERVICE
IMPROVEMI!NI'
❑OTIILR
ap?.no �/ CIa✓! tl ��/7
SWIMMINGPOOLIFLECI'RIC
Off TLETS-SWITCHES- Fix "CURES
NEW RESIOENTIAI. E -FC'UR SQ rC
SQ FT. FLOOR AREA
S/SQ. En
ncrbuilder will have Ice Kunlun it Proving that be (lid nor hold or iugnove for Pur-
pose f I ).
❑ I f.. nt exclusively contracting h licensed „ m
m'I w......(Spe
]TWO H:'revs and Prole,oinar, Cod, Tr ( t 't C
I?,oo
TOTAL.
- -
cen Law does nal apply, f pro,n, i Isfild,o, improve,th aQTY.
P-I.UMHING PIERMIT f FET?
.'si.
se
penanr the Cuno- er
who facts for such projects wth a contedads)bccnsed . n
PERMIT ISSUANCE
"
Licervw Law. _
E] I em c.wmp, under Seq. ,R&P C for miwrennnn
N.TER - DRAIN & VFW- WATER IG)
Owner Date
VALUATION
7f o .0
' WOR
DfthefotAGGN
13ACK 11.11W PIt(YI9iCf DIiV ICF
ndiR5COMPENSA'ry on
Ihereby ammounder penally
for declarations
U, V J t, J
/w/
teperjuryencofthefnsure Workers Camper-
maintain .el a 370 (it Concernin ,Code, r.. the
Thaw provided
wa0m,, ns pnrviJcd fur by Sadlnn 9]1111 of the Luhur Cole, fur The parfiamvnco nl he
DRAINS -FLOOR, ROOF,ARIiA, COND.
STORIES
'I'YPF. CONSTRUCTION
weak for which,hi, perneit is issued.
FEX'rURES- PER 'I'RAP
1
l
1 ' N
El have and will maintain Workers Compensation Insurance, et required by Section
3700olIle Lot arCode. fnnhcpadnmnative ofthe work for.1rdithi,searkis lxsual.
GAS -PA. SYS'T'EM- I INCA OUTLETS
OCC. GROUP
V
APN
My NV..tiers Compensation Insure..¢ confer and Ihtliry .coin are:
Corner: Policy No.:
CERTIFICATE OF EXEMI'I'ION FROM WORKERS'
COMPENSATION INSURANCE!
2- C- Z%_O
OAS- EA. SYSTEM -OVER 4 IEA)
❑ItIiASEIINUU51'121. WAS 111 INTERCEPTOR
If111LU1NG UIVI51(IN FEES
(Thisseciionnad not becompleleA if the pemei, is (Drone nundreA Jnllar+I31(MII
or IcsvJ
GREASE 'I'RAP
PLANCIIECK FPiL
SEWER - SANITARY - S' CORM EA. 210 FI'.
ENIRGY FEE i
I certify mal in lhepedonnance of lire workfiuwherl Ibis pernri,ls i .... d, Ixbull
not emplay any Person in any manner se an to become subject w the Workers' Compen-
WAI ER HEATER WNEMI'/BLECI'R
-
WATER SS STEM?REA'TING
z O
h
y0Will
oz
L) Qto
O Li
}h 131
y
FZ)
.Autipin A �
NOTICE TOA L' f t k g IF: C tr l I E'T pt Y should
her bl t ,h A k( pen. I p - 1 II I h C d Y u mon
foliar lir wap p rv, n.v nr lir +pvr ilnh Jl bel :ul avnkal.
CONSTRUMION LF,NDINGAGF,NCY
... hynl rat thaams cis a.om.mauan lcnd Eng agency for Ilia perfannmce of
'he work far wI I It'E. nil ie iweoed (Sec. 3097, Clv. Cl
tcndere s
%RADIIAG 1'FE
SOILS FCIe
WA'rERUI1VICH
PAID Dal Rcceip,X
NEW RESIDENTIAL PLMH. SQ. FE
I O TAU
TOTAL:
Lender's AAdrews
k�
BUILDING PEI:
I ,rify mr wital ve cad oda application anti slate the aarrivelnbafehmfan
u
enrtttr l agree eco h all city and county ordinances and stale lmss reform".
Frilleonsnumare, and herehyannamle repremmeivea of this city w earcr rpa.me
QTY. MECIIANICAL PERMIT FEE
SL'ISMIC 1rEE
1117RMII ISSUANCE!
I!LCCI RIC PEE
u
shovcmamionAl property lot inapmtim pugnrses.
(We) agree m save, indemnify and keep hannfec me City of Cupenina .,aim,
MITER OR ADD'IO MF,CIL
FLOWING FEL'
Iinhlliticv.juJgmems; cols unit eapemn which may many way uucmengaim,said City
PLICAN cc of lhiaD it
AIR HANDLING UNIT (TO 10,000 CIM)
MECHANICAL THE
WIC
APPLICANT IINDEItSTANUS AND WIhL COMPLY WITH AL1, NON -POINT
UNDERSTANDS
SOh 'fILAT10NS.
AIR HANDLING UNI T(OVER 10,001 CPM)
CONS'IBUCIION'PAN
me
Sir, enfA IicaHAZAR
15XHAUST' HOOD(WE)UCE
I IOUSIN. MITIGATION PER
HAZARDOUS MAI ERALS DISCLOSURE
O
U?,
_
IIHATING UNIT' 110 IIN),IIfXI BTU)
handle
npplianl or future building occupant tree or Kandla hucnJnu+nmlcrinl
as defined by the CupCnino Municipal Cale, Chapter 9. 12. and the IIcahn and Safety
Calm Section 25532(a)7 1
❑Yew 0 N
1IEATINO UNIT 1OVER IIA.(X0 BTU)
PAID
Date Rc.eipt X
VEN'1'l1.A PION FAN (SINGLE RF.SIU)
1{OILER-COMP171{p OR Iq),0111111'CU)
Will the applicmn or future holding Orela"mal use eq.ipmen, ordevicew which
.rdomaircanrnhuman,us defin,d by the Hoy Are. Air QualEly Monagcnnem
¢mil hm
o
.F, IAL: t, p-
HAILER- COMP (OVER 100,000 If
Dienc,^.
❑ Vee ❑ No
AIRCONDDIONER I
_
I have rend the baruNousmaterials reerminers under Chapter 6.95ofdo Cali-
foam. Health& Safely Cede.Sections25505,25533 it 25534. 1 underwtand,ht ifthe
IISSUANCE DATE
NEW RIiSIDENTIALMI!CII. SQ. ET.
haildagdree, rrcnllynavowcna•m, mut it is my rcnpmuthth ,thcr "n an
of the s bicI must nen prior to issuance-
�+
710! rQ
ISSUED ❑V:CJ_� • "��'�A"VCC'
TOTAL:
Owner or who eA agent _ 1 a,
OFFICE