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UPERTINO RT111.DINf: F.LRUTRICA'.P''�''
C DIVISION APPLICATION/PERMIT PLUAIRINGMF:C11ANiCAi,I UILDING PROJECT'IDP:NTIF'ICATIONDRESS.
"" 19 9 7
SANE IARY Nf I,
APPLICATION SI IIIMI'I'IAL DATF
sgl d/Ms C (3i.UD-�E:
LFOWNERS
PHONE:
/V If-
CON'fRAC'POR:S NAME: EJC NO��-lyOAW_Na+MJt'/,.� rs3 f 66!
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❑
CONrROI.b
NGI TER: LIC NO:
-
AUER yS-S-F-F �1 J�
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CONTACT: PHONE :
DUILDING PERM IT INFO.
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❑ ConsuBant Fees Paid by Applicant (Initial)
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76(p S U
- LICENSED CONTRACTOR S DECLARATION
I ly d that license(] d p i. f Chhmer 9 ammo,ormg
with Section i 7000) 1'U "nJof the Bus ,amd Pn 4,,n.v Cndeundmyl'rorseis
i"n,'C1 andUfe�• ys LtcN 3� Lir
Date Cmnra '%U._
QTY ELCCFRIC'PERMITi FIE h.
-.
]OE DESCRIPTION
❑ SDF_NTIAI: C3 KITCHEN RT:h10UE1,
❑ADDITION ❑PLUMBINGRE PIPH
❑MUL'17UNI'T ❑STRUCTURAL.
MODIFICATION
❑INTEI210R ❑CIIIMNIiY RII'AIR
IMPROVEMI;N1' E]SWIMMINGPOOLS
❑ BATHRFMODEIJREPNR [DEMOLITION
❑ OTHER sess
I'IRMTI NSUANCE -7
APPLIANCHS-RIiSIDUN'I'IAL
ARC11G'IF.CFS DECLARATION
IundurxtmJ niy plans Nhull he uxN us Public anal,
PANELS
lJl'T02a)AM1'S
Lfctnscd Professional
oWNHµ-HUILDHR UECLARA'TION
I bench, nation Il)., 1 nm exempt lmnt the Contractor's Liven, Law Bn the
following reason. (Section 7031.5, Business and l'mfessioms Gale: Any city or county
201-1000AMPS _
DVEµ ltxtn AMi'9
SIGNS FLECRICAL Z O
IA a W
^p�
which requires a permit to mnplfmc0 nl¢r, inmmve, datnnikh, ur rcpuienny Nlluctom
prior to its is,umice, alNo mantras the applicant for such permirto lie v signed statement
SPECIALCIRCUI'EMISC,
,S r
..0�
a t1 o tal
^4'
p=.p
Wand
ththeishemsedp... rum to the provisions of he Comruchn's Licence Lav, (Chapter Y
feonuncncing with Scninn]OfNp of DlvivionJ nflhc On,incss haul Profc,.vinnc Cuduphr
thin he is exempt theafmm and the ha i, for the allegid cxempdon. Any violation or
Serbian 7031.5 by anyafAinaim for. Nonto subjeen Ne applicant to advil pendD Of
not more than five hi ovddollars($500),
owner of Ne prop:ny, nrmycnhployec,withwagc, as lhcirmle compensation,
will dathework,amdthe structure is not intended confined for.vale(Sec. IkEL Business
Pal ... or, Code.'ILo Contmnors Liccnvc Law docs not apply man ..ha of
prnryrty who builds or improves thereon, and who does such work himself or through
his awn employee,, provided but such mprovemem., me not intended nr offered for
sale. 11, howaver, Iht huildingnrlmprovcment lvxnld within onuyovrol'aohrpha,inn, the
'I'EMP.MUTEROR LP ST.
COMMERCIAL:
❑ NEW BILDG/ADDITION ❑ DEMOLITION
❑THNAN'1' ❑FOOD SERVICE<�ha,
IMI'kOVIiM1iN'I'
[I OTHER
POWER DISVICES
eM
SWIMMING POOL ELECRI
OUTLET'S-SWI'TCHF.S- FIX'fu RR
NEW RESIDING IAL ELECT-R SQ ET.
SQ. IT. FLOOR ARI7A
VSQ. IT
-
oxacr-builder, will have the burden of proving that he did for build or improve fnr par-
t ose of sada).
❑ 1, as ownerof the Pmpcny, mm cxelu,ivdy r0ofire ing with Iiary nell rnntmetnIn
1
Ah:
omtmer,he pmjen(Sec.](WI. Business and Professions Cale:) The Contractors Li-
crate l w dnot applyl f prolsinhy vho tholds or improves thercon. and
QTY. •, PLUMBING PERMIT FEE'
who cnintrackhosand) lr Res will) 11 eolmhrtel livard puslunO [be Contractors
PERMI'i' ISSUANCE
License Law.
❑ I am exempt under Sec. ,H& P C for this reason
ACI FR - DRAIN & VENT'- WAJ HR (EA)
Diner One
VALUATION
WORKER'S COMPENSATION DECLARATION
RACK FLOW PRUI'EC, DEVICE
'
Iherthy aflinn ander penally of Penury one of the lnllowing Acchtrntinm
❑ I have and will maintain a Cenificac of Conscnno sd4imum fin-Workers Cranpen-
sation, as provided for by Section Ata of the Labor Code, for the performance of the
DRAINS- FLOOR. ROOK AREA. COND,
STORIES
TYPE CONS' I' RUCTION
work for which this Permit is isxted.
PIX'IURES-PEIt'I'RAP
❑ 1 have and will maintain Worker, Compensation Invarance, as required by Scetinr
T(Xl of the labor Code, for the performance oflhe work for which this permit is issued.
MyWorkn cc wt ranhPntc
Cance Tle Policy Nn., Il) to � O �
GAS-HA.SY,S`G7M-1 INC.n OUTI.E'TS
OCC, GROUP
APS!
r
GAS -GiA. SYS 'I'IiM-0VliRdll?A) -'^,
�CjIIFROM WORKERS'
PNIHONINSRAN
GREASH/INDUSTRLWAtiTB INIFRCEPIUR
RGI_LDINGDVISIO_NIHHS
(Thiseetionnmddont�compldediflhepnilisforonchundttt)llas15101
or Iccn.)
OR EAST: TRAP
_
PLANCHECK FEE.
,�
70 O
I cenil, Par in the N&...... heard In, work for Inch In,rrrnit is seed. 1111.11
t ploy any pers min any manner, toM1 one subject the Workers Cnmpen-
Law,v of Cal' ire. me
neem
SEWER-SANITARY-STORM EA. 2W PI'.
ENERGY ILC
WATER HEATER WNEN'17ELFCfR
GItADINO ITT.
NIyfICE TO APPI. CAM': IC after making is enificare of T:xemPlinn, you should
sol ject to the Worker's Came, ... him ton,Won. of tlm Labor Code, you mml
farhwtth comply with such pnovam—, this,armit.hall he deemed fwoked,
GONSTRGG9ION LENDING AGENCY
1hereby affirm that Iavhn isned(Sec. 30 .Cie. C) cy fate perlomvma of
the work for which ILLI pemsil is issued (See. J09]. Civ. G)
Lenders Nunhc
WATER SYSTFMG BEATING
q N
abecome
W
a�
U O
W.
V
to
V Z
SOILS PER
WATER SERVICE
PND Date air e
NEW NIiSNN.NI'IA1. PLMB. SQ. FC
'101'AL:
Lender's Address'
'fOI'AL:
11DILDING FEM
1 vertlfy ame G have read this application and state Na the above information is
correct. Ingrce mcrnmply with all city and co, ly onlimtnce,; I,frm laws relining u'
buildtngehnnsthal and hereby authorivempresamanec, nfthiscily u, enter rpm the
QTY. MECHANICAL PERMIT 'FEC
S171SMIC FIR7.
PERMIT' ISSUANCE
ELeCTk IC FEE
ubnvementioned property for inspection putpoc,
rmle the City of Ch'i nino.gamn
OW) agree It save, indemnify and keep hu,
ACI' ER Olt ADD TO MECIL-
PLUMEING '
Iimhilties.judgmems, costs and expenses which may in any way name against wid City
or n sequence of the granting of this permit.
AIµ fIANDLING ON] '1'('IU IOdX)UCPMI
III IC L li
SOO RCAN'I'ULATIC TANU5 ANU WILT. COMPLY WI'I'11 ALL NONd'OINT
SOURCE kIiGULATIONS.
AIR IIA SEEING UNIT (OVER 10,010 CIrM)
CONSTRUCHON'TA
SignvturenfApplicarYCommctor Date
//
EXHAUST 1I001)W/DUCT) tis
I01J911,46 V1 TjPAll ON Il3E
I h I
HAZARDOUS MATERIALS DISCLOSURE:
HI'.ATINC, UNIT LTO 10(1,000 It I' U)
W'dllist applinmtur forum buildingi"alsntalone It, handle hatunlon,utatonal
a. defined by the Cupertino Municipal Code, Chapter 9.12, and II¢ Ileahh and Safely
Code, Section 255320)I
[IYea 0N -
HEATING UNIT' (OVER 100,000 If TE
PAID
Dore R¢eiPl
VENTILATION PAN (51N01.1? It Ii51 U)
I10ILHR- COMP (JHP OR 00,IXI1) RTD)
W d the applicant or inure building by (he Rt use equipment of devices which
a nal humrdnux air amtmnmtuns u, Acfinoml by list Ruy Area Am Quality Manugmncnt
Diana?
❑Yes L] No
ICAI.
BORER- COME (OVER I(sad BTU)
AIR COND11IONER
I have read the u-smin, materials r 'ymret, under Chapter 6,95 of the Cali-
mm�
ISSUANCE DATE
NEW RIiS1DEMIIAL MECH. SQ Er
r Sections 2S:W, I to rohlwnd that if the
Rmnia Health & Safely rallypant
hereamnn,rninenllyhavcfain......itl.my tech
r f% / ` /J
�" L—
of the raluir morns which muNl hu ober poor eh isuenee 0f v Ctnific.¢ of Oeeupuncg
of Cindwinmlfyteation
VYI
ISSUED BY: J
'I'OTA h:
Owner or a0honwil agent Dore
OFFICE