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S 1326 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-RLECnaC'E PEI rf No RUII,DING DIVISION APP1.ICYVIONWERMIT PLUMIING-MECIANI,AL 1326 AMILDING PhilIDENTIFICATION " BUILDINGADORI?SS: � - SANITARY NO. APPLICATION SfIBMITfAI.DATE AL-LID, `3�--q S OWNER'SNAME' I'H(1 ) CONII O 'RACR'S NAME 'LIC NO: C - � NIC CONTNOLM ARHITEM)ENGINEERLIC NO: ADDRESS: 7-3 wu." G Zt a)NTncT: 1 � ZONE: - "< `',BUILDING PERMIT INFO ., JCOA,soImL' � rr&4% N (510-)q3o-96g6 El Cmnsullam Fees Paid by Applicant(Initial) BLDG IT PL PLUht13 MECH ),ICI III CON TRACTOR S OICIARAI ION QTY. ILECT1130'ERMIT,,,I ;=FEE cny I herof iter n t 1 licensed e p of Chapter 9 amm.re ng ,'' 1 _ 'l. '. -' - . 1 JOB DESCRIPTION Amo win,Sea 70001tfD' % n 3nnhe e,irco,.nd lr f: ,:.Cn It,lint t, "ema,.'s 3�ff RESIDENTIAL. W O PI I1MI'I RSI1nNCli b W in Class ef!t ❑SI OWI. [I KITCHEN ItEMOD131. aUU 1.ianse Class Ln, APPLIANCES—RISIDEN'HAI. ❑ADDIT[ON ❑PLUMBING RE PIPIT F•Z W Dm. Cumactnr - tn¢a ❑MULTI-UNIT OSTRIJCTURAI. ANCIi I'I'hCI"S DL'CLAlinl'lI1N OMhz Iunderstment,plum+hall bel used as public records PANELS - CHIMNEY Z'4� UI"fO FW AMPS 2, 20 ❑INTERIOk ❑CHIMNEY REPAIR Ias�jFW Licensed Prnfessimal 201-1000 AMPS IMPROVEMENT 0SWIMMING POOLS al OWNER-BUIIDBR I)F.CLARATION p'C4 W Q I M1erchy efEm1 that I nm exempt from the Convacun's License Law for the OVER 1000 AMPS 13AT11 REMODEhBI?PAlli ❑DEMOLITION X�aV followingcounty ❑OTIIER .)Sect ]III 5 H m I P :C d e Y ly Ire SIG451 LEC'1 RICA). 1- wt h 1 II t t h P demolish. P Y:t rent .. J6J6 prix I I 1 req m ppl tf M1p fl 6 J'I le nv rt SPI'CIAL CIIICUII/NISC, (cam I ' it Pms: a 'heP :nn if the Coal I License- al 1' (CI prcr9 _ ZC, ammcncmgwilh5eaam70X))of Drvsion 3 of the Business aide nfes:m.+Ude)nr 'fIuU P.MIiIIiIt OR I'OhIjJ" 0NEWcomBLCIAI' )hat he is exempt Ihcrel'rum unit the basis for the ullegttl exmnplion.Any vinlmion n[ ❑NEW BhDG/ADDITION ❑DEMOLITION W,,,m Section 7631.5 by any applicant for a .at,subjects the applicant m a civil penalryof POWER DEVICES Zvi. O'I ENANF ❑1'001)SERVICT FSGnm mm's than five hundred dollars(55(10), MPROVEMEN'1' Ol.mnwner.f thepmlzny,onny anployccs with wages as their sole compen.amion, SWIMMINGPOOLEIJiCI'RIC wdidnlhewomor rk.omUheamuer.ix not inumealNTomd f.rsule(Sce.]644,Business El OTHER W 3 and Professions Code 'Me Columbus,License Lax does not apply m an owner of oil'rT I:S-SWI'I'CHITS-Il%TURES prnpeny who builds or improves thereon,and who does.such work himsell.r Enough In,mcn can,imees,p ided th I.rich improvements am a.,-attended reoffered far NEW RI SIOIiNTIA1.HLEC'1'R Sp FI'. ulc.11 t1 h ill b P I I I 'd' y f pl I t n.the SQ.FI'.FLOOR AREA S/SQ.FT. as mer-hoolder willh the burden f provingtlrth did notbld or improvefelt put- Earn.1 sale. ut Ears 1. - ly [] 1,as owner of the pmpeny,alit excll usely contracting with licensed contractors to TOT' con....to the pr i(Sets 7014,liminto and Pedewinm Code I I ne Comment'si- ,• • y L, y�r Ise Law dues nut ply loan owner ofpmpcny who builds or improves thereon, QTY. PLUMHINGPERNIT � 'FEE ap who contracts her such projects with o corrections)Iieenscd mentionuo lbs Can..wbas / sL�ic•m'n.+e Law. PERMIT ISSUANCE I and exempt under Sec. ,B&P CI.rlhis reason 00 AC ER-DRAIN&VENT-WATER(IIA) VALUATION OwnerUalc _r WORKI;R. COMI'1!NSATION f iC.AR61'ION RACK FLOW PROTECT DEVICE1-6-2- ) ry_Q �• I hereby affirm under Penalty.f pe jury one of the following declarations: l\VJ/VVV ❑ I havmmd w ill nmialmn it Cenifcmc of Cnnvmn to svl(-inmm for Wnrk,'x Compam DRAINS-FLOOR,ROOF,AREA,COND. STORIES I TYPE CONSTRUCT ION sari..,as provided for by Section 3700 of the Lat or Cede,1'.r Ne pcdiumunce.1 the O work barwhvirflus pannills isxned, Z. PIXTURES-PER THAT 1 have and will maintain Workers Compensation Ipsoancu xx requited by Section 11 - :3706.1'the[,be,Code.fe,relxrformmnmnf the work for Ts Nero l hislwnnit is issued. OAS-ISA.SYSTCM-I INC.4 GO G.FI'S OCC,CROUP APN My Worker's Conpereatem Insurance carrier and Policy nounber ore: Carrier Policy Nn.: GAS-EA.SYSTEMOVER 4(PLA) _ CERTIFTCKIT OF EXEM17ION FROM WORKERS' GREASFIINUUS'1'RL WAS'1'F.INTERCLpI'OR COMP') SA'IION INSURANCES O111L ) [BION IgiFS Cm-eotinn need not be vomplcte4 iOhe pemtit is far one hundred dollars(51110) GREASEIRAP orles.a.) PLANCHECK IFE �, toy any tlet in in anymnuneeo as t work fa wuhrod 1.IlaW ixissuN,leholl SLWRR-SANITARY-STORM F.A.2010 P1'. not employ any person in any mannenn arson become suhjed lolhe Wnrkeci Cotnpen- - ENERGYREE all � . 7.1 enIt T lawsof Cllifomiu.Ours WATER HEATER WNEN'I'/ELEUTR Applicant - GRADING FEE NOTICE TO APPLICANT:IL aenr making this Cendican,of Exemption,you should WATER SYS'M-MG7RIYTINO F " beunae subject to be W.tkers Compensation provisions of the Labor Cole,You nmsr SOILS PLL Iomhwllh comply with such provisions or this pamnit shall be deemed revoked. WATER SERVICE LL44 Q CONS'I'III ICTIUN LENDING AGENCY NEW RESIDENT AC)'LMB, SQ.I'I'. PAID VQ I hereby affirm that hem is a construction lending agency arthe performance of )Tem Rccen M tire wt)rI Int which)his pcnnil is ixsuud(Sea.31197.Col.CJ Y. Lenders Name IO1Al. {UL) Lcrder's Address A fy, 1 cenify that 1 have read this application and slam that rbc above information is BUILDING 17 �k umc,a.I ugme lo comply with all city teal eomnY nrdarierea and sate haws relating os QT'Y. MR:1 N CAL PERMIT. 3,' FEF. C.J z building construction, m stion,and hereby eah. e represenmtives o [,)enter city enter uptmthe - - "1- SEISMIC PLIn' abmomemic ned prepcdY Iia inspection purls'scx. a1) (We)a m save.indo11mf d keep harmless the Cit f'Cu nt,a t I'CRMI'I'ISS _ ELI:CTItI O goo yen p arcane peni gains liabilities,judgmenl+.costs and expenses whish may in any any seems again.a said City ALTLR 'IO MI?CII, r�'� PLl1MItIN' .U; V ' �nnscyucnce ufrhe granti11g.[this permit. - 1 VV / APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR la ) I ( UINI�Tvk'O4F)III Pb ) MLCIIANI L THE o SOETICE REGULATIONS. AIR))ANGLING UNI'TOVER 10,000 CPM) CONS'I'RUC'ION TAX I Slgnatureof AppliceaVGourector Date HXHAIS'114000(W/DUCT) HOUSING MITIGATION FE, HAZARDOUS MATERIALS DISCLOSURE Will theapplicant.mom Buildingmeuponl,malshandle hozallous...head H EATING ONE'1'('1'0 100,000111'U) ns defined by the Cupenbm Municipal Code,Chapter 9.12,unit the Ileahh Imd Safety Code,Section 25532(x)'! 14E l INC,UNIT(OVER 100,kx)ill'U) ❑Yes ON. PAID --� VLN'I'ILA'I'ION PAN(SINGLE kESIU) Doc ltacei # WIII the applicant nr furore bnilJLrg.mvpanl me ryuipnanl or Ju....which emir hazardous air containments as defined by the Bay Area Air Quality Management TOILER-COM)'(311P 011 I60,fXX1 B'fU) - 'roi AL: Divinm^ Fos BOILER-COMP(OVER 100.000111U)TU) ] ONn 1h:we read the har,ndnuv madmiaN minirements under Chapter 6.95 ofre hCali AIR CONDITIONER - ISSUANCE DA'I'S Room Health&Safely Code.Sections 25505,25533 and 25534.1 millennium]Thal Ville NEW RESIDENT IAL MECH. SQ.FL building docs 11111 Initially have it mmv:E that itis my resp rsibdityt.notify the recle nl of Ibe rexryiremenu which most be met pAr,1.issuance of a Clird icam of Occupmcy. Owners aathnrized ugenl Date TO'T'AL. / O ISSUED BY: OFFICE �'