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S 2990 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO, BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANIC L It1IILDINGPR(IJECI'IDENTIFICRrlON - EUII.I OIlr -4 t'0 - SANITARY NO APPLICATION SUNNI I'FI'AL DATE Uly C a� moo/ S' OWNERS NAV PHONIF. CON'I'RA�OI'S Nl fli: LIC NO'. if Cqp _ Nl-(, SIC ^C'ONTItOL# CIII"':I IIiN('IN!I!I: LIC. : ADDItIISS: ❑ 3 / CONI'gTT: P1I0NG: BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) F Id,ECT PLU�111 MOH o� IrINSFDCoNTRACIORSDICLARAI'lo QTY r i.LCTRICPERMFI'i' rt� FEE', 1 hereby a If that 1 licensed J p I Chapter 9(comae g _ _ _ OB DESCRIPTION "Z with 700olidlo,i,mr3tfmc Buka:ad l Riskin,Cole and my Earn s L NOS in full f+n,atJ,Ifect 1.1!RMI I'ISSUANCE [el ❑KI'I'CIIEN ItIiMODIiI. QUgr) Licen,r Class Lica APPLIANCES-RESIDENTIAL El PLUMBING RE-PIPE yQM Date C,mmror F-Dm ARCIII'rECI':SDEC LARAHON I'ANF.LS ❑MULTI-0RSH ❑S'IRIICIURAL ZOyz lunderslend my plans,hull be used us puhlic records MOI)[FICAI'ION OZ.-1 OF TO 2(X1 AMT'S ❑INTERIOR El CHIMNEY REPAIR Lkan.al Professional - - 201-1000 AMPS IMPROVEMENT F]SWIMMINGPOOLS OWNFR-BI/1LDERDECLARI'ION AVER❑XNAMPS ❑BATHRIiMODFIJREPAIR El DEMOLITION cw Q I hereby affirm that I am exempt frnm the Commcmr's Lir<nse Law far the 70.0.x5+� In,O Iollowing ica.on.(Section 711315,Baines,and 11m1casion.Colo:Any city a room, SIGNS ELECT N o ❑aTHER mi Yl�+li.Na which resumes a pert to construe,aIle,improve.Jemoli,h,of o pair any,hm ar , .~.�O.J prior to its issuance,also requires the applicant for such permit to 1 I a signed smmment SPECIAL CIR T/ Sr��y in.,heislRcn.alpaman"ra,,thcpto.kir .,,fmx CL,mmadnr.liccawl.nw(Cbupmr9 .114 0 (commencing wilhSectinn 9(NN))o(DivisiunJ oftLO Businen�and Pnde,inm Code)ru '1'HMP.METEROIt POLI! 5' COMMERCIAL' C.%o K that he is exempt therefrom and the basis for Ne allege)exemption.Any violation lel ❑NI;W BLDG/ADDITION ❑DEMOLITION W-„h Section 731Sbyany:mpllcen Turn p.nnn cable,,,theuplef,am Ina civil penaltyolPOWEIIIIEVICliS �I'FNANT I*FOOD SERVICE not d ntorc than Use handled dollars N5gp. R-2Y IAIPROVI!MF.NT =6 El1,mo,sook,hepx,neannnYemntended withered F mei(Sri. LTO. hoes, SWIMMING POOL ELIiCfkIC W l„I G width,ho wmk.and ma she Conire tors License o w dr is not apply 71114.le aer sa ❑OTHER 6a property his C+de:'mp ,,,therea Liccore Laws ses'notapplymIf ,wormlel OIJ'I'LE'I'S-SWI TCHES-NIX'1'NRES Q his.,,Y who Maims It improves thenen,and veal mos such work himself ur Ihmugb his own cm to p y,the pnrvided IMr x.ch impnrvrnld v un nm intenJeJ or offered for NEW RESIDENTIAL I!1.1!Clk SQ F1'. vale,IL however,the building or lmpmvenmm is sold wllhin one Ye.n+f cnmpletinn,the SQ.PI'.FLOOR AREA S/SQ.FI'. owerf id'r illbase th burden provingftM1th did th'll p for par 1 yyp�1 Itb P pnY' IY I 'I g itM1l J t eau .A ?street theproject(S 7h nosiness d I f Come:)Th C t tors L cease law does not apply to anwet of prpedy who bums imp :Brecon and QTY. .PLUMBING PERMIT PEE who anomers fur such pmjcns with u rontramgs)LcenseA Pnnuum w theCnnl ar u" WWI License law. PERMIT ISSUANCE ,0 ❑I am cxemp,and Sce. .D&P C fi r,hi reason • owner # Dam AL11!It-UIt AIN&VENT-WA'rI:R(EA) VALUA'T'ION t F LARATION BACK FLOW PROTECT.DEVICE Q \� I herchyafi, mol per iii any me of the following declumdnm, © ll ❑I base and will mmartiona fifeam of Cor,enno selLinsum for Worker'.Comp" DRAINS-FLOOR.ROOF,ARBA.GOND. S'IORIP.S TYI' CONSTRUCTION senior,as pm,aled for by Section 3700of me Labor Cale,for the pefonnun,c of the work For which this permit Is i.sncd. FIXTURES-PER'rRAP ❑1 have and will maintain Worker's Cnntpe,salinn Insurmar.as refried by Scdlon 34X1 nIthe Luton Cale,Ea the perfnmmnee of the work for which this permit is issued. GAS-EA.SYSTEM IINC,4 OL I OCC.GROUT' ALIN My Worker's Cenpacmtion In...once runic,sort Policy another are: 1 I Carrier: Policy No.: GAS-En.SYSTEM-OVER 4(1! CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCEGREASPIINUUSTRL WASTE I I RCEI 1 (Thh cation orad not be emnplecd 11 the poem;,is on one hundred doll:n,($11x)) IIUIIAINO DIVISION I'1!E.S or los.) GREASE TRAP PLA C IP.U& Iecru I y that III due perfornnaree of the work for which this permit is issued,i shall SEWER-SAN ITARY-STOR I?13 I'. •-+ ,Ilea Io ... ,,bead...sub„no the Workl,,Comex, N ration la Dl hl'PLICAN'I':IL nllrnnukiing This Cenilical e Q NOTICE y any person in an + Applicant,imm.Dst WATER HEATER K'/VIiNI'IELF.CIR 7� z GRADING Illli q te.nI Exunnptlon,you shoal) WA'I'Elt SYSI ENVIER 3AHNG SOILS F ^-' Leconte subject to the W'orker's Compensation pmvisinns of the Labor Coda you muss {aid n�-I forthwith comply with such pmvisionsnnhls permit shall lx:deemed revoked. WATER SERVICE ik CIL. Q !� CONSTRUCTION LENDING AGENCY NEW k&SIDEN'HAL PLME. SQ.FI'. PAID a Z 1Incohyuffirm lot, k.eommmtion lerningagency for lhrperfoomeme.f Dole Receipt V � the work for,hich this fermil is Issued(Secs 3097,Clv.C.) 0 U Lendcd Name 'I'O'I'AI,: { U Lender',Address O .1,: v'© aI,edit,the I have read di,a,,hx: um and,two duo'be those ofnnna,lon is . . t f - - - -tI ' E L1 NG IE!F. X rn on o.I agree ,,comply with all city and county alar leas and sone laws mating u' QTY. MECHANICAL PERMIT. FEE Q V Z building construction,and hereby moron,reprewnmtivesofilak city former upon the SRI 111C 1'1113 shave-mentioned property for iuupceion propos,-s' PERMIT'ISSUANCE (We)ngnm a sus,,indmnnify lend kl,ai ndrs,Rte Cily of C."fi I.gain,, HL C'I'RIC PCI; Ilahilities,judgnanu.costs and expenses which may in any way scan,against said City ALTI!R OR ADD'IO M ECI I. Inctees. ac,I'll gra t ng lel'this person. PL MBING FL'li O APP'1'! Al rUNDERRTANDS AND WILL COMPLY WITH AL1.NON-POINT AIR HANDLING UNITOO 10.y00CFND SOURCE RiGUI AI'lIlNS. I MSCI NICAh F[h AIR HANDLING UNI'F(OVER h,Na CPM) CONSTR CI ION TAX .'gt rent IF a ononror Date FHAUSTIROD(W/DUCT) HOUSING MITIGATION FEE 11 ZARDOUS MATERIALS DISCLOSURE Will,Lac. If am or diene building.ore I sloe ler handlehvumonn mwrriul IHA'I'ING UNIT('10 1gl,000 It'I'U) as Jcdiner1 by the upedino Municipal Code.Chapter 9.12,and the Ileabb.led Safety Cndc,Sro n 25532(.)'! HEATING UNIT OVER 100.0X0 BTU) 1 'j VP.N'IlLAT10N FAN(SINGLE ItIiSID) PAID RR to Will then Beam or loan b.ildln occupant use c m f or devices which DSte Rcccipl# PP gr pS y prQu BOILER-COMP(31I1'OR 100,000 BTU) mil hsmmnux mrcmnuminunu un del inN by,Lac Bay Mrt air Quulily Man:Igcmnn District, T L 11011.13k-COMPIOVCR Ig1,1NXl ETU) ❑Yes 1'�Jo Alit CONDITIONFR Health Satesh ade,Ssm.mduh ng25533and 2553 .1undrshottoulcr Carrier 6.95 of hat Call, ISSUANCE D///A'Ii (orcin Hearth Safetyly IraSermons , feat,r,rayand25534.1.Ideon,')thinif Ib° NEW RESIDENT[Al.MECH. SQ.Ff. building does -currently huvcnlcnan6lh,n it is any n.@msihility et rarity thunmurynn / of the aqulmt 'lea Lich un lx me noisunnceofn Cedifcmc of[kcupaney. Dec TOTAL: ISSUED BY: OFFICE