S 2476APPI IGANTTO PII l IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING - IT.ECI'RICAE
BUILDING DIVISION APPLICATIONIPERNUT PLUMBING -n1ECHANICA,
BUILDING PROJECT IDENTIFICATION ,.
- PF:RMITNO.
S' 2476
BUILDING ADDRESS'. -'
SANI'IARV NO.
APPIACRI'ION sulsonIT'ALDATE
1,2310(c) era rt e i�✓t i r�r�%
Z- L sl
OW . _ MI!' PHONE:
C NfRACIOR'S NMI& LIC NO:
8
NIC
❑
LY)NTBOhp
AItCIHI'ECT4iNOINI?I!R. LIC NO"
/11/
ADDR�E..SxS:
¢W NJI5510M Sr_%L 21'
caN1AC1', r9arvE:
154iat /1 C-4lyso
.BUILDING PERMIT INFO '
BLDG ' INJECT YI.IJMB M1icU
❑ Consultant Fees Paid by Applicant (initial)
LICIiNSED CONI'RACff)R'S DIT CLARATION...
I (Lomb, u rte that licensed P a.' f Cb Pln 9 aorta u,
r!"
QTY. aIiL.ECIRICITRMIT r F6E
1 1_
JOB DESCRIPTION
PERMITISSUANCL
with Seclon]OIXOofD i f BmmecsandJr fe - .Code° )tic uL
In fall foam,mid enter s n eT/ �3
RESIDENTIAL
❑SPDWL ❑ KITCHEN REMODEL
APPIJANCHS-RESIDEN'HAE
license Class IJe#
Dare Cnn ."n
[]ADDITION OPLUMBING RV. -PIPE?
❑MIII:FI-UNIT E3 STRUCTURAL
MODIFICATION
❑INTERIOR [I CHIMNEY REPAIR
IMPROVEMENT C]SWIMMING POOLS
ARCI HI ECI':S DIiCLARAGON
I nndermanJ my plans shell he used m pubic r HON
IANI?I,S
EPT0200AMPS
I:aensed Prote,somal I I
201-10(IAMPS
OWNER -BUILDER DECLARATION
I hereby nf0rn thin 1 nm exon, from the Commeter's License Law for be
followingmason.Seen— 70315, Bnsire,and Prnfr_ ma, Coda: Any city or county
[I BATH RHMODEUREPAIR 0DEMOIA PION
El Of TER
OVER I(Xp AMPS
SIGNS I71 -EC' I'RICAI.
which requires a pemon to consume', alter, improve, demolish, or repair any amcmrc
SPECIAL CIRCUIDMISC.
ninrtoo,issaan,c,ski, cgalrcc the affluent (,,hilt ecnno In at ... igncd mmnnem
that he is accused Panama to the provisions of the Conrranors License Law (Chapter 9
(commencing with Section 7000) of Divisin+Jofrhe Business and professions Cale) or
Ida' he 1, exempt merchant and the bast, Ga it olcgc l cxcmplinu. Any violalimt of
'TEMP. METER OR POSH INST.
COMMBRCIAI:
El NEW BLDOADDITION ❑ DEMOLITION
Section 7031.5 byanyaMlicam for a prout subjects the efficient to a civil penalty of
POWER DEVICES
❑'N1' ❑FOOD SERVICE
Elm mnmlam p).
hum rive hundred Jul(&H
❑l.as owner of the property, or my employees with wages as their sole cdutpensmbn,
will do the work, and the structure is not intended or offered for sale (Sec. 7014, Business
'
IMPROVI?MENf
IMPR
❑ 0'1 HER
SWIMMING POOL HI.ECI'RIC
and Pmfc,ion, Crile: The Caram,.o, hiacnxo Id,, data not apply at an owner of
OUTI.E rs-SWITCHES-EmURES
NEW RESIDENTIAL ELECIR SQ CE
pntpeny who builds or improve, rh°ram, and who dues such work himself or Ihmugh
his own rua,d,m.. parvidid Mat such imprommnaa are not intended or offmrd for
cele. li,however. the building or improvement is sold within one year of coa,ac.ion, Ihr
tV SQ, Ff, FLOOR AREA
SISQ. 17E
owner -builder will have the burden of pmving that he did not build or improve for pur-
nr.Ide).
I, as owner of the property, am exclusively comr,Ing with licensed "Ousetnn m
'fOTAI.:
matt., IM1e poorer (Seo. 9044, Business and Professiore Cod,) Ibe Cunvamola Li-
selswdreanati,ly to anowner ofpmpany w bn builds or llu,nle, stereo I. and
- - -
QTY.' . PLUMBING PERMIT FEE
who comrem for such pmjeels with a eomremr(s) licensed pursmmI .,he Counselors
PUIt MIT ISSUANCE
License Law.
am exempt under S. . B & P C fin this reason
Owner Dale
ACIE.R-DRAIN & VENT- WATER HEAL
VM.UATION
WORKER'S COMPENSATION DECLARATION
BACK FLOW PROTECT DEVICE
I leachy aflml under Penvhy nl perinry one of the fallowing dechtr.iom:
-
f-IIbavewJwillmninrinaCcrtificmeofCnnsenlmsel.insrrc lit, Worker's Cnntper-
(anon, as provided for by Section 3900 of the Inbar Cale, for the Wet) -rmance of the
DRAINS- 11001x. ROOF AREA. CON 1).
SIOR[ HS
TY III CONS 114 UCI'ION
work On which this pmol Is i ... ed
FIXI USES -PER TRAP
❑ I have and will maintain Workers Compensation Insurance, as required by Section
37(nol the Luba, C it, for the Imisommoa nftbe work for which this puma'",,,I ed.
My Wod.er, Compensation Insurance carrier and Policy number nm:
Carrier: Policy No.:
GAS -1?A. SYSTEM. I INC. 4 OLT) 1.ETS
OC lUP
on
APN
✓{�
GAS - HA. SYSTEM -OVI2R 4IEA)
GRFASFANDUS'I R 11 WASTE IN'I FItCHIVIOIt
CE14'I'I FICAI Is OF IRS EM 111 ION IRONI WORK BAS'
COMPENSATION INSURANCE
91 LOIN ON 11!
GREASETRAP
(l hissectionneed nor he completed ifrlot permit is for one him reddallan(E100)
nr less.)
LANCHP.CK FEIi
SEWHR-SANITARY-STORMEA, 20114.
ENERGY FHE
Icenifythstintheperf ma ceof'he work forwhichtbis permit is issueJ,lehall
nolenlpiny any, v i y m 1s11"beeZi,o' tghe Workers' Comfit,
sarion lows of If,, i I G.• CC.-
WATER HEATER WNENT/ELIiCIR (�
Nnl
NOTICE IOct tPLICA rev' aflcr Coni,sakation sCo of Lxentptiode.e. youhoulJ
heatlnc sublenmthe Workers Compcnsminn provisionsof rhe labs Code. Yon mmt
WA'I'IIR SYS 'I'IiA1/I'ItEAI'INC
5011.5 PF.Ii
I'unhwith comply with such pmvisinlls nr this prmtit shall he deennl trunked
WA'I'[ilk SCRVICS
CONSTRUCTION LIiNDING AGENCY
he fnnnanec of
Burro iso tmaion lcadingagrney lonMr
Ihereby,(Outlet Bcons
NEW RESIDENTIAL PILLAR. SQ, E4.
PAI)
Ualc Ree #
the work for which This pernth is issued (Sec. AX)J. Civ. C)
Lender's Name
OTAI_
101 I
Lender's Adders, -
is
BUILDING IrGG
1 minify III,,,I have read this application and state that Te aabove information
mm.lagrn toeomgrly with allclly and comayord'manes and stale laws relmingm
blinding cemtmctio n, and hereby authorize rcprexematives of'his city m enter open the
QTy.. - MECHANICAL PERMIT FI?H
l '
SEISMIC FEE
PERMIT ISSUANCE
EL[C'IkIC PEL
ubovmntcnlin eve prnlwny fnr irspmrion purposax,
(We) agree to save, indemnity and keep herndess the City of Calcium) agmn,t
AMER OR ADD' to MECII.
PLUMBING IPE
l islublie,,judgments, Dotsandex en swhicha ninnyway.cme againmseidCity
in cm nequourn of the gmming his pernlll.
UNDERITEII S IND WILL G )MPLY WITH ALI, NON -POINT
SOUItCF: R Gl' IO S.
AIR HANDIANG IJNIT(f010.00)CFM)
MECHANICAL ITAPPLICA,kT .
-
AIHIIANULINOIINIT(OVER I0,1100CI'M)
CONS 'fk11C'fION 'I'X
Slgnuture nl'Applin,nl/Commnor Dmc
F.XHAUS'1' 11001)(W/DUCp
HOUSING MITIGATI)N FEE
HAZARDOUS MATERIALS DISCLOSURE!
HEATING UNIT 0 O 100,000 BT U)
Will the appllcanual core building ema,mor cor handle bacutdounnentriA
as dchind by the Cameroon Municipal Code, Chapter 9.12, and In Health and Safely
Cala Section 25532(°)?
HEATING UNG (OVER 1(0,00 BTU)
VI!N'I'ILAIIONFAN(SINGLERESID)
El Y11 VNo
PAID -
Date Rccequ#
ROLLER -COMP (314P OR I W 1X0 RTU)
ace equipment ar devices which
Will the .air comm d furore building by the
omit hazardous air cumaminams m defined by the Hay At,. An Quality Alanagcnenl
.F^
✓
pisninP
�
0Vice �Nn
BOILER - COME(OVER 1(10.0X0 BTU)
AIR CONDITIONER
I hamocalIM1e hazanlous minerals mgaimmems under Chapter 6.95oflhe Cali-
traits II & Sa' y �xlq Sec1lnns 25505, 255331md 25534.1 and, orad tb,d d Iha
ISSUANCE DA'IE
% /�Q
z_
NEW RISINHISH IAL NEED, SQ. En
laildin�Il t Ins ly havcatewnt. the, it is my rcnpntsibility to nrnify Ncrccupanr
of thnr idnnnvt be mer prior ra issuance ufx CeniOcme nfOceupxncy
razed
ISSUED BY:
TOTAL:
mut ho ugem Date
OFFICE
s
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