S 2753 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELEC'I'RICA], PERMITNo.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING.MECDANICAL S 2753
Nlot DING PROJECTIDENTIFICATION
WILDINGAUDRP_Sti: — �O SANITARY NO. APPLICA'T'ION SUBMITTAL DATE
.2.5 S ti C 6/
OW NIi . NAME: PITON; CONI RACI ORIS NAME: L /�� LI 0,^
r. v L N/C CONTROL#
'AR IRIgiCUR :E LIC NO: A 1 V ❑
I. L
C. 'PACT: PHONE: El BU ILDINGPERMITINFO
Consultant Fm Fres Paid by Applicant(Initial) BLD
I.[I. PLUMB MECH
LJ ❑ ❑
LICENSEDn Oardo ACTORS DECI.ARA'I']ON QTY ELECTRIC PGRMI'1' FCC
I hereby alum the I am IicensW under provisions of Chapter 9(commencing JOB DESCRIPTION
µqµ]]00 with Section]010)mf Division 3 ofthe In,inessa.d Pndessinm CcAu,nndnrylablenis C"n RESIDENTIAL
Fly infull farce and elle PERMIT ISSUANCE #
Q U V License Gla s Lic,p ❑SFDWL ❑KITCHEN REMODEL
ZZW Ume�Cnntmcto APPLIANCES-RLSIDIiNfIAL ❑ADDITION ❑PLUM BING RE-PIPE
Roh.11[ TS DECLARA'T'ION PANELS ❑MULTI-UNIT ❑STRUCTURAL
OZ Nr IersanJ lint/P�llx�n.c�shall Muse pYhlic rJs MODIFICATION
F to I', Lic me l UP'IY)2(NIAMPS INTERIOR ❑CHIMNEY REPAIR
Q J 211I.I(ggtAMPS IMPROVEMENT
—acre _I OWNER BUILDERDECLARATION
OVER 101X1 AMPS ❑DEMOLITIONNG POOLS
6 1 hcmhy,fromSoad the 1 am caemPt from the cootcus Co License Law,Battle ❑BATH REMODEUREPAIR (]DEMOLITION
W U followinguires a (Sanded]IBES,Ilusinevs and improve,
de to li h.or Any city s county ❑OTHER
3 LL F SIGNS F.LIiCTRICAL
F O m which requires a permit to construct,aper,improve,demolish,or repair any structure
CC yQprior in its issn:mce,also requires the applicam fir such perm'gmlilcusigncJ statement SPECIAL CIRCLE
2�} tMthe is licensed pursuanunthe Pmvixinns of the Conbunnd License Uaw(Cbaptcr9
µ�j Of Icnmmnaing with Sccuon](100)of Oivision9of rho Boniness and Pr�fessionsCNc)or
q0 THMP.MRIF.R OR LF.INS'll COMMERCIAL-
0.
q ¢v that he is cxcjl31.5 h therclfnnt and the basis for the alleged exemption Any violation of ❑NEW BLDG/ADDITION ❑DEMOLITION
IaXI lye an tion cmeth LSby any loud doorr,($50,tit subjevu the applicarnnaci vil pewpy of POWER DEVICES TENANT FOOD SERVICE
E„>y nnnrc than Ove hundred Jallurs($50(),
❑Q p L a,owner ofthe Property.ora employees with wv IMPROVEMENT
=q yc pryers wi gem as compensation, SWIM NG POOL EL.
will dothework,Code:
he Cmuisnot,Liensmofferedforsole(Sea.aan'—
n'Brininess ❑OTHER
m unJ Professions Cale:The Conwaors License Law,does not apply to an owner of O .ETS-SW ITCHI'S-FIXTUR
papery who builds or improves thereon,and who Jens such work himself or through
his own employees,provided Nm such.mtprovemems ore not Imended of offend for SII N'HAL ELECI'R S I'.
sale.if,however,the building or imtpmvement is sold within one year ofcompletion,the SQ.FT.FLOOR AREA $/SQ.FT.
mer-builder will have the burden of proving that he did not build or improve for pur-
pom of sale.).
❑ 1,as owner of the propery,um exclusively contracting with licensed contractors m T ,1.: �O
construct the projnt(Sec.7Mq,Business and Professions Gale:)The Contractor's U.
se Lawdmes not apply to an ownerofpmpeny who bunds or improves thereon,and QTY. PLUMBING PERMIT FF:
whoaahrcb forsuchprojectswilhael000r" ld licensed pursuenl la the Contractors
License Law.
❑ lant risen,under See. ,R&PCliit thirreamn PERMIT ISSUANCE
7Owner DateALTER-DRAIN&VENT-WATER(EiO VALUATION
WORKERS KERPenalty COMPENSATION DECLARATION BACK FLOW PROTECTDGVICDEVICE
1 hereby affirm underofperjuryore of the RATITIng declarations:
❑ I have and will maintain a Certificate of Cmnsentto self-in sure for Worker's Camped- DRAINS-FLOOR.ROOF,AREA.CO
major,as provided for by Section 37M of the Labor Cale,for the performance of the STORIES PIRION
work for which this pernit is jswcd. FIXTURES-PER TRAP A) /G eIJG
❑I have and will maintain Wmrkerx Compensation Insurance.as required by Section46'_41 Afd 4019^
37M of the LaborCale,for the Performance ofthe work for which this mark is issued. GAS-EA.SYSTEM-I INC M.RTS OCC CROUP QAI'N
My Workers Com}+yp i, ncecamic,mm Policy J�ytalw:r-aY
Camier:s'f�"1 Lc���'L Pull,No./sY�N 7S(I(^S Cf GAS-EA.SYSTEM-OV. 4(EA)
CERI'II�ICATEOIt EXIiminiONPROMWORKI:j3S- - 9 -3 p
COMPENSATION INSURANCE GREASHANDUSUZ ASTE INTERCEPTOR
(This",imn need not M cnamicled iffro,crmll in forams hundreddullurs($loop l BUILDING DIVISION PETS
or less.) GRHASE IRAP PLANCHHCK FEE
I cenRy that in the performance ofthe work for which thisperoha is mood,[,hall SIiWIiR-S II'ARY-STORM EA.2W IT.
nal employ day person m any manner so as to become subject to the Workers'Compcn- ENERGY FLE
Oz solution faults mf Califnmia.Dae WIVER EATERW/VCNVELECR
z Applicant GRADING FEL
NOTICE TOAPPLICANT.eIf.after making the Cenificaf of Exemption,You should Wp ;R SYST[ R
a ('" hamate r comp to.,he Workers Compeor:mmd pmviaiods of the Labor Calc,yon nmst SOILS FF:F.
IoMwith comply with xuch provisions or this permit shall M deemed revoked. nn
A'fER SEHVIC� <p
z CONSTRUCTION LENDING AGENCY NEW RF_SIDEN IAB. SQ. PAID
U OThereby aRnn that there is construction lending agency far the performance of �� Dae Receipt#
Ihcwnrkforwhich thisper 't is iasuedxco.91197,Cm.C.)
O Lenders Name—'c
L) Icmhtk Addrr,, # TOTAL: TOTAL:
a1 certify that 1 have read this application and state that the above information is pp BUILDIN§FEy cored.[agree a,comply with all city and county macho nces and state laws relmingm QTY, M.CR ICAI.PERMIT F,zbuilding corrcmction,and hereby suthve representatives of this city to enter up:nt the SEISMIC Iabove memioned pmpeny far inspection pmos,,.
(Weds ,save,Indenmif PP.RMITISSUANCE grre y and keep hanlessn the Ciryof Cupenlnn against ELECTRICIiabilitics,judgmems,cu,a and expenses which may in anyway same against said CirypLTF.RORADUTO MT:CH.nnmyucnccofthe grainingofthis permit. PLUMBIN
APPLICANT UNDERSTANDS AND W;r.qCOMPLY WITH ALL NONPOINTAIR HANDLING UN - )
SOLI} :RF.GULA'fIONS. ICI MECHANICA TLE
%.�. .`L//�.{1•/�� G AIR HANDLING U V R 10 CONSTRUCTI N TAX
Slgnatureof Apphcxn/Cnntramr Do EXHAUSTHOOD I
HAZARDOUS MATERIALS DISCLOSURE. o HOUSING MITI ATION FEE
Will the applicant or future hailding occupant store or ami hazardous mammal HEATING UNIT r
as defined by the Cal enjw Municipal Cude.Chapter 9.12,and the Health and Safety
Coda,Section 25592(a)] HEATING UNIT( ,I .000 BT
❑Yes J No
VENTILATION r' LER PAID
Will the epPlieant or fumic building occupant use equipment ar duvlees Date Rwejpt#which
emit Inflections #OILER-COun air contaminants m defined by the Buy Arca Air Quality Management /
District]
❑Yes eNo - BOILER- VER 1 J H'I' ] L:
1 have read the humorous materials reyulremems under Chapter 5.95 of the Cali- AIR C DITI 1p
forms Health At Safety Code.Sabena 25505,25513 and 255 U.1 undersand that it DATE if the NE RESIDE# SQ.FT.
car,
nm curren0y huvca¢nanq that it int •:p ruihllitymnmify the occupant
of Cher or au~B which rata duet ' rmancfi<acof Qcupa y.
04 /4��1 2
then ago Z ` U e TOTAL.: ISSUED BY: /
OFFICE