S 1672 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
E
Y OF CUPERTINO HIIII,III\(;-FILECIR � ^ �IhDING DIVISION AI'1'I,ICATION/PERMIT PfUMBING-NI:CHANICAL Lv� '2RIIII.DIN:PROJECT'IDENI'IFICAI'ION
DING ADDRESS: SANI'TARY NO. APPLICATION SUIi73S -rjZcs lir C=r I S-ts-q PS
IRSNAME: PHONI?: CONTRACTOR'S NAME; LIC NO'. NIC CON'IROLa
S v��l y/SS 4 r .36S�Ga ❑
\RCHIF12C'1'/1iNGINRER: LICNO: ADDXFSS.
o s1LP-il1-0/ casAL-�
CON'Tncf: ❑ONE. BUILDING PERMIT INFO
�O ❑ COnsullanl Fccs Paid by Applicant(Initial) LDG EL� M1 tC
760
LICENSED C(IN'IRACI'OR;S DECf.ARAI'ION QPY. ELECTRIC PERMIT FEIi
heraby aninn Han I.,it fmnsul tomer PuMW.,n.nfehapwn 9(Intmaenc'tn JOB DESCRIPTION
p f�2 1M1 Section 7gNq of Uists nJol the limine.s and Pndcuio scale,and mylicaree is
364
iSIDF,NTIAL'
WOO w' PERM)'I'ItiSUANCIi
Fw_ n full force and effect. K 3 6 L -)WL O KITCHEN REhfODEL
�UU Liccnnc Clav it Lica APPLIANCES-RESIDE,NTIAI. ]nDDITI(1N ❑PLUMIi1NG RE-PII'li
N Z Irl UulcCnnouet
'Asti). NCI{ '13CT5 UEC.n T'I ❑MDLT'hDN1'I' ❑S'IRUC'Illlts\I.
p y PANUS h10DIIICA'I'ION
ZpyZ Iundemvndtoy plans shall he used as Public mmnfv UPTO 200 AMPS
O Z p ❑INTERIOR ❑CHIMNEY REPAIR
l.4F'tw licensed l'rofe,mrsd 201-10B)AMPS IMPROVEMENT [:)SWIMMINGPOOLS
CYC- OWNER-RUIIDER DECLARATION OV13R IOIXIAMI6 [I HATH REMOUEIJREPAIR ❑DEMOI.1'I'ION
y C d•Q 1 hereby aPmt that I am exem,from the Clown s License Law for the
ad p C U followwon (S
following re , ection sRos
7031 , iness and 1'mfencionv Code:Any city Oil county SIGNS FL,CrMRICAI. OTHER
w 3 W y which requires a pant,lotan,lot",ruler,improve,den...bd.nr repair any XVtmmre
F u'5q prior tons i.....I,also«quires the applicant lmuch Penni.to File asignedsmu.Tmed SPECIAI.CIRCA IT'/M '
Ems} That he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 COMMERCIAL
�a��0 (emnmenein,,ithSemin0700d)uf Division 3 of the Business and Professions Calci or TEMit METER L
m p, C thin he I.exwnpt thcmfram l i the husis for the alleged evandiva Any vinlmlan of El NEW BLDG/ADDITION ❑DIiMOLITION
X�_1+'Section 7131.5 by any applicant Iiaa pemnisubjects the applicant to a civil penallyof POWliR DEVICES ❑'1 ENAN'1' 1;001)SERVICE
W '� oat more than five hundred dollars($500), IMPROVE NI'
,yQ D I,as owner of the prmpcnY,only employees with wages as their.olc cnmPcresation, SWIhIMINGP(X)L ELECTRIC
p... will Jo the work,and Ow svucuncunal imended ormll'roal li,r uln flee.7044,13usincs, ❑OTHEK
W 3 ro and Pmllsvionr Cale T c Contmc,.e,License law does not apply al an owner of OUT].liIS-SN'IICIIIiS-19X'IUREl
la. •property who builds or improves thereon,and wha does such work himself or through
del That.nch ins t n in¢nJcA nr offered for NEW RESIDE,N'I'IAL ELP.CTR SQ IT.
his awn a-,,.The provi pnwensn.are no
,a1e.u:nnwavar.ton nnHning or intpmvmnent'rv.sem widdtt sena yoarar..,mpwat,n.the SQ.rr.r-Laola nue. E/sQ.1-r.
owner-builder will have the burden of proving that be did not build or itaprnve ria Pur- . • /1)
pn.ofsalc.). T - (-tel`y`
0 I,av s tuntxr of the property,.,it eecluvively contacting w'nh licensed contractors to
construct tileprojml(Sec.7(44,Bushes, nd Ilrow,i(,nee c,mc:l'I'hu Unions tids I.i-
necLtwdoe—I apply lounowncr of pmPcnywho buildsorimproves hercon.und QTY, PLUMBING PERMITFEE
sell o...true forsuch,at with.c ausebr(s)licensed porsuanunthe Comrriana,
Lice ye 1-sew. PERMIT ISSUANCE
lam I.Pi under See .R Po PC R,r thus rea,nn
ALI'Up-DRAIN h VENT'-WAI ER OVA) VALUATION
her Data
WORKER'S COs1PENSAI'ION DECLARATION RACK FLOW PROfI!Cf.DEVICE
I hcmhy a1Ern under penally of perjury oneof the Ihllowtng declammm.
have trod will muimainaCenilicalw,f w
Connnn rc
kelhlnsufor Worker Collision- DRAINS-1'LUOIt,ROOT',AREA.C(INO. SI'OItIEg 'TYPE CUNSfRUCI'IIIN
non,us provided for by Section 37W of the L bar Gale,for the Performance of the
work for which this'nind is issued. FIX'I'URPS-PER TRAP )
I have and will maintain WorkclI Coopcustmon In.uruare,ns mloircd by Section
3700.1 that Caluf the perfomtanceol'the work forwH�t111,
xpP,pa(n issued GAS-IiA.SYS'll?M-I INCA UUTLE'I'S OCC GROUP AI'N
MY Worker r�ip{{tr lrJrtuumce cu r and Policy n -II//SSI 99
!Trier: TT`` IKL Te VolicY Na: G.\5-G.SYS'RJ.1-OVIiRJ1EA)
CGR I UTICATI?()It IiXEMP'I'[ON PROM WORK17RS' s s)sr♦J
COMI`IiNSATI(IN INSURANCI? GREASIYINDUS'I'RI,WAS 11:
IN'1'IiNCIJ'l(IR /. sil Is,
N<i UIVISIUNI:EEl
flbi.sectiunnmdnnt Mss,mplvledifthepermini.li,ronchundrcddollara($I(p) GREASETRA)' G�
I'LANCI{IiCK ISG
or less)
t,a.,lhnt in the perfnrmunceof(he work for whichlt pertnio'kent,Con p- SEWER-SANITARY-S'IORM GA.AIU tT.
net employ any pennn in any tnunncr so us to bcmmc subjen m the N'nrkers'Gmtpem liNliltGY THE
Z union lrwaof Culifomia.Doc WATER))EATER W/VENT/HLECfR
z 0 Applicant GRADING IEE
NONCE'10 APPLICAN'1.If.tt lartnakingobi.Ccrtililde of its nnption.youdould WAIIiR SYSTpMrrRIiAIINC
SOILS PEG
a ; Femme subject w the Workers Compensation provisio n..d dw Lnhm Code,you ntosl
forthwith comply a thsuch provisions or this perent,hall be deemed revoked. WAI ER SERVICE
Q
� rz
CONS]RUM LIiNDING AGENCY NI!W HI?SIDENTIAh1'LMI1. SQ 17. PAID
.aa Rmei1
U O (hereby affrnt that here is a construction lending agency lot the perR,nmaree of
W r the wank for which This permit is issued(Sec.3099,Civ,C.) TOTAL:
t O U Leader's Nunn
} U] I<mmrIAddms HER )
d 1 ecnify that I have read this application trod 4 he than the drol.ansnnwimn Ls
correct.l agree to comply with all city and counly ordinances and state laws relating to QTY. MECHANICAL PERMIT 1'IiE SE.' 1 IT
U•Z building construct,and hereby authorix representatives of this OdYm enter sloes the
uhnvcnual ioncd prule.ety fu lmpcctian P n'see" PHRMI'I'ISSUANCEIiLE 'RIC ITIi
(We)agree m save,indcnmily and keep harmless the City 0 Cupcnlnu st
again
liabilities.judgmems.coss andexpcnws x hich tory inanyxayacen¢aleirs said Cay AMER OR ADDTO MECH. $'LON TING PER
AI'PLIlncnc �A .
CAN' I jWI'I'I{ALL N(IN 1'IIIN"1' Alit HANDLING UND'1'TO 10,00 CPMI MECIIn ICAL PEi
/ AIR HANDLING UNIT(OVER I0.100CFM) CONSTRUCTION TAX
Sign; ut-nmra.tar Dan EXHAUST HOOD(W/O(JCI) HOUSING kB11GA1ION FEE
IIA9.ARDOUS MA'IERIAIS DISCLOSURE
Will the applicant or future building occupant store or handle ha+amlou.material H Ii Ti NG ON 11(TO I IXiNXI RTUI
as defined by the Cupertino Man Elate Chapmr 9.12.and the Ileahb and SafelyMNVFR,,(,NIT(OVER 11X,100 R"I'U)
Gyle,Section 25532(a)!
p Yes - [I No V,AID
/ N I'AN(SINGhIZ RESID) DalcWill the upplicanor future building aocupanl me equipment or devices whish (IMP QHPQR IW.(10(1 RTU)mit by lokat air contaminant,uv Jefinal by the hey Arc.Air Qual 1,MangcmmnOMI'(OVlilt IIXhIXXI R'Illl
❑Yes E)Nohaw rend theh,ardntn'nmmriul,equinntcntp lode'Online'695 of the Cali- TIONERSUANCE DATE
fnmial{callbffi Snlvty Cede Sc aiom 255115,255)9 unA 25534.1 tiderwndlhalifNeEN'I'IAL MECI{, lQ.FI'. /haddin,cl Iv Lav t !,nl.nI uis payron,risibilitym notify lbs occupantof he ml' a Ce ' f(kear,ncy.uc
Q 'I' IsSti EDRY'.
OFFICE J
m m m m m m m m m m rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn m rn rn rn rn rn m
V V V V J V V V J J J J J J J J V V J J J J J J J V J J J J J V J J J 3
N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N
-i
! ! y
O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O
J V J J J J J J V V V J V V V J J J V V J V J J J V V J J J V V J J J
in cn cn cn cn cn cn cn <n cn cn cn cn cn cn cn cn cn cn cn cn cn cn cn cn cn cn cn cn cn cn cn cn v+70
cn y
m m m m m m m m m rn m m m m m m m m m m m m m m m m m m m m rn m m m m e
V1 U7 cn Cn (!) Cn (n Cn (n (n Cn cn Cn Cn cn (/) (n fn cn cn cn cn (n Cn Cn (n cn cn Cn (/) Cn Cn cn cn y y
(n (n (n Cn (n Cn (n Cn (n cn UJ (n (n V7 Cn (n (n (n (n (n (n (n cn Cn (n (n (n ul Cn (n cn (n a7 (n Vl
r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r fn
m m m m m m m m m m m m m m m m m m m m m rn m m m m m rn m m m m m m m -i
m
m
1
0
Z r r r y x x 2 r x y r > r m A m r r >
Dmmm � � mm0oo caoymnDncomDnmmn > G) W mmccn � -
r � `- O � TTo � � � � xK = q) 9 � xK � � � � AOz MZ
mn `cm c ,D- m mAx m � cD ? O
rWn
mm z � Z -DI nl v
x -i z m y m
x
Z X Z -°i
p O
m
•m 0
m
! m
D y
m �
m c0,
N (T Cwt C\ A N N N N N N 0 A
co co N N N N N - - - - - - - - - - - - - - - - - -NNi — NN - - \ y �
cl1 Vl W W d0 N N J O co OD O A A A W W W W W OJ OD OD a OD N OJ a OD OJ (T \ \
co co <o io co co co co co co co co co co co co m co co co co m m co co co m co co co m 3
co c0 <o co co co co mcD aoo oo ao ao oo aowwwmmmooaaoo aumaoo mao oo oom
! ! ! L1
N N (\ (T A N N N N N N N W N N N N N N N N ! ! ! ! ! ! ! N N ! ! !
(� cooo W a - - o a W - - - a — Vt J J O
to (O t0 (D ID cD (o (o to co to (o (o D cc ( (O fD co to (o ( (O co to (o (o cD co (o (o cD to 7
tD c0 c0 t0 (O (D (O (O (O OD OD Ol OD OD 00 W W OJ W OD 00 Oo OD W 00 N W OD 00 W OD W OD N W fD"
C1 p D D D p 0 0 0 p p p O p p p p C7 C7 C7 n p p O p p '- O D D
(ncnnCnmppp (n (nCn (nCna7 (n (n (n (n (n V) c� C� nc� cn In (n Cn cnyynW pOw:
0
O
c
W N NCn W N N W NN N
T .t..m T 'O 'O t �l � t 'D t m T T T T T T-t "71 T T T T T Z T '0
N
-
N
O
a
A
cn
• N
O
N