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27575 -•n PFLIUAN I-1 U FILL'IN INPUMMA I JUN WI I MIN MMU LIMMO-UDG HALL FUIM I YIN VNLT PERMII'ND. ����, i1�ITYOFCUPERTINO APPLICATION/PERMIT --PLUMBING [ BUILDING DIVISION PILDING ADDRESS: / �,g/{/(' v ED NO. APPLICATUNSUBMITI'ALDA' •({yl(./ C. UNIT LOTH IZ��/� OWNER NAML �� PHO?E:� C CONfRAC 'S NAME: •�� LIC NO: L LL 55 •t Ait�V gW`v/'• "UNTRULY ARCHITECf/ENGINEER: LIC NO: ADDRESS: CONTACT: PHONEWWI 111I:DBiU PERAUI':ItIAO 'Fa�.%'I�'•''4 • - BLDG E�LEyC,T UMB M['�CIII PERMIT ISSUANCE LICE.NSEDCONTRACTOR'SDECLARATiON APPLIANCES-RESIDENTIAL JOBD Diaz Ihcrtby altirm the.l arnliarsodanderprovi.tad.fOhapta 9(comm�merrcing with 00 Sado 10MW Division 3 of the Business and Pro/eed«s Colo.and my license 6 In PANELS {JE full torte end erten. yVy ts"u�s Uccnse Clev Uc.N yF-G h Date Contreclor 201�OW AMPS �+FL000.A 3/SO.FT, ---- z F3 ARCHI'TECT'S DECLARATION OVER TWO AMPS 00Z�ev I understand my plans Aull be used n public records. 1 F� E7Jjl SIGNS ELECTRICAL � �d{BAST u«nxa prwe�innw �y OWNERBUILDER DECLARATION SPECIAL CIRCUR/MISC. gO F- 1 hereby&Rmm that I am exempt frond the Coosetoee License Law for Bre © c LL y fallowln8 rte+on.(Suction 1031.5!Business W Professions Code:Any city"only TEMP.METER OR POLE INST. h V: aJ which rtquir m a permit m construct,elm.Improve,demolish,Or repair my... y}� pBor 10 In lasuace,elsa re,&res the applicant for each peredt to rile&signed suamenl POWER DEVICES Tho,he Is II«nsW out to the provisions of the Contractor's License Law(Chapter I p0 with Pov SWIMMING POOL ELECTRIC VALUATION uL 9(comnmendng wish Sucllon 10o0)ofpivi.lo Sof the Business and Profeadoa Cade) «thn he is exempt therefrom and the basis for the alleged exemption.Any violation of VILEfS-SWRCFIES'-FlXTURPS I Fp�ZZ,,>• Sall.1031.5 by any applicant for•pernlUubjecs the applicant m•civil penalty of 6 � nes,ram then five hundred dollars($500). NEWRESIDENTALELECIR _SQ.Fp. STORIES TYPE.CONSTRUCTI( ❑ I,uowrmofthepropMy,onmyemployeeawlthw&gautheirwleconnperwdo. winI dothewont.sodthe Theaun IsrotIntendeda Law apply 1044,Bladr Of and Profescrrywh bas Code:The Cohereons and who IeW such ten apply tort orogen Of Imgenywhobuild.onimFoveathesean,eodwh.dm rvch workhim elfarthmughhia (XC.GROUP RFS. NItS employe.,pt.vMcd Ihet rvch i mpovements art of I Nended R offerod f«W c.If. bojldc gthe love of MOi.S that he Wnoeyear ofcarsome f.,thcowar- TO �` builder will have the&stria.a/ptaring Ilan he did ret build«Improve fon purpose of anis]. •u i w •x .. FLOOD ZONE APN ❑ hmowrrcrafthe ptopertY•ameaduaivelycotrmtin8 withlittnxdcotractonto A commuct the pmfuct(Ser.1oa4,Business and protest...Cat:)The Cotratnls PERMIT ISSUANCE Lia.selawdoesnrot epplymm owoerof poperty whoburlda«Improvus thcrto,erd [' �p whncmtracsfm such pmJecs wlth&contrea«(&)Ikmsod punumtlotheCotraclar'e ALTER-DRAIN&VENT-WATER(EA) "- f"!4PBE SUMFfAhYk,&Jx !'d'.r'J�'� Uttme Lew. ❑ 1 ann exempr undo Sec. .B&P C f«thio rcew. Ou I WE FEES BACK FLOW PROTECT.DEVICE SANITARY Y N_ Owner Det° DRAINS-FLUOR,ROOMAREA.COND. RECEIPI'N WORKMAN COMPENSATION DECLARATION SCHOOL TA% Y N ❑ Ihcre9y affirm ths111uveaartNttm of consentmself-Insure,«a artircne of Fl%TURES-PPR TRAP RECEIPfN .% Wofkcn Cranpmlatlo lmurarmon&mHRodcopy BenotlSuc.JSW.Lab C)which PARK FEE RECEIPfN N coven ell employee.under this perm][. GAS-EA.SYSTEM-I INC.4 OUTLETS BUILDING DI VI Policy - Company GAS-EA.SYSTEM-OVER 4(PA) PLANCHECK FEE ❑ Cedifiedcopylaherebyfornhhod. 1.Wig N3 ❑ CratlBod copy ls Bled with the city Inspectio division. OREASPANDUSTRL WASTE INTERCEPTOR GRADING FEE CERILPICATE OP EXEMPTION FROM WORKERS GREASETRAP SOILS FEE COMPENSATION INSURANCE (This sectio need trot bec"Imed ifthe permit is fmmrchmrdred dollm($IN) SEWER-SANITARY-STORM EA.2WFT. ENERGY FEE t «len.) I ceni-4 that in Bus performnee of the smile fee which this permit is Issued.1 shall WATER HEATER W/VENT/ELECR ON employ any pawn In my summer w as to become sub)al to Bre Worker' PAID i C—Posm too new.of Cdlfomh. Deas WATER SYSTEMyyRP-ATING Dam ecei"I O �+ Applicant '/. O NOTICE TO APFl.ICANT:ifafter laking this CenlOeate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.FT. TOTAL: [-� bcc«ne xuhjea m the Worker'&CoreperuNo'mmiisimu of the labor Code.You must BUIL O fuMwlth comply with such Provisions N Nis Permit null be domed revoked. CONSTRUCTION LENDING AGENCY SEISMI z 1 hncl,&from and then is•c..mocd..lending.&o y for the paf«mmce of ELECTRIC O tic work f«which this permlt is ia.uc l(Sec.3091,Civ.C.) _ Under'.Name '-s. ',s-�a:y a;K sewer- jj�.?,3 '�tMtl . j y �. PLUMBING FEE 1 O W �Nntdfyy that I have read this.iplicadan aW elate Ilan the shove Inf«metion is w' ^-' N"4-�I'''vp>tr..r•.2v v.ri°�v. f- ffLL}UUrrw� commLlegrtemmmply withtlldty Wcwnly adinmmatN sure laws fail,to PERMIT ISSUANCE. MF.CfIANICAI. ;P. Pv buildingcnnnmction.mdhereby.0 darepresemadveaof dul,citymmtau,onthe CONSTRUCfI TAX 1 mewl.ment«mN property for inxpccdo purp«n, ALTER OR ADD TO NI (We).pce m ave,i sod kap harMas the City of CLpenlo against AIR HANDLING U (TO 10. CFM) lieNlitles,)ud t +oermaer which may-ey inmywryaeL1ae«against ea' Cil in t of tMepennR % AIR HANDLI UNITIOVER 10, CFM) Signam of p Ikm muactona, Dike PX1IALXH0OD(W1DUCFk PAID HAZARDOUS MATERIALS DISCLOSURE HP NG UNIT TO IW ) Ilam Raeipt N Will the applicant or future building occupant store or handle havrdos material IEATING UN ( V) TOTAL: m dented by the C'upertimo Municipal Code,Cheptes 9.12,and the Health and Safety Cod,Suction 25532001 Il PAN(SI GL 'SID I ❑Ya ❑NoIaSSU� f: TE iR t r -0 MP(311 IW,UWB'ID r+ Will the applicmterfulumbuilding occupantuxeeauiyrent ordrAcnwhich 't hmirddu ah cotmlina s as dented by the Bay Area All Quality M BI F.It-CO P VER IW.0013 R ) . Duties' DEC 211994 ❑Yea ❑No NEW ISTD IAL MECIL. SQ.FT. r � I have read de heeaNan materiels regatmnenn under Chapter&95 of the /� p California Heolth a Safety Code,Settlans 25505.25533 and 25534.1 undmuM Net C�T I Ur �UF'tN�ANO if the building does no,currently have a Oe.mL that It is my msponsibility trotify the «cupam of the re9uitemens which mull he Oct prim to issuance of a Certificate of • Occupancy. Owner«authorised agent Dare ISSUED BY: OFFICE