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S 2279 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING..ELECIRICAI, PIi ITNO 7 Q BUILDING DIVISION APPLICATION/PERMIT PLUMBING.MECIIANICAL 22 1 9 BUILDING PROTItCr IOENTIF'IGCI'ION BUILDING ADDRESS. ( SANITARY NO. APPLICATION Sl11tMITIAI.DA'I'S 103 3 /V y�jL�� ,�,D /0 tr OWjV IjH'-NA ?' � PII 1? CON'IRACIORS NAMIi: LIC NO: NIC CONfkol.a A /II'I'IEC'1' NGINIi'I{ I'NO. ADDRIi55: ❑ le ldT/ G 263 chi CONI'ACPHONE: RUII.DING PERMIT INFO i'(JJ(/ ❑ Consultant Fees laid by Applicant(initial) BLDG Iihf:CI' PLUMB MliCH U 6T/�, 17� ❑ ❑ LICENSUD C'ON'rRAC'IUk:S DIiCLARA1'ION QTY. ELECTRIC PERMIT FEF nxzI hereby alrrnr that 1 am licensed under provisions of chapter v(countercoup JOB DESCRIPTION,0C, I'I:RMI'I'ISSUANCIi win Senitn 9(NXB of Division Jonnc Buxinco and l'ndcsaiorv,CMe,nnJ mylicrn¢a RESIDENTIAL: WOO KWF in full lirmc ati ellcct. ❑511)W'h ❑KITCIIIEN kIEM(1DEh QUU Liccno,Class Liu.er APPLIANCIS-RbMDHN'I'IAL ❑ADDITION ❑PLUMBING RIE.11IPIE FZW Dam Concxror I <6 ❑MU1.T1-UNIT El STRUCTURAL ARCIII'IECI•S DECLARATION PANELS MOUIIICATIUN OZ4Z lundcnrnd ms,h y Planall M1c uuJ a,public rccoNn UPTONX)AMRS ❑INTIERIOH ❑CHIMNEY HIiI'Alk OW Uccr,cd Protcwional 211-1000AMPS IMPROVEMENT C]SWIMMING POOLS �c1�= OWNER-BUILDRR DECLARATION OVER IIXX)AMI'S ❑BAIII RIEMOUHURI;PAIR ❑DEMOLITION C Q I bemb,uRna that I am exemp from the Conaaemr',License law fur the d O W _ ❑O'IIIER k LU follow lop r.......I.(Section 7011.5.Inoinev and professions CMG:Any city or county SIGNS P.LECIRICAL W 3 W ha which rcyuin,a,...rit n wn.m.....Bar.iinpmvu.Jcmnlich,nr repair any arvclurc I�'u•OJ prion t L 4 .th ppl tf hpe tt fl g dsttemenl hl'hC1A1.CIRCUI I/MISC. W} Intel Ip n In p n fun c u t 1 nc1 IChaFmrO COMMERCIAL: 6=OCthat he i..exempt therefrom mmld theb, j flhu Rufni.xs.Wlr 1 CMu)or 'II,MP.MIEI'EROR POLEIN$'P. <� nc verala 5utln 9lanB h D c ¢si,fur the alleged exumpuon.Any violation of ❑NI:W BLDGIAUDI'1'ION ❑UIEMOLI'IION W ti vi Section 7031.5 by any applicant for a parnit subjects the applicant ni it civil penally of M)WTR DEVICES ❑TPNANT ❑FOOD SERVICE nal Inure t hat five hundt,ti dollars 05BB- IMPROVI?l TNT SSC (] I SWIMMINGPOOLELECIRIC F• will do the work,and the wmcmm is not intended oroffcred for sale(See.9U14:Itua c 7R 13m and I'rofavdon,Code ILe Continent Liectne Law does nor apply ,, in ovn, if OUTLETS-SWITCHES-PIXTI1Rr;5 O Q�L v property who bu11Jx or improves themon,anti who does such work himself nr thnmphnOng of his i wt employees,pravidod that such Impmecmenu are not in{andel or offered for NEw RISIDF.NTIAL ELIECI'R SQ FI'. val,11,howcvcu lhchuilJingoringnnvcubic, ,,,old within nncyc¢ndcunpletino,the SQ lT.FLWRAREA 5/SQ.f4. owner builder will have the harden of pfnving that he did not Rule or improve For pun +• .11113,ac f(r I,ur, of the pnpeny,; ,crsivdy c acting with hurried)in. connvcmo m (p rust the d,w,i sat(Sac.o an t Burvostar ct,.ad rmWho builds ut dswlc.nfin te,the ,..Li- cenmlawdresnotapply toan uwnnofpnpcny wM1obod purrimpmvcs Contractor's QTY. PLUMBING PERMIT FEE Who suntrap for such projects wilt v amtmcmgp licensed Pnnwm ni the Cnmmcmh Liccnsc law. PHRMI'I'ISSUANCIE ❑ Imncxct ttace .B&I'Cforl ACf ER-DRAIN&VENT-WATER(EA) VALUA'T'ION Owner Dom v._— �I WORnder C( 'NS.Y{ NUECLARAating BACK hLOW PR(YI'IECI'.UEVICIE I M1crchy uRnn under pc r uj C sof the palliating..dedarr,Coo / IhtrvcanJ will nminprun uCc�{Illfromul Cnn,cennn,dhlnwrre hrt Wnrkcrx Gimpcn- DRAINS-FLOOR,ROUI[AREA.C N STORIES TYPE CONS'IRUCTION Rotor,as provided for by Section 3700al'the labor CMG,fur the peniarn,rcr of the I� work fur whi,h,hi,permit is issued FIXTURILS-PIER TRAP � f , I have and will mtrha:con Workers Conimnmtion Insurance,as reputed by Seaton 'V 3910ofthc WMn Code.Rnlhc perloctnanmofdu work for whi,h this pcmtil is i...ad. GAS-IEA.ISYS'IIiM-I INC.4 Oil I.E'IS UCC GROUP AM My Worker's Compensation Insurance carrier and Policy number me: Currier: Pal icy No.: GAS-IEA.SVSTEMOVUR 4(TA) CERT ipjCAIIE 01;EX17M ITION PROM WOR K13 S' GREASIVINDUS IRI.WAS IE IN'I IiRCEPIOR COM PVNSA PION INSURANCE BUILDING DIVISION(HEIS (Ou-cotiouncM not bcenmplumd ifthe Renaul is Corona hundred dollar,(SIM) ORCASIITRAP or less.) I'LANCH[CK 1:171: I rectify that in thcpcUnnnarecoflhe work lin which this permit i,iswN.I shall SEWER-SANITARY-STORM IEA.200 FI'. urn mnploY arty Pan q - yuan er a,to hcenu a"ahjccttothe Wmkers'Compen- ENERGY FEE 6 z xYlltn laws ofC116 inn,1' WA'1'Ii1t IlEA1'Ii1t WIVIiN'llliLECI'R z 0 nrprr rat co GRADING 19Eli NOI'ICI?TO PYLIC, L nl cr ma kin 'mificae of Exemption,you should NATER SYSTEM/IREKI'ING h SOILS IEE )seta a cuhieal n the Wndm"e Cnrnpunc on ruvixion.a...l'the Lvbnr Coda Yon must y fonhwilnhemhy aRllprnvisioav or pcnnrl,hull he deemed rcvokcA. WAfEk SERVICE ••�� C0N5'B11C1'ION LIENDIN(1 AGIENCY NEW kIiSID[N IIAh PLMB. SQ.I'r. PAID�9— � f 0712 VO D z nnFlatthemis.conshuainnlcndingagcncyforthe rfunnmwnf D"" Rndrpta / Sfp U. P the work for which this pcmtil' ISgc.300'1.Cr,C.) Leudet',None su 'TOTAL: L) I odaf,AJdt,, 'I'lYl'Ah; �•" 1 racily that I have mad this application and sura that the above inR...atio;is BUIhUING I I[Ii 0. f.� a building Iagreector.and whhoil rul nod ammyoNloanees tis crnc)crerupnpr QTY. MECHANICAL PERMIT PfiE SP.ISMICFRH V z building umdmnion,and ncrby uurbnrim repretvnlaivca al this city nicmcr neon the aMrvomentioned pmpeny for inspcaion purpose. PERMIT'ISSUANCE ELECT It IC Rei O (Wc)asrce It same,indunmify mW keep harmle,the City of Cupertino vgaimt Iiabilldws,pid ner".cows and exlrsmes which nay in any wary:ecru,agai ast said City ALTER OR ADD'IO M ECH. PLUMBING IyEIE coust it aofthe granting rf this permit. APPI.IC UA: SIA SAN WLLCOMPLYWITHAIA NON 1011 'T AIR HANDLING UNI'T('10 IR000CPM) MECHANICALITE SOURC I IN AIR HANDLING UNIT IOVI?k I0.I00CIzM CONS'1'RUC'1ION TAX Si nalnerl A,Ii,r lContimtar Da EXHAUST BOOD(W/DUCT) HOUSING MITIGATION FETE IIA""/.ARIR)US MA . I US DISCLOSURIE Will the applicator future buil ag enpantstomorhadleharallousmamrial HEATING ONE I'(TO 100.00 RT UI ac dufinnl ray the Cupcnine Mumtlp c,Chapter 9,12,and the Health anti Safely CMc.Suction 253321x)° IIL'A'I'INC,UNIT'(UVEIt IBB)XIII Irl U) E3 Yes is VEM'B.ATION TAN(SINGLE:RBSID) PAID Dam R ipta will the.,,Mount or hurt,building©cupa a use cyuipmant or virtual which mil kumrdom air cortamimnl,a,defined by the B.,Are.Air Quality Management ROILUR-COMP(31111 OR I(X4NXI BTU) 14PAI Diwrict.' I3011.ER-COME'(OVRR 100.0,R)BTU) ❑Yes rcuJ mNuus rna'trials Chapter 695 of Cali- AIR CONDI PION ER ISSUANCI;DATE hnnia arc c.Sections 2551)5.255;13 unJ 25534.1 untic:srnd rhxt it'the NL'W RhSIDEN'rIAh MECH. SQ.PI'. buildingJcn t c')cainv, at it re,rymxiniliry it,notify the tcnrpam of thereyni hr eiLCw'{i t are of a Coati �rIOc ma DwnernIs cat sum TornL: ISSUED BY:Jsq� �A.7O.t.-6CGi r .. OFFICE