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S0460 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY /r�' CITY OF CUPERTINO BUILDING.E1.8C1'RICAL PESd ITNO, OT O BUILDING DIVISION APPLICATIONIERMIT PLUMBING-MECHANICAL J BUILDING PROJECT IDP.N'I'IFTCATLIIN BUILDING ADDRESS: SANITARY NO. AI'1'LICA'I'ION SHIJMI ITAL DA'1li lo OWNER' AMEPHONm CONTRACTORSNAME ^ LIC NO. } .V\ 6 NIC CON'fHOLp �ARCHITECIPIENGINCER, LIC NO: ADDR;SS. n ^ E3CONTACT. PHONE: G Aw U BUILDING PERMI'I'INFO ❑ Cnnsnllant Fees Paid by Applicant(initial) BLDG El--Rc;y PLUMB MECH El 10 ❑ ❑ LICENSED CONTRACTOR'S DECLARAIDON QTY ELECTRIC PERMIT PEE JOB DESCRIPTION I hereby offi.m that 1 am licensed under pmvi.innx of Chapter 9(commencing MWp2. with Section 7000)of 3 of foo....and Pmfa,ximto Code,and.,,y license i. RESIDENTIAL, I'IiHMIT ISSUANCE X-� in full force and effe _ � vJ r S-`S ❑SPDWh ❑PLUM ITN RITE PIPE. QU(J Lt<cnu Claes Lich AI.1'LIANCES-RESIDENTIAL [I AUDIT C]PLUMBING REPIPE F Z W'1Ume Contmnor U)Q ARCHUECT'S DECLARATION ChIU1.TI-UNIT ❑STRUCTURAL ~y Z 1 understand my plans shall be used m public record. I'ANIil.S MODIFICATION Z Oy_ Oil TO 200 AMT'S El INTERIOR E3 CHIMNEY REPAIR �14 Licensed Profmxional 20toi"AMPS IMPROVEMENT CSWIMMING POOLS Q OWNER-BUILDER DECLARATION CCY'w,d OVER INN AMPS ❑BATH HIiMODE1BEPAIR CUEMOLITION CL Q I hereby aso .(tion onnl 1 1. exempt s an the Cmnor,Cox e:Any Low for the K 3 a V following reason.(Station]DJLS.Business and 1'rofexzinnz h.dc:Any city nr,..cure SIGNS ELECTRICAL OTHER W LL y which" ines a permit to conalNcl,eller,improve,demolish,or repair any.wefure .LL-OQ prior to is issuance,also requires the applicant forsuch permit m rile asignedstatement SPECIAL CIRCUITIMISC. that he is licensed pursuant to the provivinas of Ne Commcdn's Limnos,Law(Chapter 1) 1+110100 (commencing win Scctiun]WB)of Division J of the Business and Professions Code)or TEMP.METER OR PULE INST COMMERCIAL d 6 eC that he is exempt therefrom and the basis for be alleged exemption,Any violation of C NEW BLDG/ADDITION C DENIOL.ITION �yN Section 7031.5 by any applicant for a portant xobjmis the applicant to a civil penally of POWER DEVICES ❑TENANT ❑FOODSERVICE not mum than Eve hundred dollars(55011) IMPROVEMENT 0(=O C1.as owner of the property.or myemployees with wages as their sole coloenWinn, SWIMM ING POOL ELFC'IRIC 2F- will do the walk.and the%wcture is not intended or offered hmwle(Sm.71W.Business COTHIiR 3 m and Prefensln.s Code 'Me Contractor's License law does not apply to an owner of OUTLETS-SWITCHES-FIXTURES property who build,or improves thermal,and who does such work hmmmlf or through his own employees.provided that such improvements ore not Intended or oDired lar NEW RESIDENTIAL EUiCTR SQ FI: sale.If.howeve¢the building or improvement is sold within one year of completion.me SQ,FE FLUOR AREA SISQ.t1'. mer l uilder will have the Icemen of proving that he did not huild or improve for put- PAID w pu.e of sale). TOTAL C I l the posted, lu. ly t l ng-'(if l' d ttodom In construct the P ject(Sec.7AL B . d{ (._ ns Code:)Th C I actor.L �/� Li- cerise Lx does not apply to ofp pent h build pm e:access.and QTY PLUMBIN E MIT FEE r p a5- CW] f rsuchp j s with rent 1 rl)licensedpursuant theContractor's (� C7 CZj La L PERMIT ISSUANCE "/� C I am exempt under Sec. .B&P C for this reason ALTER-DRAIN&VENT-WA ) ¢'�(N Owner Dale • WORKER'S COM19iNSNl'ION DECLARATION BACK FLOW PROTF,CT. F. CP . hereby affrnt under penally of perjury line of be following declarations: I have and will maintain a Cco opt of Consentto sem lf-inre for Worker's Compere DRAINS-FLOOR.IRg CONU. STORIES 'TYPE CONSTRUCTION salinn,as provideel for by Section 3]01 of the Labor Cask,for the performance of the work for which this permit is issued, PIXTURFS-PER TRAP Fl 1 hnw and will maintain worker'.Cnmpuwutinn Insumna,as require)by Sctlinn Iderfthe laldtr Cwk,for the performance(the work for which this pemnil¢issued. GAS-LA.SYSTEM- INC.SOL 'l. OCC GROUP APN My Won sLp p�t%,ptiorf rtie�anldy icy numbv,.i¢:/5.//,2 GAS-EA.SYSTEM-OVER J(EA) Ca_",des N =f9LL V CP,RTIPICGIT.OF EXEMPT ION FROM WORKERS GREASOINOUSTRL WASTE IN"I URCEITOR COMPENSATION INSURANCE BUILDING DIVISION PEES (this amount need not becompleted date permit is forme hurdled dollars(Slight GREASETRAP I'I-ANCHECK PEE Icunlly that In the performance oDhewurk fur which Inspection is-s.uoJ,lshup SIiWBR-SANI'T'ARY-STORM ITA.21X0 FP, not employ any pcnon in any manna m as u,become subject m,the W..kccC Coarsen, IiNiiXGY hili Z .cellon laws of Califomiu.Dare WATER HEATER WNENT/ELECTk �jGRADING ItiE 0 Applicant NOTICE APPLICANT:If,efer making this Certificate M tificate of Exemption.you should WATER SYSTE ?REATING 'H SOILS ITT E become xu comply the Worker's Conal,or this pmm, hal of We Laboaredn Costa You must f1: � forthwith comply with such provi.imns or p{trtnil shall be Jecmed tanked. WATER SERVICE LC Q 'y CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLh1B. SQ.IT. PAID `7Z Ihnnhyoffirnt that there is.......motion lo.din c (onhc I moneuoT Date kecciptM V 0 gogen y per the work for which this permit is isucd(Sec,tIW].Civ.C.1 TOTAL: O ULeader',Name TOTAL' Lenders Address yI,entry mol I have read this application and stale tbal he oMwu information is BUILDING IEE Fp) correct.I agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEE SEISMIC PER V Z building construction,and hereby authodze repolownsi of this city to enter upon the above-mentioned propeny for inspection purposes. PERMIT ISSUANCE ELECTRIC PEE $ O V (We)agree to alive,,mbe ily and keep mmaloxx be City of Curynino mmind labilitics.judgmems costs and expenses which may in any way amort,against said City ALTER OR ADD 11)MECIL PLUMBING FEE in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1.NON-POINT AIR HANDLING UNIT LTO 10,0(0)CFM) MECHANICAL FEE SOURCE Rp,('ULA'1'ONS. q 1,e�71 AIR HANDLING ON[[(OVER HI,IXXICFM) CONS]ROM ION]AN Signaturcnr Appl t 'onlgo,)) ate M- 1AUSTH000IWIDUCD HOUSING MITIGATION FEF, i 'ARDOUS MATERIALS DISCLOSURE Will thea scant or fumrcM1uilding xcupum sbuc nr M1andlc bw.arJnux matcritd ABATING UNI'1'(TO IfX1.INXI NTD) as defined by the Cupertino Municipal Cole,Chapter 9.12,and the Health and Safety Coda Section 25532(x)'! (XNI HEATING UNIT(OVER IW. BTU) 0Yc, M1�Nn VENULA'I'SON FAN(SINGLE RESID) PAID Doc Reetipt p Will the applicant or future building occupant use equipment or devices which BOILER-COMP(JHP OR 101,0(X)BTU) emit para d.,air economical,as defined by IM Bay Area Air Qualify Management 'DOTAL: CYe, XNto Uinrim I []OILER-COMP 10vBR Ig100,010BTV7 I have read be holowa .material. 1,under Chapter 6.95..(floc Cull- AIR CONDITIONER ISSUANCE DATE 5.25 bumix Health&nSafetyot came Code,a Sections 25505,255JJ and 255)4.1 a to antify the Lha if the NEW RESIUF.NTIAI.MECH. gQ.FT. building Joax notcurtan hevculennnpthat h ixua re(ita Certificate ythemracy. of be; oe m.di n a h' muIr st h n prim n,Issuance of a Cenifiealn of(hcupmtey. Own ol LAL� T ombodzed etc Dam TOl'AL: ISSUED BY: OFFICE > 4 > • � - � - \ _ ) © � - � / ) � \ ) - / \ ) , § 9 7 ' 2 \ 2 \ - 3 ) ) \ \ \ ® 7 ) � IM � � \ ) $ ( � @ • \ § z \ z � - \ - / ,per o C:5 � \ ■■ :