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S 2881 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUI'F.N'PINO BUILDING-ELECT RICAL PERMIT No. BUILDINC DIVISION APPLICA'I'ION/PERMIT' rLualRlNr.-MEcunNlcnl. BUILDING PROJECT'IUEN'I'IF'1CA'HO\' S" SANITARY NO, API'LICAI'ION SUHM1II'1'IAL IInTIi BUILDING ADDRESS: q I l WoL OAp O0 r/ 2 -Q OWNER:SN E: pAtA I'ho.' CON'I'RA(DOR'S NASI E: LI 'Np 650- 44 OO �� •q� /V NIC CIININULp ARCHITECIENGINEER: LIC NO' ADDRE.SS: of F'/ f-I'i ❑ 2 7 O CAM AZA4.4,l..) C'12 S6 All uta IA s„xnE 1000 Spill K0 CONTACT`. PHONE: 13UIIAING IERMITINFO ❑ CnnsUHant Fecs Paid by Applicant(Initial) BLDG Fului' PLUMB MECH 99Elr/ PAP, .�� �2 V- � W k LICI?LASED CON I'R :I OR'SIIECLARR11ON QTY IdLECT'RIC PERMIT FEE I herehy alrrru mat Inn+hcea,ed ander'revi,sion'of Chalon,Y(commencing JOU DL'SCRIP'I'ION with Seetieln 7g)OolU sion3of the Huxincs'anJ 1'n,fc,viom CWe ted my licetcls RESIDIiN'f1AI,. W C10 / PERMIT N%UANCL -1- in liJl li�¢c wild Blit ld�O b O r ❑S(UWL ❑KITCHEN REMODEL <UU Locate 'as Lic.If ( gp'L1ANCE1-kP_SIDI!NTIAL ❑ADDI"FION ❑PLUMBING R17 PUIE F•Zty IJwe �� •�" Coll tn6a �S - ❑MUUI'1-UNIT ❑S'I'kI1C1'URAI. p„'J h PANELS WilMTrypt ZOtj V I undcraund coy flails slwll he used an futile records UI"1021XIAMI'S ( VI OZ• ❑IN'I RI It ❑CII NI:Y N a14tcj Liccnsa.I Pool..siomd 2111-IIXh1AMPS _ IMf�I{f�11 iME _y—. ❑S MIN IS `t�,�J OWNER-BUILDER R1HU1LDIiR DIiCLARA'CION OVERT I ' ❑IIK,l�l11I``I4ILR�I:MODHUREP.\IR (]DIiM01.1I'I N 6 I hereby olfom Ilan I: x nVa 1'nm+the Cmn"mtnr',IJecnse Law for the (yCI�I*CQ R X d U [allowing rut.on.(Seaton]0315.Homiletical]Professions Crude:Any city ell county S S IiLECCRICAI. W 3 LL y which tcyaims u pu"n"t In camVucl,aIle,impress,demolish,or repmr any satellite --x 1,�c� prior to its isumnce.also requires the applicat our inch permit m file a signed statement 4 I'IiC1AL CIHCUI'I/ Nan he is licensedpucwnnl in the J,oilier,ill''Ile CnmrnctelI cense Lnw(Cbtq+mr9 —RU �adp0 (comnwvming wiN Bretton 9lXppd Division 3nftM1e Bu,inesa and Professions Codc)or [MV.AIFTEk OH POLE S' AI a a e IY then he is exnnpa thetuGelm:mJ the basis Iia the allebeJ cxcn+pdnn.Any violation of /ADDITION ❑DPMO 'I'1nN R' Section 7031 by any xp,head for a permit subi Ne applicant o.moil penahy of IY) 'ER DEVICI?S NEVA, E .- not mom than rive hundred dollen($510). FSQ Lin owrmndtlm n,unn to ecxwithwa'csmtheir.volccum tion. SWIM VG IYR)I. iJ: IMPROVIiMhNT EpmPe > yanp r g penya ❑OTHER p. will In the work.and the structure is not intended or nnerW for sale(Sec.70.14, foo'e.vs LL1 w unit Ii..teoiane Lode,TM1e Canntdnr's License haw Jxs not apply ,,an owner ill OUTLISI'S-S "fCfilLl- S f 1 property x he build,or+mprose,thereon,and on Aae,wch work himuelf m or tight It,own cini loyces,provided That steel inpnovelawle y are all intended ter offered for NEW kP 1 ""'TIAL : 'GTR SQ F . sale.If,however,Nebuilding orintpinvcmentiss sold within oncyenrefearnpletion.the SQ.Er.FLOOR ARRA VSQ.PC. cnbaildcr will have the hutden of Proving that he did nal halo ter oupmve for par- S ,16 ❑ I,a owner of Ihn property,mal sennsvald cone"ultg wit IiconxN baso,ons l- ( 3 mse La the plant(Sec.'/IOy Baseness unit Pmw holo n es or oustThe eemmreon.,ad nclaawdts for such Er m,es with acafpoS+eny whesedJaronyprnve.mercon,und QTY. PLUb PERMIT FEE who„mvaete far wen Prnjeeo wiN a cnmmeu+rtsl licensed pumuam m ahs Contractors li,xnw law. I'ERMI'IISSUANCE r I� t��S ys �H k P^C,'fnr Nisdrp5on G �_ Y�� Gia( AI:I'IiR-DRAIN Nt VIiNT-wAl'IiN(HA) VALUATION -�flwncr I ..f WORK17R'S Co MI'ENSAI'ION UECLARMION BACK PLOW'1 ROGII`1',DEVICE IQ Q QQ l y Ihcrcly uffvm ander pun:Jty of Perjury nuc of the following Jwluttionc fff / Q Ih:rvcanJ''ill mmnlainv Ccnificvle of Consent to xdl-imam iia WnrAcr'n Cnmpcn- DRAINS-II,OOIt.Rf TOR AREA.COND. g'IflR1I?G '1'1'PE CONS'rkllCCl(IN xminn,u,Ile'ldnt lin by Section 37Ib of the Lnhor Code,Tor the perfnorn nce of the work fell which this pcnnn is i...ed, I;IXI'URES-[Ili A o�1E Fj 1 June unit will Maintain Warkcr'.v Cnmlwnslnion Imam l,c,as required by So,, n 37M of the Labor Code,for the performance of the work for My Workers Conq+<nvallon(mnraoce cerricr:md Policy ata" G - B-2EML 6Ff66 316 OS-0i5 IJ canter: roucy Ne: CER 11171 CATS IIP EX EMIT IONI+NOM li S "tl LICE U 1 CIIMPENSATION INSURANCE: HUILUING DIVISION ITCS (This section need not tecmnpleted ifthc permit i,for en In L, tPEAS or less.) 1'I,nNCI ECK Plili I certify lhvl In the pvrfonnanee of lhewnrk lorwhich Ibis Isbal Sllwlile-SANITARY-S'roRM1?A.21x1E1'. "ill nuplay'any person inany manner so as to become subject to a .Compete- IiNP . tZ cation Lw,of California.Data s WAI ER HEATER WIVEN'1'/171.17(:[1" OO Z O Appl�:ard r D FEP: NOTICE TO APPLICAN f:If.after akin this Cerailleate of Exc"tptinn,you should WA'I'FR SYSTIiM/I REAPING rte )I. Illli I"t forthwith moan In the Worker's Co..,I,,]It, pais"but 01 the coned Code,you mmt W > Hmhwifh comply wilt such provision or dais permit shall he JeaneJ rcvaAcJ. Wpl'Hk SERVICE, a r, CONSTRUCTION LENDING AGENCY NEW RESIUEN'IIALPLMH. sQ.Ff. Uac kcceiptx U O I hemhy ullirm(hill is a construction lending agency or the pertbrmance of U. E-- the work for which Nis permit is i...ed(See 3097,Ci¢C.) ( / O Vixieer's Name , (.ender',Address 1 eenify that I have read thlx upffeufi..n and'late thm the aho,,infotmmhm is BUILDING P li .F., to coned.(agree a+comply with all city and county ordinances anti no.law,midnight Q'fY. MI:CHANICAL PERMIT FEE SHISId Q UZ buildmg Sairseucaion,ond hewle,authn.j,roparocntativesof thlxcay ,,enter apnnahc '- above-mentioned popeny for infection parptxs. PERMIT ISSUANCE f IiLE 1' li / (We)agree a ...c.milearnlly and keep Aannlas blue Cay al Call agau-I lialiliaies,iadgments,c Jexpe w%which may in any way accrue against said City ALTIiR OR ADD TO MECH. I'( it 317171? © f mseque t e gran� g of this permit. API' .,NT UN1)F ANUS ANU WILL COMPLY WI'f11 At.[,NON-POINT AIR HANDLING UNIT(TO Ifk(IHH CPM) Q SHICH NICAL ITT r S I. DNS. � Alk HANDLING UNIT(OVER 10.000 CFM) CON. 'RUCCION TAX g lit d ,p s.;, Dae E.XHAUSTHGOD(WIDUCf) IIOUSIN( 11TIGXI*iON FEE HAZARDOUS MA'IERIAI S UISCI.OSURE O Will the appliemn or tuuac bailiingosc....al toreor handle ht artalomaterial IIEACING UNI'1'pT111x1.ULYI ETU) as Jdmnl by the Cupertino Municipal Cade,Chapmr 213,link the Hcehh and Sofev HEATING UNIT(OVER 100,('x)H'1 U) Code,Section 25532hC p Yeso VENTILATION FAN(SINGLE RP_SR)) PAID Dulc kettiPt x Will the applicat or Yh ere lultJing oectiont use equipmcro ur evices which BOILER-COMP(3HP OR 1(IH.DxI H'1'U) t hevardous air enrol sear as defied by the Pay Area Air Quality Managcmcnl 1( �Diouin'I HOILER-COMP(OVER(00,(x10 JIM) C)Yc, + I have read the loanknorntetiak is under Chaterfi 95 of the Call- AIR CONIII'1'IfINISR ISyUANCF,DATIi myutrcnu° P (F/Tf�l// F lorda Ileallt R S 'IY Colic,tinct,.....255115,25533 and 25534.1 undemm�d Nut if the NEW RESIDEWIAL MEC I. SQ.F4. huildmgdee,no 'u m( willNount.that it is my re"m,infily In amity Nc..ccnpant oflhcrngdre oh"o, Vow,Pner m iwwumw of a Cc It I I o9cnpvney. Owner nwht reA agent ) Dam 1 Al It (SSUI!D BY: ` OFFICE