B 0345 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING..FLEC'I'RICA], PERMIT NO
BUILDING DIVISION APPLICATION/PERMIT PING PROG.MECDANIFICCA S0001 .0345
HUILDINQ YROJIiC'I'IUEhTIFIG1TIfIN
HU'i INT ADURESS' SANITARY NO. APPLICATION SUB41TTAI.DATE
l C /7YF
OWNRR'S NAME: PHONE: C NTRACrORS NAME: LIC NO: _ O
kill Firr_ •I W& G' C�� 1pC �d7Z 3 N/C COV'I HOLT
�ARCO]FLUT/ENGINUR: LIC NO: ADDRESS'. ❑
CONTACT: PHONE: BUILDING PliIi MIT'INFO
❑ Consultant Pecs Paid by Applicant(Initial) BLDG F,LECT PL11M11 MHCH
qC 3 / 1' (9 O ❑ tom ❑
LICIiNSF.0 CUNTItALTOR:S DI.CLAHA'DON QTY ELECTRIC PERMIT FEE
1 helebl affirm Ina I am licensed ander poodmarx of chapter 9(emnmendng JOB DESCRIP'T'ION
O�Z 1hSenior7y'H`fDivishm LtOhe❑nxincxx valPmPonians Coro.and my license is RESIDGNTIAh:
ado mor PERMO'ISSUANCE
FW2 in full force anA eRc P O fPZ1O UR��'O ❑SPDWL ❑KITCHEN RHMODEL
GUU Littnm Cl;�_,.,�_.��V Lic.M APPLIANCHS-RESIDENTIAL ❑ADDITION ❑PLUMBING R17 PIPE.
tort Date ^�' Co.lme m lC
AHCIII'IF.CI'S DECLARATION ❑MULTI-UNIT ❑S'FRUCTURAI.
1..p w PAN LLS
ZOi Z 1 understand my plans shall he used us public records MODIFICATION
OZ T- UP FO NEE)AMPS [I INTERIOR [I CHIMNEY REPAIR
F'_'.F.W Licensed l'ndeoional 2111.1000AMPS IMPROVI:MEN'I []SWIMMING POOLS
�YS- OWNER-IIUILDIiRDCCLARKIION OVER 1100 AMPS ❑BATARFMODEI/RF:PNR ODEMOLITION
at 6 1 hereby r(fnmo that 1 am exempt frothe Clouse....'.License Law for the
El
xa O a V following mean.(Section 70115.Business unit Professions Coafc Any city or county SIGNS EhECTRICAL QfHFR
til 3 4 N which requires a permit la conduct,alter,intpmve.demolish,or repair any.nt
prinrm'na issuance.elaorsqulre Neupplicanl furnish le red,refile a signed xm¢me, SPECIAL CIRCUIT/MISC. MC\
ffy�Y Ilial he is licensed Pursuant to the pnwnruroof IM1c Conownes l,kenm law(Chapter 9 r�
-.Co (enmmencing with Section 700)of Division lad the Besinma and PmfcssionsCodc)o. 'TEMP.MIi THP OR POLFINS91 CGMMERGIAI:
11
d a e W Nat he in exempt Ncreflso and the basis for the alleged cs orpam .Any violation of ❑NIiW BLDGl HUN ❑DFMOLI'I'ION
y Section 7031S by any appliarnlfora permit xobject,theapplicant at a civil'malty of POWER DEVICES ❑TFNANT ❑FOOD SERVICE
m marc Nun five hundted dollen(5500).
[-ZY IMPROVEMENT
Q p1,a.owner of the pmpcny.or my employees with wages as their site compensation. SWIMMING POOL ELECTRIC
will do the work,and the small is not intended or offord for-le(See 7044,11nsinen.. ❑01 HHR
I�il3m and Pmfeesiora code:'rhe Control License law del not apply u,an owner of OUrLFTs-SAFE CHFS-PIxTURCS
to pnmery,who builds or improves thereon,and who docs stmh work himself or through
his own employees,provided Na such ideprombi is um out intended nr offered for NEW RESIDENTIAL IiLECIR SQ I-r
xnle.It.howl the buildi ng or lmpmventem is mold within one Year of completion.the SQ.1'r.FLOOR ARIA SSQ.FI'.
cr-builder will hnvethe harden of proving that he did nm hall]nv improve for pun-
' paw of sale.).
❑I,as owner of the pmt rt%unt exclusively central ng with licenser contractor,to T(t'I'AU
construct he pmjbct(Sec.7144.Ruaim,,,..it Prefcssinnx Cr JTheCommetorx1.l-
Lawdoes me apply m an ow net of property who builds or improves them...and QTY, PLUMBING PERMIT FEE
wmho comms,,,for such pmlects veldt o eontmcmr(x)limnsod punmrm re.Ne Coolraocov s
License Law. PHRMIT ISSUANCE
7 l um exempt under Site ,[I Ar to C lire toomillion
ALTER-DRAIN Re VI:N'i'-WA'T'ER(LA) VALUATION
Owner Date
WORKERS COMPENSATION DECLARATION HACK FLOW PRUI ECT.DRVICF. V� OE)
affirm 1 hereby arm under penahy of pe jury one of the following declantiam: V
Ihnvc and will meinwrn a Certificate of Consent In xd[-'noune for Worker's Cooper- DRAINS-FLOOR,ROOF.AREA.COND. STORIES TVPL CONSTRl1CUON
motion,as provided for by Section 4700 of the Labor Gds,,for the lerfnrmunoe of the O 1
ark liar anti Nispanni)is orker I'IX'NRI!S-I'ER TRAP /{�(—'
❑ I have and will natintfor Worker.Gnce nt i,w rkfar which
h required by Section
Aro rill,}yrJa��hn Cods.for theyyPlInnc•trtli��tnn•,an{{[[ce of Ne work fyoyr�wlh�irch�ryNis pcnnitis insmd. GAS-FA.SYSTIiM-I INCA OUTLETS OCC GROUP Pb?
Cu ertrk 'ora nit7/''�p)e p`Jcy,.... (I 70t IFS GAS-F,A.SVSTI:M-OVER4(IiA)
CHRIIFICAIli O�PI'[ON I7ROM WORKERS'
COMPHNSAI'ION INSURANCH. GRFASUINDUSIRL WASI E INTPRCEPIOII
BUILDING DIVISION FEES
(This seeion nerd not the completedHNe pennil in forobe hundred dollars(S IH)) GREASIi'IRAI'
nr Icss.) PLANCHECK IRE
Iccnily lhmi perfarmanc O cwork for which this ryrmir' ual.lsball SI:WI:R-SANITARY-STORM I:A.2101T
not employ anY le r any mann No hccome nubl¢lle.lhet r ri Compcn- FNEHG1'I�EE
O Z svlion Lnwx ofC 'r WATER IILA'IER WJVIiNT/FLBCTR GRADING TEL
Applicant r i c
h N(IflCii T< PI'[.]CAN'1':IL al staking it 'nilicute of Ir emPlion,you should WATER SYSTENVfREATING
became subject to the Workers Compemahon p lions of Ili .vhor Cads,.You mall g(11Lg P
WToro comply with such pro l.bns..rrnsx noir sIt Jibe coed resulted. w'ATIiR SI?RVICE
d Q
U1 CONSem is acONLENDLNGAGE 'Y NIiW NESIIl1iNTIAL PLMH. SQ,FT, PAID
L arc Recmpl M
UO thereby n(firm mm nmre is ac..nnwetion lending a ncy mor am permnnancc..f
Ne work for which lhin peroor i.issued(Set.7197,Civ.CJ
I U 1xr=Nall¢ TOTAL
r Lender's Ad ince, �IAU H�111. ;PF.B
1 ttnify that 1 brve read Nis application and state Net the ebrve infommtion is
,H. h correct.I agree m comply with all city and county ordinances and state laws relating to QTY MECHANICAL PERMIT FEE
U building construction,and hereby vatho...c repreacntatlres of his only roomm�rponrhe SERVE .FRE
alarvomemioncd pmleny li,r in 'tion popo,zs. i'BRMIT ISSUANCH
(Ws,)age o e me,not sin y and keep handle, a Cit If Cu,,onm)against P,LIi HC 1'EE
Iiahili ZitiJ mcnslaan ,.Inch magi Y wary 'meugain.rsaiJCily ALTER OR ADI)TO MHCfI
once. -,a u- dNe grand lot his perndx PhUh1B1 ,PEI. 0
.APP_IC UNDFRST . 1) AND WILL Cr. PLV 'ITII ALL NON-POINT AIR HANDLING UNI'I'ff0111.dol CPM)
SO IR ' 1GULATIO MHCHANICAL FFR
/Q AIR HANDLING UNIT(OVER HL000CPM) CONS'1'HUCr10NTA%
si mea Appl WC vnranor u Dam BXHAUs'1'HOODCVMUCTI HOUSINGMII'IGATIONFEIi
HA9ARDOUS ERI IS DISCIASURB
WillrM1eapplicanloraturch dingm abort uom or handle haieardsos material It EATING UNIT(TO IDIly)BTU)
as defined by be Cupcnmo Municipal Code.Chapter 9.12.and the IIcu1N and Safety
Cale,Se.on 25532a)1 HFATING UNIT(OVER I(0,(g0)BTU)
p Yes ❑Nn PAID
VENTILATION I'AN(SINGLC RI?SID) Dae Receipt#
Will the applicant or future building(occupant use equipment or devices which
crnthamrdaa.mrannantinan¢as defined by he Bay Arco At,Quality Management HOILER-COMP(31 IP OR 10(1,(X0 It I'll)
Distn"? Z'f 'AL O
El yes ❑No BOILER-COM P O)VIiR I)OdMO)BTU)
AIR CONDITIONER
I have read the haul smnrn rryuianenu under Chapter 6,95 of Nc Cali- ISSUANCE DATE
fomiu IICWN cit Surety C Shin 5. 5.25544 wJ 255;41. nnJcntwul Thal if the NEW RESIDFNf1A1.MIiCH. SQ.14. C
htildinglkexnone, y veal earth. it is mY rc.pmxihilily ossify the rav'nrym
of the requncreants i- test met demiauanccor'Ce R mol(kcuryncy.
—It0
(honer ar emh9na agent la TOTAL ISSUED BY:
OFFICE