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S 3162 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CI'T'Y OF CUPERTINO BUILDING-ELECI RIGH, PERMIT NO. BUILDING DIVISION APPLICA•1'IONIPERMFT PLUMBING-MECHANICAL S 3162 BUILDING PROJECT IDEN`fIEICA'I'10N BUILDING ADDRESS � ' SANITARY NO. APPLICATION SUBMITTAL �DA TI IMI, (V. . t (hTv� q5O'� Q VCA 1 ACONTRACTORSNAMFLIC NO ,2I _45SUTP NIC cons oLn ARCH]FEC'VINGINL'L'R; LIC No ADDRESS: ❑ COM'AC'1PAUL, -r �SOl4le C� BUILDING PERMIT INFO Au� TAra p s CU � �� 26� ❑ Cmnsullanl Fees Paid by Applicant(Initial) BLDG C PL9 ME LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT' FEE irk,/ I�'I{ 1 hereby afenm that I ant licensed under pmvi ion of Chapter 9(commencing .JOB DESCRIPTION <0 V with Se.on 700(d of iv'mim 3afthe Bunke erd Pndey.mr,Coec,mil my hircus. RESIDENTIAL: F w full H n PERMIT ISSUANCE V LicenoC ❑ADDITI TCHEN REMODEL Xaa Dan APPLIANCES-RESIDENTIAL El ADDITION ❑I'hUMNING RB-PIPE F,Dw ARCHITFCTS DECLARATION PANELS El MULTI-UNIT ❑STRUCTURAL Z O on Z I andetsmne my plans Quail be used as public record. I MODIFICATION O Z,.= UP 10200AMPS ❑INTERIOR []CHIMNEY REPAIR {-Kt:W Licensed Professional 201-1000AMPS IMPROVEMENT ❑SW'Ihf MING P001,$ �W=< OWNER-BUILDER DE he Ceri110N UVE:R JIM)AMPS �.lPA'1•a REMODEIIREPAIR ❑DI?MOLHION Q 1 hereby affi Iha I ten excite fnmm the Centrndor's License Law fur the X 3 a V following rcasnn.(Section]UJ 1.5,Business and I'rvfersinns Cale:Any city or county SIGNS ELECTRICAL ❑OTHER a In which mi,rirex a pennil to construct,aller,improve,delnorsh,or repair any orr clmre o) Prior m un its ismce,alxorn,ne.IM1e apploan'el'orsuch penuitto tilt,a signed swtnment SPECIAL CIRCUI'UMISC. fu},., that he is licensed punaantto the provisionwfthc Contactors License iaw(Chatrar9 Wa�GO (nonm¢neing with Section 70(0)of Division 3of the Business and Prufeanimn CtalcAa TEMP,MISrRR OR POLE INST. E ' A.Z.ey that he is uxcnnpe therefrom and the basis for the alleged cxcreplion.Any violation of NEW HLUGIADUITION ❑DE,MOLITION XmlaSection]031.5 by any applicant for a permit subjects the applicant to a civil perrilty of POWER DEVICES {�-y El TENANT' ❑FOOD SERVICE not more than Five hundred doll...(551X).�• IMI'ROVIiM1iNl' =6 do theverof the pestruc,mmyomntended with wages asae,(Seee (W.Baation, SWIMMING I'OOI.IiLF.CTRIC IJortework.andthe.ramose is not License Law Jofor salelSce.]t1w,Business (n El OTHER Y 3 ce and Profe,aiunx Code The ConOvamr's License Low Aron not apply m an owner of ' OU'fLP,'I'S-SWITCHHS-PIXTl1RE5 t 'Z propa"y who builds or improves thereon,and who Joey ouch work himself or through his own employees,provided that such improvements me not intended or oOered far NEW RMIDFN'HAL ELFCPR SQ ET sale.If.however,tbeh.ildiogor impmvemem issold within one ycarafe—proom,In, SQ.IT.FT.fN)R AREA S/SQ.EI� cr-builder will have the barren of,r ing that he did not build or improve for par post of wlcy v ❑ I,as owner of the prop ,vrt am exclusively connecting with licensed eumme ni n, )IAL: nswc.the project Ser.9140,Bushes.and 11 fessit I,Cale'.I'Ibe Cuntmnor'I I.r Law does not apply man owner ofpropemy who builds or improves thereon.and QTY. —PLUMBING PERMIT FEE who commetx far such pmjeas with a unnmcmds)licunal prea antto the Commetors License Low. PERMIT ISSUANCE O 1 am exempt maker Sec. .B&P C fro mi...... Owner Date ALI ER—DRAIN&VENT—WATER IEA) VALUATION WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE V^ I hereby affirm under penalty of perjury one of the following declamlitms', o [have and will maintain a Certificare of Consentto sell-insure fir Workers Compact- DRAINS—FLOOR,BOOP.AREA,COND. STORI TYPECONSTRUCTIOD cation,s provided for by Section 3700 of the henforan s Code,for the permce of the work for which this pcomb is issued FIXTURES_PER'TRAP ❑ I have and will maintain Worker's Connpen.tiou Insurance,.,requircJ by Section 3700ofhe Whir Cale,battle pcmm muwc wfthe work for whichthis pe.It,is issued. GAS—EA.SYSTEM-]INC.a OUTLETS t OCC GROUT' N'N My Worker's Compensation Insumnce carrier ane Policy number are: Carrier Policy No.: GAS SYSTEM el(EA) , CERT1121CATE OIP EXEMPTION FROM WORKE3RS' COMPENSATION INSURANCE GRIT DUST .WA9'1'11jiPTORIn (I his nceA nonMammplcmJ EDM permit isl ranchnmdmd dollars l5lfX) GRE BUILDING DIVISION PEES F,' A or less.) ENERGLANCY IEC E TLE toy on Whatin the actinic ntt tithewad for whichthisffba,Wtiser,'Col,.- notemploywty)wnnn In may inumm�mas nm Mcrae. Necnn the Workert Com w1 pen- ENEHGY FEIi O z. .tion lawn of California.Date WAT R HEATER W/VENDELECTR O 2Applicant GRADING FEE y NOTICE TO APPLICAN'R ll;aIle(making This Ceailicate of Eorrunin I,you shoulA 'l a ; become subject to rhe Worl Cnmpe"scion pnecomnna of Ne Whir Cale,you must WA 'J i%ATINC SOII S FEE forthwith comply with svch provisioir,or this pcemnshvll he dccnncdn,.$ood. WATER SERVICE act 7z CONSTRUCTION L6WINGAGIJJCY NEW RF_SIUENTIALPLhIB. $Q.FT PAID UQ IherchY off rte th;nehcmixacnnswcunnlaneingngency fnrehnparfnrmanreaf Inlc ReceipeM w P-' the work for which his percia is oacd(Sec.3097,Civ.CJ Q Lenders Name TO'ITI.: U Lenders Address IO AIU: �' y I retify Ihut I have read Thia npplicnion Inti xrere Iha the above infnnnution ie HUILDI. EI r O 0 rn conen.I agree In comply with all city and county ordinances and slate laws reining m QTY MECHANICAL PERMIT FEE 0 U z building conswmion,and Mrchy auehnrim rcpresemnives nfthin citymener upon the SEISM ) EF ubomc-mentional Pirelli for inspection purposes. PERMIT ISSUANCE ^� (We)agree to save indemnify and keep harmless the City of Cupcnino against J EL L FEE babilitie%,jadgnmetes,c00%and expense%which may in any wayacemeag.ina said City AL'I ER OR ADDTO MECH. II F O in sequenceol'the grunting in this permit. PLUhilf I G PEE APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(T(1I0.000CFM) ©© SOURCE pfifUL IONS ^ MECII CN)NT —^Iyyl)/ � ///l AIR DANDLING UNIT(OVER 10.(X0 CPM) CONS'THUC NTAX Signamrea pplicnVCunmm t Doc IIXHAUSTIIOODIW/UUCP) .D HOUSING MI'rICAT10N FPB AI, OUS MATERIALS DISCLOSURE. Will the applicant or future building aruparrome nr handle haeandar,un iel HEATING UNIT(TO I00.0t BTU) v.defined by the Cupc"ins Municipal Cole,Cha .1 pter 92,and the Hcallh and Safcty Colo,Section 25532(.)'1 H17A'I INC.UNIT(OVER Militia)H'1'U) p Yea kNoVENTILATION FAN NINCI.Ii RESIIp 2� PAID e Will Ibe n scam or one,mildln•oera t use n in t or aevicce which Date Rmclpt N PP 6 pan 1 pmmt BOILER— mit hmardour air comumiwnu as dchneJ by the Hay Area Air Quality Management COMP(JHP OR I00,00o BTU) DismcC Yc �o BOILER—COMP(OVh:R IIXL(XO B'N) (] hate read the ba audeu.emend,no is under Cha tee 11.95 of rhe Cid- AIR CONDITIONER 825533" ) ISSUANCE DATIi build Ilii &Safcty GMq Saainns 2arr r aryand 25,51(. unduatand that ifthe NEW HESIUENTIAI.MECH. SQ.FT. build Jces not nenJy hoes Lehae it i.my rcspnmihility ton tify nh pane g �y q ) O ofeh�l+.ie(nc.Adwhis n s wiasuanec ul'u Ccni4�u/�(sgv0,mvltg{ Ownerctamhori 1 l/ Date N XU TOT ISSUED BY: OFFICE