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S 1483 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY Ti CITY OF CUPERTINO BUILDING-ELECTRICAL Pli Il'NO BUILDING DIVISION APPLICATION/PERMIT PLUMBING.MF.CRaNICAL 1483 BUILDING PBodF,C'f IDENTIFICATION BU .DING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE 77 E, Ess TA-Ta #f, , OUPOVIA/0 (I,& S'0/ —` O ER' NAME: ////� __ � � �"qqI Nli: Ct1,��u'l1'RAPTOR'S NAME LIC NO' /RAl I7X/1L6 l(/ p. To KV! COtiS _PC UC7_641 4,35 Y/0 NAC COON�TROL# 1TECTAENGINEIR IC NO ADURB3S: AL �rj_ ❑ (•��`"fir C SRT✓ fin/ -d-4 /d ALSO IjIOn 140 TVl 7—\ CONTACT: PHONE: BUILDING PGRMIT INFO lVJO `//kn6` /�� ❑ Consultant Fees Paid by Applicant(Initial) BLDG III PLUMB "i LICENSED CONTRACTOR'S DECLARATIONAfR7ATIONQTY ELECTRIC PERMIT' FEE I M1erchy offiml mat],too Ilrenved older Plnvkimis ofapter Ch9(crmmerdng JOB DESCRIPTION Z with Section]aro)ofniviol 3ofine Bnvinesxand Prio ofeunxeoJe.midmylicenscix RF.SIDENTIAI: E„DOti in fill furccvndeffea. PERMIT ISSUANCE aUZV Lica CP ss Lacs# .35 �Wo WL [I KI REMODEL ydi Dmc Clmurwlul UK Ix N V APPLIANCES-RPS IDF,N'I'[Al. LIADIX I[ON [I PLUMBING RS-PIPE F-pm ARCHITECT'S DECLARATION PANUS ❑MUI.TI-UNIT ❑STRUCTURAL. Z O h Z 1 and,,and my plans sh;dl he used as Public records MODIFICATION OZ,-Q UPT0200AMCPS ❑INTERIOR []CHIMNEY REPAIR Q4„]; Licemcd Professional N)1-1000 AMPS IMPROVEMENT 0SWIMMING POOLS ya�J OWNER-BUILDI!R DEChARKIION OVER 1000AM1' ❑BATH REMODEWItEPA1R ❑DEMOLI'TION L W 6 1 hereby affirm that I ant exempt from the C'ontrac Contractor's License Law fm the W'fie 6 U following roman.fgeaion]0315.Businoxs and Professions Code:Any any nr mm�1Y SIGNS ELECT 16, ❑OTHER 31zN whmh reyuim,a permit to onotrect alter,improve,dr, lid.nr ,,.a,any,.,fare F+�O printer it issuance,also lxyoims thwipplicant forich perrio to File aslgnNsertemcal SPECIAL CIR SC. �LL}� that he is licensed pmnxnnr the provisions of the Camra s License Law(Ch MEMO (commcnci ng win Section]100)of Division 3 ofthe ll.omrsvnd Professions Code)of 1EMIR MF I'HR ORPU. ST COMMERCIAL: a at, C Ihttl ha is esaam therefrom and the burls for the alleged exmnptlnn.Any vinlutinn of C1 NEW BLDG/ADDITION ElDEMOLITION W Section)03L5byanyapplicantforaprmltsuhaicstheapplicanttoacivilPcnahyof ;!PW' DEVICES ❑'1'IiNAN'1' ❑FOODSERVICE FSQnot mor than five hundred dollad(550 ). IMPROVEMENT ❑ Lacownerof the propcny,omy employees iW wages us]Leir sell,eompnxatior. GPOOL ELECT F- will do the work,and the structure is nluneadcOm.ffcmd fursule(Sec.lDlJ.13noneas ❑OILIER 0 fy w and 1'n,fossions Code the Contractor,Llceme Law items not apply m an ownerS S 'I' .HES-FI%TU ES propny who huiId m improves Ih...un,land echo does such work house, rr 0nrougIt his employees,pfuvided that such impr,carac a arc not intended ur offered forSIDENT CTR SQ I'll s:de,l(nbnwcve9 the M1uilding ur iinprovennonn ls.voldwhbinoneyeur^fcampletinn.the SQ.FT.FLUOR AREA $/$Q.IT. ow bar-builder will have the burden of proving that he did not nulla or i,itpruve for par- ^,s.. pan of sale). /S/S try 1,as avna of the prlpny,nm exclusively nourecting with licensed cannot m T eta me,the pmjaa(Sec.](Ua.Business and ProfP,tran,Cala:)The COnwaorS �� ea se Lawramsmol apply ,,aruwmnof proisny who build,ur improves mcreon.:tad QTY. PLUM GPERMIT FEF. • who contracts for such Projects with a comrannrW licensed pursuant,,the Cnntmnur'x License law. ` PERMIT ISSUANCE ❑I am exempt ander Sec ,B$P C for this reason AFTER-DRAIN X VENT-WATER(L'A) VALUA'110. ` 2'56 �3d WORKERS COMPENSATION DECLARATION BACK PLOW PROTRCI.DEVICE l� I Landry nl mai under pnaby of perjury ane of me following de avers Co lh:mc andoide maintains tion icnm of ConunuoCode,amre a N'orke/s Cnmpn- DRAINS-FL(IOR,R .cation,m pInch thi for by is Lata 3]Ip of lads Code,for the perfrmtanm of me S BS '1'YI'1?CONS'IRl1CT10N work have inmaintai is orke. FI%'NRF,S-PF.k'I'k E, ❑ 1have vLa will ode,fine .,fs Cawsol,the w rk I., hic.as Dan by Section 3]1X1 Nial Wader, sn-1 unheryanceca^ce^fmuwod(murder am Permit is innted, GAS-CA.$YSI'liM-I ()Of LETS OCG GkO.P My Workers Cmnpcn,atiun Inwrun<c const and Policy numhcr are: cileo: PIONNn.: GAS-F\.sysnaM-( Ratvt �3 O2©00 CERI'IPICAT'li OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASEANDUSTRL\I' TE INTHIN-1 MOM (Thin¢cnunrecdnobecunnpleed i f the pout is I.,one hundred ball.,($1 W) B ' )1 iDIVISION FEES orlcss) GREASETRAP P, PLANCHEGKI Icenify than in the perlormaneenl the work for which anis permit is iswedlsball mSEWER-SANITARY-S'IORM f A.2015 IT. I eploy any porn in any manner an nn to Freomt...bjca m the Wmkc,,Compo- ENERGY mN. O Z -,run Wws of Califomia.Dane WATER HEATER WNEWIELECTR Z Applicant GRADING FEE y NOOCIE'IO APPLICANT:IL after making this Cenificmc Of Him prior,you should WATER SYSTEMiIREAI'INC, a ; Femme subject tome WOrker'x Compacvion pmvi,ions offal Labor Cale.You must SOILS FEE I orthwim smuttily withsuch provisions or this permit shall be deemed revoked WATER SERVICE a � D CONS ,,is.e]ON LENDING feadin \CY NEW RFti1UGNTIAh PLMB. SQ,IT PAID V Q I Ima,mb,hien his that mereiw ad s ce.3( len ding agency fix the lrcrhnmvne of Date RecciptX 1~' Lill work fur which thi,pmtit in issued(see.3p)].Civ,C.) Limber,Name 'IOTA L: U IsndcLs Addrea.. fr' as I ccnify that i Lave read this upphemlon unit sotto thin the,,have infmnwtinn rs BUIL . dG to correct 1 agree to comply nim all shy and county ordinance.and smm laws rdming to QTY. MECHANICAL PERMIT ITE "NICALII-EE �,t y� U Z huildiageonxuuetina,and hereby muhorize reprmenmtives of this city w ermruponthe V aMwomcnrionedpmpcnyfurinslneafo^pu�s. (We)norm w save,indeamify and keep burtnlm,the City of Cal min against PERMIT ISSUANCE liubiliticalud8memc ones mdexpenses whicM1 may in any wvy:¢rnte ngninu said City consequencein of the granting of this permit. AM RIO ON ADD R)MECH. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IQ(00CPM) SOURCE. GULATION& X^ 1 O4 Q / l AIR HANDLING UNIT(OVER 10,000CFM) CON. ' IfCIION TAX "gnaturc of ApplicanpContctao Doc F%HAUNT IIOOD(W/DUCT) HOUSING IITIGATIONIEE I IAZARDOUS MATERIALS DISCLOSURE, Will nhc opplicam or nor,buildingrccupam,bare or handle hnz.aduusnwmnul HEATING UNIT(10100.001)BITE) an defirdl by the Cupertino Municipal Code,Chapmr,9.12,and the Health and Safety Code.Section 25532(,,)? HHA'I'ING UNIT(OVER 100,000 B'IU) C)ye, t VENTILATION CAN(SINGLE R&CH)) PAID Dane ReceiplX Will the applicunl or future.building occupant use tquipntem or devices which BOILER-COMP(3FlP OR 100,00)BTU) urdnua air cnntamiwnts as defined by the Bay Area Air Qwlity Managmnem ,.unR BOIL12R-COMP(OVER I WAf0131Of Yee 11' .ulthch d .met ' Lal t. I Ch'pl (.151'dc Cali- AIRCONDDIONEklt) ISSUANCE DATE bui II 110 ffiI f ty Cal S r 255115 2551) d 2551,, J r J th I it the NEW RESIDEN)'IAL MECH. SQ.FT. hu lJ' I t mlyh t n IM1m s :p :'bl rylon tfy th cupam L Of ILL Jy- L_ hicb mint tµ. l"i",Itnsu ceofv Cernfic �C'a my. ter orvmhumal esugcm all O' \ SURD HN OFFICE