S 2183 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO RUD,D:NG-ELECTRICAL rE nNa. q
BUILDING DIVISION APPLICATION/PERMIT PLUMB ING-aIECHANICAI, 2183
BUILDING PROJECT IDE.\-11FICATION
BUILDINGAIIDRESS: p SANITARY NO. AY%.(CATION SURMfITAt DATE
IQ531 S - F6o O
ILL L-v
OWNER'S NAME: I'll(lNE CONTRACTORS NAME: LIC NO'.
T `t W EyZK)eP-1 aS7 S O S Co P J eL_T 1 NIC CONTROL«
RCI IfII!CI't GINIII!R; LIC,NO ID13Zl,&yYvl pr,
CONTACT. PHONEBUILDING PERMIT INTO
_- �� J ❑ Consultant Fecs Paid by Applicant(Initial) BLDG BLECr UMB Sire
�- ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELEC-1 RIC PERM I'I' FEE
1 Fa rthy vlfrm WI I an,IiccnscJ umkr pmvidan•M Llugm 9(commcnain6 JOB DESCRIPTION
,OZ wim Satioll]tx10)ol Uisiriln Tdthe Bueiwwvwd l'mfessiann CUJe.and mYlieenu is /� RESIDENTIAL:
F,,O in full forceari ether %:RMIT ISSUANCE ❑Smi ❑KITCHEN REMODEL
U�j Nemec Chistic.M
'L<i Umc @nlNcl« APPLIANCES-RLSIDIiNTIAL ❑ADDRION ❑PLUMBUJGRE-PIPE
rFi)
As shall bi TS NhIk ATI(IN ❑h1U1.TI-UNIT ❑MODIFI RAL
MODIFICATION F�m PANELS
7.O'"Z Ium4cmvM MY plains shell he lucd ve p.Mc rtc«ds Z� MUUIPICAf10N
-1. ❑ AIR
UI'T(1?fIU AAII!S
iOVE ❑CHIMMINGTY)OL
IJ«aud Pndcsicnul 2UI-Rx1U AMI'.S IMPROVFJs11iYf SWIMMING IY)OIS
�y'.yt,, OWNER BUILDER DECIARATIUN OVER IgM)AhdpS El BATH REMODELBEPAIR ❑DEMOLITION
C W Q I Woeby affirm that I am uemD fmm the me Coonacnu's Lila•v,for Inc
KOCU followongn'awn.(S•cli...07031.5,IWri1-ort l'n,luuiunv CollAnyanyw
thy«uwntY SIGNS CLEGTRICAL ❑OTH172
il '-
which tra .it wor
crool all,, Jcnmf.h,,rc,cpoir aahlaru
Omar old icvuarcq olso lryuirtn the al,PlicaNfmmchpesmit lofk a sigresh amu,ras,t SPECIALCIRCUT/MISC,
E Y.
that In is pressed pur,ount to t he Imvisionrofthe CoutmctorLr License Law(OlaperY C2,60 e
W==O (csmlm mcing wish Scmiun](X)0)of Division g ofmc Busincs mel l'rofcariouv CeJ,)nr 'n?MP..NIHP,x OR KILL INST COMMERCIAL
a a Inas k is exionla nanclimm end the basis f«the alkgcsd eacmgion Any violation of ❑NEW BLD0ADDITION ❑DEMOLITION
Satins 70113 by any applicwl for a perona subjece,me uplamear,to a civil pcnWly of ROWER DEVICES
w_.y t more thou five hundred lksllon($!")) ❑IMPROVNANOT [I FOOD SERVICE❑Las mvrcrof meRmcnY•or mr emplgeex wim wage a.tkir u0e eompenvtiun, SWIMMING I'O(R,ELECTRIC IMPROVEMENT
1.. will im Uc work,mW cy,drumum k net intcldWo fIci fm sak(Sa.](11J,Busirtn. ❑OTHER
G
3 and Nofwions Critic The Comwaor's hkc.,law dohs to avply loom nwncr of I S'
OUII,IHS-SWUE -19x1'URBS
(,roil wtm Wilds«impovcx moms,and who Jres such work himself oe m ough
his own employers,frcusdN Uva such imfmnemenr•art Out imedM or dlcned fm NEW RESIDENTIAL F1 ECM SQ;�R;2
ede.If.lmwescr.Ilse buildingmlot...vcnnm isurld within o ,yamofcomplmion.Use SO)FT ROORAR.\ LSQ.FT.
ac budIdcr will bev'c the W,dcn of proving that hn did not build ur improve for Mroe-
pou of sak.).
I,ns�,wner of the pnphny,vn exclusively correcting with:,ficeraccol Coilocc contractors to Nusineftors P,whonns C«kp'Ibe Cmnranods Li-
f%nrrrty weronuilJs,-11 ma,Conno,vrd QTY. PLUMBING PIiRMIT
who contrxu fur such Pmjtt'u wim a nntmn«(O Iw<,uN pursuant to Ux Cminctnls
Licift,Law' PERMIT ISSUANCE
Ej I afn csrnlfx undo Sec. ,B&P C for lois reason
Lkj - AUIT,R-DRAIN&VENT-WA'I'R(FA) VALUATION
WORK:R:S cosiMENsATION ULiCLARAToN BACK Ir LOW IROTL'Cf.UEVICI? 2 /1
I hcrtbr aline u Wer mil perjury mrc of Jc fdl-ing deelaratiurs: OO 0
Q IM1ave and will nnslinmina Ccnllieounl Cnnrcnlmscll-inru¢I'nr Wurkcr'v Cnmpco- DRAINS-FI.00R,RWE AREA.COND, SIIIRIIS TE CONSIRUCTION
on
cation,,n pmvidM for by Scomm J]UI of ilr La"Code.for me Nrfnmm�cc of do
..A for which Old,pom ixsucTR
ris d. FINTURES-PER AP
I Lave and will maintain Worfkcr'n CUmpenuti«I Insurance,ss soamod by Section
370l labor Code,ter floe pcforrmrrftnc ceowork fur which mi s panni lis ivmcd GAS-PA.SYSTQh1-I INC.d OUI'LEIS OCC.GROUP APN
My Wolkels Compemut:n I.insie carries end Policy number DR
:
Cartier. Pulfcy No,� GAS-FA.SYSTTM-OVER J IFA)
CHRTdMPI
IFICATH OF'ExIION FROM WORKERS'
COMPENSATION INSURANCE GREASMNDUSTRL WASTE INTERCEM Ok
BUILDING DIVISION FIiPs
flhk vzti'nnW rsol hecampk'esl if the Oremdt is f«arc bu,uhN dWlon(Slip) GREASE MAI' - - - - - --
or Icn.l %ANCHF.CK FEL'
Divinity that ithr,, d«n r.fthe-Af«whichthis Iii is,u,L[,hall SEWER-SANITARY-STORM E.A.200 FL
,vv eutploy troy phrsun in any nommi W as to benm
s ,subjeel to the Worknx'Conpen- ENERGY Illi
I
O ,2' vuiol lows of Cal'dforl(Fate WATER HEATER W WENTM,li R
u Q Applicant GRADING Mt
y
NOTICE TO APPLICANT:IL after making any Ccrtlhicutc M Esempirn,you should WATER SYSTEM?RPATING
a ? Mx`IIm enbj,xl m Ibc Wm4tis QmlpotlSaliM pmviviuns nl Bc(alcor Colo,you twv SOILS FEE
LL7 fmrwith comply with such prol.,i- me,pc'mdWloll he dmmnl mvn4'd. WAI'B
U 0 CONhereisCcomoo worlioGAGLII4CY NEW GTOAI PAID
U O IhenhY affirm manhcru isamnnmwtiun lending agency,fonhlu patlnnnarccof k«eipM
OF Uew«4f«wnicb tnivpermit isi.ssuM lScc.JW),Civ.C.)
U Lerlcfs Addo TOTAL:
lsmler's AJJrcu S TO L
} 0.. 1 anify that I hast.1 this application most nam hum the alloc information is BUILUMG ai
Ir VJ cslnecl.l ugmc to comply withall city unit county nNd ini acute lows mialing to QTY. MECHANICAL PE IEC O
U Z Wildingconsmctirn,sud hereby nuHvnicrtpracntmivc•of Nis city in mncrul.m the SEISMIC RA
.1broc-onsmi.ri Totem for inspcclion In,eii PE b UANCE
(we)ngrm 10 use.Indemnify and keep barinku•the City of Cur irw attract ELECTRIC FRIT
Bane Id aa,jui,mcols.ce,wJ echen.u_r is ordinary in any way mems ahem.said City ALTER OR ADD T(1.
in mna mcori of Ise gamingof Isis permit PLUMBING EEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNII'tTO OjXX)CF11)
SOU( EkECU//L�IAT1Ut.. ^ pppp MECHANICALITE
�C.�'1+/^-�✓_ 9 ]O AIR HANDLING UNIT(OVERI0.00(GF,1) CONSTRUCTONIA£
Sigwurt of A,1 Cmm.foe Dae EXHAUST 11001)1W/DUCT)
HAZARDOUS MATIiRLALS DISCLOSURE HOUSING h11TIGA'IION LIE
Will theapplic-am m forme building«c.Pom store or handle hu noun mmcrial HEATING UNIT(TO Bnlplxl BTU)
or defined by flc Cupmim)Municipal Code,Chuptee Y.Il,and the Ildth and Safety
Co,lc,Seclion 25532(.)': Hl[[NO UNIT(OVER 100.000 BTU)
Dye n No
VENTILATION FAN(SINGLE RESOD) PAH)
Kill Useu licum ur Tarlac Widin uY Jevwcs wbihh Uste Receipt1
p+ g«aupvn Jn
sir cunmminn
mit nAircm« BOILER-COST(31 If OR BIOlX)U BTU)
ssarJsus nl.us ti,nJ M1yC ILIfuy Area Air Quality ManualO
Dis4icl^ I I"
0Yn MNn HOILEk-COMP(OVER 100.000 BTU)
Ihast rtsd the hvmdous mmaials rsyuhemmxs aider Cnaper 695 of me Cul h AIR CONDITIONER ISSUANCE DATE
f«nu Ihcahm&Safay Code.Sr O«e 25505,IS533 and 255:34.I wdmgnrd that if me NEW RISIUIRPI'[Ali MIiCH. SQ.IT. / L/� tea O
Wfth,cl csnlocum,nHy have cicmnt.dlm it is my ry.withilhy m Redly Uc'ccupara ( 1 _l VA
d de rtqui.s whiOn must lc nn Onorm issuance 0 n Ccmilicanc of lkcvryrcy. �I /--�
Owaerurowturieedagcm Dom TOTAL ISSUED 13 LLL���Lr-
OFFICE
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• NOISIAIO N01103dSNI
ONI183dno 30 Aim