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23568 (4) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Bulldir,,Proed Identifiutiw 8ulIA"Addtve: , 1'F7IMITN2 3 5 6 8 �- �Asv�atevvicw C'v ss ern vo / r• esj 0 CPIYOFC'UPERTBNO-BUILOBVGDMSION Cwtndue.N. . IJc.No: APPLICATION /PERMIT O BUIIANGd0.'IRICALPLUMUNGKfSCHAMGL CATEGORY CONTROL# Anehlteet/Pngneer: Lie.Na WING Irt.:,u;wasn�m;y;,•,.: U3 �PFRF149'aNFO� ^ r_.. ELECTRICBAIIYITE .asass .. ' Add. PFRMITISSUANCE ❑ ❑ LKENS ED CONTRACTOR'S DECLARATION (hereby .70that tam B.3.f B prmbloruo(Clupter9(eonunmc APPLIANCES-RESIDENTIAL JOB InBwlth9e tbn7fMD)d DMfenct. lhe8udroe.nd Rvle.Iw.Cade.nd �,� Ilwnr bin fu8 fora and dfN. PANELS �` VGa Lae License Cha LieI Date COMactm ARCHMCrS DECLARATION q�+�0yu Z I.ednwnd eny pluu,hall be urd u public rcaad. OVER 1000 AMPS SQ.FT.FLOOR AREA --I/SQ. yj'ZZUO Lion HdesbNi SIGNS ELECTRICAL Q OWNER-BUILDER DECUBATION SPECIALCIRCUIT/MIL F. Iberebyaf8rmthatlameumptfr the Co&n es Uoe Uwfmther ^ following reason.CSecron 70315,B..iner and Po(,rune Cdc Any dty or TEMP.METER OR POLE Il... ,RK• wuntywhkhrnprimapm wwn Mh ter,tmpm dm lbh,wreptlr qqq any.hucture prim to lb lruuev,also requireet the.ppliaot for meh pemdt to POWER DEVICES A. d 5 Ne.eigne l Matertwn that he Is licensed pursuant to the pwWlon.of the inContnctor',L&oense Law Chapter 9(mwrcndng with Section AIM)of DM. �'O'U'BNG POOL . n3ofthe Butl ma Profmb Cde)ortluthebocmpttkr mad m.AyLLuC M VALUATION < the hub for the alleged Beets ter. Any violation d Selly o 70715 by any Ali 15_9V.7�E�FC(TURFS V �a7 ppVaat fora pemdt subjects the appVant to a dull penslty d not moat than V >. 110 red dollars RS001. L 1 uowrcrof the Property,mmy empty,,wth wageutkk.oe NEV.'R®QJ77AL ELElIR SQ'E7' RISS CONM N wllldotkworkandtheMr mbeat Werddorofferedb O b Sec 7IK4,B.at .rd Pr mi.m Code:Tk Comndoea Ileem.IAw B dere.not apply to an.1 dpopMy who WIMa or imptv,e thertaR and OCC GROUT' RFS U=a whodoaauch Mm�Ifmthrarghhbw trnplaympro that,udr Improvement are rax Inbnded oroffeml fmaae.IL haveser,thebulMNg m TO ' ImProvemem b.oM VNhln omycardcampleOOM1tk owner-0ullderwW kw .,�r t raenaprodngthat hedd nabuud orlorpcoveforle rpmeofule.). (ny: P�;[j/y{gj(.jG,j> [yQ'I', r Cj�; -- icy LJ C a.owner d the property,amac ehWvely contracting with Ilmnaed FLOOD ZONE APN PERMIT ISSUANCE contreet.to wmtrud the prole¢(Sec 70K Suaieer and Prderbru Code: The Codndors Umar Law dca not apply to an owner of property who bund,or Improves thereon,and who conrtrads for such pW*ft whh• ALIE"RAIN(c VENT-WATER MAI op{[�Rm(a llaneed pument to the Cwtr.dor.Llmm.LawF6E.SFJMMARY� LJ I am e.empt under Sec B 4 P C fm s thio rm &JtY F[nw PROTECT.DEVICE rea - =qlnp Mee DRAINSFLOORROOF,AREA,COND. SANITARY Y_ N_ Owner Data RECER'T a WOR KhFAN COMPENSATION DECLARATION ❑I hereby afllnn that 1 haw a mni8ab of consent to.elf-Irwn,or a FDCAJRE4 PER TRAP SCHOOL TAX Y _ mdl0ated Worken'CompeauMlwl�wranm maaM(ed oopythereol Sec. RME3PT Lab CJ GAS-FA SYSTEM-1 INC,OUTIHM PARK FEE Y_ N_ fay kY a— GAS FA.SYSCE7.TOVFR I(U) RI3rELr1'a many BUILDING DIVISION FEES I ICenmed copy b heavy L,ml.kd. GRFASQ/INDUSIRL WASTEINTERCEPTOR PLANCHECK FEE Lh�JI CenNed copy Is filed with the ed,Impedbn dtvlYon. .l7 GREASE TRAP L CERTIFICATE OF IXEMPTION FROM WORKERS' PAID COMPENSATION MSURANCESEWER.SANITARY-STORM E.A.700FT. Date Remi t# (I'hla.eodon need not be cmrpkted V the pemdt Is fee oro hundredde0n a 0I00)ar le..) an wWATER HEATER W/VFN'f/E7rCR ENERGYFEE Y N I I aruthattothe parawwedtk was NNthis hued,dell mR empty any IA w b any wenn an r to b.wme.ubled to the WWATER SYSTEM/IRFATWG Workers* mpematlun lAw.dGllforNa. Data PAID O = AppOant NEW RFS DEMIAL PLNB. SQFT. Dater Recei H Z !? NOTICE TO APPLICA.NT:H,.ter madly this Certificate Of Exemption.you ,hold become subject to the Wor4npemwvbla s'Comation pns of the Labor TOTAL WN Code,you roust forthwith cunply with eh provbbnu or this pemdt.hall he_ BUILDING FEE > deemed revoked. CONSTRUCTION LENDING AGENCY SEISI d IharebydBmt tkttherab a comemctlon ledingagercy for tk doer. TOTAL ELECTRIC FEE Z anmdtheworkfor which ehb pmNtbbsud bee 30Y/,CW.CJ pe () O Lader.Nameg PLUMBING FEE IL LedersAAareas QiY: bIECF1AiVICA4;PERINIT ,. FEE O WIcertifythat t kw read this application and w stare that th..be mformad. ,-. . MECHANICAL FEE IL bcorren.l.gree to complywkh all dtyad county odlmnmand tlate law. PERMIT ISSUANCE FEES PAID: >_ IL re]Miylo WlMingwmmdiman Mrebyauthorkereptanudva Mthly dty, Z to enter upon the above-mmtbmd property for lnsERH. pedlon P. ALTORADDTOMEC IWd.gee ro WenWry an d keep l unni.the Clry&Kp" Date Rece1 tp .g.tmtlhbwdee, a mA n,,open.wh,,,nvyln anyway.. AIR HANDLING UNIT(TO 10,01DO CPW SUBTOTAL - as. I m enerdtk grtmly dtNa pormk. AIR HANDUNG UNIT(OVER Ik000CPM) CONSTRUCI7ONTAX turcdAppltont/CwtrnRtm Date Ep Iwf75'THOODD(W/DECCONSTRUC170N TAX PAID: HAZARDOUS MATERIALS DISCLOSURE Will the ce huturn WVding omepant More or handle haaardw. HEATING UNIT(TO 100,000 SDI) Date Recei [M nWerLl u ddlnd by the CupertinoMuddpal Cole,Clupt.r 9.17,and the Heath ad Safety Code Sedlw 75537(a)t HEATING UNIT(OVER I K000 BTU) TOTA . qYee No ul the:pptaMw tore Wudingar ,ant use equlpment m d outer VENTILATION FAN SINGLE RESID) ISSUANCE DATE whkh emit has dons air owbminama ae deBnd by the Bay Am Ak aAbFlty M..g.e em Dunrict7 BOIIERLIDMP OHP OR 100,000 BM Y.-a No kve red be hu.gd wtcrlb requirements u oder Cha pier G95 of BOILFRCOh1P(OVEIt 10()," u) e• /4 the California Wath 4 Safety Code,Sedbns 75505,25513 Md 755M. I A[k� rd car dthatifthe Wlldlgdmandwrrentlyhave.ten.nktktltbmy NEW RESIDFNIIAL MECH. SQ17 ponebllty to notify the oavp.m of the requirements wtkb trust be root ^l/r lir ,•. prior to lmuance daCeniOcatedOmoprry. .a /`,1JU) Owner or authodad agent Nit— IS5MDBU TOTAL' OFFICE COPY