S 2348 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELRCYRICAL PHRMI INO.
BUILDING DIVISION APPLICA'LIONITERMIT PLUMBING-MECHANICAL S 2348
BUILDING PROJECT IDENTIFICATION
BUILDINGADDR S. 1 �� '- ^ SANITARY NO. APPLICATION SUBMITTAL.DAD
OWNERS NAME Tu, PILON[: V`(C'ONT�pC3(lR'S N. L: 1 CNG:
GO o✓� S L G� ILS' £ �G C_% NIC CONTROL.#
I El I:LT/ENGINEER: LIC NO: ADDRSSL43 r ^IS ��
CONTACT; PHONE K BUILIIING PERM11'INFO
86669 ❑ Consultant Fecs Paid by Applicant(Initial) BLDG EI ECT PLUMB MECO
❑ X ❑ ❑
LICENSED CON'I'RAC'I'OR'S DECLARATION QTY ELECTRIC PERMIT FEB
I hereby alRrm Inas 1.m licensed under prn.Wonc of Chapter 9(aammemit, JOB DESCRIPTION
Wal. wilt Seellion 7000)"1 Divirinn 3 of the Businessland roons Re.anmy d Pfessidd license I%
1100 PERMIT ISSUANCE r RESIDENTIAL:
F in tome and etice ;(
Q V U I.icenac Class 1 Lic,p O V ❑SPUWI. ❑KITCHEN RF.MODEI.
aFrl Qat UaeConmacmrLlL API'LIANCCS-RIiS1UliNfIAL ❑ADDITION El PLUMPING fttid'll'Y:
ARCHITECTS UECi, AI'1)N% /�—"• ❑MULTI-UNIT C3 STRUCTURAL
N'=w PANELS
ZOmZ lundmslvnd my plans%hulseJ ands MODIFICATION
OZ=� CC UI'T02W AMPS OINTERIOR ❑CIf1.MNEYREPAIR
a�4LM Gcensu' ndc"and 201-1g)(OAMPS IMPROVEMEN"I' E)SWIMh11NG POOLS
OWNER-BUILDERIIECLARAHON
y C Q 1 hereby affirmsthat 1 am eacmpl from the Convvemr's License Law for the OVER IIKKIAMPS [I BATH REMODEIJREPAIR Q DIiMOLITION
W
x 3 6U following reason.(Section 9031.5,Businessland professor,Cale:Auy cdy ar caumY SIGNS ELECTRICAL [I OTHER
LL H which requires a pemtit na construct.vlw%improve,dcmnlish,or repair any surnamemU L�L✓AC
0�' prim at its issuance,a6n re9uito the applicum for such permit to lileasigneJ macmem SPECIAL CIRCUIT/MISC.
Ems} that he is licensed pursmantto the Oil isiom of the Contractor's License Law(Chapter 9
W C<0 (ronmanci IS wlim Section 7000)ad Div slon J ot'the Business and Professions Cods)or TEMP.METER OR POLL INST. COMMERCIAL:
d cc o W that he is exempt therefrom and the basis far the alleged exemption.Any vallutinl'of C1 NEW BLDG/ADDITION ❑DEMOLITION
Seclloat)031.5 by any applicant for v Permit.subjects the applicaul to acivit Penalty of POWER DEVICES
not more than five hundred doll...(S.NIOy El TENANT ❑FOOD SERVICE
Sp ❑I,as owner of the pro,pro,or mycmployces with wages as their solecompeosition. SWIMMING POOL ELECTRIC IMPROVEMENT
p, willdmheworA.vndthestrtmom is not infrared.....forced for-sale(See 90H4,Bovines D ❑O'T'HER
W and Precisions Cale:The Contractor License law Jces not apply to an owner of OUTLETS-SWITCHES-FIXTURES
propeny who build6 or improves Ihercnn,and who docs such work himself nr Ihrnugh
his own employees,provide)that such improvetttents are not intended or offered for NEW RESIDENTIAL ELECI'R SQ FT.
safe If.howcvcr.lhe holding..,ilnpnrvcman isaold widtfonc yuaral ompl,oar,the SQ.FF.IROOR AREA $I PT.
rrhuilder will have the burden of proving that he did not build or improve for put-
",of sale').
❑ I,as owner of the properly,am exclusively contracting with licensed course is to
mstruet iM project(See.91Ni,B-11 and Protessilms CnJcp'ITc Conirucuns b�-
oww
LudoesnolapplymanownerofproperlywhobuildsorimproGveslhfamon.vnd QTY, PLUMBINPERMIT FEE
ono imams fmsaeltnmjecawitn r,traaor(sl 0cemal pnruanno Pm ConlmanM1
Licence L.I PERMIT'ISSUANCE
❑lantcacmptur Scc. .B&PCtinibisrcamn
Owner Dare
ALI-HR-DRAIN&VENT'-WATER(EA) III O VALUATION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
'I hemby affimt under perully w perjury one of the following Jcdumtin%
11c,".)
huve and will maintain a Certificate of Canwatto self-insure of Workers Corl DRAINS-FlAOR.ROOF AREA,GOND. STORIES "fYl'Ii CONSTRUCTION
,it provided fin by Seoion 3700 of the moor Code.fm he perliencowc of the
for which this permit is issued. FIXTURES-PER*1 RAP
h:wc:md will maintain Workers C....Na,atiun Insarla..c.as required by Section
oflhe Labor Cade.for the yWerfoomnce of me work for which this permit is issued. GAS-EA.SYSTEM-I INC.4 OUTLE7S OCC'.GROUP APN
Carrier V• 'oletNaYN1Nk+(_ec carrier,olieYatrNlayn h GAS-FA.SYSTL'M.OVERJIIiA)
CIiRTIIICA'EOFEXEhllHONNINS RAN WORKERS I PIT GRE:ASI IINDUSTRI,WASTE INTERCEPTOR
COEOIF S/s'fIONINSURANCE
BUILDING DIVISION FEES
(This section nttJ tan nu.nmplded if the pfrinil is lnrnnchunJreJ Anll.rs($IINB GREASETRAP PLANCHECK FEB
I#tiny thalla the acyl'manO,,cofOne wnrklot whlchlhis permit's issued, shall SEWER-SANITARY-STORM EA.21X1 IT.
not employ any person in any m�nner.n as m become suhjecuo the W'mAces'Compnt- -
C) z x:uion I.awe nl'Califo......hate WATER IIFAT12R WoVENT/ELI.CTR 1
Z O Applicant RADI '1 li
N N(H ICI:IU AI'I'I,ICANT:II:alter making this Ccnilic:ve nl'ExemPtinn,you snout) WATER SYSTENUTREATING
hecome subject to the Worked Cnmpcnnvtiun provisions of the Lobar Coale,you must SOILS 1111
limhwith comply with such pe,,iotas or this D.mtit shall be Jecmed mvoked. WATER SERVICE
a0
CONST RUCTION LENDING AGENCY NEW RESIDENTIAL PI.M1f i3. S
V O 1 herchymfimtmat'here iea construction lcadingagency faI perfomonwe of ¢rT W�EE
I Ile M
Q. P the work for which his peril is i,oad(Sec.3097,Civ.C.)
C) fended Name TOTAL:
} Leamer's Address
HT1. I cenify that 1 have real this uPPlicvtio 0 and emu distill,.bove im m e,co.is PER
ay correct.i agree m comply with all city and county ordinances and state laws relating R% QTY, MECHANICAL PERMIT FEE
L.1Z building construction,and hereby amearire representatives oflhis city it)cal"opon the EE
uhove-ommioned Properly for inslaaion purpose%. PERMIT ISSUANCE(We)agree to save,indemnify and keep harmless the City it Cupcninn agonal FEL?
labilities,judgar is costsandexpennes which may in any way accrucagainn said City ALTER OR ADD TO MECII.
in twe,ence Otte grmfng of this pcnnit. FEE
APPLICANT'UNDERSTANDS A ILA,C PLY WITH ALL NON-POINT AIR HANDLING UNIT(TO Ufldg CFMI
SOURCE REGULATIONS. '• TTT AL.I'EIi
I G 1- AIR HANDLING UNIT(OVER 10.001 CFM) CONSTRUCTION'D
Signature of A,Nicant/Coutrator Dae IiXHAUST HOOD(W/DUCT) II'IGAI'ION aEE
HAZARDOUS MATERIALS DISCLOSURiC
Will the application Of homes building occupant%lure or handle hitmous material HEATINGUNIT'(TO100.0001HU)
Is dcllocd by the Cupcnlnu Municipal Cod,Cla tm 9,12,and the I Irallh and Safety
Cone.Section 25532(a)1 HFATING UNIT(OVER 100.000 BTU)
Vee ❑No
VENTILATION I-AN(SINGLE RESID) PAID
VIII he EcanI Or')tune Each yuipmanl or devices which Dam Recdpl k
nn sby The
u%ee
Mous air contaminants as defined by the Itay Area Air Quality Managmrrcnl I101LIiN-COA1V(ll{POR Illfl,lNM)BTU)
Ulsll_I
i]Ycs [I No BOILIiR-COMI•(OVER I(X).(NNIBTU)
AIR CONDITIONER
I h n de. t I. 5. t. n ler .1 pt h 95 that
Cd'- ISSUANCE I7AFE
Or mi II III n Sao,tl Seel 25505 25my s 2553Gmdali Iunderstand Thal if the NEW RESIDENTIAL A1F.CII. SQ.Ff. of �/ f✓
bmdd gh currentlyh I ttkl y of ibiftyt ifyticsxrmy. Ii D
H fthu rcgah avna wliJ nu%I lc tup'a no sauunac o(u Cenilleam nl Oceupanty.
Owner Ora ehortaal agent Doc T(YfAhl-
6 : ISSUED fly:
OFFICE