S 2942 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CCPERTINO BUILDING-ELECTRICAL. PERMIT NO.
BUILDING DIVISION APPLICATIONIPIERMFFPLUMBING-MECHANICAL
BUILDING PROJF.CP IDENI'IF'ICA'FION
PUILDING ADDRESS. - - SANITARY NO. APPLICATIONSUHMI'ITALDATE
76/7s Ktrwitsi, L..v
OW iR:S NAME: I-HONE: / CON3'RACTOR:S NAME 11, LIC NO'.
74 —,67 f^ -} N/C. CONFRO],If
ARCHITECF/ENGINEER: LIC NO. J ADDRF_SS: J �] L-1FJ G
Wd
CONTACT: PHONE: C T 4 d ILDING PERMIT INFO
222D ❑ CDnsullaDl Fees Paid by Applicant(Initial) BIAG ELF.0 PLUMB ME❑CH
LICENSES)COMI'RACfOR:S DECLARATION QTY ELECTRIC PERSIIT FEE
I hereby ul'lirm Thal I am licenxcd under prnvisin:w of Chuplcr 9(eom,oundng ]OB DESCRIPTION
"Z with Ser,Jon 7gN17 of Divisinn3ol'rhe B:isincax and Pmfex>innn Cala.and my licanm is RESIDENTIAL'
W O p PERMIT ISSUANCE Q
f- = in full force and ellen1^ s-`��+ ❑SFDN'L KITCHEN REMODEL
PUU Lustr=e Class W Lick APPLIANCES-RESIDENT AL DADDITION OPLUMBING R&PIPE
Nut Dme Cdnhannr
FDtiCy ANCall is, ter DEC). r 1p PANELS ❑h1Ula'1-UNIT ❑MODIFfURAL
Z O'er I nndenunJ my plan.shall he marl us public records ^ MODIFICATION
oz- - UP TO 2W AMPS [ O El INTERIOR ❑CHIMNEY REPAIR
Hq�FW Licensed 11 uViond 201-1000AMPS IMPROVEMENT []SWIMMING POOLS
qy$; OWNER-BUILDER DECLARATION OVER IIXXIAMPS O BATH REMODELfRI?PAIR 0DEMOLITION
yS IY�Q I hereby affirm Thal l um cxumpl)ram the Contractor's License Law lar the
'x O F V roilowln,mama,tscir an 7031.5,ILomc,n and 11 frwi...n Cade:An T CI M IIER
s1 h y ci y nr coon y SIGNS ELECTRICAL
Owhich requires o permit re crmcwm,open improve,h emit t or repair any slmnurc
y� padded licenmmcuramin inithe the applicant for mon Senor,mcctoele Law acdmummenT SPF;CIAI.CIRCUIT EM
y (,caurerein,wall Sevutim mlhepf Disinm 3 ,f,film
Buoimr'x Licence Vior,Capmr9
4 (mai he
i.gwiWSeefro and of UivasanfrnOheeged exAnyc Cnde)or TEMP.ME II?N OIi POLE INNF. COMMERCIAL;
S,i he 7 exempt Therefrom and The anis far The old=e=r exemption.T Any vialmion of ❑TEN BLDG/ADDITION C DEMOLITION
u]..y are nu ll than by anyappdinmm,CS50rmit subjccrs tM1e nPPlicum vw civil pcnulty of )'OWER DEVICES []IMPROV FOOD SERVICE
y nm none❑ton rive huntlrel Jallxcs lS51XIL OTHERVI:MI?NT
home work,The norm Inees mothered erasthei(Sec.mm Tins, SWIh1MING POOLIS.F,CfRIC
E c ❑ prop= r ,=tont > s peso
will do llework,and the be Ct isnot,mendeddofortole(Sec.7Uai weer os ❑OTHER
trod Itnlbasinne Code:'llm Gmtrvdo,'s License how Joos not apply m nn owner M OUTLETS-SWITCHES-FIXTURES
progeny who hi ilds a imprnvus Thereon,and who does such wank himself or Through
his own employees,provided that such improvements ate not intended m olDred far NEW RE-SIDENFIAI.F.LEC R S Te
sale.If.however The building or improvement is sold within one yeurofmoraclion.the SQ.FT.POOR AREA LSQ.IT.
1ioeurnladhic,will nave The horde.of pilling that he dad not hand or improve Lor par-
T pose ofsale.).
0 L i s owner of The Sumba am esclusivcly manufacture with licensed carrin n m
...note do, t Sec.7044,Business and Pmfcssinns CodeU'Ihe Cnnommor's Li.
escor (.
sconwdtsfr sapply toan ith a effpmmus who
sedprtImproves
ent ro the Counselor and
QTY. PLUMBING PIiRMIT FEE
Lwho iman ,acts for such pmjmrts with aconmacmdsl licensed punuam TU The Camracmr's
7 1n or exempt
VERMI'F ISSUANCE +n
` ❑ iu,nexcmpt anderSa. .B.@PClor Osis rcamn
Owner Dam ALTER-DRAIN A VENT-WATER(PAT U � LUAT
WORKER'S COMPENSATION DECLARATION RACK FLOW PROTECT DEVICE
I hereby indium tinder penalty ofperjury one of the following dmiamiom APR i q itsinn I 9
D l have and will maintain aCeniOcauof Consent mvlf-insure for Workees Compem DRAINS-FLOOR,NOOE AREA COND, STORIES Tjvp 'TRUCf10N
saint,as provided for by Section 3701 til The Labor Cale,for Its performance of the
nd liar which this proud,Ls issued FIXTURIPS-PER TRAP
1 have and will maintain Worke,'s Compensation bmmuce,as required by Section B TV
37(X1 ofthe Lan)r Code,for The performance of The work for which This Nonit is issued. GAS-EA.SYSTEM-1[NC.401_TLF pry
My Wo,kmaComp.rr,14 n Imurunee conic,teal Policy oumnef am,
Cartier: Policy No: GAS-HA.SVS'II;M-OVER 4(EA)
CERTIPICA'I E OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASPANDI15TNi.W'A53'li INTERCF:PfOR
BUILDING DIVISION FEES
(flhissatiern onamd be cumplmcd i0 heternh is Psaume hundred doll un D I Off ORBASE'FRAP
or Ito.) PL\NCIIECK PEE
I certify That in de Nnhomanccofthework for which this permit is issued,Ishall SHWF.R-SANITARY-STORM EA.20p FT.
not employ any person In u, to become x,,bjc,t m he W akcn'Camper- ENERGY PEIi
zz, sationI sus of Colifomir,)W �-y WATER IWATER W/VENI'IFLFCR
Applican �� ^5 ��(--4� _ GRAVING FEE
Ir ZJ NO'OCI: dltc(dm�C,ng nv Cenifcnte of Exemption,you shsuld WATER SYSTEM/fREATING
F ; hmaa a subject,o The Workers Cumpensadon provisions of the I.ahur Cade,you nwst SOILS FEE
vJ fonhwidt comply with such provisions or this permit shall be deemed mvoked. WAI'ERSHRVICE
0.
z CONS'I'Rucri ON FUNDING AG HNCY N HW RBST DENI'I A1,FLMR.' SQ.Ful PAID )a . NeceiptN
L) 0 (hereby am.hurt isae onactio.lendingagency for The performance til
the work for which this pemuit is issued(Sec.3097,Civ.C.)
{I. E•'� Lender',Name 1 'DMAL
{U lender's Addmss TOTAL:
I cenifr Thur I Imes mad This application and sum that the abuse information is BUILDING r
F' IRI correct.l agree mply wimall city and county ordinances and state laws relating to QTY. MECHANICALPERMIT FEE
U7. building consmucdon,and hcrchy andurie repmscntallvus ofthis city tocmtrn upon The SEISMIC F.i:
above-mentioned Propeny for inspection purposes. PERMIT ISSUANCE
(We)agree to%am,indemnify and keep harmless the City of Cupcnino again, ELECT R 'FF]:
lubdine"'jn llamas,ers1,and ets"or,which may is„try way accrue ngnio(aid City AGI'ER OR ADD'I'O SECT
in necquenme at The graming of this perms. PLUMBIN Eili -
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING IJNFrGv,Ig000Cl:hO
SOURCE REG(;V,ATjkNS MECHANICA.FEE
AIR HANDLING UNIT(OVER I0,000 CIM) CONST RUCTION TAX
'ightnurco A LcanUG no-ucmr Dec EXHAUST H(JOD(W/UIICq HOUSING MII3GATION PEE
HAZARDOUS MAI HRIALS DISCLOSURE
Will The applicant of l umre building om.,ain sureorhandle hamNatc,amcdal HEATING UNI'F(TO 100,000 111 U)
as defined by the Cupeninn Municipal Code.Chap e,9J1,and the Health and Safety
Calc,Section 25532(a)^ HEATING UNIT(OVER b)(1,000 BU)
El Yes LJ No V GOV I LAI'ION PAN ISI NGLE]TESL])) PAID
1 - Date RecelpT M'
Will the applicant or futumn,r building by he B use ea Air Qu or devices which BOILER-COMP(311P OR 101,0 B3'lJ)
nmit huaurdous air mnunnimm�s us deputed by the Buy Area Air Vmuliry ManngenTern YYfAI.:
iammT7it
[2 Yes Fl No BOILP.R-COSIPIOVFR 100j)(01116
I have rend The hwmdoas materialsns,armicnrs under Chapter 6.95 of the Cub AIR CONDI'1'IONER ISSUANCE DATE
fomia IId &Sufery IT b Section 25505.25533.TW 2.5534,1 urdersmml that date NIiW RIi.SIDENTIAL M[C11. SQ.FF. /` ..-. / s-
nuikling dt rt Tly lav mnam.tom iT is myrupnnsibility Tn nnti(y TM1c oacupom `�
'du, yuircan h,ntuTg quer pun wnl'u Ccnitiu,tc of(kco ancY.
'l ' ter ",:am �S' j
fit rur/ota Wmen Z Umc TOTAL: ISSUED BY.
OFFICE