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S 3080 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO PLUM NC-MECII NIAL I'EItyY1n'No. 0 O BUILDING DIVISION APPLICA'1'IONIPERMIT PLUM PROJECT IOHnN1cn1. S BUILDING PROJECT IDI?N'I'IRICAI'ION BUILDING ADDHI//SS: SANITARY NO. API'LICAIION SIJIthl l'I/T�5ALDN"li i OWNEOR'S 5 /D v PH(INIi: CON'rRACIDR5 NAM11Ii: LIC NO'. Mla ^ NIC CON J AItC1{I I'li T/ENG Iil!R: LIC NO ADDRESS: El\ nSLI CONTACT: THONG: BUILDING P13RMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLOC, ELECT Pi*114 MLCH LICIiNSED COKTRA OR:S ECLARATION QTY ELECTRIC PERMIT FEE JOE DESCRIPTION I hereby affirm that I um licensed under provisions of Clear,9(cmm�mwm,9 'OZ with Sectioo 7000)of Divisb,n 3 of the ltuvine,,and P...I-ions Codc,u..dary l lcensc i, RESIDENTIAL: H full force ural eRa'G'. �= ' I'IiRMI'1'ISSUANCIi O C / . l �a � � E]'LL", ❑KI'fClll?N RY:MOUL+1. QF�.UI` Llccnu Clav bice p /1J�� APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBINGRE-111111; WQL Dau---4t- slen6 �—Contrednr ❑MUhI'6UNIT ❑STRUM URAL ARCI I I PCI"S DECLARM ION PANELS F hZ 1 andemm�d my Plans shall be sed as public rawrd.s MODIFICATION UP'I'O100AMPS ❑RSTERIOR [I CHIMNEY REPAIR CZ Licensed Pro(aslonal 201-10n)AMPS IMPROVEMENT (DSWIMMING FOOTS 6 .] (IWECLARATION C C Q 1 M1erchY alien Thal 1 am exenNER-BUILDER Dmt four Inc Comraanr's License I.aw for the (IVI?k 1000AMPS C1 BSI 11 kEMODI!Vk1iPAllt DEMOLITION a U following noon.(Section 71O 15.Business and Pr.fe,Mer,CNe:Any city wrrounT SIGNS ELECT"RICAI. ❑OTHIiH a�31, whin requires a inanarldt t .improve,demolish, l y,tmem. 1��dA .�.^0e/� Port t '1. 1 Ih alpl' If hpe ill IIhowledkora ncnt SPECIAL CIRCUIOMISC Se y thath Ic dp t Ih p fn f t r',I I' (Chupter9 .14<0 frnmmencing with Seaunt 91X10)ofD� ,on31B If .' s and Frolicsome,Cnde)m T I:MR METIER OR POLE INS r. COMMERCIAL: 6H e C lbw he is cxamPr rherefnrm oral the Fossas!ur the alleged exnnption.Any viola;-a of NF, aFP LITTON ticutinn 7031.5 by any nppllcum far ul'rnnit subjects the applicant mucrvil pewllY of POWER DI?MCPS TIEN ❑ ' SIiRVICIi re than live hundred dollars($VXUEd Rod FSa an fl as owner of the o,orm toes,with woes as their sale eam tion, SWIMMINGPOOLEI.l-MR 01 I E C the st Y Ynnp Y % ,Bus; 01"HIiH p. will Jo Mc work. Mc,tmnure i,nrn imm�dNonlBc.d for vbc(Sec.911th,Business Wm and P.fe,aions Code, ",Convnctor'n License law Joe not apply m un owner of (IUTLETS-SWITCIIILS-FI U - f)A prnperty who build,or improves thereon,and will,Anes such work himself or lhamsh V ���� his own employee,.Provided that such improvements am not intended lir offered for NEW RESIDENTIAL ELEC R 'I' sale.if.howasi the building or improvement is sold within one Year of completion,the SQ.lT IIAR)H ARIiA &sSQ.I'1'. cr-hu ildcr will have the nurden of Proving fled he did not build or initiative for par- Y pax.of,alc.l, 'r(yl'A1, M 1,as worrier of the Nati, at exclusively contracting with Eccn,al-allocation, mel.ct the project(See.9161).Business and Professions CNet)I re Comnaor'I Li- ocivulawonesnotapplytnanownerofpropertywhobullo,or improves theuon.and QTY. PLUMBING PERMIT FEE who cwnm¢N irr such projects with e.wnuvcmu,)Ii'eawd pursuant m the Cunnrmnr's License Law. PERMIT ISSUANCE ❑1 am exempt ender see. .B&P C fur tai,.cora ALDER-DRAIN d VI?NI-WATER(EA) VALUATION Owner O WOHKI!R'S COMPENSATION UECLAHA'I'IOION BACK PLOW PRO['li(:'IIDGVICI? I I hereby affirm under Penally of Perjury line of the fid.c oog JMaraions: 0 I have and will mainerm a Ccniicmc ofConscm to self-insomw Worksra Grmryn- ORAINS-ly,(IOR.HIR)Ir,AR ,COND. STORIES TYPE CONSTRUCTION nation,us pmvlded for by timbal 3900of he Lntxn Cale,fur me perfmmanee of the work for which this permit is v..rd. FIXTURES-PER"1'RAI' 1 have vad will maintain Wnrkers Cothpenrutilm Insumnce,-require)by Section X)of�thle{laYm mi Code,hnthe Performance of the work for which thin pert is issued. GAS-EA.SYSTEM-I INCA DOI'LEfS OCC.GRIIUP APN My Wo ,MPI'1Oil Policy numlfer are'�.�CJ Cnrricrl�C,CE I CCAIE IsSAT10NalNN IROM WPulacy No,, ORKERS' GAS-I?A tiYSTF.M OVI?R4Q?N 5UBOM GRIASF/INDUS'fRh WASTE IN'I I:RCEPIT)N BUILDING DIVISION IIiGti frhiswcdonncul not heemnplcted ifrhe Permit is Barone hundred dalln6(51(X) CREASE'I RAP lir less) . I'hANCIIECK FBI; I crony that in he D:rforromwewfthe walk for which this Permit is;loud,I0a11 SEWER-SANITARY-STORM BA.200 PI'. not employ any person in any manner w as to became subject to the Walken' mMn,Co ]ENERGY 1:171.1 Z ,ation Lawlor Califianne,Date WATER DEALER Much T/fiLEMR GRADING FEE Z 2 Applicant �. y NOrICE'IO AI'PLICAN'C IL alter,ranking this Certificate of Exemption,yen should WATER SYSI H fpREMING SOILS I:E13 f" Menthe adem In the Workers Compensation provisions of the Labor Code.you must forthwith comply with such provisinnsm this .it hall IN,deemed.,liked. WATER SERVICE aQ Z CONSI'HUCfION LENDING AGENCY NIiW RIiSIUIiNT1A1,1'LMB, sR "Il PAID Ihereby'ammr thatthemisaconstrucm,n lendergagency fur the perfonnanceof nota Be upra CUL . the work lbs which this pmol it ix i...ed(Sen.31X99,Gv.C.) TOTAL: O I<tder's Name 'IOTA1; rU Lcndm's Address BUILDING FE1? 6. 1 unify that I base read this op,lication a.I seae rho the cMrve infunnstiwn n F. ln comet.lag.c to comply with all city and county ordinances and state law,renting to i9fig ANICAL PERMIT I`E SEISMICITE its U haddingum,vudion,and httehy and, file mprncnntives alibis city rat enter upmnhe shove-mentioned pr,,,,Iy fm in,pc,'Iion purial ea. ISSUANCE 11 CrIKIC PEE J (We)li to save,indemnify and keep harmless the City of Crisman isolator lerbi'itic,judgmente,costs and expenses which may in anyway accmc against said CityO MECH. PLUMBING FEE = in rnscyuerec of the granting of this"ril, APPLICANT IINII1?k STANDS AND WILL COMPLY WITH At.[.NON-POINTUNIT(TO 0.000CEMI MECIIANICAI,I:IJiRCi REGULATIONS. CUNI'TrOVER I ld"i CFM) CONSTRUCT ION TAX Signtu o1'AppornIA hancou Dat, 17%HAUS'I'HOOD(W/DUCT) HOUSING NU I GADON FHT! HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building r¢cupant,m.or handle harardur,mamrial HEATING UNIT LTO 1(X1.00011 FIB ;is defined by the Calandra Mmricil it Cede.Chapter 9.12,and the Health and Safe,, HEATING UNIT(OVER 1g1.fXq R'rU) Cade,Section 25932(u)'f E3 Ycs1 VENTH.NHON IANI SINGLE RESID) PAID ' Date Reshape x Will the applicant lir rumre building acupant use equipment or deices which BOILER-COMP(ILII'OR 100.0 BTU) coil hue:udous aI.......mincer,rte defined by Thu Buy Are,,Air Quality Managemem TOTAL: District! BOI Lint-COM P(OV IiR 100JXXI BTU) ❑Yes AIR CONDITIONER �^ ISSUANCE DA'I'li 1 h.rve rcaA Il,o h:vaNnu.,mumrials rcyuircnrcnle.",let Chapter 6,95 of the it thee V lirmia Ilculth k Safety CNq Scdiwm 25511$,255)3 unA 2553).I unJc,'nomNEW I11151DiN'rl Al.MECII. SQ.Ff. � J 11,11,it the kk'�t� gdel.mcunnnly bm'cumnanl,thm it i.smv.......bilitym arlythcsvcupant son ,which.. dlvout primo issuance of a Cenificao of Occupancy. owner lir aamnn.d'gena Doe T(mnL. ISSUED fly. OFFICE