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S 2365 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMI F NO. BUILDING DIVISION APPLICATION/PERMITPLUMBING-nD:CRANICAL S 2365 BUILDING PROJECT IBEN'i'I FI CATION BUILDING ADDRESS. SANITARY NU. APPLICAr[ON SUBMITTAL DAT Ii OINI!R'SNAMP� PHONE: )N'1'RACTOR'S NAME: LIC NO 2-2- s=4 Atill �a NIC CON'IROI,M O ❑ ' ARCHITECT/ENGINEER: LIC NO: AUURESS CONI'ACI': /I -/- PDONii'-T Oj 13UIIAING PERMITINFO 00��// T / ❑ Consultant Fees Paid by Applicant(Initial BLDG ELECTPLUMB MECII EJ El LICENSED LICENSED CONTRACTOR'S DECLARATION TY. El-rCTRIC PERMIT I hinny afnrin elan I amt Iterated ander pro,s,om of Chaplar 9 aarmeralag Q JOB DESCRIPTION MXZth Salina 91110)ofOivkien Sot the Btiance and Prele"inn,Cmdu.and my bee's.la RESIDENTIAL: wcO wt PERMIT ISSUANCI: 1a 1= suit Hires andel 2l p J! ,i� ❑tiIUWL ❑KITCHEN REMODI]. dVU License Clas- L Lic.p APPLIANCES-BESIDES'1'IAL [I AUDIT [I PLUMBING RE-PIPE tFaa Daa C mDECL ❑MULTI-UNIT ❑5"1'RUCTURAI, DN ARGIIIIIiL I"S UECLNi PANELS F'w Z I undenwnd my Pluns,ludl reared es ithhe u r CHIMITIODINEY RE N OZ-.. UI"1O21x1AMPS ❑INTERIOR El CHIMNEY REPAIR F`gtw Limned Prafewa nal 201-IM)AMPS IMPROVE MIFNT �SWIMhf]NG 1'001.5 OWNER-BUILDER DECLARATION d M1crchy umhnn thw 1 am axontpt from fac Contrmmor's License Law lin mac OVER 1000AMPS El BATH RI?MODELBtEI'AIR DIFMOLITION LL,LU follnwin (Section90315,Husueess and Prolessions Calc:Any city or county SIGNS ELI?C'IAICAL ❑QTHhR �. gtea,nn. Lf a� y whi,b rt lmia,a permit or can.aru.1,alter,ilnrrovc,dcmalish,nr mpmr any,tmclurc FLLd prior to its issuance.also rcyuircs the applicant for such Permit o file a signed statement SPECIAL Cl RCUIT(MISC. A that he is licensed pursuant to the provisions of the Contractor'.License Law(Chapter 9 COMMERCIAL' Ilial�p0 (cemmm�cing with 5cdion 7lNx8 of Dividon3 oflhc Husinc,s andi fir,xinn.s Codme, '1'HMP MET VR OR POLE INST L G e C mbar hu is exempt re rfm:n end dm huts for Ile alle,ed rearoi Linn.Any violaliun of ❑NFW BLDG/ADDITION ❑IJEMOLITION k m_LL S,ctlon 9W LS by tiny npplicam limapermit suf+jccfx the vpplicunnn Cemex(pcnahy of POWER DEVICES ❑TENANT ❑F(bDSIiRVICH LL mu nor,than f,c hundred dollars($500), FZaFAIIFNT ❑Lax Owner Of the prnlcny.or my employees with wages as their side compensation. SWIMMING POOL ELECTRIC will do the work,and thestrati m ix not intended meHcred for sale(See.9614.Businos ❑OTHER THER {ail~ib trod I-r ,le,xions CoJm'rhe Canbumor's License Law duo not ip+ply to an owner of 0U1 LP,TS-SWI'TC - TURFS prieny whit builds m improv thn'cer.and who J,xs each work hiaoalf m through his oxo employees,presided that such improvetncros are not intended or opened lin NEW RESIDCN'IlA �CT SQ Fn ,side.If.houmcr.the building nr impmrement ix sold within me,emof,uripletion,the SQ,IT.MOOR AREA S/SQ ET we,,builder will Irascible pardon of pmvirg that he did not build er improve fur pur- qme of'rhe" )PAL'. M 1,u of the O"I eny,n nclusivol,a arms with I'aensed ceurmmr,In emarum the pmgad(Sec.8114,Bminc,,s and Professions Cal)Tac Con-ow-to Li- cemeLmwdoesnotapplyb+en owner ofpropeny who builds or improves thereon.and QTY, I'I,UMBING PERMIT ii FEE who contracts for such projects with a centrana(x)licensed pursuant m the Contmcmrs Exam's l.aw. VERMI TISSUANCE ( l(J ❑ I am exempt under Sec. .11 Ae 1'C ter this ne:wm ALTER-DRAIN&VEN-h-WN!ER(FA) VALUA'I ION Owner Cnc .. WORKER'S COM PEN'SAI'[ON DECLARATION BACK FLOW PROTECT.DEVICE Q- M 1 hereby a1Enn trader penalty of par m,one of the following drelamunro 413 �Ibuvc and will ntninminuC,nilivulc of Cunscnnn mlFlnone fm Wurkcr's Contpmt- DRAINS-FLOOR,ROOF.AIt I!A CON EUP 'I'YI.,CIINS'IRUC , ,taxon,as pewulad fur by Scctinn 37 a of the Labor Code,for the Performance of the k for which this permit is issued. FIXTURES-PER TRAP 1 lint's and will maintain Work,-Compensation Insurance.as required by Section 700afthc labor Cade,for the peJuiternce of theotakerwhichan,permitls issued. GAS-HA.SYSTEM-I INC.4 OUTLETS AP.N' My Wnr. ',Cn:npcaroat u - .nd I'nlicy numhcr"1O' Currier sur.nem. mmttPoliey Nne�0.w'siY-{� GAS-1!A.SYSTEM OVER 407A) 'IiRI'IIICATE( 'IIXEeMPTION FROM W'O Kli S' GRWSIIINDUSTRh WA.l-TIi INTERCEPTOR COMPENSATION INSURANCE BUILDING DIVISION FEES ('flio,r<tion need not be enmplated ifthe permit is foram,limit dollars(SI00) GREASE*1'kAV i'LANCHI?CK IEIi — orle".) I candy that in mbcpafarinaiecol the work torwhich th,,mnuutix i,wOrl.LshAl SHINER-SANITARY-51'ONM CIA.200 I'I'. ref employ any person m any mnn aer sO as m u beenmubjecnothe Worker'Cnmpen- ENERGY PHE Z ration(ax's of Calauraio.Data WATER HEATER WNEM9ELECTR RATING ' ZO Applicant h NOTICE'S)APPLICANT`If,after nuking this Ccnilicum of laenlptiont you nhuulJ WA'I'F.R SYS rl'.MII'REA'1'ING IIS F!L FSMbecame wbjecno mac Worker's Contpen.safion POw,,j, ,cj the LxN+r Cedc,You inuxl forthwith comply withvah ine.,kitumor mi,pennm slmll IN deemed revoked. TER SERVICE j r 4' � CONSTRUCT ION LENDING AGENCY NEW RFSBAIN'I AT PLM1t. SQ.ET. 1'AIUr E� a 5 U 'Z' I hereby anon that(here is a construction lending agency ter perforntuncc of Uwe scaiptn U 0 the work lin which this permit is NALAcd(Sec.3097,Co.C.) TOTAL: OU lender's Name 7101} � IcnJc/z AJdres. t 1 ccnlfy thm 1 have read this cnrrc<L I ogres n)aunply with all city and cooun ay ndnordinancescnces tic amwc Infamtmiov ix and swm lows reputing u' QTY. MECHANICAL PERMIT FEE SEISMIC PiEI: U millog ceoamcaieo,and harepy nudtarlee eltresmmlives onhix city menter open the Chow unenforced propemy for inepccmien Pupane,. YLRM1111 ISSUANCE ( ELECTRIC FEE (We)e)agree a save,fndnnnify end keep homeless the City of Cal enim+aga ted Iiabilineajudgmenn.costs and expenses which may in anyway mane against aid City ACTERORADDTOMECH. PLUMBING 1; ( O in consequence of the granting of this crura. AYPLICAN'I'UNDP D 111.1. " pLy.WT I .LNON-IOIN"r AIR HANDLING UNI"1'1'101(LINECFM) MECHANl( L Er.. O SOURCE RF.C ,"IONS. AIR HANDLING UNITOVLR 10,000CFM) CONSTU ION TAX S+ o mrcof Applicant/ VGc Dmc EXIIAUSTHOOD(W/DUCT) HOUSING ITIGATIONFEE. IIAZARDOUS MATFRIA.S ) 'CLOSURE �© ®row-,�,�Ytlihilllcplil� icaut or future buildingocalla, t fare of handle ka-m! ixtnwcrial II UNI Old I'(TO 10111011 BTU) as J' ab"PC Municipal Code.Cha cr 9.1'_,arctic Health and Sahel, HEATING UNI']'(OVER HxDxg)BTU) )' ,�/Y3Ns' VI NTH At ION FAN(SINGI.I REMD) PAID Late HeceiptN 'r Will the upplicunf or future hudding o:xupunt axe raimpmcal or dcvicus which •mit ltamrdous air umlanamer m damned by the(fay Arca Air Quality Management R(]ILER-COMY(3HP OR (N),IIgI BTU) Diu a! ❑Yes Nn BOILER-COMP(OVER 110800 BTU) have mol the hunrduus macrials Bunds Cbxner 6.95 of the Cal, AIR CONDI I IONER ISSUANCE DAIT rcyulrnncn I11) fnmiu Hoalm&Safety C Scale) 29505.25533 and 25534,1 understand that if the NEW RESIDENTIAL MSCI I. SQ.FT Z�- �r�Y budding does into It� mm tat h i>n oinnsi iry tifv the mccup:nn I/ oft enequi ems wa h t t Lu t Ennis m onto "i teat of Occupancy. )saner nr nmhorireA u Orate ' fIfISSUHU IIY: OFFICE