S 2199 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
RICA m; Ir No
CITY DI CUPVISION LUMBING-MCCIIINICL , 2199
BUILDING DIVISION AI'PLICATION/PER61I'P PING PROJECT
TSEENI IFIL
BUILDING 1'R(UI!CI'IDRN'FIt'ICAI'ION
BUILDING ADDRESS: SANITARYNI AI'PI"ICAIION SUBMITIAI,GAS
20315 /.10-2,THGL6IJ - cuFocif"+ lJo -95D14- 6 ,Q.?
OWNERS lk. P11011, ,( COyYfHACfOH:SNAME: LIC NO:
M
S S NIC COM'NOL
AItCIIII'f:GIIENGINCEIR LIC NUI ADDRESS: ❑
COnTACI: PHONE: BUILDING PF;RMrr INFO
❑ Cunsultanl Feu Paid by Applicant(initial) BEINGELI❑!CI' PWMII MECH 2 El
LICENSHD CONI'RAC'IOR S US CLARs TION Q'll'. ELECTRIC:PERMIT FEE JOB DESCRIPTION
1 Society.Birm Sha Suit licensed under pmvisinns of Chiq,ml'9(commencing
p�Zwith Seaion]INNI)of Division hdthe Rusinns xnJ l'rnf......s Gde.and my licenw,i. RESIDF:NTIAI:
LL:p p PERA11 f ISSUANCG
�Iy,E in full force and effect. []SFDWI, E3 KITCHEN RE,\fOD1iI.
QUO Liceme Class Lic,N APPL1nNCES-RESLDIt UAL CADDITION CPLUMBINGRE-PIPE
HZW Dae Coataemr
mQ1 CMUI:II-UNIT CM0 IdI.'U1RAL
g.,pm en—Juill be use DECLARATION PANELS MODIVICA'I'ION
Oz='� Inndenlund my pllmx xball he used ux public records
US'10200 AMPS
C IM'I:NIOR []CHIMNEY REPAIR
W Licenud Professional 201-1000 AMPS IMPROVEMENT CSWIM11h11NGPO0IS
OWNI:R-BUILDER DECLARATION OVIiR II0)AMPS CI{ATH REMODEUREVAIR []DEMOLITION
a ¢ I hereby omrm that I am exempt from the Contractor s License Law for the
�L p a U folkwing....ol,.(section 7031.5.anoint,..and I'mlcssmu,code:Any ail,m enlnly $1Grv$HLIicrRICN. ❑OTfiER
IA 31u h Much rnlui a per nit ,,c n. rl.alar,linpm u,den kh, rq,a any st scam Z�XSr N
1_.pa poo I t e*
m. y napplicantf tip rtnhl dit it mmxrmnnt SPLc1Al.clucmrmus('.
E y-I
and he 1 cd pnrw tl ra p fn C I am,L 1 ve(Chapter 9
�e(�O (co Eng 'NSen ]1X01 Iti'izi til 0th B .nes. roll l .num CoJO or TLIARMEfERORFULEINSr COMMERCIAL:
St.a C that he is exempt therefrom and the basis for the alleged exemption.Any violation of []NEW BLDG/ADDITION ❑DEM1IOhI'fION
boy Secimn7031.S by any applicant for a Permit subjects the applicant to a civil Penal yof POWER DEVICES
arc tlmn live hundred Anllur.(5501). []TENANT ❑POO[)SERVICE
~SQ Lux ownen,f rhe m, n IMI'ROVEMI?N'r
1 pc Y•o'nny nnpinyws wide wngesmlLelr nvlc amtpcnwtiun, SWIMMING POOL L'LECI'ItIC O'IIIL'R
t. wiIIdo the work,and She,,...ure ix not inanJcdoroffcred forsale(Sec.](W4.Bu.ae..
6a 3 m Communities and Professions Code:The Conities License law does not apply to an owner of ULU[]IRS-SWITCI{ILS-Sit xTUR1S
property who builds la innpnwm thereon..nd n'ho Jtes such work himself or Through
his employees,provided that such Improvement%me not intended or offered for NEW RESIDENTIAL 17 A;.FH SQ Fi
sJc�lfnnuwe elle nuilJing nnmpnrvs undcalJ within c,carofcnmplctiuto the
SO.IT.IH.00R AREA 95Q.IT.
ter-hu'JJer will have the burden o(pruving Ibm he Jin ant null)ur improv,for...
we t ). ss 'fO'I'AL:
I f thep Ineny exclusively contracting with licensed contractors tin
o t n thep ) m(Sec ]BW Business J professions ns Cadet)Me C van Li-
Law doesnot'pplyt f picaparty wha builds or hiatusesthereon.and QTY PLUMBING PERMIT FEE
who snuruts for such poiceis so an a countimatod%)I' sed pursuantt She CimS tors
L'ca, Law PERM I'1'ISSUANCE
❑ [It pia a Se .Il h l'C for Shia reason
AFTER-DRAIN A VIiNI'-WATfiR IIiAI VALUATION
O
WORK. 'S COMPEN. PION DECLARATION BACK FLOW PROTCCI'.DEVICE
I
notelly
offimt under venally of perjury one of the following decimations:
� InuvcunA will mainminaCcniGcumufComenuosclf-insure❑nlV9rker'e Gmnlery DRAINS-MOOR,ROOF.AREA.CANS). 5fOH16S 'FY PH CONSTRUCT ION
cation,ax novid d or by Section 3900 of the Iahol Cwle,fur Ih,peb bounce til tins
work for which this peon ie i...OIL FIX'I'11RE5-PER INAP
F I have and will maintain Worker's Compensation Insurance.as reNsircd b)'Section
3700ofthe labor Cele,fur She performance ofthe work forwhich this permit is issued. GAS-IiA.SYSTF - TLE'. O OCC"GROUP APN
My Wnrkoev Compensation Insurance courneetarl Policy tender am:
Carrier: Policy No, GAS- . YSTEM" 'A)
CERTBFCAI'IH OF HXEMPIION FROM WORKERS' GRIF St I STPI.WAS'HEINTERC"
COM ENSAIION INSURANCE BUILDING DIVISION FEES
IT his section need not So,completed if the pum,it is for one hundred dollar.IS I W) GREASE -
or I¢�.I PLAN'CIHiCK FEE
I ttnifY that in the ptdonnanee of the work for which this{,omnis is i...ed,Ishall SEWER-. ITAR1'-STORM EA.21X119'.
nut employ any person many manner so as to become subject ,,the Worker<Connpen- ENERGY FEE
nor
ration law.at Califtan.l}m WAfE141112 "F.RW/VHN'1"/ELECI-
z O Applicunl GItAU1NG PGP
N(ITICH'Ifs APPLICANT:II;ulicr making this Cenifca¢of lisvnnptinn,you snuulJ WA IF SYS'I:
a ? become,efco to She Wodefx Compensation proomem of mhe tubo Code.3^u Sousa SOILS hlili
forthwith comply with such provisions or this permit shall le decmeJ rooked. WATER SIiRVICE
6 Q JPAIDCONS'IRUCIIONLIiNUINGAGIiNCY NF.W RIiSIUEMIN.Phhllt. SQI?. ReceiptsU ZO nnon:nymrrmnta d�meiaaeon.tmtde,lomhng ogooy bit ant p.7e,nnaam ofIr. — me work for wni.So dda woull Ls I..ned(Sce.309].Civ.e.) TOTALO V Isnder's Numc �lLendr.AJJreasTOl I,edify that 1 have read this application and state that the above information is
Fy ounces.l agree in annply with all city and county onlinances and state lax,refining it) QTY. MECHANICAL PERMIT FEE SEISMIC FF.
U Z banning construction,atm hereby.uromiLe repre.cnmrnesoftmx city roomer upon the
abovamentiuncd proPen,for Inspeclinn pure"ccs. I'IIItMI'f ISSUANCE
(We)agree to save,indeus.mnity and keep harinlthe City of Cupertino aguest ELHC'IRIC
liabilities.judgmenl.,mess and expenses whichnuy tranywayacemeagaimisaiJCoy ALTER OR ADDTO MECH. PLUMBING
in nstquena of She granting of this permit.
AP It.CA 'I UNI) STANDS A D WI . PLY{61TH ALL NOH-POIM' AIR HANDLING UNIT(to HLIXO CEM) MECHANICAL i
ti0 I! IiGUL TH S.
AIR I IANDLINGUNI'I'(OVER HI,00OCI'M) CONST RIICf[ON'1'
Sign. r , p,fuumucoma nr DOc EXHAUST HOOD(WIDUCT) HOUSING MITIGATION ITE
HAZARDOUS MATERIAIS DISCLOSURE
Will the applicant nr fmmt Inildingoecupumumreor handle hrmahnxmaanol HEATING UNIT ff080.1011 BTU)
as defined by the CupiNnn Municipal Code,Chapter 9.12,and the Ilcalth and Safety
Code,Seeliun 25532(:p'f HEATING UNIT(OVER 1110,IX0 B US
l Yes [J No V17N U IATION FAN(SINGLE RES I D) PAID
Dae Receipt p
Will She applicant or future building arupted use Nuipmenl or devices whichppll.liR-GGhf I'IJHI.OR IULafNI BI-of
emit hv .arthoair coen as define)by the Bay Area Air Quality Managemnl T
District? BOILER-COMP IOVIiR 100.000 B"IID
Vcs C Nn
I hale rt,Ud,he hamnWusnmtarial.rcyuimmcno.under Chuptsr 6 95o She Cali- AIR CONDI'I'IONI:R ISSUANCE DAP I;
India I Icallb&Safely Coda Scanlon 255115,255)3 and 25534.1 unJcrsund that if the NEW RESIDENTIAL.MECH. SQ FI'.
buildmgdoestern,soInch Soustha metpi'I'Volume'If-C'iwa,nnlifylhepancy. t ( o
m ob,reyrocare P xhich muss
be met prinnniaunntt ofu Cenitieum of Occupancy.
Owner tit'anlb9nmd ugnu Dine 'I'f YI'AL'. ISMICE BY:
OFFICE