S 1886 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPFRTINO RUu.DING-KLKCI RICA PE IT No.
ITUILUING DIVISION APPI,icotTONTERMIT rLuunwr.-ao-:cunnTc,O' V 1886
BUILDING flit IJEC'I'IIIDN'I'IF'ICAI'ION
IS1111.DINGADDRliSS: SANI'T'ARY NO. APPLIG'1'ION SUBMI'FI'AL DAI'IL
OWNE 'S NAME: PHO - CUNTItACTON'S NAME: LIC NO: SIC CONTROL al
�q �RAshnRVAsFty1 973—d4�
�ARCHIT-CT/ PI NO ADDRESS: ❑ 1/ r / `�1
CONTACT: ahIf
!it II,DINC PERMIT INFO
I(/ a J--d ❑ Consultant Fees Paid by Applicant(Initial) RLDG IiLCCr PLUMB MCCB
B' 69— CZko"
LICENSED CONI RACIOR'S DECLARATION Q'T'Y ELECI'RICI'ERMIT FEE
1 hereby affirm that I an licensed under pmmsion.,of Chapter 9(commencing 1013 DESCRIPTION
DeaZ m,hS,,IIi nndeffcclivl.ion3ol'ImBusinec,anal Pmresoiens Ctde.and my license is RESIDENTIAL:
I'IiRMI I'ISSUANCli
�u,= Fall t. 0�S'P'�DWI, ❑KI'1'C1113N REMUDEI.
aUU Liccnnc Class LIc.0 APPLIANCES-RESIDENThod, T10N El PLUMBING R&PIPE
Nay Dmc Conlraclnr
ARCHITECTS DECLARATION ❑MUhfl-UNIT ❑STNUCTURAI.
Foam) I oil...r:ud my Plans shall housed ns pioddamcords PANELS AfODIFICAI'ION
OZtnq UPT200AMPS ❑W'IERIOR ❑CHIMNEY REPAIR
F4CW locmn.nl l'mfc.dnnnl �-I(000AN
PS IMPROVEAIFJST (]SWIMMING POOhS� � OWNIiR-RUILDIiN DECLARAf10N R'Bdr MP5 ❑RA'1'II RIiMODI?IJRI 'AIH ❑DIiMOLIrllIONC 0. a I httcny u(Rnn that l um exempt from te enmomm�rs Llccnx Law fnr theXOUi I' nwmg rcavoo.(Section 911315.Bu,noW,..it Protusion,Qdc:Any c'nyor connlY NS ELECT RICAN ❑OTIIF;R
1e-u7i which requires a pemot to vamar ,almr,improve.demnlisn,or repair env etmmu.e '
11..0.0.] pr+rt t '. I. 4 Its, pplc a M''_W i '- '1'FCIAL CIRCUIT'/MISC.
that h licensed p ant t the p o f Ili pet rocs l orr,�la U.t 9
i� ' ns C. { COMMF,RCIAL:
00 (urn none nbw'IM1 Suitt 9(Xa) fU '.an t 14 R ine.xs�df�f a nr Eh11'MIifER OR I'ULF.INS'f.
y yx e C that he is excmin Iherefnnn and oho basis I'ar On IId cse on.A violati n of ❑NEW SLUG/ADDITION DEMOLI'T'ION
Wim Section 90315 by any applicant for a permit suh ftvkie applicant to a civil pf..try of WIiR DEVICES [I TENANT [I FOOD 9 17R ICI!
neo more than five hundred Jollurx851101. 1J `I q '7 IMPROVEMENT
FZ� Las owner of the pmµny.or my employfen tlsvageN Vw,,2pe'fg WIMMIN6 POOL ELECT RIC
LZ.o w Ido ahcwnrk,and nbc ztnaeavc ix not inaendcd fried for sure(See 7044,Rosmoa< ❑09'1{I{R
3 m and Prof ssinns Coh,The Conanomr's Licen w doer an(apply to un ownero UI'L,TS-SWI-CIIEti-Ir X'I'l1RF:S
pro,cany who build:or initiatives theater,and so to drives sch tork himself through
Motown taloI Y :, ro,ided Int 'rep 1, not' I I J derul fnr EW RESIDENTIAL ELECTR SQi
If.if,h hetbuildingimprovement � 'nt2slm' SQ.I'f.FLUOR AR_
SISQ.I"f.
h IJ llhvc lh,f d fp w , hall lidoo,M1 litimproveforpit [/h/4 Y
Rise f I J. 'I'O'TA .O
❑ 1,as ownar of the prnpti am exclmively contracting with licensed contractors to
instruct the project(Sec.91,14.lat'inus and Professions Calca'fhe Comortr nos Li- ]�wI(]✓O (aY1I//,
cenm Low docnot apply to w owner of propeny who builds or improves buron.and QTY. PLUMBING PERMIT FEE
s
,hoc+nraclx fnramhpmjeomwti,aconoracnn(p)I lc en.WPu oanno the Conwmor's
License Lax', n PERMI1'ISSUANCH
❑I an crcmpl ander Sec B&1'C for this mason
ALI'IiR-DRAIN&VIN T-WA'l lilt UFA) AI. +'I'I
Owner Dom
fS COMPIiNSATION D151,ARATION (SACK PLO OrECI.DEVICE Q O�
Il-m affirm on or penalp'of perjury one of the following declarations:
I have and wdl mni.tnan a Catifcam of Conanl h+.self inure For W'orkerx Canal DRAINS- Of R.ROOF nRIiA.COND. STORIEy TYPE CUNSTRUCI'ION
satin.,m provided for by Section 1900 of the Latin,Code.lia the pedumunle of the '^
Fl%T'ORES-PER AI'
work lnr which th lx suit is issued. Cj
mmlit
❑I have nM will maintain Worker's Compenso t In.urwme,or,nyulrW by lection
3700 fthe Litho,Code,far the Rcfformoncudahe work for which this permit is issued. GAS-FA.SYS 1'Eli .d OR DARTS ( '.GROUT' AI'N
My Winkles Cominvrextino Insurance carder and Policy mother are:
Cartier. Policy No.: GAti-IiA.5YE'fE VI?R int
CERI'IPIC,ATE 01'EXEMPTION(ROM WORKERS GREASI✓INDUS"IRL WAS 'RUTERC5PB)R
COMI'ENSAI'ION INSURANCE BUILDING DIVISION ICES
(Thi,;section need not be completed iflhe pamnit is foronc hundred dollan(510)) GRIiASF,TRAPIt IS-10
Q
or less.) .ANCfIIiCK PtiE
I cenify that in the peffarmancewrfthe work for which this permit is issued,I shall SEWER-SANI'T'ARY-STORMEA.200"T
not cmpluy any person In airy neat.......it,to bmonnc subject to the Worker..,Cninpea- ENF:RGI'llili ('
Z ration Laws of California,Data WATER BE W/VIiN'f/IeLEC'IR
AVING FLR
z Q Applilear GR
NOTICE TU APPLICAII If.aflcrmaking olds Ceniliwm or Exemption.you sbnmd WATER SYSTEM?R17AI'ING )INS 1I717.
a , M1ecnme.subjectto the Workers Compensation provisions of the Wh+r Gde,you most
Lmh,ith comply with such pry e,or this permit shall he deen®el revoked. WATER SERVICE
LILT0
CONSTRUCTION LENDING AGENCY NEW RESIDENI'IAh I'hMli. SQ.I'll PAID
Receipt p
I hereby affirm that thele is a conwmction leading agency for the peRnnnnionce of
ICJwork for whidt ohypinnil is iaufJ lSue.J(3097.CI¢C.) T O
der',Nome. Cs�•
Lcndcls Address IlT r _
i cenily loin I h:nc read rhos npPlildinn and nude that the above infamenion is
FN
same,Ir,eea+comply with all city and county nNinances and stale laws renting to Q'T'Y M FCI I A N I CAI,PER M IT F14177 SEISMIC 7®
Vnmtia
Z handing conwa.trod herfhY amhorim nprewntaoivea of this ciDm etnerupm the
'- ab+ve-mentioned propurty lin inspection purposes. 1'ERM1111'ISSUANCE f J ELEC'IRI PER
(Wel agree to sm'c,indemnify and Imp bamdcss the City of CuNninn against
s favkeanlie"s, swhicnma wary nmmcagaind nuiA Cit CI'HRORADU'fOMECIL
air....ir...iu,ludgmcnL. I Y nnnY A. PLIIMRING 'Eli 3 k/
nsCANT U N the gmming of toms pfmdl.
AI'I'I,ICANT UKUF,RS'1'ANDS AND WILL COMPLY N'ITII AL1.NON-PONT AIR HANDLING UNI'I'(TO Io.0lX1 CPA1) MECfInNICA IIiE
' EGUTA110' -
y—Zc>--o AIR HANDLING UNIT(OVER I01Xp CIM) CONSTRUCTION TAX
agnc tum VG anUCnntrennr / Dale IiX11AUS'1'1100DIW/UUCI) O HOUSING MITGAOON FIT:
a( HAZARDOUS MATERIALS DISCLOSURE -
WIItheapplicantoat future building"soupcon wore or hout bamNous macrial RIMING ITN I'I'(TO I IXIOND BTU)
Imnl by Inc Cid i.n Municipal Cale.Chapter 9.12,and the Health and Safety
m
Code.Sution 1553200?1553200? I(EATING ON I 'IOVIER I(XI uin B'ru)
❑Yes ,I;r/fJo VENONCIITION FAN(SINGLE RESID) FAIR Dae Receipt0
Will the applicant orfuturebuilding occupant use eyuipnnlnt or device.which BOILER-COMPOHPOR 100.000 RTIO
'.mit h o-alum.air c+lamimnas as Jciim(l by the Bay Arca Air Quality Management T(
141
Dmdcll I{OILER-COMP(OVER 100.00f)It i ff Is
0 Vcv V-I
-
I h ad the h ,, ' dal req c nit. nits of the Gd' AI R CON DI I'I ON17R ISSUANCE DATE
-
Il hh A Sftl I S n i n255115 1255144.1 1 o J tyndpool tftha NEW RCSIDLNIIAI.MECIi. SQ.1'f
building
u
bIi IJ' gJ t currently
tlyh I is inyr
tenant.that t Y .P nsih'11yt ifY lhc'ncupem
f tuns he them
Ipn t faC til t f(kcu�ry
t vfJogcnt Dmc O T ALa ISSUED BY: l/
OFFICE