S 2090 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.REECIRICAL I'le IR N(l ('�
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL � 2090
BUIEDING PROJECT IDENTIF'ICA'TION
BUILDING ADDRESS'. SANITARY NO, APPLICATION SI/IHMIIlII'AL DA[
OWNER'S NAME: 1'110X1:: CONTRACTOR'S NAME: LIC NO:g
C BIC CONIROI.p
.ARCHITECT/ENGINEER: LIC NO: A RESS: ❑
CON'IAC'I'. PHONE: BUILDING PERM PI'INFO
"O-O ❑ COOSUBaN Fecs Paid by Applicant(Initial) BLDG IihECI'
PLUME NEED
EJ/JeZ ❑ ❑
I.ICIiNSEDCUNTRACIOR'SDECLARATI� (. QTY ELECTRIC PERMIT FEE
I hereby anintt mal I..fecund under naviainnx of Cha rte,9(woman ang 1013 DESCRIPTION
WQO wilhSminn 71XN11nfDivision3nfmc liuxincss and Pm(cxsiunXCalc,atonylII is PHRMI'1'ISSl1ANCL RESIDENTIAL:
F�y W In Ltl1 font send eaten. ❑simm, ❑KITCHEN REMODM,
QVU Llcuosc Class I.icX APPLIANCES-BESIDES I'[A]. ❑ADDITION ❑PLUMBING RE-PIPE
FZW pato Carlinville
ARCHITECTS DECLARATION ❑MULTI-UNIT ❑S'1'RUCI'URAL
PANELS MODIFICATION
zo.z
I understand my plans shall be tend as public records UI'T021XIAMPN
❑INTERIOR [j CHIMNEY REPAIR
pcfi ]apt Licensed Profe,morll 201-IRMAMT'S IMPROVEMENT E]SWIMMING POOLS
,xOyU lidlowing reason.l5ntinnWNERSJiusiln �anJive RHUN OVER 000AMPS ❑ItATH RfiM011iilARI:PAIR (]Ill?MOLITION
C 1 hcrch"eftion mm I ant eoent t linin the Cnntruetan'x License I,uw 011'the
'cW - ❑OI'Hf:R
s Code:AnY C�fy nr cnunlY SIGNS IiLIiCfRICAI.
W 3 W H uaich requires a permit ,,conswct,niter,improve,demolish,or repair any swemrc
F�Og primmitsl,uunae,alsowl-wesmc applicum fur such penniuo file asigneJ sw¢mc11t SI'IiCIN,CIRCUIT/MISC.
LLiS that he is licensed pursuant to the provisions of the Contractors License Low(Chaptnv (� O COMMERCIAL:
p�j tY��
(commencing with Section 7")of Division)ofthe Business and Profession Code)or �/ TEMP.MITE RPOLE INST.
d d ey
that he ix cwn pl IEumfrom and the basis Ibr the alleged csnnpliow Any violminn of El NEW BLDG/ADDITION ❑DP.01)SERVI
DIm1�
Seen- by nnyappliutm lin a peouil'object'the applicant,a dvil venally a( POWER DEVICES ❑TENANT ❑I'(IOU SERVICE
W^m not norcman live hundred Jallun(S5t111),
�=QI,as owner of the n SWIMMING POOL ELECT RIC IMPROVIiMIiN'I'
Q property,or my employees wird wages os their sole unnpcnsnl°n' ❑OTHER
F. ssdl Juthcwnrk.awUIw,tmcwrisnot intended ordlered hostile(ST 76,00,Business
Wim and Professions Code:The Comracmtn License Law does not apply to an owner of GOUTS-SWITCHES-FIX'I'ORES
property who builds or improves meteors,and who does such work himself m through
his own empluyees,provided that tach iniprovemems arc not intended or offered for NEW RESIDENTIAL ELECI'R SQ FT.
,III.If.howcvctthe bmId'mgor improvement is,sold w main ane year of completion,the SQ. FLOOR AREA i/SQ.FT.
cr-builder will loo.the burden If pnrvl11g that he did not Judd nr'unpoo,for Pnr-
pudcof omlc.b
❑Las owner of the property.ata esdusi,cI,cnnvacony with licensed emnmcurrs to
mnrvcl the project(Sec.701 liusinevs and Professions Code:)The Contractor's Li-
no law does nm apply to as uwnerdu property who hands or improves thereon,and QTY. PLUNIBING PERMIT FEE
who contracts for such projects with a eontracter(O licen'ed pursuant to the Contractor's
Licence Law. PERM1"1ISSUANCE
1 um excu,lunder See .B&P C for link rnwon
AdCR-URAINAVHN' -WAfEf, VALUATION
Owner Date /
WORKT;R'S COMPIiNSAT10N DIiCLARATI(lN BACKFLOW PROTF,CI'.DIiVICE L
I hereby affirm under Penalty of perjury one of the following declarations
I have and will maintain a Certificate of Cunsenttoself.insute for Worker's Cnmpen- DRAINS-FLOOR.ROOKARHA.COND. STORIILS 'I'YI'IiCONSTRUCTION
,mina as Provided Int by Section 3700of the Lahr Coale,for the performance of the
work for which this Tern d is issued IISI'URHS-PER TRAP
❑ I have and 101 mulntain Workles Cmnpu lsmion Iivavencu,as rnlwrcd by Section
3700of the Luton Colo.fin the perhnnnnndcel the work for whicbmis pennil lxi sued, GAS_12A,SYSTEM-1 INC.JOU'ILE'I'S OCC GROUP AI'N
My Worker'x Contpcn,bnn lnsunmeo canter and Policy allover arc' GAS-EA.SYSTEM-OVIiR iIEA)
Cartier: Policy No.: pW-I-
C'R IIrICATLOIs E,'EMPTION FROM WORKERS GREASIVINDUSTRI.WASTE INTERCEPTOR
CONI`ENSAHON INSURANCE BUILDING DIVISI(IN FIiIS
Ghcwvlinnn ed not McumpleNdlf the permit is noun.hundred dollar,(SI00) GREASE TRAP
ser Icssl PLANCHECK FEE
Iucrtily that lnlbe peifnnnaneeol the warkflnwhieatho,,nnit i'Issued.I shall SEWER-SANITARY-S'IORM 1?A.21X1 ITE
not employ any Teton in any manner so u.m became subject m the Workerd Contpen- !.N.RGY FEH
Z ration laws of Culilinnia.Date W'AI ER I117ATER W/VRIK,'IIi1.,GC R ING FLIT
ZO Applicant
y NOUCE TO APPLICANT:If,after making this Cenawne of Enemphon.You should WATER SYS!EM TREATING FEL
Ir become subject to the Worker's Cmnpensntion lines cions of the Tatou Code,you must
lYi � forthwith comply w llh.such pow.'ao or this Permit shall lodnntedrevoked. WAI'17R SERVICE
Q
� z CONS'IRUC'I'ION LENDING AGENCY NEW NESIUFN'IIN.I'I,MIt. SQ.PII
I MTb,dfmuhat there Ili cnnsmI I lending ugnmy Ibr meperfmmanecal UWc RnxIpIN
he work for uhich this permit is kviied(See.3097,Civ.C.)
Irn lve,Nome TOITL:
V Lended Arkhri TOTAL:
r y I certify that I have read this application and nate that the above infomutiun is BUILDING hili
Grpcancer.la,mentcolmly wah as city and county oninanme and Time lows reladngm QTY. MECHANICAL PERMIT FEE SEISMIC FEE
U Z building c'all[Inatlrnt,11111 hcrch,1 11 ruce,rc,nnoo—offbi,city locn¢rnpon the
it
abo,e-mentioned pmpeny for inTeetin I purposes. PERMIT'ISSUANCE 'I.,C'IRIC FEE
(We)agree to save,wdlanrify Told kdc
keep hems the CITY of Capetian again f
liabilities,Judgments,costs and expenms which may in any way accnee again,said City ACI Iia LIR ADD TO MECH. PLUMBING FEE
in conselacnee of the grunting of this pc'.air.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO I0.000CFM) MECHANICAL PIT
SOURCE REGULATIONS.
AIR HANDLING UNI'I'(OVER 11.0X)CPM) CONS'TRUCHON']AS
.SignunwalApplicant/Clurnewtnr Duro EXI SAGS'I'HOOD(WIIJUC'II I HOUSING MI'1'IGAI!ON FEE
HAZARDOUS MATERIALS DISCLOSURE
Will meapplicent nr future building Neutron store or handle hsrnNnus nmterial HEATING UN IT CFO I W,(XX)BTU)
as define)by the Cupenina Municipal Code Chapter 9.12.and the Health and Safety
Code.Seainn 25532m)R BEAT]NG UNIT(OVER 101.001 BTU)
El Vic, C]No VENT LACION FAN(SINGLE RESID) PAID
Il'alc Rccciptp
Will the tgopllcanl or him,.hued ng w,.tonal a,,c,uionv nt ur dwices wl.lch pO11.liH-COMP(3111'OR I00,0m)BTU)
mit fie-olone air cdmfmnmom'm defined by the]toy Arca Air Qeallt,Mannancol 'I
Dietrich BOILER-COMP(OVER 100.000 RTU)
❑Yen No
I have real the Emardnu.smaterials requirements under Chapter 695 of the Cali AIR CONDITIONER ISSUANCE DA}jd �s
form.Health&Saet,Code.Seelians 25505.25533 and 25531,1 understand than it he NI?W RESIDENTIAL MECH. SQ.1'1'. �n1/ /Zy!/(Y/
huilding oils III,( l,ha,.II ITut,m:a'tisnry ce.Ponxihi bit,Inn...i ly flu swngnm
of the uirensnts rte hentefPrint ful,ianeenln lnifcawof(koupuncy.
-� P- Q
Owner or amhon. Dae IDTA1- ISSUED BY:
OFFICE