S 1598 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-CLNCI'RICA I. 'liy�p•�TI'NO.
BUILDING DIVISION APPLICATIONAIERM IT I'LUMBING-ME1`811 8 1598
BUILDING PROJBCP IDCN`1[FICA1 ION
ILUING AUDItli55'. �� v SANI I'ARY NO. APPLICATION SUBMITI'AI,DATE:
o/y
9� -1r;-k$
VWkR'S I AMP' PHOy. f V CO TRACI ORIS NAME: LIC NO
0 �� 736— ;tyF NIC CON TROI.p
ARCIII'I'F,CT/ISNCANEER: LIC NO: ADDRESS: ❑
CONTACT: PHONIi: BUILDING PERMIT INFO
❑ CmnsmHenl Fees Paid by Applicant(initial) IihpG F,LEC'I' 'Ll MECH
LIra hm line
e lic,o d TOR ooth,S DIiCLnRATION QTY. ELECTRIC PERMIT PEE JOB DfiSCRIF'TION
1 hereby a1Krm teal um hehe Ra unJer pmv;%;uns of Clnrtter 9lcummmacing
n�7 with SecludeXXB of Division3of the lousiness and PmPossfow CMO,mdnty licensev RESIDENTIAL
W PERMIT ISSUANCE
�U� ;n fillfen1cIII.Class cBieL ❑SFDWL �TCHI'vNREMODEf.
QUU Lium%c Claes Liu, APPLIANCHS—RESIDIiNtIAI. ❑ADDITION �PLDMNING RIiI'IPE
yQL )at,—Commdor ❑MULTI-UNIT ❑STRUCIURAL
ARCHITECPS DECLARA'I ION I'ANFLS
F m Z ssndemo I my plmtxshah weed a ,adallc retied% MODIFICATION
OZ`—"- Oil 10200 AMPS "HRIOR ❑CHIMNEY RITAIR
-Qy t:owLiccns Vmfemfessiawl 201-IIXpAMPS IAPROVEMRNT 0SWIMMING POOLS
CY ; OWldiilll.DBR DIICLARATION OVHR 11X0AMPS ❑HA'I'R RF,MODEL/RIiPAIR DEMOLITION
C Q 1 hereby uflirm that I am exempt(runt the Commmm)Lireme I.nw fume
°'o a U following reawn.(Seainn]11]1.5,Rosiness vnd Professions Ctdc:Any<ily or mm�ty SIGNS ELECTRICAL. ❑01'lllik
3 LL E`i which require%a peonll to consnuel,alter.improve,demolish,or repair any umema,
paualo it,o,r:utoc,at,)rcimus,the applicant l in such permit to l ile usigned%mmnsomtjCIRCIUTI.MS�IALCIRCUITIMISC.
S tai mm he i%licensed paouinno the Pno%isionsonhe comvanors License haw lenapmr) COMMERCIAL'
W 0C) (mmmcncing with Section IIpO)of Division 3 of the Busine%%and PmM%%inn,Cale)or P.h1EI HR OR POLE INST.
0.y o c that he Ix exempt.Lure tram vnd the basis I'or the alleged exemption.Any vielvtiore of ❑NIIW BLDG/ADDITION ❑DEMOLITION
W n y Section 7031S by any applicant file a pcnnit o-ubjuul,the uppliemn m a civil penaltytil' GIe DBVICIiS ❑TISNANT ❑FOOD SCRVICIi
not more than five hundred dollars($500). IMPROVIiMISNT
O Las owner of the fantasy,or illy employees with wager as their sole complication. MING POOL BLFCfRIC ❑Ol'l11?R
F will du the work.vnd the,lo,mrc is an intended or offered far sale(Sec.9144.Bmsnnc%%
3 w and Profession%Gyle:The Contractors License law docs nm apply m an owner of1,1?'TS—SN'ITCHIiS—FIX'TIIRISS110
property who builds or improve..thereon,and who does such work himwlf or through
his employee,,fmvided or,such 1mPruveniculs are not intended or offered or NESIDIiNfIAL BLBCTR SQ FT.
sale.if,however.the building or improvement I%sold within one year of couldelinn,'heSQ.I'I'.I'LOOR ARBA $ISQ.IcI'.
n ner-haider will have the burden of proving that he did not build or improve for Pur- x(,10
P ec til%;it,). TOTAL: P
I. l the p pent nue IY I f tg%%tl licensed vat to ;
A t t theproject p c 7041 Businessland, i'mf nz f,o ) pr C thereon,
I i-
cel 1 J . nch"o a p pony n build. p Com dPLUMBING PF:Rh11T FEEsun I t:r -veer 1 I- 'd ,tit , (.)r edn - IIB c%ntlt rxLiccnw Law. MIT ISSUANCEI am exempt LodeSec, ,NRPC(nr df%remonik—DRAIN&VIiNT—WATHR ICA) .VAT, ANON
sumere. iCOMPENSATION Da thefuADON K FLOW PROI'ECI'.OBVICIi1 ¢achy ullsr"I nnderp'I' ofpaHury one of the follwing Jeelameons:
01 hevemal will mvinm;n a Cendican til Con,vent,owifinsure fnr WorAvd Contpcn- INS—FLUOR.BOOK ARIA.COND, ES'I OItIHS 'rymp CONSTRUCTION
ration,as provided for by Section 37M of the Labour Code,for the p,rfommnce of thewalk lot whichIhi%permit is ismodURES—PEk TRAPO 1 lute and will..I a n Wnror,Cnngensation Imuruncq as...... ed by Section —Bq.SYSTCM-1 INCA UUTLRIS3700of the lalXmCode,lite the Ndivmemcof the wink fur which the,pcnnit e;s.uadOCG GROUT' APN
My Worker's Compensation Insurance carrier and Policy number are: GAS—EA.SYSTEM-OVER
Canner: Pavey Nix:
CERTIFICATE UP HXEMPI'ION FROM WORRIERS' GRFASFIINDUSTRL WASTE IN'THEOCEITOR
COMPENSATION INSURANCE BUILDING DIVISION P[I!S
(This Xenlon necdoot be cungdcued if otic Permit ix Insure hundred dollars(S lip) GRHASC'FRAP �rI
nr IcsxJ PLANCHECK 197E
Icenirythat inthe pedommnceoftheaork for which this permit isi%sued.l shall SEWER—SANITARY—STORM ISA.2W 1T ENURGY Hili
nil employ nay person In any manner sa as m becnmu subject the Waders'Cmapen-
z svtina laws of Califinnin.Date WA'I'F:R HcAlLR W/VBN'1'/EI.LCTR GRADING PHC
Z0 Applicant
tiNUUCE TO APPLICANT If,alter snaking this Certificate of Exemption,you should WADER SYSTIIMITRHATING SOILS FEB
bens e subjcal ,,the Wader%Congmmsmon im stuns of the Labor code,You muss
fosnwith comply with such parl000s or Ivens it shall the deemed revoked. W'MER SERVICC
A Q
CONS'r1dJCTION I.CNDING AGENCY NBOV RESIUISNTIAL YLMB. SQ.PT PAID
Z Iherehyvl[rm that there is v cumtrvclion leading for the rfnmumec of Date sftX
UO .C.) y n
the wad for which this pcnnit is issued(Sac.3097.Civ.CJ TOTAL
Q Lunde-None 'TOTAL:
} U Lendcn's Address BUILDING 19711
6. 1 curtly that I have read this application and state aware alarve infomtaion w
F (n correct.l agree to comply with all city and amnp�ordnlwas and state laws relating to Q'PY. MECHANICAL PERMIT FEE SEISMIC FEE ��
U Z bmRtrmg em,almClinn,and hereb,ami mdle remeemlal;1clut tho"4y ho"'I'napmn the
alnwe-mentioned partially for inspection purposes. PBRMIT ISSUANCH EL12C'I'RIC ITF
(W c)ng¢c m save,mdumnify and keep harmless the City of Catenation against
liuhililiu,judgsncnl%,cn,ts and cxpcnse%which may in any wayarecmc against said Cay ACI HR OR ADD TO MBCH. PLUMBING IB!'
in on on,"'le of me gmnsy,g of an,perms.
APPLICANT INDF:H" SSUS AND " L COMPLY WITH AL1.NON-POINT ALR HANDLING ONI'I'(TO IB.IXp CI'AD MECIIANICAL IT-E
SOURCE. 11LAl' .S. �
Alit HANDLING UNIT(OVI?k III.IXIB CIMI CUNS'IRUCI'ION TA%
/ Si�Apphcun`An Dan EXHAUST HOOD IW/DUCT) HOUSING MITIGATION FEE
HA' an
MAE 17RIALS OISCLOSURP.
Will the applicant or future building oecupvnuvuc or handle h ire dal,nmtedal 11 BA'I'1 NO UNIT('10 10bOAO H'IU)
as dermed by the Cupemm Municipal Cale Chapter 9.12,and the Health and Safety HEATING UNIT(OVER IRjg0 BTU)
Cndc Scctum 25532m)'
❑Yes ❑No VRNTBATION PAN(SINGI,IS RESID) PAID
—Date RcaiplX
One, Will she applicant or future bolding ocupant use equipment or dcvico which BOILER—COMP(3111'OR 100,0701{'1'U)
pis baamdous air....am imam a%defined by the Buy Arca Air Quality Menxgcown, TOTAL:
Duatull. BOILER—COMP(OVER 100.000 BTU)
❑Yes 0 N
I have mad the bmallou,mamrivls requirctacros under Chapter(�95 of the Cull
AIR CONDE I'IONCR ISSUANC Ii DA'i P
famin Health A Safety Code,Sections 8505.'_5533 and 25534.1 muleround that if the NEN'RESIDENTIAL NIECE], SQ.14.
btdlding mer ten catremllY ba%e a mnamt,titan b i%aty a%tam tallay m amity m'easol m
It the of;eh must be let titintoI..manee or.certificate til Oampany.
Owncn or truth..."d remit Dole TOTAL: ISSUED BY:
OFFICE