S 3230 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CPPV OR CUPERTINO RU1LDING-F,IX:CI'RICAI, ELL KCh+UT NO.
RUMPLING DIVISION APPLICATION/PERMIT PIAMBINO-MDCIIANICAI, J 3230
IIUILDING PROJECT IDEN'I'IFICA'1'ION
Iil11LDINC ADDRESS: // SANITARY NO. APVhIG\PION M11tNIT1Al.UAIY
�gyO �Jr 2F_'TRI515 �A�3r v , sz,.3� �'�' 95D �� 9
OWNERS NAME: PHONE: ,.,ems CVNTRACfUHM1 NAME; 1,1C NO:
7kJA�=� Z -MAA/Sec. 1 - s-wd ^cam /3�• rvlc cGNTRcn.x
ARC({Til aC--INIi B: LIC NO: ADORISS: ❑
CONTACT: PHONE. ❑UILUING PERMIT INFO
A �/ - ❑ Consultant Fcev Paid by Applicant(Initial) BL❑DC ELECT PEUMB ME❑CH
I.ICENSEDCONTRACIT)R:S DI?GEAR (IDN Q'hY ELECTRIC PERMIT' FEE JOB DESCRIPTION
I hereby affirm that I.sell licensed under Provisions of Chapter 9(commencing
Dat. Ih Sctllnnlifl ofDI...mn 3 I the H+nlnessand Ime—irns Code andmy helme is RESIDENTIAL:
W p PERMIT'ISSUANCE
��� in Ill lisrce mJ dl.p) K'(]% :2 ❑SfDWI. ❑KITCIIEN REMODEL,
U Livoue'Ibe. !.• Liuxit, APPLIANCES-RESIDENTIAL ❑ADDITION ❑I'IAMItING RI3-PIPE
in G1 Duh°-�--s C °Ir'mfSa��--OI ❑MULTI-UNIT ❑STRUCTURAI.
=y ANCIIITECI';SDEC1, NFION G I'ANIiLS MODIFICATION
ZONZ I understand my plan,shall be tried as public ocennd,
OZ�� UP TO 200 AMPS ❑INTERIOR ❑CHIMbit Y REPAIR
w Licensed 11 resulted 201-1000 AMPS IMPROVEMENT 0SWIMMING POOIS
ac OW NIM-NUILDIiR Di-CLARATI(nN 5SIGNS
d AMPS ❑BATH REMOD'I,IRHPAIR �DHYL ITIOL
EL LLQ 1 hereby uffim+Nat 1 am exempt from lie Conentror's Licenw Taw lin the El TITER
x p d U following re, n.(Section 1031.5.Basin,, and Professions Coda:Any city or eruntY CTRICAL3which r,nnio,I,pyoid o con,imct,uloy ipovu,demolish,or repro,any saucmoc L �9 Dproal h n y tl pplie hf 1 c min I :g •d,ule+cm IRcmrIMISC.Nath 1 ,edp rw u th r : m. fN c t tnr'sC I (Chapmry COMMERCIALW�G0 (coo g ith Sat loin) fD :'i+ J ftM1 E . ss ndP f. +m Code)or TER OR POLE INST.m 0.e Ccm he is usentpl Nerefmnt trodNc hail Thr Inn alleged clengnlon.Any violovon of ❑NEW BLIKIADDITION ❑DEMOI.ITION
x m_n- Section TI3I.5 by any xppli.nutfor.penrihsubjemsNe applicmn u+a civil penahy of EVICES ❑'I ENAN'I' ❑FOODSERVICE
not month,,five ha.d.d dollars(S500). IMI'ROVIiMF.NI
q ❑ Lo(liework,Ne,piesome omyotineyec.wiN ILord us their Solen'mpemminn, G ol,, ELECTRIC ❑OTHER
gic p. will Johhu work.xnAhhc ndoeutrc isnot intendednruffcreJ forwlc(Sm.9(Wq,Burinu.Ww and Professions Cal, 11,Commcmr:Uneme law dock net apply u+an owner of SWITCHES-I'I%TURKS
property who builds or improves thereon,and wile does such pork himself or through
his own employees,provided Nut such improvement,are not Inderd.l or nRertrd for NEW RESIDENTIAL ELECIR SQ Pf.
sale,If,however,the building or improvoncm+,sold within ono year of completion,ON SQ,FI'.FLOOR AREA $ISQ.IT.
xner-builder will have the burden of proving that he Nd not huiiJ or improve for pur-
pura of sated. TOTAL:
❑1,m cul of llie pmprny,arl L16e,Nrl,",hunting with Ifan,rd amrnchln h.
instruct the project(See 7044,Business and Prole,cons Code:)Me Contractors U-
meLawJ«.not apply b,cleric of property who bmild nr impmms thereon.and QTY PI.UMBING PERMIT FEE
whoconoums forstrcbprojed,with U contiou y licensed instead it)Nc ConUI
License law. PL'RMI'f ISSUANCE
I im coup,under See ,B&P C Ion this teas,,
ALI ER-DRAIN&VENT-WATER LEA) VALUATION
Owner Date affirm `./1�'
• WOR KEES COMPENSATION DECI.ARAI'[ON BACK ROW I'ItOTECI'.DEVICE y� �/�I/�' O
I hereby arm under penalty of perjury one of the following declaration 1 v
-1 I leave and will nainmmaCenifcamof Comenunsclf-insure Porto ke,,Censpcn- DRAINS-MOOR.ROOK AREA.COND. STORIES TYPE CONSTRUCTION
ration,n,povided for by Section 37(X)oI the labor Cale,for Ne performance nI'Inc
k for which his permit i,issued. FIXTURES-PERT RAI'
r1 have and will maintain Workers Compemmion Immune,as requited by Section
(X)nlde Lnbn.Cndc fertile PIUI. arc ofthc work for wIuch this perm.'is i,Sued. GAS-EA.SYSTEM-1 INC.q OUT OCC.GROUT' APN
IIIy�' Compenot S...m a came,and Policy mmnM�r;1� �IOIa GAS-EA.SYS'IL'M-OVER a(I:A)
CamernIs% i']i,l-k PolicyNnQ.I�IL.�.—
CERDFICAl1iOFEXEMPTION FROM WORKERS' GREASM NDUSTRI,WASTE I NI'IiRCEVI OR
COMPENSAI'I ON INSl1RANCE RUILUING DIVISION Lg31S
('Ibis,eind neMnot hccompleeiifNip,mat is Nrenc hundred dollen($I(A) GRFASETRAP
or less.) 1'IANCI{IiCK IEE
Irenify that in Neperfurnalm,ol he work far which this prom,is issued.I%bull SEWER-SANITARY-STORM HA.200 FE
not anpiny y penton in amuuumrcr,s sb h t the Warkcrs'ClIDmcn- ENERGY PIi13
Z whims low Cali_f�a Date ����� �• WA'IIiR HEATiR WNEN 111,F it
C Applicant w l T O S U y GRADING hili
NOTICIi'10 AAPPLICANNT'.FILralma making tbl,Ccnificaho Ill Pacmpunn,you should WA'T'ER SYSTEM/IHEATING SOILS Flili
berome subject to the Worker's Cnnemwtion precisions of IabnrCude.YOU ems
Qforthwith comply wah uch provisionsor this permit shall be deemed revoked. VOLT ER SERVICE IU
CON S'I'RUC I'ION I.EN DI NO AGENCY N 13W RES I DUN'I IAL PI.M W SQ.P' ('AID
7 Z Ilam Rcculpdp
L) O I hereby affirm Nm there rsacon.Stmetion lendingagency for the performance of
4T. (•-t the work for which this permit is issued(Sec.3091,Civ.C.) TOTAL:
C) F- Lcndcr,Limit, I( 1) .
Landers Add¢„ r
Q 1 certify that 1 have real this application and state Nal Ne above infomhmion is I NO Fliii
f' t0. 9
/) corrat.I agree m+comply with all city and county ordinance%and state law,lelmng to QfY. MECHANICAL ,RMIT g. i1 IG ldili
U Z building conslrucfien,rnafhmehyumb...oc ryn.-,dUv�,at'fhiscihy m rewrupon the
abo,raintinnW popcny for im,pectin I purpn,xs. PERMIT ISSUANCE B TRICITE
(We)agree mindemnify
se su , and keep huric the City of Captain.agximl
r Iiahifitics.judginents,c swhlch may in any way accoe against said City ACI IR OR ADD TO MIKE. 111.1 BINGFEE
,,amlenfm 11 go bin`permid.
APPI,ICANI'U ' NO AND .1 'OM1`, WITH ALL NON"POINT AIRIIANDLINGUNIT(10 If1,(XX)CFM) HANICAI.FEIi
SOURCE RF.0 l :
AIR HANDLING UNIT(OVER 10,010)CFM) CONST RUCTION TAF
Si mreofA accord. y Date FXHAUSTHOOD(WIDUCT) HOUSING MfI1GA'I'ION FEE
HA9ARDOUS MATF,RIN,S DISCLOSURE
W III fila applicum of more building occepunt entre or bundle hvnNoms m;ucrial 111TATTNG UNIT(TO 100.001 B'1'0)
as defined by the Cupenine Municipal Code.Chapter 9.12.and the Icahn and Safety HHAI'ING UNIT(OVER 1110.0X10 BTU)
Code.Section 25532(x)^ ���//
[D Yes IYN^ VENTI LAT ION PAN(SINGLI:RI SI D) PAID
Unm Rvciphx
emit hoWnt
ill the applicant of future building occuMm use equipment or devices which ROLLER-ER (JHI'OR]BILLION)BTU)
ardous air coaminant,as defined by the Ray Arca Air Quality Management
Disaicf; _I; BOU.f;R-COMP(OVI3R 100,000 BTU)
Ye, CKLI
AIR CONDI I'IONER ISSUANCE DATE
I k .ul N h � J oriel sy t mJ Chapter h.95 ofd Cali-
Juncialbidd,ciSsic, C d �X 25565 25531 J 25534 1 1 t nl ll'f if hl¢ NEW RLSIDEN fIAI.MI:CH. SQ.L'P.
bu ILL it .n he ntlyh tent, hl:nY P'n:bltyl nhfylMl�$sy�yy // k0
of hh 4 . be cc t f.c mc.if c_llak(y.
ell r ((
Owner or auhhnriecJ age.
Dme T(YI'A1.: ISSUE If Y:
OFFICE