S 1520 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CI Y OF CUPERTINO nuu,Dfur..ELncrlucu, rr 1H No.
,.DINE.DIVISION AI'PLICA'1'ION/PERMIT r1.uMBING-MECHANICAL 1520
r III111.U'U;PRO.IRCI'IIIRNTIFICA'I'RIN
hUING ADDkpSS: SAN)IARY NO. A III-[.ICA PION SU If M 1'19A I,DA'I
OU O EUI
LtkstnleD
r YAdN ' ME' Go _PHONE: CO'1 OR:SN a
LIC NO: S4C
J NIC CONTROL
ARC11114CI iN WEER: AC NO DRESS JOE E:1CONTACT. PHONE: 11// BUILDING PIiRMIT INFO
� g ❑ Consultant Fees Paid by APPlicanl(Initial) BLIT ULF.Cr PLUMB MECH
LICENSED CONTRACTORS BI!CLARA'rioN QTY ELECTRIC PIiRMIT FEF:
I homy amen mm i am Beamed coder pmvixlon.of Chalna,9leo 1 voui„g 406 DESCRIPTION
�aZ with Section 7000)of Division 3 of the Nusine,,mad l'rolexsiens Cale.'nPERMIT ISSUANCE il lylkcnse 1. RR IDS
W p "
F�U� full force and dTen S ❑SFDK'1, �kLITCHEN REMODEL
.it UU Lic.X APPLIANCES-RESIDENTIAL DDITION t1j PLUMBING M1 PIPE
FZ Dam Cnno-aaor
G aox ARCHI I'IiCCS UIiCLARAI']ON IjM11UI:II-UNIT STRUM URAL
Z mulemm�d my plan.shall b,used m public IcmnL. Pp UIS CHIMNMODIFEY
RIUN
Z O y�„ UP T(121111 AMPS
OZ�•Q ❑IMPROVE ❑SWIMMING EPnIR
W Liv ail Prulo,menul 201-1000AMPS IMPROVEMENT [3 SWIMMING POOLS
5 C, 1 hcrch m.n OW'faR;601n pERoDECLARATION
the CH utnOaurs Liccmc Law for the OVER IIXXI AMCS BATH RIiMO1lE1lREPA1R (]DEM01.11'ION
6 y•a ❑OTHER
{Xy13 LL F following reason.(Section 7031.5,Maine,,and Nolussionx Cole:Any city or lemay SIGNS IiLECI'RICAL
which requires a permit to construct,alteq improve,denith,lb,o,repmr ally struoum
prior I,, ,,i..nancc,ale)requires the applicma for such permit u,File a signed statementSPLCIN.CIRCUIT/MISE.
thy`' that he is licrnxeJ pursuant m the previsions of the Contractors License Law lChapar9
Xa�0 (commencing with Section 7(0X0 of Division 3 of the Business and profession.CMc)or TF.MP.MCI'EN OR POLE INS'..
a a c C that he is exempt therefrom and the basis for the alleged exemption.Any violation of NEW BLDG/AUDITION CJ UEh101.IT'[ON
XmLL
Section 7031.5 by any applicant for a permit,subjects the applimil 0o a civil penalty of POWER DEVICES �41 �71rJD ❑EOOD SERVICE
^0 not more than live hundred dollars($5(Xp. X
FZQLn.ownur of the n In mwn•cs as 0hm"ole''on, non, 111 Vk
C7 'he h ylon+rycntp intended wi b penes SWIMMING PU(11,FhIiC'IxIC
Wwall Jmfc,,inrk.nod the s o C I ie not 4Lim,m nr Law
es of apply
t)as. umereof bO'IHI?k
13 m and h, ani,,b Code Thc Conovaor'.Liceme law does not apply n,an owner of OUTLETS-SWITCHES-PI%'ILRES �'� I (1�
prop...who buil,,.ar improvers l seelb i and who J„es inch wed himself orined f M1
hi.......loyees,provide,,that such improvements este not emended or oOereJ for NEW RESIDENTIAL F:hliCl'x PI'.
sale.IL howcvmq the building or improv.meetis sold w'illamoun,clrof c nplaion,the SQ.11.FLOOR AREA 5/SV.I'I'.
oohed-budde,wit]have the ma,wo of pm.ing mat he did ern build...imprnce for pun- ��
Fore nI sale,,. pi
❑ st us Awe praj the Sec.7 Y,:,m exclusively enmmmhng with licensed contractors m
construct me prnjoa apply
ow4.Business and nywhfic�i bui door improves
enmmet„r.triscen {_
uWwdrc..not apply to an owner of pmpenY who builds or improves thereon.and QTY. PLUMBING PERMIT FCC
who ctm,ransfor such prajcan wimacommcmHs)IiccnwJ punuannn me Comracmr'x •�
License I,aw. PERMITISSUANCE
I mn cae,npt under Sec. .B&P C mi-mis ovist(
AUI'ER-I)RAIN A V ENT-WATER(EAI VALUATION
�Owner Date 12�,ID
WORKIiR'S COMPENSATION DECLARATION RACK FLOW PROTECT.DEVICE
1 forty affirm under penalty of Perjury one of the following declaration.
I have and will maintain a Ce.ificateof Consent(self-inmrt for Workd.Cantata- DRAINS-FLOOR,ROOP.AREA.CONU. MORIIS 1'YPECONSIRUCIIO
.atinn,as pruvidcd for by Seclinn 3710of me Luhnr Calc,for the per[nnnonce rt me
work for which this lermil In issued. FIXTURES—I'ER IRAI'
1 have anil will maintain Workers Compensation Mucrones,as re,g.irN by$.aeon
3700 ofthe Labor Code,for pedunnonce of the work for which this permit is issued. GAS-EA.SYS TEM-I INC.J OUFLEfS (ICC.GROUP AI'N
My Wed.o n rlo 1 -mance carrier and poirypy�
Camcr: Policy No.:1l 6-Y�!'� GAS-EA.SYSTEM-OVER4 Ilii)
C11R ERCATE 01;L'XEME,MUN FROM WORKERS OkEA51%iNUl15TRL WAS 117 INTIikCF,l'1'OR
COMIIENSATION INSURANCE BUIfh6ING DIVISION FEES
1'fhlx nectiun nceU nm bueanplod if mepenniti,lot n,lmndred Jollery lS l W) GREASE'IRAP
I'hANCI I
less)
toy ayl c in the anymnunceo(sthe workmesuject which to the Ilit Wixi.wedlshall SEWER-SANITARY-STGxNI F.A.21X1 F'1'.
not employ any corn in any manner m a.to heanne subject n,the Worker Compcn, ENE Y '
Z wtion Laws of California.Dam WATER BE pER W/VEM'/CLEC IR
Z Applicmil GRAh
NUEICE'f(I APPLICANT:If,afar nmking this Cenllicm.of Exemption,you should WATER SYSIENU REA'1 IN(!o--1 S( LS llil
haonm xcMew y with
wall pro i..y><,..:this to l i mi n thc be
hcrcola.ke. :+:,:a
I'n.hw'nh unuply wire such prov' 'n'or this late limit he JeancJ evoked. WAIEx SERVICE
a �
CONS'1'RUCTION LENDING AGENCY NEN'RESIDENTIAL,PLAIB, SU.I'[ PAID
= Z I herchy affirmthm them is.conamminn lending agency for the pednnnraee of Doc RwciptX
{ULO the work lin which this panel is issued(Set.30ID,Civ.C.) 'I'f ITAL:
O U Lender's Nunn
Lender's Addrex. 'I GIN.:
1 canny that i have rend this application and alae that the aM+ve information is U LDINO Flili
Fro mortem.lu,,cc mreality whh.11 city and a..tyordinuova,andaw¢law,rclaing or QTY. MECHANICAL PERMIT FEE 21SY11CFEE
U Z building con.arvction,and hereby authorize reprewou bass of this city In Vamrug,n the
ab.c-nmminaid property for inspection purpwe.. PERMI'I'ISSUANCE eLECI'RIC llili
1 Wc)«grad I,, air indemnity and keep hannlcsthe Cityof Cupc.ino.,.in,,
liahiluic...... numns,mqa end expenses which may in any way accmcagainet sued City Al-TVIROIRAI),pME.C.11. PLUM 010(111,1?
meynensx of the granting u1 this pencil.
APPI.ICAN'I'UNDERSTANDS A WILE.COMPLY WITH AI,1,NON-P(IN'r AIR HANDLING UNII'OU 10,000CFMI MECHANICAL.Pr:E
SOU 'f RI CUI TION.
AIR HANDLING UNIT(OVER E0.000CFM) NSTRUCI[ON TAX
Signalureol'ApplleonVCra ca'. r Ih EXHAUST HOOD(W/IIUCf) HOUSING IGATIONFNi
1IAZAIi DOHS MAI'HIVAIS DISCLOSURE
Will Ihcapplivent or(mum Ndding accupunt store or handle hazatJous crucial HFNI IN(!UNIT H 01 W.IX0 H 111)
as defined by the Criterion Municipal Code,Chapter 9.12.and the HcaRh and Safety HEATING UNI f(OVER 100,0B)BTU)
Calc.Section 25532(0)?
❑Yes ❑Nn VF,LH'ILN'[ON FAN(SINGLE RESID) PAID
Dam Reccipl p
Will lbeappllaua orfimne building cccnpam are cquipmem or devices which Bou❑I<-COMP OIII'(IH II111dX111 ETD)
inn hnaumaa air a,ma,,dnnlua a.dem,ed toy don nay Are.,Air Qaallty Munagemem I HAL'
District! BOILIR-COMP(OVER 100,000If'rU)
❑Ycs ❑No
I have mad he Iaetcousmatcrivlx export audit,Chap,cr n.95of the Cali AIR CONDITIONER ISSUAN )DATE
ywrtmm�
fain Gould,A Safely Cole,Section,25505,25533 and 25534.1 that if he NI?W RESIDENTIAL MECH. SQ.E71'.
building does col armmly huvc a Italian that h i.my r Y4....jahly m notify lheoccupam
of he re,morns nts which meet Mme,prior to i"ti nee of a Ce.iEcam of Occupancy.
' Own<r of aahorized aged
Date TOTAL ISSUED BY:
OFFICE