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S 2955 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PF.RMITNO, BUILDING DIVISION A1111LICATION/PERMIT PLUMBING-MlICHANICAL ItUI1.DIRG 1'R(I,IF:C3'IDF:N'1'IISICA'1'IUN HUILDINGADIPRUSr: SANITARY NO A I'LICA'r10 S 1M 1'IA,DATf � l (o 4/ ccIVA-r R6 `f-2o ,P / c NER:S NGGA��MEi: Cr..,� /� PHONE C�N-1 RyACE�IN:S NAMI? /•�� ( LIC NO: )W 6 �c�yy (..r l TV, o�o7-SJt J I rY I� H�L�G YIN p N/C COM1TROI.p CHITECF?FNGINERR: hIC NU: ADDRESS' (� ❑ �61A(96 -1,V q 1780�OSSta�60/� v•fiel. (Q VO2 Z coNTncl': PUONF'. .HUILUINO PERMI'I'INFO • ' Ko ❑ Consullmat Fecs Paid by Applicant(Initial) BLDG ELECT PLUMB MIiCl1 Gr7Wa6� s �� r� d ❑ ❑ LICENS1D CONIRAM ORS DECLARATION QTY ELI"CTRIC PERMIT THE QWzwpm saes 8nf coat t + JOB DESCRIPTION F?N mate on7NNBr". ARCHI'1liCI Sn11lFCIpJI I �hnsGidcrmdui Ylss cg 1'ANI]tiNCES-Rli ^� D STOWEEN'fIAJa; W O PIURMI'I ISSUANCI, h full lora Baal ellect. ❑SFDWh � ❑KITCHHN IIEMOIJI31, U apSS SIDEN'FIAL ❑ADDI'DON [:1 PLUMBING R17 PIPH mQ ❑hl IJIM-UNIT ❑STRUCTURAL. Z p.2 1 understand my plans shall he used as puh[' MODIFICATION lIP'r(121N)AMPS OZ C ❑VAPR VF ❑S IMMINREPAIR SRW Licensed l'rntcxaianal 2nl-IfNll)AMPS MPI20VEhIGNT �SWIMMINGPOOL$_ H OalNI1141f❑ILUI3frm the Ci PION OVHK 1000 AMPS ❑IINIRREMODEL/RI?PAIR ❑DEMOLITION I hemby u(Snn on I nm from the Co.was Co License city lin the X36F whichin6reas^a(Section]031,5 It.aincss and ve.dsinifi Corr:Any city nrcm:m3 SIGNS FLFCfR L ❑OTHER u1 LLyQ which res t...a permit m cnrolrucl,vllcq Improve,dmnnlisb,or repair any structure I 1 IJ prior Ernst ahn requires Ne applicvm for snen pcnirir if lite asi6neJ 4memenl SI'IiCIAI.CIR II/VS �JY that he is licensed pursuant it)the provisionsofthe Contractor's License Law(Ch tmmr9 - (comnancin6w'IthSection 7000fof Division 3 ofthe Frainessand Proesatfnx Cude)nr 'II:MI'.M1tETERO I'll ' ST. COMMERCIAL: W y o a Ihm he is exempt Ihcro in and the basis for Ihe cllugod usemption.Airy vinlulinn A ❑NF.W SLUG/ADDH ION ❑DEMOLITION X Y. Section 7031, y Il 5 bny applicant fm a pennil sunlmis Ibe npplicwn m a civil pauJly nr POWHR DEVICU W In 11N *11; E]FOOD SERVICH Fs for more Chun live hundred dollars(SSM), IMI'ROVFMIiNT =Q1]Lasnwncr ofthe pmpertY.nr my cnIDlnyecs wish u'ugcv asiheirreole nmgensminn, SWIMMINGPOOLFLIiCIN1G will do the work.and the structure is not intended or offered[or sale(Sec.70,F1,Business Nm and Profenions Gde:The Contractor's License Luw docs nor apply to an finer of OIJI'LITS-SWITCIIF.S-1'I XTURP_4I C property who huilds or improves thereon,and who does such work himself or domgh _ I own ellgdoyecs,porde]that such Inrpmvenems xa nnl inrendeA nr nllenel for NEI RISIDENI'[Al.rUrc H SQ PI'. sale.If.atiese,Ihe huddingori ngmrvcnenlis sold within nuc youndcnmplctinll,Inc FFFLOORAk17A - Pl'. par-nl:finer wd1 Imve Ina namm�ar ptoving Into rte dnf IIm nada frim"ona rm pm- JUN arse f,de,. 2 9 199 0 1,as owner of the property,am exclusively contracting with licensed contractors to IYlTA 1.: construct the project(Sea 7044,Business and Professiens C:deq Toe Convucror's Li- c se Law does nut apply to an owner of property who Fonds or improves lhcrcnn.and QTY. PLUMBING PERMIT 'FF,E' By— Law whocomntmN hesucb projects with nenmmctof(s)licensedpurxuna IndiaCr mianr's License , PITI1M I 'ISSUANCI? I am exenmt under Sae ,If&P C lin thus reason Owner Dare N1I'FR-DRAIN&V UN'f-WATER(EA) VALUATION - W'ORKER'S COMPENSATION DECLARATION BACK FLOW PROTIiCI'.DP.VICIi / O 1 hemhy u(fmt u Wer penally of perjury one of mma e following decimations: 1 Inmx lmA will muinuin nCrniticatcof Cfnsent to edlansura for Wnrkm's Cn r,wr- DRAINS-FLOOR.ROOT A RFA.CON O. 530 IFS TVPF.CONSI'It I1C1'ION sultan,as provided for by Stennn 3700 fl the Labor Codr,hn'Ihe wrffnea not the musk for which Nis lermil is iswnl: IIX'lll HI35-PER'I'kAP E]I Neve and will nwinwm Worker's Compensation Inmmnce,as required by Section 3700 of the labor Care.Joe the pedinlnnnce of the work for If Ithi ami is issued. GAS-I SA,SYSTEM-I INC.4 OU1'LUS X:C.GROUPM,sX - A" Carrier Policy n sCArel nrric and Policy Policy No OAS-EA.SYSTEM.OVI3R J(CA) s� CI?RTIPICATE OPIi%EMPION FROM WORKIRS' J ©c> COMPHNSATION INSURANCE ORHASIANDUS'TRI.WAS 113 INIHIdCHVIOR SION FRES (Thixxemion neulnot be arogtlemdlftue,rain is for an elf reddolla,61gb IfDILDMG DIVI _- GI113ASIiTRAP or less.) PLANCHIiCK Fl3[3 3 I cenlfy lhar"' nperfa mance nl"lie work forwhichtnis permit isismcJ,lshill SEN'IiR-SANITARY-STORM EA.214111'. nm employ any n any manners avo be me sari ca bs the Worked Cnmpcn- ENERGY I iii z cation Laws ( D WAI'I7R I I EATER WIVHNII/HLECTIt O Applicum GRAD[ FF L_N.I N(YI'IC13'IO WANT.11;nR akin&Ihis CmUll"'a of Esemprimr,you should WA FIR SYSTEM/TRBA'I'INC. become xuhje s Ihe Wm kers Cnmpcnewinn ervikinus nI the Luhnr GlJc,yon nnut $O . Plili I'utlnwith annply x'ilh sucn prnvivianx fr this Iermit nNdl be AcenteJ sanded, WAf13R SERVICH Ij a0 ` z CONS]RUM ION LENDING AGHNCY NIiW R SIDFNTIAL PUMP, SQ,FT PAI U 0 [harm,affvmdammare k a,metrocnnn lendin,if,awy fmme penternarrard 1 re RMCipt4 6. P: Ihe work Ior which IN,peamen is u...d(Sm.3197,Civ,C.) 0 U Lenders Name 'I MAL: Linda',All.... 'Tt YI'AL. / � y ffyllea I have readII 1plet oil file ILnI im nforrai : - - r - - BUIL INCITE - Zi nirz e9.l ab mply 'ih n 'ly J ty rJ J.ml FI 61 QTY. - MECHANICAL PERMIT FLEE U z buil l' g nvlmaifn,end hereny euthomr pesu.ntuovu nfrh scnymenmr upon the SEISMIC NEI: aMve-meminneJ propenY for inspcerifn puryoses. PHRMIT ISSUANCE (We)agree to save,indemnify and keep harmless the City of CupcnELECT ina against RIC iE liabi lines,judgments,costs and ex penses which may many way aecmea,ind said City Alll'FRORADDTONII?CII. umsequrare or lifegmnring of Inas pcnnif PLUMBING FEE APP CA T UNDERSTANDS AND WILL COMPLY WE 111 ALL NONd'(IINT AIR HANIPLING UNIT1'1(110,000 CTM) S IiOULAT10N5. MECHANICAL ITIi - 1GA[It HANDLING UNIT(OVER 10,00f)CFNI) CONSTRUMION TAX Si a mmApplicanaC reactor Dle F,XHAUS'I'HOOD(W/DUCTI HOUSING hII'DGAI'[ON FTII[ IIA.A RDOUS MAlER1ALS DISCLOSURE Wdl theapplicant or future building occupant store or handle ImnlNoes nuecriul [IIiA PING FIND('10 N ('ICI 100,000[]TO) its defnerl by the Cupertino Mwiuipnl Cndc,Chapter'9.12,and Ihe Hralth and.Saba, Code,Scoion 25532my! IRA'I'INC,UNIT DV I3R 1100,0110 N9'U) _ E]Ya, VHNTILATION PAN(SINGLE RESIDE PAID Data Receipt M Will Ihe air coutm of ruts a million,einby the B ase equipment or Meati'when ( mit hazmdnm air amraminmrx az JdincJ by the Pay Area Air Quality hlunngemmet IIOILER-CONN(3111'OR Ilq,q)0 B'1'lll \. DiuriaB to 1: E]y" —./ 11111LER-COM P(OV 131211111,g10 RTU) I hove rwA the h:fraider,rri'utcriulsammmn-ndor Choler 6q5 of the Cali- AIR CONDITIONER teV P ISSUANCE DATE fomin Bear h&Safety Code,Sections 25505.25533 and 25.5.10.1 understand that if the NFW RESIDF.NIIAL MIiCH. SQ.P. _ but Ing snrneune ly1m ,'e t 1h Iit is my rcspnnsihility to nrnify rM+icnrpanl _ �f ,�—Q : uiremcnuw ch mast prp,rmissaance nor eemfaale ram'., �T O c rcumhn it Igen C•/ y me ISSUED BY OFFICE