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S 1264 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO DUEAINC.ELEC71 RICAI, rl:k`1rr ND. BUILDING DIVISION APPLICATIONMERMIT PIATABING-MECHANICAL �J 1264 1.BUILDING PROJECT IDENTIFICATION BUILDING ADDRESS: - SANITARY NO, AI'PLICA'11(3N SUBMITTAL DA'li O ER'S NAME PHONE. CONT ACfIIR'S NAME: LIC NO: � � ?So Wr, L 0 NIC CONTROL# ARCHITECIAiNGIN([FI?RN: LIC NO: ADDRESS ❑ Y7l0 Q11 ',CMWRI�Tf r c ,�0 88 777 R, CONTACT' _T)F rj5 yR U N N PHONE - �'f /IA q`5114 13UIIAING PF-RMIT INFO - ,'] Y ❑ Co`n'stiftant Fees Paid by ApInicunt(Initial) BLDG Ii-EC'I' PLUMB - MIiCH 5- OD .I.ICI NSED CONTRAC ORS DI CI ARATION Q py LI,IiGTRIC CERMIT' s I hereby total to t l hemostat l p .ar chapter v Bo nn nb,a ng JOB DESCRIPTION ow CW) web Section 703( f 'Divisione l fiBus dprofessions code.andmy licenses RESIDENTIAL: O O PERMIT ISSUANCE Indl force effect. CSFDWL ❑KI TCHEN REMODEL C U X" hicensn Cluvs Lia II FR U - AI'1'hIANCILS=RHSIPI3N'I'IAI. ❑Alll31'I'ION ❑PLUMBING IiI:-PIPh y<E Umc C mato ARCfII SDIiG1.ARA'i N - 11 SIX ❑S'i'RUCI'URAI. F,ppwp PANELS MODIFICATION ,Z O 0 p 1 node n I', he usbJ icr public records Ozg n 111"1'0200 AMPS ❑IN'I FRCIR E3 CI HMNRY RI?PAIR Nye; Lianscd Poill 201.1000AMPS IMI'ROVF.MENT SWIMMING POOLS F Q ) NER.BUILDER DECLARATION all% Q 1 hooch altirll ut I an,exempt Goan the Cuntrnemr's License Law la,the OVER UX00 AMPS ❑BATH REA1pDELRIiPAIR Uj1 JOLDHON O E U follaxin re1u1 a ISmwm]1131 5,Busih..s and Prole..a a,CnJo:An t ❑(YI'11ER y y ci y nr coon y SIGNS EI-EC'I'IIICAL W 3 t N which realmob a fiction to constucL alter improve,denmlkh,or repair any same ure OWprior to its issuance,also q the ppl t forsuch pe it to file a.lignedsttemem SPECIAL CIRCUIT/MIS NyIaLi lie 11 111calledP a lhe pbot,mr,afmp Coantsme,Liocuse Law IClapter9 ea 0 (10ouniancou,wthS,O 7nlx8 fI)M,i i 3 l tire Bur,inea,unalI f.: ,CodeNr rTMP MID Hk OR POLE I 114 e C that he is exempt tharefterna J the basis f [lie ll g d exemption.Any violation of ❑NI? BLDG I I($d©�DEMOLITION W=y Section 7131.5 by any applicant for apermit'ubjeasthe applicantinacivil paraltyof POWER DEVICES nutnnore,hon five m lots[dollaars($51N). IiNANT ❑PUOD SGRVICIi � ¢ Lmowmrk.and n 11' NT C ❑ pmpe y,orney empinyccv with wages os than ell pen'reion, SWIMMING IN) ELF(SIRIC p- will do xerk.toil lhnwmurcisnot imcndcJomHcreA for notsale apply ]0lgituxines: ❑0TH: {fry E3 m mW Professions Code Me Cnmruthm's License Law Joel nm apply m an ommer of WETS CHIS-FIXILR&S property won huilAs ar impmvu toerwn,iced who dnee such work himsalf m throughIlit"V Its own employees,provided thin xuch oulaux meats arc not intended or till for NIIW RESIUIiN'CIAI. •,li 'li SG PI'. xale.If.bnxevec the thudding or improvement ieeold within nneycar of.oa.pletinn,,he $Q.1"1.FLOOR 8/SQ.FI. owner-h older will have the burden M im proving that he Aid not build or prove far pur- ple of,do.). I of the Property. I ly clatatiefin,vvin I'' J oun-ons It, cons t dic Faucet fS ]mi Btsmv,, J profession,C.c:,Hic Cibirraccar,1J. �O0 close I I n rpptyt fp pent h m .h ids r npth I QTY. PLM UBING PERMIT PEE. xino tan'fora,J,I jiscasivilhen t f.71 onnnlp .non lheC„o-mm-n License La, PERMIT ISSUANCE El I am eaemq unAe,Sec .13&P C for,his reason Dwncr I3cm AU117R-DRAIN&VENT-WATER(IA) VAI.UADON WORKERS COMPENSA'I'IONDHCIARATION BACK FLOW PROTECT.DEVICE ` L /ry�J� I hereby affirm under penalty of perjury one(it the following declarations: T 05 \\ ❑ ihuw unJwillmuinwinaCenifcmenfGmsenuo solGinmre for Workcr'x Camper. DRAINS-FLOOR,ROOF,AREA,COND. S'IORIHS 'I'Y 1'F.CONSTRUCT ION ' status,,as provided sire by Suclann 3]110 of,bb Lima Crde,for,hc Perfnnsunee of tbb k fm whichahirpcnni,k issued. 1'IXi'URU., I RTRAP 'ISY 1 have and will maintain Workers Compensation Insurance,a,obtained by Section 70u1'ihc Labor C«la,fanhc prdormunccnRbe work tato whmh this perosis is issued, GAS-EA.SYSTEM-1 INC.40UTLETS OCC.CROUP AI'N My WarkS1' ro'm'an o toot tonic y runt Policy nunmer mc' Cmnbr.� Policy No.: GAS-EA.SYSTEM OV ER 4 TCO C13RTI FICATE OF EXtsvUel[ON FROM WORKERS' COMPENSATION INSURANCE GREASEIINDUSTRI.WASTE.INT'ERCEPTON Hl11LDINli DIVISION FEES (ilikoec,inn need nal be complcmd i l,bcperini,is forams bi fred Jul bun($100) GREASE TRAP or leu) PLANCHF:CK ItiE tolm Iccrsify tout in tam pefornmscafth.work w ishichthis psanis is issued,i shall SEWER-SANITARY-STORM EA.200 FK non employ any person In any murmur so o"a become subject b the Workers'Gamper. ENI3RGY PF.H , P T� Oz sats Lawsof C.1insain.Dam WATER HENITR WIVENTIELECTIt GRADING FEE Z Applicant Vy NOTICBTO APPLICANT:It,otter making this Certificate of Exemption,you.bould WATER SYS'TEM(I'RHATWG SOIhS FEE lee I : hI , ,hew k C Im,st tourist isofth 1'h C yon t ,st frme it ply wish It pooi,am,or,l parrail:Iil as,decanned revoked, WAIBlt SERVICE. D. 1 {�p` CONS I RUCTION LENDING AGENCY NEW RESIDENTIAL PLMR. SQ.ET. PAID - " •� 7i I bcmhy allirm that nnac'ls uconxhmlaa lendme ugu,cy na hr,w ibrmnceal Dom Be let U the work for whlch,bl,permit iX issued(Sbc.3097,Civ.C.) - U. 1"' Lenders Name TOTAL U 1"cndcrn AAdre„ 9 ) A yIccnify that I have read this.,,,Omimn told'tire mal dm above Infonnmlm,is - BUILDING Plili N cornets.l agree to comply with all chyond rummy cohnnnresnnd love laws rbluling no •QTY MECHANICAL PERMIT , U Z building construction.and hereby authorise representatives ofthi.s chym enter upon the 1 SEISMIC FEE above-mmntioned property for inspection purposes. 1113RMIT ISSUANCE (WO agree ,,arse,indcmldf,and kwp bmud...the city orcr,ninn again„ ELIiCIRIC PI!li Iiabilitin,juJgmnus,costs anA cxpensn which may in any way,meme aguins,said City AI. - OR ADD TO MECIL O I. 0 robquence of the Sromin,of thio permit. PLUMBING FYI APPLICANT UNDERSTANDS AND WIL1.COMPLY WITH ALL NON-POINT AIR HANDLING UNI['(TO IB,IIfXI CFM) SOU URE( ILA'I'IONS. MECHANICAL FEE z AIIt HANDLING UNI'I'(OVER 10.1X10 CFb1) CONSTRUCTION TASI Signature of AppliuonOCantraan - Onte EXHAUST HOOD(WIDIICI) HOUSING M I I IGATIDtHeec, I IAZARDO AlliRIALSDISCLOSURE Will the applicant or future building occupier store or handle harsrdous material HEATINGUNITUD 100,00BI U) as relined by the Cupertino Municipal Cash.Chapter 9.12,and the Health and Safety -' Coda,Sbaimn 25532(1)? II HATING ONI'r OVER If0,XX)HTU) El Yes No vEN'rILKIION FAN KINGUI RESID) PAID Umc Will are applicant nor mfurore building by the Int as equipment m twice'which ' �lomh iurJnm air cnnamninwd'us dotlnalb sato l3a Ares,Air Quul'd Management 1t01I.ER-COMP(7111'OR I(HI,(NHIBN) _ � Y Y Y TO'TAh: ❑Yes ` ' �'1]y`ll? /,�u' BOILER-COMP(OVI?H I(N),IMNI RTU) I have real the hatartlour,omrfiul.requ . nnd iremc .. cr Cnup,cr 69501'the Cali- AIR CONIII'TIONP.H ISSUANCE DATE to Ilcalth&Safety Code.Sw,ions 25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL MFCH. SQ.EC bui i docs not currently ht r.hSonsit,llimucOny resrymsibiliiym notify the mcupam oftconvert,which t met prions,issuance ofa Certificate of Occupancy. _ Owns ,rumhmicedage Dom UTAL: ISSUED BY: OFFICE