S 2185 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF,RTINO HUILIIING-EIA:CI'REGAL Pit NO
BUILDING DIVISION APPLICATION/IOERMIT2185
i'I,UMIIING-AII!CIIANICAL Vl
,BUILDING PROJKC'I'inTSTIICA'TION £'
BUILDING ADDRESS: SANITARY NO. API-I.ICAI R N SUBMI'1'IAL DATE
F6 , Q vg
OWNBR;S ME: PIIONE CONI RAClOR S NAME: LIC NO:
OxN �/ FAS NCE _ 2 NIC CON'IROLM
.�
ARCO 111'I!CI AiNdNIVIO: LIC NO: ADDR ASS: ❑
/:?,* CZk
CONTACT. 1410NF.: - HU LDINC PERMIT INFO
��
ED Consultant Fees Paid by Applicant(initial) HIDC I
HI,FCI' PLUMB MliCH
/ ❑ ❑ + ❑
LICHNSED CONTRACTOR'S DECLARATION QTY. ELECPRIC PHRM IT FEG
I h,mny afore Oat I am licensed mdse pm,isiess of Chapter 9(mon..entdng - _ JOB DESCRIPTION
ozz widiSeclinn 711p(b.fDivisinn3o[thc l3usinese and Prnfu.ianv Code.and my liauvc is RESIDP.NTIA[: '
Fon in full force and effect I'ERMI'I'ISSUANCH
yl- ❑SFDWL ❑KI'I'CHEN RP;MODEL
aVU License Clara Lick APPLIANCES-RESIDEN"I'I Al. ❑ADDITION ❑PLUMBING RI:PIPF
E�W IAtc Cmeractor
CC ARCHITECTS DECLARATION ❑MIJI.TI-UNI'i' ❑X?ROCTURAI.
'D to PANELS
ZONZ lundmtand uny plans shall he used n.public records MODIFICATION
OZ=C UP TO LXI AMPS ❑INTERIOR OCIUMNEY RIEIAIR
Fd14t,LLI LvIc,ed Pml'cssionul 201-I000AMPS IMI'ROVHMENT E]SWIMMING POOLS
ate ; OWNER-11I11LUP.k DI?CLARA'DON OVUR INX)AMPS ❑HA'I'HRs )HI./RpVAIR I]DI?MOLIHON
C Q I hereby action that I ran exempt from the Contractor's License Law lir the
pj
3=.0 following mason.(Section 7031.5.Business and Professions Csde:Any city or county SIGNS CLFCTRICAL sR
y which malates a penin u)construes,ultra,innprave,temurivh,lar mpuir uny xmmwre
�O
t it aortic,II ppl tf -: II t to til "g LIa+e+t SPIeCIAI,CIRCW'1'/MISC.
} that '. dpun t Intim p 'loo. 1 the C t t 1 1 (Chep cr9
.�00 (co g with Set 7000) fDvis 3 DI B di ( . -Coshoor TEMP MITER OR POLI?INS'IL ER
CIAL
t4.p o E nun he Is cWnun III...I an and tire hares for the alleged axe cid nn.Any vilaoon of EDNHW BLDG/ADDITION [-1DFMOLITION
DDC..m Section 7011.5 by any applicant Pea pennn subjects the applieunt or a civil pe udty of POWER DEVICILS ❑'I'I:NANT ❑1'QGD Sh;IiVlCli
of more Iban five hundred dollars(55110).
IMI'ItOV1iM1?NT
< 0 Lo nwncrnfthe ndompeny,maty employees with cared box sale(Sm.
compensation, S\4'IMMING P(HlI.IiLECfRIC
qZy� D will do the wok.and the sruqum in nm intended or tis snle(Sce.]044,Hmincsv ❑O'1'HIiR
W and Pofcesiuns CIA,:'I Concrel-,License Low docs not apply ,,+m—or.of OUT
No
propmy who huilds lar improves thus e,vnd wno rices such work himself or dumugh
his own employees,provided that such improvements am not intended or offered for NEW RESIDENTIAL BLEUR SQ FT.
IL however,the building or imp..cmem is sold withlnone yeoot completion.the SQ.FII FLOOR ARBA ESQ.FT.
nwln
u-hander will have the bunlre,l poling had he did urn build or bnpmve for Imr-
pom ofyulcJ, '1 OTA,:
0 L re er of the i n'peny,am exclusively connecting with licensed commanrs to
construct tire project(Sec.7044.Husines,and Professions Cdep'Ihe Contractors Li-
seLuwducsn.0qoPly to anownarnfpmpeny who hu'ldsnrlmpnor,mcmon.led QTY. I; .PLUMBINO PFRMITi FEB .
M ho contracts(..Such P...Pro,with.coal...bma)licensed par oetal ,,fie Cmcl ucror's
License Law. PERMIT1SSUANCR
O l am exempt under Sec. ,B&P C for this mason
Owner Date AI:fFIt-DRAIN&VHNT-WATP,R(IAA) VA ON
WORKER:SCOMPENSAIIONDLCI.ARATION BACK FLOW PROTECT.DEVICE
1 M1cmhy afhnn under Penvlty.f perjury nnc.f the tiNlowing dcdumtionr �,y�N�
❑ l havcand will nuhrelo aCOlifilamof Cnnscnuoac[kinvum for Worker's Compun- DRAINS-FLOOR,ROOF,ARBA,C)NU' �Sr{IRII?,5�� 1 YI'H CONS'I'RUCON
ration vs provided for by Section 3700 of the Labor Code.to,the pca'el'manm of the 419
work for which this Pencil is issued, FIXTURES-PFR I RAP EP
❑I have land will maintain Workers Compensation Insurance,m required by Section r
3700 of the Labor Coda,lot iter0ee
nnceol the work fur whichuhis wood is issued, GAS-PA.SYSTI?M-I INC.40U'rLETS OCC.GROUP AI'N
My Worker's Compensation Insurnnee carrier and Policy number are
Carrier: Policy No.: GAS-IIA.SYSTI?M�OVBk 411?A)
CERTIFICATE OF 17XE ITION FROM WORKF,RS'
COMNINSATION INSURANCH GR1!ASILINDUS'I'RL WAS'Ip INTERCEPTOR )y
ItUILDINO DIVISION FHES
(Tlik--nuanced not be completed if er
the pms(isRa one hundred dellars N 100) - —�
or less.) GREASI3 TRAP PLANCHECK IT!E
Icenifythat in the perfnnnlanceoftheworkforwhichthispemnit iNissued,Ishell SEWHR-SANITARY-STORM EA.21X1 FT.
not curio,tory pulse in uny manner so as to become subject to the Workers'Cmnpcn. ENI?RGY FEE
.anion Lawsef Califomia.Date WAI'IiEt 111HATER W/VPs I/Ii1.LCTR GHAUING ITR.
A,pliant _
ti NOTICE*10 APPLICANT:IL after making this Cenihcate of Exemption,you at old WATER S YSTESf/I RF.ATING
a , beeome... 0, ,,the Worker,G+ep,tor lon P-O,u ,of the Labor Code,you neat - SOILS FE6
W onhwilh comply with such pomemnu or thlspennn shall Mdcenmd revoked. WA'IHIt SI3RVIC'1? -
0.
CONSTRUCT
cmoionlNGAGENCY NEW RISEDENI'IAI.PLMD SQ,FT PAID
� z Ilneruby vfhnn that there isunmswmiun lending agency(oohs perfovmmec of Receipts
O the work for which this periit is issued(See.9007.Civ C)
Lenders Name TO.I'AL:
C.7 Lenders Mldreae 'IT)TAL:
. 1 cenily d rat I hive read Ihiv uprieatlon and state that the above information is BUILUI G IdiE
F+. EA correct.I tlgnc c mmrly world city and manly to dn1 e'and sale laws rcluling u. Q'IIy MECHANICAL,FERMI"I' FBI?
L) Z building consurctinn.anti hereby mmmn,,,representatives ofthis cilyln enterupon the Sh ISMIC I!I!
above-mentioned Pmpcny for inspection purposes. PERMIT ISSUANCE
(We)agree I,save,indcaud y and keep boomers bar,City of Cupcnim,against BLECTRK Ill:
I mdulieOc.judgmnus,co.1,and espenaes which may it)any way accrue agairm said City ALI PIR Olt ALI)TO MECII.
nscqu'reu of
the granting sof .mil. PLIIMIi1NG 'Hui
APPLICANT'UNDERSTANI ANDWILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO I Laid CFM)
SOURC RE .ffi'IONS. MIiCHANICALFEE
AIR HANDLING I[NIT GVCR 10,000CPM) CONS'IRUCI'ION TAX
Signa m+ Ap cant/ ial c it Dale EXHAUST FOOD(W/DUCT) HOUSING MI'I GXHON FREE
11 ZA DAJSMATCRIALSDISCLOSURE
n.applientorful it Ien.ucu....au mu'u u.'handle ha'eaale o rait'rial HEM)NOUNIP[rO11XL1ainnH
s Ened by the Cupertino Municipal Core,Chapter 9,12,and the Health and Safety -
C c,Soaion 25532pd? HEATINO UNIT(OVER IINLOM)BTU)
❑Yes 141NI VENT I I.RrION I AN NINGLV RESID) PAID -
•
Will the applicant or future building occupant use equipment car devices which Date Receipt k
PP 6 Pan quip ROILHR-COME'(3HP OR 110,1X10 BTU)
emit htenrduns aircontaminanu m JetineJ by the Huy Arta Air Quality Management �wh
Disuimo, CYT'
❑Ycv 1,(Nu BOILER-CONI 100,000 BTU)
I have read the hazardous materials requirements under Chapter 6.95 of the Cali AIR CONDITIONI?R ISSUANCE DAIT?
fomiu Hadlh&Srety,(iipalic Sections 25505,25533 and 25534.1 understand that if the NEW RF.SIDEMI'IAL MECII. SQ.FT.
huiJng dues not sane Ily h: calcnant,(hal it is lay mspmGsibllltym nnlit'y the nuupnnt Cl/ jVX
n�flmenta wh`lu sedate(pri.nn issuance ol'n Cenifcmo ul'Ocenp:ury. ��//
/yyl. r. shore cd g u Date TO`VAL: ISSUED BY: ✓`-"
OFFICE