S 2326 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.ELECTRIC L PERMrr NO.
I{UB.DING DIVISION IAPPLICATIONIPIeRMITPLUMBING—MECHANICAL S f� /")
BUILDING PROJECT'IDEN I'IFICATION ' V L G
BUILDING ADDRESS: SANITARY NO. APPLICATION SURMI TDD-DATE
We -sVLIrs WK-14 �o•�� PB
OWN17R'S NAME: I'IIIINIi: CONTRACI'O R S NAME LIC NO
� l nNh1� ev__k -33 N/C CON'fIiOLN
�ARCHI'I;CI'/F.NGI'JR: LIC O:
ADDRESS iI pw d� TT a ❑ Q �
CONTACT: 1 PHONE: - I` BUILDING PERMIT INFO
I1!`.'� ^,—s t..�� L- 1 ���_�! ❑ Consultant Pees paid by Applicant(initial) BLDG ELECT PLUMB AIECH
El El El
IICINII )CONT RAC90R S I IICIARAGON QTY r„ ILIJC'TRICPERMIT "+ FEC
1n h)an d t1 licensed 1 1 .++f Chapter 9 Bo+ +s+s +g JOB'DBSCRIPTION
qaZ wigs I ]lulu) m she uus a n f ssio"sa� dn,y l'se xcis RESIDEN'r1AL:
140C who Ph Rh11'FISSUANCE
W—b- in fun force and effect '336a ❑SFDWL (.1 KITCHEN kIiMODEL
t-u License Class YYY Lica APPLIANCES-RFSIDEN PIAL ❑ADDITION ❑PLUMBING RE.PIPE
F Z W Uam (• Ilia III_ Commc AM N1'r.
f�H ARCHITECTS DECLARATION PANIiIS ❑MULTI-UNIT ❑STRHCI'URAL
Z py,L l understand at,plans shat l be used as public records MODIFICA'T'ION
OZ_,Q UP TO 200 AMPS Ll INTERIOR ❑CHIMNEY REPAIR
F'F'W Li,rb,d Professional 201-1000AMPS IMPROVF.MEN'I' 0SWIMMING POOLS
N OWNHR-BUILDHR DIICLARSHON
. OVER 1000 AMT'S ❑HATH RFMODEIAWPAIR ❑ )FMOLIJJON
{Ay� Q I hotels,Onto tial I am exempt ran o the Conte Ins"License Law hano
X 3 L O f 11"wing reason.(Section 9031,5.Business and i'mmss ons Code:Any city ur county SIGNS IzLHC RICAL El GO
W U.I- which requires a permit m cons rod,alley,improve,den"lish,ter repair any eraame
E"LLO prior In its issuance,also requires the applicant for such pknatto rile a signed statement SPECIAL Cl RCUIIUMISC.
"I that he islicenmdpunuanrlotheprovisionsoftheContracror'sLicenseLaw(Chapter9
m�'OC (°"nunaming x'ith 9caien]OKpnf Division 3 of the Bmincss and Profession,Code) TEMP MICf1:R OR POLE INST. COMMERCIAL:
11%o C the,he is exempt thendrom trod the basis for the nllcgcd exemption.Any viahalon of [-INEW RLDCUADDI'I'ION Y:MOhITION
R1, N
Sardinia 7031.5 by any a,hcam for apernin mi,oOsthe upplidmt m a civil pemaby of POWER DEVICES ❑'fl?NANT ❑FOOD SI?ItVICIi
�6nal same Wkin fisc Itnndrtd d"Ihrs(S5(M).
n1,ouwneridtheproperly,nranychnpinyuawilhwager usthcir5olec"nq,ea+xuliun, SWIMMING POOL.ELECTRIC IMPROVEMIiN'I'
will do the work,and rile structure is not intended m alremd ba ki de(Set.7Ut4,nudnass ❑OTHER
ae m and Professions Chdc:The Cammctnr's License Law nous nm apply to an owner of OU-HAGS-SWI'T'CHES-FIXTUR is
L prnpany one build.ter improves Ihemon,and xno does such work himself kir Through
his own employees,provided that such intpmvenxnls am not intended or nomad lir NEW RP_41DENTIAL F.LECrR SO FL'
sale.IC however,the building or imperveomut is sold within one year afcomplmion,da, SQ.17.IrLOOR AREA 5/SQy r¢
ncr-builder will have the burden of proving that he did not build or improve for par-
q+mnlsnlcJ.
I,as owner of Sha Poperi,um exclusively emm'ettmg with beensal cordoa...m 'I'DEAL
:
.,,,I,i,ct he n icd(See 7041 I1 :i ss I Poe on,Cade)rhe C+dr d+ a l:.
1 a . oalilyl refp p ly whon ildsoriupnves Imeka ,d QTY,* PLUMBING PE1VvI[1. 1T r• FEE
who conaans sur mel+pr jauts won a c"mm�nar4sl lieaasal purnunm m the G+n anon,
License Law. PERMIT ISSUANCE
I am exempt under See. .B R P C for this mason
Owner DateALTER-DRAIN&V - ATIiR H A) VALUATION
�x�5
• Wo RK17R'S COMPENSATION DECLARATION BACK 171-OW PRIME("iVICE 3 S V 00
I hereby affirm under pcn:dty of perjuryone"flhe following dechmadom: 7 V
I hava:md walmuinwinn Conifrem of C"nsenno wlGinmrc for Worker's Connie, DRAINS-FLOOR,R F REAL . CID
' STORIES TYPE C'ONSI'ItUCI'ION
,anon,as pmvidad for by Seaio..3]W of the Lahr Code,in the jhedin mmca of Che
kik Ibr which This wnnit is issued. PlxfuaES-1'13R TRWIT 8
I I have and will inulnwin worker's Compeasatign Insurance,as mquirad by Seenon
sal oflhe leut, Con,.bonne peKnnnnet,"film weal-for which this pencil is issued GAS-EA.SYS'I'EMI NC.4 OU"I.E'I:S OCC CROUP APN
MyW"rAerc + •n•' iminsumnce carticrand Policy nu
Cartier. Policy Nn: r�r yo GAS-EA.SYSTEh ER 4(EA)
CERI'IITCATE OF EXEMPT ION FROM WORKERS'
COMPENSATION INSURANCE GREASE/INDUST R.
IIIIILDING I ISION IIiIiS
(Thiswction need but he completed if the pcnnil is f+nme hundred dollars[S IID) GRE
ASE'I'RAP
kir less.) I'I,ANCIiIiCK Elili
I cenify that In the perfennured nfde weak Inrwhl.It this permit i s i.wnrd,L'hall SEWER-SANITARY-STORM HA.201,FE p�
not mnplty any pe son in any,nanner,.as m Item".subject 1"We Workers Cuauiwn- i?NERGY PEE V
O Z scion Laws of CulHomiu.Dec WATER HHA'I FR W/VENT/ELECI'It
Z 2 Applicant - -
GRADING PEI
N NOTICE TO APPLICANT.IC for making this Certilicam of Exemptinn.,m should WATER SYSTHMrTpNATING
a ? become subject to the Worker's Compensation previsions of the Labor Code,you most SOILS i
rn
Lia forthwith comply with such provisions kir this permit.shall be deenicd revoked. WAT17R SERVICE
0.
U
CONSTRIICI'ION LENDING AGENCY NEWRL+SIUHN'I'
2 IALPLMN, SQ,CE PAID a _ Dv ReceiptA
1 herby which
mi that Thera is u snnsma,.30 I7.Cilllg aguncy f it Iia pm Cna'uanuca nl
� � the work forwhich lhi.v perndt is is.wW(Fu.3(M],Civ.C.) '
0H Lander',Name TOTAL:
V LamE,'s Address J'OPAL
yI cattily that I have mad this application and sone Iba the above Inf+manon is - BUILDING FF
zn mrrcet.I agree to comply with all city and county ordinances and state lows relating to QTY. MECHANICAL FERMI'rFEE ,Iryy�
V z buildingcmadawlion,and herby amhmize repmeeactives"(thin city maoe,1"..the SEISMIC THE
id l l Ip„,,any I inspectionpu” a. PERMIT RSUANCE
(W) givel 1 fy keepdl' I :'th Cly fCpol gains ELECIRICFEF.
� Ibmd' 'fulsome... .....
l made
dxspensu wl'vb mhy + ryw.yaccmc.gu nts 'ICity gl.fla<llll A1111 10 ME,CH.
ttm
%..drone of thegmnlin,A [,is perms. PIAMBINC I EE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT AIR HANDLING ON['((TO 10,000 CFM)
SOURCE REGULATIONS MECHANICAL EHIi
AIR HANDLING UNIT(OVER 10.000 CPM) CONSTRUCT-IONTAX
Signature of ApplicandConlracmr Data EXHAUSTHOOD(W/DUC1 HOUSING MITIGA'i'[ON FEE
HAZARDOUS MATERIALS DISCLOSURE
Will he applicant or onto building oaeupanl store or handl,hazardous rud"itd IWA'fINC,UNI'I'(TO 100.000 It I'U)
as defined by the Cupcninn Municipal Cade,Leper 9.12,and the Ileahh and Sabey
Codc,Section 25532009 HHAI INC,UNIT'(OVER 100,000 It ID
D Yes ON. - PAID _...
VENTIL61'Il1N PAN(SINGLE ItIiSIDI Dam Boerne#
Willthe air cou ioffuer"building by then axeod Airnehlordeviceswhich
emit hazardous air amwminnms as defined by the llny Area Air Quality Management BOILER-COMP(3H1'OR I00,00i1'I'IA TO•
District?
❑Yak J-1 No BOILER-COMP(OVER Haitian 13 1 ID
I have read the hazardous anterial,requimincres kinder Chapter 6.95 of Ilia Cali- AIR CONUI'I'IONER ISSUANCE DNrE
forma Health&Su@ty Coal,Sections 255(15,25533 and 25534.1 undoeenJ dial If tele NEW RESIDENTIAL MECH. SQ,Cr. /.I �, <J•�
huildingdocsnotOnremly Inikeemnant,thin it Lsmyrccponsibility to nndfy elmsenyvmI ( l
of the ri eimmemswhirl+red he mel prion"issuance Ufa Cermics,ofo'culned,
Owneror authorized agent Ilam TOTAL: ISSUED BY: t
OFFICE