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99110089 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY I CITY OF CUPERTINO BUILDING.BEEcTR[C ale, PHRMt I NO BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL BUILDING PROJECT IDENGHFICATION BUILDING ADD NUS SANITARY No. A LICAfl)NSUBMITTALDATI OWZERN N*r. PHONE TORS NAME N/C CONTROL# AM C?zT U, IMF ENC AD[RNSS Agl'.1illb /� INEEt czl� P4 V, 6w CON I ACI: PHnNE BU PLUMB MECH �OM�r*\&qo Consultant Fees Paid by Applicant(Initial) BLDG _ELECT ls� o, 2, D F-1 LICENSED CONN RACTl\5 DECLARATION QTYJ ELF FEE JOB DESCRIPTION I hereby affirm that I cons license Up"I Is I In,0 Chapter 9 bmarrolouiu, E�� M=Z with Section 7000)m Dim....3.fdhcB.om,,.m do1iM1J�rdF.dxnyIkcroci, RES10hpol I IAL WOF PERNUT ISSUANCE I= to fall PF,c and effect.72, C]SFDWL [I KITCHEN REMODEL X-i- Lic.# []ADDITION [I PLUMBING RE.PIPE �_u E,).ccnLWq, APPLIANCES-RESIDENTIAL h-z at — C.."m rARCD1T1(7I1D17CLA ION C]MUUThUNFF 0 STRUCTURAL PANELS zo,�K I ome,,00aml my Bloci te,.,Fdoo,adlir record., MODIFICATION OZ- UP TO 200 AMPS [:1 INTERIOR 0 CHIMNEY REPAIR 4 t:a W Joro'.1 lor"Ifir"i rol 201-1000AMPS IMPROVEMENT E]SWIMMING POOLS s4 OWNER-BUILDER DECLARATION OVER WOAMPS ()LITI 0 BATH REMODELIREPAIR E)DEM ON < I lumby oiffi...o that I a,,,F,coula It cen, row(or he X 0 W followi,no-o. ri, o"non, SIGNS E=RICAL (TETER U It which require%a pennon to consure,aller.uapso)vc.diconclish.-t r Y came 'c en c oc R of us u in nod an'so' on hon LA Contract" TT-,'dD,C ithe I G e -m recer It....... q A"A�T Foe ''in ,". .a n 'ead r other oupsovo dran p,i... its i...arcs..],I sc,lince,he applicant f..molopeorno,fac.6,rordwoo nen, SPECIAL CIRCUIT/MISC on that he is licensed pursuant tode ponvi6mooffhe Contowtva's License Low(Chup 9 of vivo', I,Erne Has radilocconficum,Cock) FEMP.METER OR POLE REST COMMERCIAL 0 (commencing with Section 7")1 f Division 3 of doc Business a .so . Fo ��2= that he is exempt therefrom and the basis for the alleged exemption,Any violation a C3 NEW BLDGIADDITION El DE:MOLrrI0N X POWER DEVICES OTENANT 0 17001)SERVICE �=E­ Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penally of Fall core hall five mendrod delta,,SSo0) IMPROVEMENT 0 1.as owner of the property,or my employees with wages as doir vote compencoxar, SWIMM ING POOL ELECI R IC EI OT14E will do[tic work.and the structure is uni intended or affevrl for sale(See.7=.B.,,,�cnrc�sv W otod Pod...on,,Code The Counnuon's Liven,c Uor,does oil apply I.T,cw,,�cnrc�sv LETS-SWI ICHES-FIXTURES Pp property I I...Itf,I, ar,loso,,inemn,and ol does ouch Zoak bym�cll...frous'lo \T J his own co,ployeto, re,ided that...Ii no,wo,enneon,tire ran intended or onous!I NI7%\USIDENTIAI_HLECI it SQ IT sun, L h,-cv,,. he bmlcho,u,im,roven',,on i,,,,Id widur o.s,,,ar.f canpletionAn, SQ.FT FLOOR AREA VSQ. ownor,hould.,will have the Waske.of,alwin,Ehl�action!I.,hard I,improve for pal, 'e'o,at loo). TOTAL: -1 1.as owner of the property am exclusively contracting with licensed contractors it)) c(ln%tmct the rojost(See 704kol,Business and Prolessino,Cckdc�)File Contractor%Li- close Law dFv%not apply to an low net of propercy who build%or improves dameon,Iran QTY. PLUNRING PERMIT FEE whocontracts forsuclopreject,with a conamcluds)licensed punulmitothe Contractor's Lio..c L vs. PERMIT ISSUANCE 0 1 a.exempt under Sec. —,B&P C fundis reawn AUTER-DRAIN&V17AWATER BEA) VALGATI.N Date— — — — 4 , e7 WORKER S COM PENS A]SON DrCLARxrION BACK FLOW PR(AECT DE I hereby all....code, raAk,offset:.......col'he bdluwro'd�vlaanafion, n C TYPE I he,onand ovillumuntid.a Cloulfiern,if C......lot towil-inume,fis,Worker,C......en- DRAINS-FLUOR,ROOR ARHA ,inion.so oMiLd I by S-,i...1 17000 doe Labor Code,I the pelout,-.1.-1- _NND, STORIES CONS I RUCTIO� w, k fill which his permn is mu,d. FIXTURES-PER TRA fit an have and will maintain Worker s Con,coodivin Insurance,us required by Section )K,')of the Lx1hor Core.for the performance of the osork for which this Wrnmi is olued. GAS-12A.SYSTEM-]]INC.4 OUTLETS OCC.GROUP APN Elj�l O.N My Workp� ounce examer and Policy .ERTEF[CAn 0 GAS-EA.SYSTEM-OVER 4(HA) EXEMPTION FROM WORK�0� COMPENSATION INSURANCE GRHASEFINDU�RL WASTE INTERCEPTOR BUILDING DIVISION FEESS (Dissection need not be completed it the ennot is fmonse hundred obollar%(SIM) GREASETRAP PLANCHECK FEE ,or lc,,) I cerry that in the FOIlormanstolune work fur which this peraut is issued,I shall SEWER-SANITARY-STORM EA.200 FT not employ any coon in any manner sit oo.it)beconne subject to the Workerx Canaan. ENERGY FEE Z sali....Lmv,ofCioldunnia.Date WAI Ell HEADER W/VFN DHIJT�FR GRADING FEE Z 2 A,Froa,�, I DO APPLICANT If,aftv,redon,fluk Com,ftatoof ExcrEam,III bit G o) NOE CF r -111 WATIM�e_WTN CILS FEE Wc,)oc ninto or he Worker,Com,sm,noun he Lute,Code,oilum foub"do e opl, all such i....I,,., his permit hall be ch,cursed re,ulled. WATER SERVICE W-U01 I IP C CONSTRUCTION LENDING AGENCY I N Z) z Houthylaffiran,haaffierem.o... M le Ri U 0 and/. I 0.n., accept Pthe work for which this Permit is issued(Sec.3097.Ch.C.) I U I.odcA No. FebPUIIbIUIII full COI&Rpling—d—duft ns. TOTP\ Lendcr',Add.x, ."aBLDING 'A I colony that I have mad this application and state that the above information k \\ \\\ fzv IC FEE' U Z building conwoiction.and hereby authorrie reprosontalives of this Vfi;�i \ - 0 couffect.I agree to comply with all city and county onlinarces and stale laws relating to QTY. city to enter upon the ol ansive.uncolored pro,my for oullorel on parpow, PH or o� a roclogn-EcridCay (RnAthiltv days �H cu! ue1,liliv,.jmlmrut......1,and o,,,cocs 11hill,troy 11,any w y else WOa,oc to .,c,inalen ily laid kv,tu.... 'he City of C-Penual ala,1�111 in....�,,loorolc ofdoe jurmai-I"fill'I'loon APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR finff,UNIT(T(/10.(X&4) Ad NOURCEREGU AIR HANDLING UNIT(OVER IV 4�� I PD.000 CO" Sip"ofAiSheancisCusiffactor - ExTusigretweu I FE-E HAllARDOUS mxTERIAUS DISCLOSURE 44 - ZL Will the applicant or future Wilding occupoolvoure or handle hurcandous material HEATING UNIT ffo I 0E),000 B I ED as thfined by the C.,nom M.rici,ad Code Chapter 9A2.add the Hoolth and Safety __ -W�7=_a Cod".Nest 25532( P .1Affa LQ6--- F-I No PAID VE NTILATION FAN(S[1,61.17 R EMD) _D�lx Rocs,qo# Will de,r,hcara or mure hadifirg occu,not use equipmenn c" nd: BOILER-COMP(311POR 00,00011FIJ) Igo , ;,i�yob, cloll h,,.Iliou,at,comommul"'ed,fined h,,ho Bay A.A, Quit y0ana,enuou DGAI, I D11ni'v, Cl No BOII�ER-COMP(OVER 101).ax)BE U) I have mad file monadjous tilacrials on,mrimucal,under Chapter 6,95 of the Call- — AIR CONDITIONER ISSUANCE DATE firmin Health&Safety Code.Smtiory 25505,25533 and 2552kL 1 understand that if the NEW RESIDENTIAL MECH. SQ,pr. Wilding does not c th,It .,he,it is my Froproxibilit y to notify the occuptint — tl ? u blue,, e prortoissomccofaConfi t of ley. 1 6, TOTAL: ISSUED BY. 0 cr r atilhorilrestait v I P OFFICE