S 3125 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-'FILEM'RICAL PER Fr No,
BUILDING DIVISION APPLICATION/PFRMIT PLUMBING-MECHANICAL � 3125
nun.nlrvc rnGlEcr InENrIPlcnnory
BUIhUINCiADDkES3 SANITARY NO. APPLICATION SUBMI'MAL DATE
- 1�1+�6�v I -ld
OW JJR'S NAME: ^2 ,.us ,r CO ,AF'0R:S NAyy: LIC NO:
VA (lh! r.J LVV, L l/�rAC 7NIC CONTROLN
'Cr/ENGINEER: LIC NO. ADDRESS, �O ^ /
ION'IAG'I': PHONE: - BUILDIN'C PERMIT INFO
/9 (5110 - 2,Z6-1702
_iv - 2 ` —Z 7O ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECII
—LICENSE[)CONTRACTOR'S✓DECLARATION (GrMAMPS
� ❑ ❑ ❑
I hemhy adinn mat nm licensod unAcr provisions of ChapaT @ooancacing QTY 'LECI'RIC PERMIT FEE
O0Z whhseceon 70fla orDivision 3onhe Bu,ineu ane Prores=mnscole,nn ,n it JOB DESCRIVFION
WOO v 'cense is
Fly in full farce and effect \� ANCE RFSIDENTIAL
�UV License Clms lila# t ❑SFDwL ❑KITCHEN REMOGEL
HQ LI Dau Conttanos APPLIANCES-RESIDENTIAL
[]ADDITION ❑PLUMBING RE-PIPE
I-iDo2'c ARCHTFEC`PS DECLARATION
z NG IunJmslund myplum,ball ha mcdns nmlic,,c�rds ❑MULTFUNIr ❑S'I RUM LIRA?
O Z—n PS MODIIICAI'IONF 4t:a2 Lmemed Profcsmonul ❑INAERIOR ❑CHIMNEY R F.I' R
S IMPROVEMENTHP OWNI?R-B1111.D[R OIiCLAItAT1ON SWIMMINGPOOLS
y1 hereby aflimt that I nm exempt from We Contractor's License Law for the MPS ❑BATII REMODEI/REPAIR ❑DEMOLITION
k 3 L F following rearm.(Section]031.5,Ba,iness mul Rofessioas Codc:Any citym county SIGNS ELECTRICAL ❑OITIER
Ne which require&a perm))to construct,alcor,ingnave,demolish,or repair vcry ,.,or,
NJ prinno N iesuanee.ulso requires meappli,ant forsuch permit a Eleasigned statement SPECIALCIRCUVUMISC.
y�y thin he is licensed gamont In the pnwiniam W'he Cammam's Licemel.aw(ChaNer4
WSQ� (conunancinp wim$cclion 901NRofD visinn3,floc llusinesx and Pml"e:.dons C'adGmo
O O 'I'F:MI'.METEk OR PULE INST. COMMERCIAL
a a o That he is exempt therefrom and the hasia for the alleged exemption,o Any viplmion of ❑NEW BLDG/ADDITION ❑DEMOLI'I'[ON
Section 70315 by an'upplicnm for d permit suM1 ects the l w uou civil penalty f I'OWHR DEVICES
^'nk J PP i'n yn ,
FZY lot nmm man fivehunArel Anllurs($5O(H. ra"M.�ANT ❑FOOD SERVICE
xa0 [f•1,as owner ofthe progeny,or my employees with wages as their sole root nxation,
SWIMMING POOL ELECTRIC IMPROVEMENT
0.' o wiltpo he work,and mc,aucmrels a,,,i mended.1.4fr sl for,ule(Sec.'/0d4,Business 00HER
Lro and R�c elcons CnJc"rhe Coemclare Lkcnxe Law does not apply h,un owner or OUI LETS-S WITCHES-Fix rURI?S
S proNal who builds or improves lherton,and wha 11,such work himxlf ar Through
his own employee',provided ihnl such impiovemems arc not intended or offered For NEW k1iSIDEN'fl AL 17I.F0k SQ FII
\r
safe.11,,howacgme building or impowelnenl issold within one y1mnf,omp1rfoa'dm SQ.FF FLOOR AREA VSQ.IT.
m.cobuild,will hove the harden of proving chat he Aid not huild or improve for int,
pock of sale.). f•`pp
I Is owner.('me progeny,a a,1,,i,ciy contracting with licensed"almaors m TOTAL:
' onntmel the project l5ec.9014,Business and 1'rofess;nm Clde:)The Contmcmr',Li" -
-t cense lalw Aocs not n'pply run owner of progeny woo hnilasmingtrnvas)loco,,nnJ QTY. PLUMBING PFRMH FEC
who eOnliMd far such projects wird n conorenni,)licensed pur,annl Indic Cmacw ar's
Limes,Law.
014m exempt tmdk,Sec ,Is&P C innhls rcn.on PERMIT ISSUANCE
Dwncr hale AFTER-DRAIN&VENT-WA'FF,R(EA) VALU61'ION
WUIorder p0ty n 3N 1jmy N DECLARATION BACK PLOW PROFEGI'.UEVICF. nr�eS
1 hereby affimt ander penalty of p'jury one of the billowing to,declarations:Carper- 000
ti Ihnveund will mainmioa Cenif'me nfCnnsennn xif-insure for Wnrkcr's unDRAINS-FLOOR,ROOF,AREA.GOND.
salmon,us prov Acd Ibr by Section J91N1 of Idc labor Calc,far the pafo.a ,cc of the STORIES 'FYFE CONSTRIIC I ION
work for which this pemit is mo,d.
FIXTURES-I'I:R TRAP
❑1 have and will ode.I in Workers Compensation ,kIn,insurance,as ra,pera by Scninn
My ot the rkers,bmCnJeronm1mancecanoaneer and work for which Ibis permitkiasual. (iAS-I?A.SYSTEM-I INC.40UTLIdfS
My Worke/s Compensation lnsumnce currier and Policy numbervrt: OCC GROUT' npN
Carrico Policy Na.: GAS-IIA.SYS"I'EM-OVER 4(EA)
CEJU IPICA]E OF EX13MPTION FROM WORKERS'
COMPENSATION INSURANCE GREASI%INDUSTRL WASTE IWERCEP1OR
(This scelim.,adore bcmm 1rt.d iThaparant is fomnc hand, BUILDING DIVISION PBFS
or lens.)
Icenifychat inthe performanceofthe work for which this permi I( ed,Ia P1.ANCIIIiCK FEE
oat anplay any person in any manner No ns to le,ome eahjepo ino ,W'Cnmpen- SEW _SAN r -STORM PA.2q1 IT.
Z sminn Laws of C.fiaan0a.Date ENERGY EEE
Applicant WAFER HEAT' 13NT/ELECTR
�! GRADING FEE
F7
NOTICE TOAPPLICANT:
r,Cammuk;ng Oi is O,io,of of I?xa ode.Yon
IW 3'1 1?APING
M1ecnnne subject, the Worker's Compensmiis previsionl of the lel'. r sine,you mull SOILS IEE
D.l fonhwimcOntplywim suchpmvixions armis pclmil,hvll be Jeem rweked. WATER SER
CONST RUCTION LENDING AGENCY y SQ.F1'. PAID
NEW RESIDENT 1L I'I,MIi.
V Thor which do,cubere isanmsuumion lending agency for perOmm�nm Date Receipt#
w the wo'k for which tltis pemtil Ix issue)(Sec.31009.Civ.CJ
Q U Lender's Name TOTAL
w Lender's Address TO'T'AL: .f
y 1 certify ilial I have read Ins application and&line mat me shave int"om aline is BUILDING FEI3 D Q
U �W comet.I.,me to comply with all city and cmnyoninanrex and smr laws reliningto QTY MECHANICALI'LRMI'I' FEE e
y buillir,eme, erimcand hereby amhnnf,cp,msenmdve,nfibi,city toemel aponlhc SEISMIC FEE
abole n amlinned property for i opeoion pOpows.
(We)agree to save,indenmify and keepharmless me Cit fCu mina a ainal 1117RMI'F ISSUANCE
cm pc 6 ELECi'RIC FEE
in
th,cossanofthi,ncswhich may inany way uccmenguinu,uiA City ACI ER OR A DO'I'OM13CH,
m consequence of me gmnling of this Derrell. PLUMNING PE13
APPLICANT UND' SAND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT )
SOURCE REOUI.A'HONS, l'1014(XIBCFM
y�^•f MLCHANICAI It
(1 10 { AIR HANDLING UNIT(OVER IO,(NII)CFNU CONS'BUCTION'IAX
mil urcofAl be_ a1' Dcw Ex1IAUS'FHOOD(W/DI1Cf)
HAZARDOUS MA'I'ERIAI S DISCLOSURE HOUSING MITIGATION FEE
Will the applicam or future building ocenpam,¢vearhandichaurAousmamrul HEATING UNIT(TO HX),(p0I1"I'll)
as dclinN by or Cupertino Municipal Grde,Clupttcr 9.12,and are Realm and Sale,
Cade,Section 2553200? HEATING UNIT(OVER 100,000 BTU)
❑Ye
VIiNTI1.Al'ION FAN(SINGIL+I11iSID) PAID
Will the applicant or fmnre refined
y he B um equipment or JMmin which Date Receipt p
,it h:mvNous air ,cnmaminama as detincd by the Rny Arca Air Quality Management BOLLEN-COSiP(1HP Ok 1110,()(10 BTU)
❑Yes fsn BOILER-CONIP(OVER IW,(NN)13TU)
I hove rent me huurJou,usi`ntainh rcyuimnmm,ander Chapter fi.YS ofthe Culi- AIR CON Il1'1'IONER
forma HcaLh&Safely Conic:Yeetmn. O5,25533 and 2551).1 umiersmnd m0I if the ISSUANCIi DATI7
huilJing Jne Icumndy haven mnu a bilis rarann the Deco and NEW RI3SIDENI'IAL MECH. SQ.IuP.
yy111p1+ .y re,In,n,i v r P
of men pAienA swhleh must n ,once ora Cen'lica/t91,fV�(X//cvollp1an�ycfly. //� �
Owner nr aumonmd user j (pe�
55ueD Bv:
OFFICE
�P°' ARa °goy FIRE DEPARTMENT
SANTA CLARA COUNTY CONTROL NUMBER
14700 Winchester Blvd., Los Gatos, CA 95030-1818 -S3 /Z
(408) 378-4010 (phone) • (408) 378-9342 (fax) PERMIT NUMBER
PLAN CHECK No. _
PLAN REVIEW COMMENTS
1 CODE/SEC, SHEET NO. er2ttllTe!- Sb'er+/ieb 01J'rA4Ajc *
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L / `C}4E�2G�TA/C'i AtCEis e.44b key .5#44t $a usTiO��rD
A3,0 X.
gOX X17 TSMC ®r' i/NAL YA✓9/'ereT1oAl.
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APIA✓�U : ��q.0 7'v 155�d ,gur1 DING P��N t r
JURIS PLANS SPECS NEW REMODEL AS CONST.DESCRIP. BY DATE PAGE
Ls ❑ ❑ 1 ❑ lJlaSL6'Y 1 S>P L ►r. �0-4� _ j
1 OF
SEC./FLOOR OCC OCC.LOAD AREA ARCHIENGICONTRAnnCTORIOWNER
# I `�� .
\ NAME OF FACILITY LOCATION
L'a,�PA !3j /6533-
A
DSSSA California Fire Protection District seruing Santa Clara County and the communities of
Campbell, Cupertino, Los Altos, Los Altos Hills, Los Gatos, Monte Sereno,Morgan Hill,and Saratoga