B 0663 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO RUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATIONIPERMIT 1'LtlbutlNG-NECIh\NICAI. 16Q/b�O�.J/ 2
BUILDING 1'ROJh:CT IIII:N'I'14'IG4111N �
SANI'T'ARY NU. AI'PI.ICATIONSOBMII-1'ALDAT
BUR-DING ADDRESS:
r OT; SCEP (c .6 L U 0 a - Z
OWNERSNAME: PHONE: CONTRACTORS NAME LIC M1O: NIC CONTROL 01
2, po nSoJAtJ ❑ � 5_
1'IiCfgiNGINF.ER: V
IAC NO: ADDRESS:
1 7
I'uONE: BUILDING PF:RMI'f INFO
CONTACT
V46 -3 ❑ Consuu
ltant Pees Pail by Applicant(Initial) REDO CLECI Pl.Untlt ntEC1l
LICENSED CoNfRAC )R'S DECLARATION QTY ELECfRIC PERMIT FEE CJ JOB DDIiSCRIPT❑IONN
I heathy alli,m Ina,1 am I'acnsud under pravinin o ol'Chapter 9(contmeacing
M� me it ine,,m,d Prolus.ime Ctdaaa nln liceeix RESIDENTIAL
Z ih Smuan 9[NNB nfDlvisitnJni' Y �° 1'IiRMIT ISSUANCIi
F O wi full fsccind Ilea. SIDWI. ❑KITCI{lith kiiNWHiH.
CWH m
aVU I.mcnae Class link APPLIANCES-RESIDENTIAL 110CAUDIJEON 13 PLUMPING RE-PIPE
ZZ, Dae Commct°r ❑MULTI-UNIT ❑STRUCI'URN.
AHCIIITIiC1'$UECLARN'ION YANIi1S MODIFICATION
OZ '�Z lundeta
nnd my plonsshall be used as public monody UPT0200AMPS ❑INTERIOR C1CHIMN17Y REPAIR
Liscn.al Prnfusiultnl 2(tL IOtNIAMPS IMPROVEMENT ]SWIMMINGPOOLS
-1 OWNER I1UIhDER DIiG1.ARA'IIGN OVER 1000AMI'S ❑BAHT RHMOUpIJRFPAIR ❑DHMOIA'IION
CQ I hereby affirm that I am excanpt from the Contractor's License Law❑n the ❑O'IIIER
U fdlowin8 mwatn.(Section 7031.5.Hosinms and Pridessiom de:CaAny city or county SIGNS ELECTRICAL.
ad
which requires a permit to construct,alar,,mpmsc,demolish,Or repair any smucerc
prion t t"O'ne"slOu requiresthe ppitc t for suchpc itt file a situraudsuotemand SPECIAL CIRCUI UMISC.
that he is licensed pn the provision,allow C , t r',Luccurt,L..(Chapter9 COMMERCIAL;
�..DO (cont mnutgwth Stelam 91X11)t f llvian Satthu Ila' ss JP l ;' is Code)Or I LMP MEI'ER OR POLE INS'T.
P.p,ay� That he is r,moupt IhemGom and dot h:oiv f r the allayed unem,fam.Any violulion of ❑NEW Ii1.OG/ADDI'T'ION ❑DIiM01,1'I'ION
X.1+ Serum.I1)1.5 by any applicant for a permit subjects the applicant to a civil penalty Of POWER DEVICES ❑'I"1:NANI' ❑FaIDSERVICH
V^m t more than five hard"dollen(5500). IMPROVEMENT
F=� ❑I.us owner ofthe property,or my employees with wages as their sole compcnwtion, SWIMMING PULL ELECTRIC OTHER
will do the work,and Inc matcere is not intended or offered for sale(Sec.1W4,Business
and Pone,ons Calc:The Commeon,I.icense Law dies not apply m an owner of OUTLETS-$WRCIIliS-FIXTURES
property who butdc or Improves thereon,and who does such work him,h m th o.di
his own undo ocs.I n vided but notch imp rovancn,s are nn,intended or oacmd I., NI:W RESIDIiN'TIAI.i?hLCI'k SQ 10.
SQ.hC IB.UOIt AREA $ISQ.tT.
salc.IL nsnvever,,he building orimpmvnnem is sdA within nue Year ofmmpl......towlne ,S
nephuilder will have the burden of proving that he did no,build or improve It,par- 7
7 poyF'f yule.). TOTAL
Is owner of the pmpeny,all,exclusively contracting with licensed ennamoto,to
coanmc,,be prOjeel(Sea 1044.Business and Prahssions Code:)ITe Canlmc(tlrY Li- CQ
cense Law docs ma apply to an(,a m
a11")1 prapcny who hand.ar impveN there...,,and QTY. PLUMBING PERMIT FEF. / I
who eanmtcts for such project,wishu.....haat,(.)ticenncd Pmmmano the Curlra m'I
License Law. PERMIT ISSUANCE
I am exempt male,See ,B&PC for this reason
ALTER-DRAIN&VL -WAIIiR Ili\) � SLUATION
Owner Date T�
WORnderfoakyofNSATiON DECLARATION HACK FLOW PR(JIhCT.DC OCJ Q
1 handy affirm under ponnity of perjuryone of the fidlowing dceb,,,C;,:
J Ihavc oust will maintain nCcnlEcmc of Conacnt In hall-insure(ur Wnrkcr's Cnmpcn- DRAINS-FLOOR.R00111 AkEA, ONU S'fpµlES 'I'VI'II CONti'IltllC'I'Ic
nation,as provided for by Section 371X1 of the"Nor Col,forthe pedlanance Of the Il%TURES-PCIII RAP `L
work for which this permit is issued .yam
1 have and will raintafn Work,, Compensation Inmmnce,as required by Section GAS-EA.SYSTIiM-1 INC.J ODfh S
3100 of the Labor Coal for the performance of the work for which this permit is issued. I OCG GROUT' 35�A1'IY C'
My Worker's Compensation haumnce camlu and Policy number are: GAS-EA.SYSTEM-OVER I(EA) R-"--'3 p s-
07
Ca,ricr POIi,y No.: O J
CERTIFICATE(azEXiMPTION FROM WORKERS' (.It EASUINDUS'1'HI.WASTE IN'1'IiHCIi14UR
COMI'f"NSAHON INSURANCE BUILDING DIVISION ITES
Oonsometion needno,Mmmpletedifthepemtil itioronehu,tdnedd.ilors(8100) GREASETRAP PLANCHECK IT 20
m Ics.l
Toctal ythat ithe performancthe e termitic issued.'Com hall SEWER-SANITARY-STORM EA,21019'' ENERGY '
not employ any person in any manner no as m bccnnm.mhjcct m the Wo,keri Compcn-
z scion lows of California.Due WATER HEATER WATNT/HLECIR GRA H IF,
O7. Q Applicant t
= become cl to the Work If,otter making this CENnsae of FL b rJnn.You should WRIER SYSI'EM1VfREA'TING SUIL: ".E
femme h comp rot the Workers Comlenr this previsions of the Lahr Cale,You must
I31
forthwith comply with such pmvisionsmthis permit shall be deemed rtvakeJ. WATER SERVICE "-
n' z T RUCI'ION[.ENDING AGENCY NEW RESIDENTIALPL� 61 �SQ;FT. I I _ PAID
z CONSDate Receip,k
I hereby affirm that there iNa cnnamelim,lending agency fart he performance Of //--L� IJ I✓
LU➢0 he work I wltid„bi,pannit iN ir.adl(Sec,3010.Cls.C.) 'I' 'TAI. d
O U I.ender's Name T TAI
r Lender's Address WILDING FEE 7 p
O. 1 cer ify that I have mad this application and state that the above information is I
IrN rotmd.l agree to comply with all city and c...lymne rows relating to QTY. MECHANI AL PERMIT' 'E .FISH iE
U Z buildings immction,and tlemby authorize representatives of this city to enter upon the
uhnvo-mcminncd property lin nspcmion purpose,, PERMIT ISSUANCE
IiLI:CI'kIC FEE 1.6
(Wc)agrse to save,inJanrlt'y and keep hi olt,a the City of Capemino against �s
I t I which may me u6ain.a said Ci, �"--'--
liahilities,jmIgmen s.urssms expensesw Yinany way ace Y Cl ORAUD'TOMCCIC'"-'-�- -�- _ _ _ I'l( IN FEE
in
nseyuence of,fie granting at this permit.
APPLICANT UNDERSTANDS
(�AND
�WILL�COMPLY WITH ALL NON-PONT AIR HANDLING UNIT('TO Il1.000 CFM) ME 91 ICAL PC 1
SO' IEIIiGULATIONS.•`� ^'CJ AIR HANDLING UNIT(OVER InO0CFM) ') I'RUCTION'D\F
Signature of ApplicunUCntmaol. Date 17KHAUST IIOOD(WIDUC17 I USINGMHOA'HONFI?E
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant ar fmurt Moldingtxeupan,cert arlaudehat tNouN macrial UPATINGUNIT G"D I00.000 HTU)
res define)by the Cupcninn Municipal Cade.Chapter 9.12,and the licallh and Safety 1117ATING UNIT(OVER 100."BTU)
Cole.Section 25532(o)?
(]Yes 0 N VENTILATION FAN(SINGLE RESID) PA
Dam RccciplN
Will the applicant or l'amrt huuIdinyoccapuut mw equipment Or de,iccs which HOILFR-COMI1(3HPORI0a,0I U U)
tit hvardams air cnnwmm '
anan,us defined by the Buy Arca Air Quality Mmtngecnl IAL: 1
iarjet! BOILER-COMP(OVER t W),IXX11i I'U)
'I '. ❑Yes ❑Nn
AIR CONDITIUNIiR ISSUANCE DATE
have read the hmanlnus materials reyuimno<ns under Chapter 695 of the Cali-
lomia Ilcallh,@ Suety GaIC.$anions 25505,25513 unA 25533.1 unJcntund thus if the NIiW RESIDIiN I'IAI.MECH. SQ.4T.
/ 0— ,3^
builJln d,ex nal wrcntly have a shah,,tum it is my InxPn'nihility In notify the ncntp;ne
n' irItrenswbmnt tet pure a,iswamae ala cendmae artxeapancy.
raumori'rd agent
Date TOTAL: ISSUED BY:
OFFICE