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S 2935 (2) APPUCANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY +• ITYOFCUPERTINO BUILDING.-ELEC'T'RICAL PERMITNO. ILDING DIVISION APPLICATION/PERMIT PLUMBING MECHANICAL BUILDING PROJECT'IDENTIFICATION ' ,BUT INC AOI]e1ESS: SANITARY NO, A PLICATIO .'t1 MITTN.DATh: 10372 SCS6, CAtrC e Y• /g 9 '. ;:a� r.afAI P110Nbi: 46D� CONT A;TOk'$�NAM( Winds LIC NO: MI V U�JI�WI I NIC CONI'k01.M All it IiCI'/I:NGINEBR !HC DI RLSS: A ❑ . . n 1'A.uJI /YIf Iv INS CONTACT P N+: .BUILDING PCRMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG LeCr PLUMB MHCH 1CKa+ 4a- - 351 ❑ ❑ ❑ I.ICENSEDCON'rRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE I lovely affirm that 1 an hodived under proviamis orchodid 9(cnmmenaing JOB DESCRIPTION nfful l lbrr'esait fe X11 Lie.daces and Profe„icros coat,and my Eaan,a is RESIDENTIAL Qat lon]0mb fDi ivin 13 of the Hu: 2(sa W O FORM ISSUANCE ' FW 381 [I SCOWL ❑KU CHEN REMUDEI. aVU LicenseCM APPLIANCES-RESIDENTIAL ❑ADDITION [:1 PLUMPING REPIPE P�W Date Comraartr m 0. ❑MULTI-UNIT ❑STRUCTURAL. RCHITLCI'S UEChAR ION PANELS MODIFICATION ZO yZ..i Inndernlnnd my pions shall he used as pnblie rectNs O Z.-Q UP'I'02110AMP5 [_1 INTERIOR El CHIMNEY REPAIR [=i4Fqq"Iy Licensed Pmfessionul 201-1000AMPS IMPROVEMENT E]SWIMMING POOLS �Wy.V] OWNER-BUILDER UP,CLARAT'ION OVER 1000 AMPS ❑RATA REMODELIRP,PAIR ❑DEMOLITION yyC CWC 4 I hereby afllrm that 1 and exempt from the Contractor's License Law for the 0.H Following rculer.(5 i 90315 Business and Pr r..' C d Any city mcnunty SIGNS ELECTRICAL El Otn R A, D Wyy wl h q' p rt n I .Ilr p d I 1 pir any strctue /4 ,✓ J j pn i i 1. q the applicantf hpenal l fl ''g J statement SPECIAL CIRCUIDMISC. T A y 'he,he,,1 _dp nuu Ih to '.'r.nonlife Comicuber,Lumes,Law(Chop d0 camm.aang withSecton]U(Npnf D'viiat3 ofthe Bmille—end Para,,in:Courier TEMP.METER OR PO NST, COMMERCIAL' 0.Ro C Thal he iv exempt therefrom fall Uc basis for the alleged exemption.Any violation of ❑NEW BLDG/ADDITION El DEMOLITION W..m Section 7031.5 by any opplicmt fora permit subjects the npPlient,ton civil truthful POWER DEVICES Ll TENANT El FOOD SERVICE not mathan five hundred dollars($500). IMPROVEMENT' E. 'Q ❑ 1,.s owner ofthe properly,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC ❑OTHER H will Aothe wnrk,rndihcsirursureisnrn imended m efered torsade(Sca.]044.Business and Prof aunts Code:The Commodore License Law for,not apply in on owner oI OUTLETS-SWITCHES -FI IiS Property who hands or improves thereon,and who does such work himself or through his awn employees,provided that such improvements are nalIntended or offered fur NEW RESIDENTIAL ELFCTR SQ sub,Hfohowever,the building or improvement is sold within ane yeurufcomplelon,lhe SQ.IT FLOOR AREA $/SQ.UP. nenTuilder will have the burden of proving that Ito did not build or deprovcf c pur- pnxc of sale.). ❑ L as owner of progeny,am exclusively emlmcdng with licensed contractors to msmrs the project(So](1t4,Business and Pronasions Cade:)'I'he Contractor's Li- en Law does not Imply to an owner of property who builds or improves Iheman,and QTY, PLUMBING PERMIT FEE who umtracts for such projects with a coatrarsar(s)licensed pursuant to the Contractor s License Law. PERMIT ISSUANCE l um exempt under Sec. �7 ,B&P C for this reason ...r ACI NI(a,.PRA11V do VE)V'f-WATER 7 VALUATION )wncr Date � /—© WORKER'S COMPENSATION DECLARATION BAC K11,0 PR(>{[!J­TUVICE i,findwill unde pentdly nrperjury one of Nefname Radcdare0om: It (]Ihwe ono will main6, eCeni 3700 ofCc Landun Code, renradderms Cempeo- DRAIN 'h[iLLOOR.?OOP, RE�C 5' )kIES TYPE CONS'rIiUCT10N tiff,uc providedhhis ear by Swlian ll, of the father Gtde,for the perfnnnnnm of ono which tills permit is Issued FIXTIJR '-PER AI V n I war have Lawill ,o1maintain Worker Cnmprnsadban Insurance, h his at. by Section (N 37IN0nfihe Latwr,C,of he'a'""a work for which this confit is dewed. GAS-E Y51'LM-I INCA(IDTLL'r5 OCC.CROUP APN My We -Cp�n s 't surto; o 'e dd_P'lloleypy //aa �S 7 �� Carrier1j" n �N,,..W GAS-EA. 'W$'�B:Ms)V CERTIPICA'I'li O .XEMPfION 17ROM WORKERSORFASFJI DSSRL WAS'I'H INTERCEPTOR COMPENSATION INSURANCE `RU18DhJD DIVI910N FEES-__ _ Ght,walinnnued nm becampleed if the permit is rnntnchundreddoihu,($10a) GRBASHTRAP nr PLANCHECK FEE less.) I certify that in the performance offe work f h h this permit is issued.I shall SEWER SANITARY STORM EA.200FIK not employ' y P torn y .n .t b blc rl the Workers Gnnpe n ENERGY ICE z cal' f fC bran Ca WATER IICATP,R WIVFNTILLLCIR zApplicant - GRADING FEE NO'1 ICE TO APPLICAN'U If nor ranking this Ce if cow I L m aver.you ebur Id NAIER SYSTEM/TREATING SOILS FF.P. (~ became wbloa to the Workers Grmpcnemlon pmv sons nrthe Labor Cade,you mall LF1 fonhwitbcnmply with,nch Pmvisinnwnhis permit shall hedeemedreyoked, WATER SERVICH Q a CONS'IRUC'1'ION LENDING AGENCY NEW RES IDIiN'I'IAI.I'I,MB. SQ,FT. PAID z te Rot# I hereby churn that there is a cconstruction,lcndiugaguay lot cc he pcommuannr U O the work farwhioh this permit is d sone+l(Sm.3ot], is.C.) L>r Lenders Name 'i"Dol.: U Lender,Address TOTAL: I lenity that I have rend this application ltd stem that the above into...came le BUILUI G FP.E iH. L01 correct I agree to comply with all city and county reformers and state laws relating to QTY, MECHANICAL PERMIT PEB UZ fallible,ametructionand barely liable fee of,mr,nmlives ofihis city a,cntorupon the SETS GFEL abnve-meniinaed progeny for inspersion pugnoeos. PERMIT ISSUANCE (We)agree m save,indemnify and keep harmless the Cay of Cupeme,against F.LF.0 IC FEE Iluniliticv,jutl ms.coetsandw,rar,which Toyinany way atvmeolicallseld City ACHRORADDTOMECH. PLUMB GPEP, nscl ei the graining ofd pennil. AP LA A r NDERSTANDSA DWILI,COMPLY WITH ALI.NON-POINT AIR HANDLINGUNIT(TO OAtgCPM) MECHANICAL FEE SOGR i ULA'H( AIR HANDLING UNIT(OVER 10,000CPM) CONSTRUCTION TAX Signatureaf pp-rnmKoile c rt Data EXHAUSTIIOOD(W/DUC1) HOUSING MI'LGATION FEE IIAZAR US MATERIALS DISCLOSURE Will phoon,or future buildingaceii i stare nr landla hrzanba,newn.l HEATING USE I'(10100.00011'IU) as defined by a Creature Municipal Code,Chapter 9.12,and Ile Henith and Safety Code,Soldier 25532(,)? ITAI ING UNIT(OVER I011,0(10 IG U) E]ye, _ VENTILATION FAN(SINGLE RLSID) PAID Date Reempl x Will the applicant or future building occupant Use equipment or devices which mil occulter,air contaminants m defined by the Buy Area Air Quality Management BOILER-COMP(3HP OR 1(111,1100 BI U) L Di...in,t Yes ROILHIt-COM P(OV ER 100,00U)OBT ❑ hes end the hmnrdl sn icntd,regtureco fe.under Chapter 6.95 orthe Call- AIR CONDITIONER ISSUANCE DATE dards &$a,Iy ode, esti ns 255115,25533 aad15534.1 rudersbmd the 1flhe NEW RESIDENTIAL MLCIL SQ.c U build g not aarc nunh�ll fat it ie my responsibility In not ytM1c nm �'��'� �— entswh' Iprinr to lssuono.1 Certific Uw er ,,to rived agcnI Data TOTAL: ISSUED BY: OFFICE «