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S 2630 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING.ELECTRICAL PERMfr No. BUILDING DIVISION APPLICATION/PERMI'1' PLUMBING-MECHANICAL S 2630 BUILDING PROJECT IDEN'1'IF'ICA'1'ION BUILDING ADDRLSS: SANI'ARYNO APPIACA'r10NSUBMI"1'I'ALDAH 167 Scevti v 0111 NAME. Qr TOG 821 C(INTRACIORSNAME NO NIC CONTNOLa ARCHITECT/ENGINEER: LIC NO: ADDRESS: CONTACT. PHONE. BUILDING PERMIT INFO ❑ Consultant Fees Pail by Applicant(Initia) *BLDG b;LLUI PLUMB M1iGf LICENSED CON'I'RACIOR'S DF.CLARADON Q'rY ELECTRIC PERMIT PEE ❑ I hereby arum,that 1 ata Hcnxed under preamxilan,of chapter v tr:t:tmenalns OD DESCRIPTION WO, witXection7000)ofDivision3oftheBusinessvfdIsnuesamoCtdeandmylicmwo © RESIDENTIAL' FWO in full forceand cllccd. g2W) NCE �U V I.i,vnm Class Lica Cl SF OWL ❑KITCHEN REMODEL QL Date Cuntrenor -RESIDENTIAL []ADDITION ❑PLUMBING RE-PIPE I„p in ARCHI'FECPS D17CLARATION El MULTI-UNIT ❑STRUCTURAL. ',z Ianals"It I my plan,shall he owdol'ahre re,vrds 'n OZ-O PS Z W MODIFICATION F N.,F"m FlnmuvJ Pmfcsamal 0191HRIOR ❑CHIMNEY REPAIR. .� S IMPROVE:ME:YI^11 � OWNP.R-Dl11LDEH ULCLAHA'fION ❑SWIMMING POOLS C W' I hereby uffredust 1 am coanpt fm;n the Cnmmale",License U:w Tor the PS ❑BA" I?MODEIJRIiI'Allt ❑DI?M(]LITI0 K 3 L F following reason.(Section 7031.5,]business and Prell ions CaAc:Any city or county SIGNS ELECTRICAL HER 00 F`O r� which squires n permit m cnmWed,uldeq improve.demolish.or repan any swewm ❑❑ h prionon.,aaamn,a.IfForo,fore,II ppT II 91i to I I allied"mention SPECIAL ClHQ1IT/MISC. 2 p. that he is Incrovedp if, the,rowi,iffei Coruscate,Licari F (Ch pler9 M Qf (con, en 6 th Serf ]1X10) TIT t fth I{ ; dI d C Ie)ar TEMI'ML"1'EIt OR POLL INS' EI 1 L M That h:. .exempt Zany a pli.i d theformal basis to the subjects the exe opt ao Ani v'mlaann of EW BLDG/A ON ❑UH )L ON W w malfunction 7031.5 five any applicant for u permit subjects due applicant to a civil penally of POWER DEVICES ^Z,} not morethaf fvch prop dollars my yeXpl ❑IMP VICE ma ce � Lo the worol thek,and e....c,ormycintendedwithwages eold flstheirxole 0shi.1nxali... SWIMMING POOL I?LIiCfRIC IMP C Fo wJl do the work,and the nrucmreis not intended or o0e.ul for sale dSec.7fFW.Bmincxs ) ❑0'1 HER 3 m and Professions Codi The Commemr's License Law does nod apply to an owner of OU3"LITS-SWITCHES-IL C pmlerty who builds or;mp.ves thc.dm.:md who docs such work himselfee thong Sto his own cm to ors,pr...ldcd that such improvements are not intended of offered for NI1W RESIDENTIAL HLECIIt FI'. � p v pt Ascild sale,IL hoxer%theve th burdenpmvament isat heiwithin on mild improve fogthc .00R F_ cr Iter will have the burden of housing the he diA not huilA or improve for par- �y'�I�x^ulcJ_ owoV11,as'mner of We Property,am exclusively ennVacong with licensed contractor m AL: conmmct the project(Sec.704FL Baslners and Professions Code:)The Commit[.i- re se Lnwdoe nt apply'o an owner of property who htdldsor improves lLefton,and QTY PLUMBING PERMIT PEE' win.fo laws fursuch projects witha'emar o s)Ii cowed Platinum it the Conannor's Q ❑ lam exempts cr R&P C lin This Hasan PL>Rh1I'I'ISSUANCE. D —1,11 1 Owner �— ALTER-DRAIN&VEIII-WATIiR(EA) ��� Doe RI .R'S COMPEN ON UEChARA'I'ION BACK FLOW PluDECP,UEVICL MARAI /A'I ) ehy tarn under pumltyo ;ry one of the following deductions: ❑I tend will maintains CertiRca fConsenll—od-insurefor Workers Camper- DRAINS-FLOOR.BOOK ARBA,GOND. .tion,as provided for by Section 3700 of the Labor Carle,for the perh rises of the ,$TORIES 'TYPE/CONSTR ION weak la,whwh l lov,s ail is ismnf FIX'1'13RES-I'HR TRA Is O Y ❑I have and will mlimain Worker's Compcnvtion Inmmnce,as bapArc:l by Section 3700 of the labor Code,for performance of the work fear which this profit is issued. GAS-PA.SYSTEM-I INCA OUTLETS My Worker's Coutperval on Instal earlier said Policy numhcrare: OCC GROUP APN C.mmrr: Policy No.: GAS-BA.SYS"rEM-OVER4(?A) CERTIFICATE OF EXEMPTION FROM WORKERS' .Yr COMPENSATION INSURANCE GREASWINDUSTRI,WASTE INTERCEPTOR or less.) Tlak-,oo on ndnot Iscaman lesedil'the permit is fomnehundredGREASETRAP dollarshilm) BUILDING])]VISION FEES PLANCHF.CK IEE (certify per"athepeflinmmel111 theworkfm which patient lifelix-C shall SEWIiR-SANI'T'ARY-, not aridityrvf parson In In, STORM EA.2118 PI: ymammr no asm became nugect In life WofNurF Cangsof' e ENERGY FEE O Z Applic Applicant of California Date WATER HEATER W/VENF/ELETR 4 2 Applievnt GRADING FEE (A NOTICE'f0 APPLICANT':11,rBcr making dds Cerdillanc nl' SVS'Ii Ilxontpenn,you xhwdA WAflill 'IMTRI?A'P1N0 17" Mromcsubject,,the\Vorkcrs Compensation paravism,ofthe labor but you muss forthwith comply with re Inch pvisions onhis permit Shull he dented revoked. SOUS TLE W A WATIiR SERVICE CONSTRUCT ION LENDING AGENCY Z NEW RIiSIDIiNT1AI.PLMR. SQ.FI'. PAID W. P l her by which thi that isanmswmionlending agency fur the performantt of a¢ Receipts W. ,� tM1c work aim which this permit is i,encJ(Sec.309],Civ.G) Landers Name >. W herders Address TO'1'AI OTA1: pr certify mat 1 have read tui.application:red Lou shut the a,.,a iffnrmmino is BUILDING FEE h a ild,.,1 ugme m comply with all city and reasuny eardm:codex and come Inws.lml'na e Q'I'Y. MECHANICAL PI?RMIT FEE U z allu"ingmm�maiogand horchs umtionm representativcs of Nis city mercer urymlM SEISMIC FEE alxrve-mentioned property for inspection keel,ex. fWcl ugma to cava,indemnity and keep hamdevs the CiY^IGIncvinuu6IJnsI PEHMI9'ISSIANCP IiLHC'I RIC FIiIi r eamticlul. nu'nts,cosrain,ailikK which may in ally way acsnne agnirot mid Cidy ALT17R OR ADD GO MECH. onICA Nthe gSTANNfthi,pctmit. PLUMBING FIiIi APPLICA ' ON STAND�AN/DW :OMI'hV WITH ALL NON-POINT' AIR HANDLING UNI'1'ITO 10,000CFM) SOURCP .GU ONSCZ MF,CIIANICAL193F. AIR HANDLING ON[[(OVER 10,00if CONSTRUCfIONTAX Sift IP .onlmemf Date F.XHAUSTHOOD(W/DCCT) ALARDOUS 1ALS DISCLOSURIi HOUSING MI'r IGATION FEE I the al diad or future mg:scupsm stn.or handle hamnloe,material HEATING ON IT ITO 100.000 B9U) as defined by the Cupeniso Municipal Cale,Claude,1).12,snit doe Health sod Safety Code,Scnion 25532(x)? HEATING UNI'I(OVER 100,000(ITU) ❑Yes Li No VENDLATION FAN(SINCLB It IiSIU) PAID Will the applicant or luturc building deet ant use a Da' Rcrcipt p p Area Management BOILER-COMP amidirl? us air cunmminants as defsed by the Ray Area Air Quality Management (JHP OR IW,gq BTU) Disvin" 'IOTA 1.: ❑Yes 7 N BOILER-COMP(VER IMiss) HU) II I have mud the hmnrdons mrvmriuls reyuiremems order Coupler 695 of the Cub- AIR CONDITIONER Stria Health&Small Gdq Sections 25505,25533 and 255311 understood that it the ISSUANCE DATE building does not comedy have a reform,that it is my responsibility to notifytheoncupend NEW RESIDENTIAL MrC11. Sp.FT. of the requirements which must he recd prior to issunncc nl a C,,bBefte of(Occupancy, water of authorized agent Dae TOTAL: ISSUED RY: OFFICE