99120039 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY O1 lQSSOOLI
U ITY OF CUPERTINO BUHMING-ELF,CI'RICA L Phil IT NO,
RUD,DING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING PROJECT IDEN'I IF'ICA'1'lON
BUILDINGADDRESS: SAN]IARY NO, A'I'LICAIINNS MIT.DAI
/91 ; atom C?nm IfrID) q, 2 Gr
r 5 AA11r /./{L I'HgO /� '7 C( 'R TORS NAME: /� //(r/qNO �-n/
�WYMP-i L(,.RNL/ / IV��/ NIC CON'I'HULa
Av
NCIII'I'ECI/IiNGINI!LH; hIC NO'.
JDRESS Ol.>•-O/� � • •/ ,X^ ❑
CONTACT: PHONE: �Vp l'AY HU ILDING PERMIT INFO
q-� O� ❑ Consultant Fees[laid by Applicant(Initial) BLDG ELECT PLUMB MECII
BL Kry/(yWp r/ ❑ ❑ ❑ Ld'
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEL
1 hereby affirm is.11 aan Iicerned under pnrcisinm of Chapter 9(aummemang JOB DL'SCRIPTION
Z :mSenion 9lxxnnf Davlsion Asfm Huninesxand Prnfcnsnmscalc.admy lfcen.a is RFSIDFNTIAL
WOO S , 1'17RMII'ISSUANCE
FEW toll force vnA fly1� ✓� '7 0 ❑SFDWL ❑KITCHEN REMODEL
04UU ]-le ClussllC .icN APPLIANCILS-RESIDES I JAI. ❑ADDUION ❑Pi.IIMBING BE PIPE
f-ZW Date Contncmr
waa MULTI-UNIT ❑STRUCTURAL.
AHCIII'I'ECTS DECLA ATI(IN
1„.m PANEL ti MODIFICATION
to Z unJersl:mA my plans vhall he used ossa public recnrJ.v
OZ=O HV'TG 20u AMPS ❑IN'T?RIOT ❑CHIMNEY RIiI'Alk
FZ, Licensed Pndessional2o1-IIMNIAMPS [MpROVI!MEN'I' (]SWIMMING POOLS
OWNER BUILDER DECLARATION
C{ydW's Q 1 hercM1y affirm that I um exempt Gum the Contractors hiccnw Low for the OVER IINXIAMPS [I BATH RIB,10DEURITAIR DEMOLITION
L O 6 U rhowltg re a.(\,[lana 7031.5.Bm nav :rod Pn.te,,ionx Ode:Any city n u 11, SIGNS I!I.l!CI'RICAL ❑OTHER � T
3 W h which re,fima a Permit to cnnar.n,alle`in:pmve.Junolish,or«pair any anmmm (��/Y/ ) (,�j -
�J prop . 'I: 9 -th ppl If h111-111 Ile '6 ea Immanent SPECIAL CIRCIA LIMISC.
f�T that he Ip a .h p fth C . .lL La (ChaPler9
apo (u.nmm�c:.bwthSufnn➢NXq dDb's im3of the]I : ar II 1..' sCAxlclnr TLMI!MLTER OR POLE INST. COMMERCIAL'
tL y o y' Thal be Is cxcntpl Ihcafnmt and Inc falls for the alleged everiplion.Any violation of ❑NEW HLDG/ADDITION ❑DI!MOL1'I'ION
ad Sectio 70 5 by any applicant for a penult subject,the upplicam mn vie I pcnnllY of I'OWGk UI!V]CIiS ❑'TENANT ❑POOU SERVICE.
W y a more than five hundred dollars(SYXIL
~ZQ I,as owner of the n OTHER IEMEM'
Q pmpl, y,mmyenmpla,obaw ollaresasale(Ses.compensation, SWIMMING I'pOL IR.I!CIRIC ❑OTHER
p. will protework,Core: does
sal....[, 911 n4.Imxincof
u1 uniterty,hio b Core:or
Camrerent hiccmc dos casnotapply run nwncr.. OU'['LE'I'S-SWI'1'CIIES-PIX'I'll
R his own err builJx or improves tnsuch i exit who does wen wnrk himself nrered fee
his own employees,praviJcA that such intpmve,mnu ort not intended or offered for NEW RESIDENTIAL liLECTR 5
sole.It,hnwmer,the hundo,or iurpnwrmem is sold within nuc ycurofmmplmlou.the SQ.PC FLOOk AREA ASR I"C
own
ca'�fb lder will havelm I...r nl proving Nat hedid nm build or IntPmve Liv pure
I,-of paled. '1 rn'nl
❑L m nwncr of the pee 70,1 am exd and cmtreoiny with rttnseJ rontmsv.a i-
mmuct.Mproject(Sec.]IIW,wnerof andrty who
Li-
cfusc docs rTPlymonnwnurotpropcnywhonuilJsoringnnvwmcrcon.:rod QTY. PLUMBING PERMIT msr:
who nm.met,f ouch pmja'Iv wilM1 v vmaalmctor(s)IkcnscJ puaxuunnn be Cunuaetnrs
License law. PERMIT ISSUANCE
I am exempt under Sec. ,B&1'C for this reason
ALTER-DRAIN M V ENI'-WATHR(EAI VALUATION
WORKER CUS1PIiNSA'TIUN DECLARATION HACK FLOW Fall'I!C'I'.DEVICE S (_
1 hereby o1Tnn under penally of perjury one of the foHowiny drelmo.ions: ty
Cl Thaw and will maintain a Ceral of Conwnun elf-insure for Worker's Com,cn- DRAINS-FLOOR.BOOR AREA.COND. S'rOR]ES '1'YPECONS'TRUCTIOI
tion,av pmvidnl lit,by Sell ion 991X1 of the latae,Code,for the pcilrome or of the
our which this peon:.in issued. 19XTURIiS-PER PKAT'
e unit will maintain Worked Compensation Insurance,as rcyuired by Sectio
KRN)of the tabu Code.for Performance of[he well,for which this count is broad. GAS-EA.SYSTLM-1 WCAOUTI.LIS (ICG GROUP // AI-N Z�
My WorkCI!kT1I I'CAl1n�lar mW Policy nu
Curlur: mPniky Nom / h GAS-HA.SYSTEM OVER 4(EA)
2 OFXIN
CO
ION FROM WORKERS' GRIiA51%INUUS'1'Hh WASTEIi IN'I'IikCEI'TOR
COMPENSATION INSURANCE BUILDING])[VISION FEES
(T his section need no,be coundchrOl the permit is foram hundred dolim,.(SIM) GREASE'IRAP
PLANCIII!CK PEE
or less)
(certify aha a.the perl'onnmmeeot'the work howled,mho Ls,"ail is moat.I shall SEWER-SANITARY-STORM HA.21111 F1'.
uI employ any pe.xn in any manner so as a.became'abject m 11'e Wnrke,i Cnn.No- ENERGY FILE
Z sailor laws of California Date WATER HT/
EATER WNENI!LECTR GRADING ITE
z Q Applicanl _
SOL ICE'10 APPLICANT: Lnll,rmoklnythis Certillcumul'[Setnptmn,you should WATER SYS'I EM/['BEATING
LAI SOILS PHI:
> became vestal m the Wader's Cnlu,111..ion pmvldnns at Labor Code,YOU roll -_
forthwith enn.ply with such provisions or this Near shall M deemed revoked WATIilt SERVICE LL
L
CONS'I'RUCI'ION LENDING AGENCYNEW RI!SIDEMIAI.PLMR. SQ.Er
PAID Dle.ml ReceiPIN `f^___
U O 1herchylaZ)z 'firnm mall dsm is o annxhnaion lemfingagnrey for lac Pedonn.mco of
Lt. r- the work for which this peon is issucA(Sec.3097.Ci¢C) LJ In
C) U ].enders Name TIyIAL:
Lenders Address BUILDING
I eenil'y Thal I have l Ib'u appl wadi e,and sync mm the ahove iof Orion is BUILDING FEE
F y . ncc..l agrcaln comply with all tity wW roun.y nrJinuncev and.amcl�ws rclwingm Q'fY. MECHANICAL PERMIT FEE SEISMIC PER
U Z M1nildingcons.metion.and hereby a ital re.epresentmivesahnis city mema,min me
aMwe-mcmion d property liar inspection puBxases, PERMIT ISSUANCE ELECTRIC ITEJ y_.
(We)ogrce m.....indemndy and L
keep ha the City of Cali against _
liabilities,judgmeal......Ixondagsma which may In any way"cnmagnindvaid Cry AL']'1!k OR ADD 10 MECII —�
of t of . PLUMBING PEI: -�
in nse9mmee o gra my o panni.
AI'1'LICAM'IINDEK$'I'ANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TU Io,INXICFM) h1ECIlANII'Ah FEE
SOURCE REGULATIONS,
AIR HANDLING UNIT(OVER I Ron CI'M) CONSIRUCTION'FAX
Siburnment ApplicanJConterco, Due EXHAUST HOOD(W/DUCT) HOUSING ALITIGATION FEE
HAZARDOUS MATFR1A1 S DISCLOSURE !
Will file applicant in Ill huiliing.wcupanlo r.reterle hozardousnumrial e HEAPING UNIT(TO I(i BID)
ax de, ed by the C.,tinu Manic:Pal Can ir,Chale,9.12,unit the Heolm and Sorely
Care.Section 255321x0" HEX[INC,ON IT LIVER MILAN)]ITU)
VENT'ILA'TION PAN(SINGLE RESED) PAID
Date Receipt a Lift
Will me 11,11canl or Boole holding oaeupant uw climPocul or devices'which HOMER-COMP(31IPOR I HIIINNIBTUI
and loomdnos nor coronion."as defined by.he Hay Area Air Vuolny Management 'I OPAL:
Older'? BOIIXR-COMP(OVBR I(NI.(XNIIITU)
❑Ye.s No
AIR CONDITIONER ISSUANCE DATE
I one awl.M1e humuluun nuaerialx rwgairnncntx nnJea'Ora,,M195 nl the Cali
hamia Heath h Salcry C.xlc.. lin. 55(15,259))and 25534,1 mode.xmad Ihm if.he N'12W RESIDEN'HAL MECII. SV.17L l�— Q /9
Nil ' -doc,ni TSnR IN -at man Irl it is my msrymsiM1ility mnaify the lxxupan. /
ofa c ran,' ehToo niormissuayge of a Clubiea.e of(kcupancy.
Uw rum uni'ecJ^yen. Lry�a�U/3%rL/all Dare 'I(11'N,: ISSUIiU I1 V:
OFFICE