S 3227 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO RUILDINC.-ELI!CI'RACAL ITRMI"FNO.
BUILDING DIVISION APPLICNI'IONA'ERMIT PIAIDIDING.MFC11ANICAL S 3227
BUILDING PR0jIECI'IDNN'1'IFIC.V'1'IDN V
BUILDINO ADDRESS: SANITARYNO. APPLICAJ ON SUBMITTAL DATE
MIN
PIItINI?: GI1N'TRAI:TOR'S NAME: _T4G. LIC No:
' 11
.C�//1' .. NIC CON'I'ItOl.p
qae
�ARCIiI'I'H T7I;NOINEPR LIC NO: AUURI'S StJ d U ❑
COKI'nCi`. PtIONE:
BUILDING PERMIT INFO
p /� ❑ Consultant Fees Paid by Applicant(Initial) HLDG 1iI.IiCT PLUME H MLCII
Df-,Q _610-all-3-t900 ❑ ElX ❑
LICENSLD CONI RACE OR'S Df:CI.ARAI'ION Q'T'Y. ELFCTRIC PERMIT FEF. J013 DESCRIPTION
I hereby utfirm that I am licensed!under provisions of Chapmr 9 monall ncing
0�Z withScainn]gp)of UivisinnJof rhe Hminess and l'rolesiem CuJc.aml mYlicense is RESIDI'NTIAI'
W OO �J p PERMIT ISSUANCE:
CWH in hill faracandett (}7 ❑SPDWh El KITCHEN REMOUIiL
aUU License Class _ LicN AI'1'LIANCIS-RIiMVF.N'I iAL ❑ADD]TION ❑I'LUMIIING RLiI'11'Ii
H-ZIy Dole Cnmracmr t ❑MUI:1'1-UNIT ❑ST'RUCITRAL
mai ARCHIlrj sD1s
F7mZ IunJemm�d my plans shall he usnl xs t dx PANELS MODIFICATION
OZ`nz UVIO200AMPS I ❑IN TI?R1OR ❑CHIMNLiYREPAIR
H 4,FJa] Licensed Profi i...A 201.1001AMPS IMPROVEMENT ❑SWIMMING POOLS
OwNER-l4)ILDIHtDIiCLAitAfION OVHR101K)AM1'S ❑BATH RI;MODVIJRIiPAIR I] d 01ION
F C C a 1 hereby affirm that 1 am eacmpt from the Contractor's License Law lin the El THf:R
x dO follmvingmson.(Section 903 LS.BUlinen and Pro(clsions Cade:Anycityorcomm, SIGNSELpCfRICAI.
m 31n ti wnmh regnirex a parndt m an2lheeL weer.i�tmawe,dermnfixlt.m rmnh:my amntnre
FSPICIA.CIRCUIIIMISC.1eupnn &4,5
f�>� tbar he is licensed proment tome provisions of me Comencmrs License Law(Chader9
W25 (unmm'lcie,with Strtion]INXpufDivision 3ofthe llnsincse and Professions Ooic)m TEMP.MICI'r:R OR POLH I NST. COMMIiRCIAI.:
d 0.eC that be is exempt IM1ercarm,middle basis for the nllegcd exsorption.Any violation of ❑NEW N.DGINIDII'[ON ❑DHMOLI'UON
xMNSection]031.5 by any applicant for a pcnnitsubjects the applicant to a civil penalty of POWER DHVIC'LS ❑TENANT ❑FOOD SIiRVIG1i
t more than live hundred dollars($500). INIPROVEM17NI'
SD ❑Lon owner nl'Ihe mngreny,nnny cmp]nycos with wages its their solo cnmpcnsieion, SWIMMING POOL.HLECTRIC
p: will Jctffic.ok,mdlhenpeome isnot mondcJorothered aurwlc(Sec91144.Bnsineo ❑(ITIIER
W
3 m and Pri fessions Code:The Contractor's License Law does not apply to an owner of OOfLLTS_SWI'ICIIM-FI%TURIS
pntperty who bn11Js or impose thereon,mnJ wont docs,Inch work himvelf ur through
his own employee,,provided that such improvements am not intended or offered for NEW RIiSIDENFIAI.HLLC!'R SV FI'.
hale If.however,the buildingsurimprovement is toldwithin one yearof compktfthe SQ IT.FLOOR ARG SISQ.FI'.
Ir-bullJcr will hove the M1unlcn nl proving III,he did nm M1uild IIIIm
r prove fill
pur-
plow of mlc.l" TOTAL'
❑1,as owner of the propen%am c®lusively contracting with licensed contractors m
m,atuct the pr,,jc,t(Sea.9194.IWsincxe and Inde......Cat,,Tno Conun"In I close QTY. PLUMBING PERMITFEL;
who umtmes for such projects with a contrnemds)licensed painumn or the Contractors
License Law. 1'IiRMET ISSUANCE:
❑ 1 an,e.mnpt under See. .li&P C fur Ihix rwst
nt AI.TIiR-DRAIN&VENT-WATER(EA VALUATION
Owner Date
WORKER'S COMPENSATION OI?CLARA'rION IIACK IEDW I'itt11'LCT.UIiVICL 3UQ nV
hive
and Y al m.nio er C n dw,m of Consent
on ens of the Workers
o
\ ❑on,.and will mamba:no,lis 37mc of Gmsantr Cod�inwrcfor Workers Compcn- DRAINS-hL(1(1H,RWIr.AHHA.COND. STOgH_S 'I'YPLCUNSTRUCI'ION
V ' .work l nI pmv1Ahi for by$ninon J91N)ul the Lubar CoJc,for IhC Ixr(arm:mm of
work have and this mentalis issued. 19%TURBS-PER'I'RAP
❑ I have and will odr, on Worker's Gno,cof dh o,Insurance.as lir, ,a by Section
3](X1 of Ins L:Ihor ,Coda for the purEtmwrce of lbs work for which Nix permit nixsned, GAS-BA.SY$'fI:M-I INC.40UTLIffS (qC.GH(rt1P APN
MYWnrkers Cam -n`/�tu lM1wnncecnrrfgr and Policy nun ��9��,.
carver: C�faF) /�OS1 Policy No.:�_511QODI6� GAS-lin.SYST1inf.OVER4(EA)
CITORECATh OJILXEMIHTON FROM WORKERS' GR&\SIJINDU51'Rh WAS'I'IiINI'IiRCEI'1'OR
COMPENSATION INSURANCE 11UILDWG DIVISION PELS
Mi,chimmocJnal be compkleJ iflhe,amit ufmonchundreddo11an($100) GREASHVRAP
I'LANCIIIiCK hili
da'n'dy)lia,
crn deficit nymnnerol'sinbeche klinwhlce this thepermlWorkers
Cashall SIIWIik-SANI'I'ARV-S'rORM EA.2lH1 FI'.
not employ any meront in any manner.m as m Mamm subject nt the Workers'Comment (.Y E
Z mann Laws of California.Date WATER 11HATER WNENT/ELECIR ADIN( Ti
ZApplicant
h NOI'ICF.TO A'I'LICANII 1f,after nuking lois Cenifcute of Exentphon,you should WATER SYSTEMO REAPING
become subject to the Workers Com tion f the Labor Calc,you must "OILS I'IiE
pcma provI,hall
Hrvthwith comply with etch pnrvlsinm nr this pcnnil hall he Jccmnl revoked. WATER SRkVICE
:D CONSTRUCTION LENDING AGENCY NEW RG.SEDEN'I']AL PLMB. SQb-T PAID
hereby uflirm lhanhcrc ix a,uawmatia.lending agency fnnhc afomtmtreof Dateeciptp
Fthe work Inr which Inas permh is i...ed(See.3097.Civ.C.) 'POI'AL:
Q U Lenders No. TOTAL:
rLoa Lcudvr's Addmes
G 1 cooky that I hove read Ibis applkntlnn and state thml in,above rotor...a, I in BUILDING FT:E
F rq colica.I agrecm comply with all city and county ordinances and Stam laws relating to QTY. MECHANICAI,PERMIT HE SEISMIC IZE
J mAkfir,iamtmednn,and hereby sort ill reprewrous"of thiseaty or emerupm the
A uvc-nmminnc I mrnlrccty fur Ingxcnbn pup"111 1',,MI'I'ISSUANCfi IH,ECI'ItIC PHE
(We)agree m save,indemnify and keep hanmles the City of Cali against
hahi limes,judgmeny/coss and cxpcnses which may in any way accrue again raid City ALTER OR ADD'ED MECH. PLUMBING ITER
ucgnenc' I for, t'Ihis Pumi
APPLICAN' IA' SA t'LI Y WITH AL1.NONFOIN'1' AIR HANDLING UNET(rTU I ddk)CJiM) MLCHANI MI
SOORCF :G f IN.
2_Vq AIR IIANDLING UNIT(OVCk II1,(XX)CI'M) CONSfRucTri 'TAX
.'$italic nf,pplfcanpconmamr Das RNHAUST HOOD DYMUC) HOUSIN64;ZPOGAT NM
HAZARDOUS MAA RRIA.S DISCLOSURE
Will the a"heunl nr furore huild ng Ixcupinn stoleer handle hanvol suracti.1 IE7A'1'INGUNI'T(TOHM,000R'I'U)
v defend by the Collection Municipal Ode.Chapter 9.12,and the 11.1do and Safety HEATING UNIT(OVER i00.000 It I'U)
Cola bey y45532(ip1
X VH;NTILATION INN(SINGLE RESIU) PAID
Date ReaiplM
Will the apmliaum or from building occupant use equipment nr Jevim which 8011 ER-COb11'(JHP OR IIIa,IXX111TU)
mat hasurdras air cvnmmi nuns as refined by the Eloy Arai Air Quality Munagcmcnl 'A r
Dixoict'i — / IIOILER-COMI'(OVLR 100.000BTU)
�ijA'ss A�'fe AIRCONDI9lONLR ISSIJANCE DATE
1 have mail the nmmdoux mammals requirements under Chapter 6.95 of the C:di
fnmin Health&Sda e,Scci s 5. 5,255}J and 25.5.00.1 m ucheaund mail(the NF.W RISIDENI'IAL MECH. SQ.FT.
bnilAingAmaxno c Yh,; mit is my 'pon.ih'fla,,I tify the arumtot
of the mqui in' s t201 v w mor m is tl:'gv�o a C i9l tit�ye,1(h pd l� 2--
( t I)�iTc/r TOTAL: ESSULD BY,
OFFICE