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S 0522 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING.ELEO:OUCAL P1511 NO. 05 a�^ BUILDING DIVISION APPLICATION/PERMIT PLUMBINC-MECHANICAL. J LL IIUIIDIN'G PROJECT IDENTIFICATION SANITARY NO. AI'1'LICATION$DtlMI'E-ITh OA'I'li BUILDING ADDRESS: /f/y`��] O N!R' NAME: / s PHON f: CONTRA I'OR'S NA � LIC U: N/C CO�kO me /Z ❑ RCHITECT/F,NGINGiK: LIC NU: At ,C'. 64ae Ay S• ONTACf: PH(INIi: BUILIJING PERh1IT INFO ❑ Consultant Fees Paid by Applicant(Initial) BLDG Id.' PLUMB M1731 ❑ ❑ ❑ hICENSI!D CDMKACTOR'S D[CIARATI(1N QTY ELECTRIC PERMIT FEF JOB DESCRIPTION 1 hereby affirm That I an,licensed under provisions Of Chapter 9(commencing zwz ntullslcn n]XIO)nfDrvi,am3ol he Business and Professions Code,und my license is pl!KMIT ISSUANCE RESIDENTIAL Z l,S CSF force and effect. ❑SFDWI, ❑KITCIIIiN kIiMODIiI. QUU License Class Lica APPLIANCES-RESIDENTIAL El ADDITION ❑PLUMBING RIc.P1'C v Z d Daft. Coatecmr ❑MULTbUNIT ❑STRUCTURAL. ARCHITECTS DECLARATION PANELS MODIFICAHON Z FO N Z 1 understand my plans shall be used as public records UI'T0 2M AMPS ❑IMERVE ❑SWCHIMNEY RI OOL W Lircnsd Professional 201-10ra AMPS IMPROVEMENT SWIMMING POOLS CYC, 1 OWNER-BUILDER DECLARATION OVER 10X1 AMPS ❑BATH REMODELIREPAIR El DEMOLITION C Q 1 I hereby affirm that I am exempt from the Cnmrnclnrs License Law for the ❑OTHER X O 6 U Wdowing rcawn.(Sation 7031.5,Business and pemsvions Codc:Any city Or county SIGNS ELECTRICAL W 3 6-y wfiich rcnoims a Permit u)construct.alter.improve,demolish,or repair any structure OQ prim t I L q .th ppl' tf fortieth ' 11 signed statement SPECIAL CIRCUI'PMISC. �,r/,j}.•.•11 thud licensedp : It Ih p :n . fth C t t L 11.(Ch,PII19 COMMERCIAL W�00 (commencing with Section 7000)of Osco 3otlhe Rusmcs.and l m, ms Cde)nr ILMP.METEROR POLI!IN. L G e Ihm he is exempt Ihercfrom vnd the M1nsis for IM1e alleged exemption.Any violation of C1 NEW BLDG/ADDITION ❑DEMOLITION Xm Section 703 L5 by any applicant far a perout objects the applicant n,a civil Penalty of POWEH DEVICF_S C1 TENANT ❑FOODSERVICE t more than five hundred Jnllun 65W), 1 PROVEMF,N' FSC ❑I,ns owner of the property.or myemployees with wages as thcirmk compensation. SWIMMINGPWLfiLLC1RIC 13'OTHER F. will dothe work.and thearNare in not intended or offered for.wle(See N/W.Business OUTLETS-SWITCHES-FIXTURE W m and Professions CNe.The Commcrors License law docs not apply m an owner of aa,ey who builds or improves thceon,and who Jas such work hintwlf or through NEW F.1.1!Cf Flthis own employees,provided that such improvements ate nn,Intended or Offered[nrSQ.PR FLOOR ARIA $ISQ,FI'..sale.I,however,the building Lir improvement issold within one year til Ileadction,the ovarcruildcr will hondoe hadenoLproving thath,dad no,buildorimprove forpur- "'.ofxvleJ. T AL: �1 p1,as owner of the Pa,vo,,ant exclusiely contracting with licensed Iontectors m P P9comwct the Project(Sac-]M0.Business and Profit.sions Cod,:)'Ibe Contractors Li- enveLawdoesnotapply ,,anowncr ofpropeny who build-a impmva mcreon.and QTY. MBING PI7RMIT FEEwhoconermtsformch projects with a Onamenals)licensed Pursuant the Connectors :Aura I1��Littnx law. CE, RL(X uIumexemptLindaSa. .B&P C for this reasn &VENT'-WAHiR(EA) IIY VALUATION Owner Dam WORKHk'S COMPENSATION DECLARATION BACK PLOW PROTECT.DEiVICH 1 hereby aliirm tinder penuhy til perjury One of the lollowing dcclamruorn: I haveand will anavolnaCchillcuteofConsenno sail'-immre for Worked.Compen- DRAINS-FLOOR,ROOF.ARCA,COND. IOR"S TVPI!CONS'I'KIIC'I'ION tion,as provided for by Section 3700 of the Labor Cute,for the performance of the r which this permit is issued. F1 X1 -PER TRAP .,itI have and will maintain Workers Compensation Insurance,as required by SectionOCC.GROUP AI'N 37M of the LaborCNe.fm,mT rfnrrr((Pnnance of the work for which this permit is issued. GAS-EA.SYSTEM.I INC.O OUTLETS My Werk,'. nw' last..Ecumeruld Policy aymher ye� � MSYSTEM-OVERSTEM-OVER J1 EA)Carrier Policy No,CERTIF ATI:OP :X1iMl'fION FROM WORKERS' US'I RL WAST Ii INTERCEPTORCOMPENSATION INSURANCE! DIVISION ICES Ohitwenon need no'ircc, ltd ifthe permit is faro..hundred d011an(SIBEP PLANCHECK IBES le".) Letilythm into,eatornarte.d0 veod,forwhach'his l,t''all is issued.i shallNITARY-STORM CA.2(X1 E'F ENERGY lid! nal employ any person in any manner.so as m become subject to the Workers COmpen- Z mtlon laws ofCalif xem.Date ER WNENT/P.LECTR GRADING FEE zC APpiicamyNOTICE TO APPLICANT:If,nfmr making this Ccnifcme of Cxnnpninn.You shnalJLATING SOILS FEE become subject the Workers Compensation Provisions of the Lahr wAm you mot �•� fonhwith comply with such provisions or this permit shall 6e deemed revoked.0"oCONSTRUCTION LENDING AGENCY AL PLMB SQ.FT. PAIDnam Reedpta I hereby affrinte them ix u,amxwainn lendingagency ser the performance of IU&O 'be workfor which the.pennil ix issued(Sm.309].Civ.C.) TOTAL: 17-(- Lenders Name TOTAL: r W Lcauto's Adds— EEM7 G ITTWI atiythat 1 have real tns.,pliation and store that the aM,ve infsimach Is to correct.i agree m comply with all city and county ordinances and nate laws relating no QTY. HANICAL PERMIT FI:F, PCC V Z building cons0uaion.and hemby all write mprescnwtives of this city to crime upon the ab„ve-mentiond pmpeny for inspection purlmses. PERMIT ISSUANCE, C FEIi (We)agac to save,indemnify and kap hmndcss Ibe City of Cupertino against liabilities,judgments.costs and expenses which may in any way accrue against said City ACTOR OR ADD TO MSCI 1. G ITB! in consequene,of the granting of this permit. APPLICANT UNOF STANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO I(L(NX)CFM) ICALEEC SOU RCF R! UhA M'S. (�/�� • AIH HANDLING UNIT lOVI1H II1,lNN1 CPM) CONS'TRUCI'If IN'ITA S"nome U( pli ono ontructor Dam ELIAUST HOOD(WIDUCI) HOUSINGMiI GAI]ON IPL H %ARDOUS MATERIALS DISCLOSURE Will the ap +mor future hualding occupant.Line nr handle harallous mmcrial HEATING UNIT(TO 100.001)NT UI as defined by the Cupertino Municipal Cods.Chapter 9.12,and the Health and Safety HEATING UNIT(OVER 10(000 BTU) Code.Section 25532(x)' // PAID ❑Yes `t VENTILATION FAN(SINGIdi RF-SID) Date Rcccipna Will the applicant or future building,ecupant rice equipment or devices which BOILER-COMP(3111'UR IIXI,fXNI BTU) roll let...do.,air conwmilloo ns defend by the Buy Arca Air Quahly Management TOTAL: ,Ida? o BOILER-COMP(OVI!R lflEOXX11'TU) ❑Yen ��//��/,I�•p'¢/�/{�/��[) nIR CONDITIONIiR ISSUANCE DAT�I - I have read the hwnNnus materials requirements under Chapter 6,95 of the Call- fomia Hcalth&Safety Cade.Smtions n505.3533 and 2!sSM.1 underslad that d the NEW RESIDENTIAL MECIL SQ.FT. buildiogd sod cu I have roam.Ihmt it is my responsibility to unify the re"Pant of mems ichor trct Orinr m nmaae oh Cf{tj(�ay/uf 2atu e Owner or athon nl S b_Dac T(yfAL: ISSUED tlV: OFFICE \ � \ , § J « « : 70 \ \ \ 7 ) 6 ) � \ \ 4 � : » ) \5 OK ) & § \ / § \ CM _ \ \ 4 Ft } § \ / � , n \ \ \ \ \ / § ) tA G ; \ � _ ) , © ■ / Z r \ a • \ \ } \ \ \\ƒ ~ t \ \ \ \ \ \ �ktK %m . k&& k�k A\ d& . ! . p + fi \ '6 i l •ill , �`, ► ��t � \ J•FA r ( c d� a 4p, z � j.� w. ... .... :.�Wir.' s.. .k. .1 ..wi.,. v:...:x,i t 1 s:r, 'a . . ..^ �. .\:'�� . 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