S2337 -- APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMB ING-MECDANICAL S 2337
BUILDING PROJECT IDENTIFIC FIUN
BUILDING DRESS: SANITARY KO. APPLICATION SUBMITTAL DATE
OW 'R' NAM" PgqONIi: COI:BACIY)R'S NAA11?: LIC NO:
J� O NIC CON TROI,0
• ARCA 1;-1 'IiR', LIC N. ADORES$'. ❑
C~G/('/1J��
COND\W PHONE: BUILDING PERMIT INFO
❑ Consultant Fm Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
RrIA Z _3-ZSp` Qk_� ❑ ❑
LICENSED CONTRACTORS Of QTY ELECTRIC PERMIT' IEE
I hcrchy afthat lam I ccoscd urWcr g"
eann,a Cnagn 9mmm
lcncing TOB DE$CRIPI'ION
r i
O�Zwith Scclien 7000)af Division 3 of l he Susinca and Prof,.iCode,and my liccnm is RF,SIDEN I IAL:
w o,, in PERM I'r ISSUANCE O
I- full tlxee and cited. ❑SEDWL ❑KII'CH IN REMODEL
�U$� Idccnvc Ch.0 I,icd APPLIANCES-R-SIDENTIAL ❑AUDI TION ❑PLUMBING RE-PIPE
F G W DA' ❑
Cadomlm
U?:1
y a ❑maid I-UNIT' STRUCTURAL.
'I ' . ARA'I'ION
F vai^ al he pu T aIle PANI]S
MODII9CA'I'ION
OZ`3 / - UP'IONb AMPS El INTERIOR [I CHIMNEY REPAIR
Mn dPrn c'io 1(11-101nAMEN IMPROVESIENT E]SWIMSIING FOOTS
�M
OWNER-BUILDER DECLARATION GVER I110UASIU!S ❑BATH REMODELfREPAIR ❑DENIOLRION
IY, 1 hereby af—Nal 1 a,a cxcmq from the Cao."',License Law for tM
u1Kl O W U fdlewing resan.(Smion]031.5.Holme,.,and Pmf¢.iom Cede:Any city Ix aludY SIGNS ELECTRICAL NIiR
rn which requires a permit la cmxutel,alter,Inyvm
ave,deolish,a rtp.Ir any sattnme
F'LL'�g pdor to its iexaema,also a,ailns the applicant fm such permit to file n sig ndsnocnenl SPECIAL CIRCUI'IIMISC.
�y I[Ihit i.sheenscdpuo,oaOalheprovinionenf'be Cammnm'ILicense Iuwl(lugn9
oap (nwmw;oingwilh Sradim]IKlfpof Division3 nflhu Budrcty unl Ymfotzilmx Qdc)or 'rl?milmm?ROR1v)LEINST COMMF.RCIAI,
ap,ca Thin It.,is cavnpt IIICrcfntnt aid the h;Lis ax In,ollcgcd mmnpnna Any v',,44mo of El RLUCJADDHION ❑DEMOLITION
W Section 90315 by any uppl'tcanl line nait suhja�W the applicant l a u civil pcn;'Iy of IOWER OHVICLIS �ThNAN'I' ❑FOOD SIiRVICI?
x n✓re than Eve hundred dullan($SXf, IMPROVI?MFN'I'
Q Lmwvlrr of the prvperty.Ix my cntphrysys with wugo astMir udc rontpcnxutisn SWIMMING POOL ELECTRIC
will lodcwo4'wd the stry ore is m itlerded or offered for vile(Scc.If".Ru+iress � [I OTHER
Wand Prolexsinm Code:The Conlmcllx's Lannise law does not apply to N awm o OUITEr$-SW'ITCEFS-IIXTUHES
prstpeny who builds or tmpm.v incision.artd incin. who docs such winds himself or through
his own emplo ees,prmidvi flail h ifoia—lotcnrs hue trot imcn"or oR'cml for NEW RESIDENTIAL,F3,F,C!1tt SQ I.T.
vk.if.hlv'ner,the building ne co ctvett.,is.sold within not year at compkenon.the SQ.17.II.00R,kRFJs SSQ.IT.
rcnhuilJcr will Lase tM bua&n M qn,o,,Thal he did not huild or impmse lift pur-
'oe.1 ala.).
1,ns owner of the gnpmY,nam exclusively cnntmctng with licensed utnaamnIX In AL: �/
,nxtnial Ile gn;ect IS..7010.Baacs.TIMI Proo,sinns Code.')The Cln orallla I I, - "Z7/
minw Alws roe aplyY to un nwoer of pngeny was M,Ilds or'Inlgovc.Ihcram.and QTY. PLUMBING PF,RMIT FEE l
well trot nrarsurn pnlj¢Lx wimaunitlrtanas)nr�wed numaamwmu L'alnmdnr+
License law. Lit ISS C1: d
Tum exemq Mer See. ,Nhl'C fnnhin Hawn
A I.TF,R-L IN k VENT-WATER(IW 3 O VALUATION
Gw� 2
OR E C $j ON DECLARATION RACK ILON'P fECT. EVICF. O '^
IhertM1Y ellitm urxkr pewlty of perjury arc of the fdWwin6 dccl.ntinns: lJ 1 V
Thawandwill
oiCeofCanvf-inwre fur W'ader's CamfpcmC
DRAINS-MOOR, COND,
Nation, to,by Sclimn371b0of se Iailso, me pedsmume oLSTOR1 TYPE CONSTRUCTION
voglot which tats prmit x aldti.
FlXTLHIJ-I'I?H AP
I-] am
I have and will Tmin Worker's Cmnpcasafloa In+urance.av myaired by Seetim
3]IXlof lh WMe Cldc,bsr,h ryifnntmlwc of the work R,rwhich this Ps rut no is',.d. Gn5- 'A.SYS'1'I?M-II JOIPI.: . (CC.GROUP MEN
My Wmkern Clmpenuvio i Insanncc,ander and Polley nua;in,are:
Comm Poo icy No GAS-E?N.SYS ON OV BH d DIA)
CERTIFICATE OP EK IN PITON FROM WORKERSCHIiA51%INDUS'rRI.WASTE INI'ERCIiYlY1R
COMPENSATION INSURANCE BUILDING DIVISION ILFS
(This.ecrim trod m beeninfdead ifthe penrul is forme hundtnl JWlan(SIM) GREASE'rHAP
ar Is..)
FT?C `J
I cmily Jut in the pedonmnce clam,work an which this permit is icsuN.I shell SEWER-SANITARI'-STORM EA,31X1 IT.
m employ any persm in any tmmer sat vs Ill hcaate subjm ro the Worke,v Conlon- ENERGY PER
Ozmuim l awn M C,ibf.ai Date WATER I II?AIT:R WNIM1ELECTR GRADING IIJ?
z o Appli,mo
N NO'IICH'IO APPLICANT:11.allcr teking This Ccniftaae of IN'Tal"na ym shrwld WAITR SYSIUNflBEATING
2SOIIheuno s.hjud In the WnrkcLs Clanpencwnn no...Iof lhr ox oInns Code,yell nal.
3 FlHi
Lmhwith nattily with such,.,"Iiln,an Ihls Icnnit'hill M donna ne,A 1. WAI-I?H SERVICI?
Lu
Z' z CONSTRUCI ION LIiNDING AGENCY NEW RESIDI?NHAL PLMB. SO 191 PAID Ua Rcaeipt#
V C) I herthy action that there is amnNinction lending agency for the perfonrcnce of
D.
F the work far w1aich m
ths. emit nivuda
(S .309,Ci,C.) O
^ 1m 'Nana
Ictders AlMrtxs
} 1 cenify shat I have reed this applicoim a d!sure that the ilnse in worm tilt is �0112Bu G FF.E b
Nrrlrtttl.LgrtclocmmplY with.11nly and county nNiwea etW uam low.¢Tying u' QTY NTE . ICA,. ERN
V z building mnsvunim.end hereMndhriee regC.YnmlivesMOis<ilymmlerugm the CITeI: Ib
ahrvo-meminted
Incipient fm inspmlion purgtses. PERMIT ISSU I, O
[Wc)agree m save,inlcmnify and keep hvnnlcsc Ih City of Cupcnilrt uguinwIC .TRIC FI?P, r
liahilaics.]udgntanl'.cmLvundcslwnvr-which uwy lnwtY w;IY aacmcaguin..said Cir ALI'1?H ORA '10NIECE-
MBING hili
' IseyaCMCnf nIC gNIt1111g of this pCllnll.
APPLICANT U DERSTANDS AND VYIB WITII ALL NON-POINT AIR IIANDI. U(TO 10.X)0,10) ,CIIANICAIL ITe
SOURCIipy. 1. -�'���
AIR HANDLING . C STRUCHON TAX
SigtluurenfAppli.VC.uwIor Gain, EXHAUST HOOD OMMUCI') HODS GMITIGATIDN FEE
HAIARDOUS MATERIALS DISCLOSURE
Will tie eWacem or future building ocyn,cm nom or hudlchvertMlu+.1elf+l HEATING ON IT(Tin I W,OM BTU)
a'Iktiml by the Cupdtino Munai,el Code,CTugn 9.12,end the Ileahlb and Safny
CLL,,SPllion 25532(m] HHAI INC.UNIT(OVER I00LII00 BTU))
Na
[Dy VIiNI'Il.AfltlN FAN(SINGLE,RESID) PND IAIn Rscigtt
Will late applicant or fulnre hlilAing lv;cupanl axe c4uipnem nr,1M,cv wh'nh
emit lwrxrdou.saircmlammuols w ilefimd by the Buy Arta Ai,Qualny Mwwgemmt BOIIJ2R-CCNU-(111PORI(X),g")B'FU) AI
Dinaicl^. MOILER-COMP(OVER 100,001 B'rU)
❑Ycs ❑No
AIR CONDITIONER ISSUANCED T'
1 have rtad the barursYtln tmcrial.rtyuitrnens uMn Chggcr 6 YS III the Cali- n
rani.Ikalth d Safny CWc.Ssians 2SN15,25533 and 2553J.I urvknuN thu if de NEW RESIDENTIAL MECH. SQ.IT.
hal",docs m cvnedly hove. ,..That it is my respusilnlity h unify the ottapw
of Ik ne'e rc-1 wt iclt muss be non P.to ic.Itanse of a Cmiticluc of fkcnpai /�
Ownror aullxtn"n!agent I Ib'fAh: ISSUED BY: TQ
OFFICE