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S1673 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECFRICkL PDRg�`M�+fIT No BUILDING DIVISION APPLICATION/PERMIT PLUMBING MECHANICAL V 1673 BUILDING PROJECF IDF,N'TIFIC61'ION BUILDING ADDRESS: SANITARY NO, APPLICATION SUHMI'I'IAL HATE 710735' TReSSLer GT OOR'NF SCN'AME O IRiO/F:: CONTRACCORti NAME LIC NO: S I N/C C) ROLA �ARLIITCTCT/EIJ INE[R: LIC NO: yDHtS�S:S _ A. ,( &05"5j—T66 ❑ �© CONTACT: PHONE. /� (7$ We' BUILDING M INFO U' ❑ Consultant lr c Paid by Applicant(Initial) BLDG, ELECTPLUMB MECIl tic LICENSED CON RACrORS DECL\RATK)K l W ELECTRIC PERMIT FEE I neem,vllinn mm I an IiccrtaN under prrnisions M Chapter 9(commencing JOB DESCRIPTION MWaZ Ih Section 7000)oIDrvixi....30Ibeim'ucuuXl 11 fission,Coral,wdmy l irensc ln. D Op �� PIRR-M1'TISSUANCE Fly,_ n E AL full face mdeffea. DWI. C KITCHEN REMODEL rFub IJame Cl"'_ y A Lic.� APPLIANCES-RESIDENTIAL ADDITION ❑POU M B ING RF,-PIPE NZ' Dvtc Lam!/,/ Cnnlracmr ARCHITECTS DECLARATION ❑MULTLUNU' ❑STRUCTURAL p=N7,. 1 urd,,amo my plons shilh l used!os public oreards PANELS z MODIFICATION pz' � UPR)2(X)AMPS CINfEkIUk ❑CHIMNEY REPAIR W Licensed l'nrfttilmul IDI-IIf1(IAMPS IMPROVEMENT E]SWIMMING POOLS OWNFR.HHILDER DECLARATION OVER11XAIAMI'S C HATH REMODELIREPAIR [IDEMOLI[ON C 1 h �Fiw Ilaxe ereby'a !I am exempt hour thomtm e Cemr's License,nLaw Ior the K 3 L U fdloving ancon.(Section 7031.5.Bucitco mad Professions Code:Any city or county SIGNS ELECTRICAL. �OTBER W W which r,ger4 u lvtnait rn n...oxi,me,, mimvp,dcm,livh,o rcpuirmy Vmfiare pmr to its i.esmvec.also"mae,doe appwcimt f«tach Permit to Fik a ugnd sutentenl SPECIAL.CIRCUIT/M P. yIM1ut he is liarsttd parson!to lhClonviaiona oftle Cottmewrs liernmlaw(Clwpa9 OO COMMERCIAL, patnhe is exgwllh Smir m rppd Dects or the lhcegect css and l'n.Any st ,fitm or ❑iMC MISCL'R OR 14)LI3INSI'. M p.o y Sec he is 31 5 h Iherefmm eM the basis for the cis tho rli,o W Any viPLakn of L1 NEW BI.DG/AUDITION C UFJd01.IT10N _ X Section 7031 by nny apPlicam fnrorynnit nunjn'ts the ulrpllcam loo<rv'd Penalty of IrcyWF.H UEVICFS CT6NANT CFOODSERVICE W�w not mmothin Five handmL Jollms(S5(XB. F_Z Y IMPROVEMIiNf 6 Dl.ntownerofµtd ltoespa'n)'mr,is mmploym-oficagesas NcifsWe Cnmpertution. SWIAIAIING I'OOI.ELF.CIRI f will An ticwiA,unJ the srtuclurc is not lnmidW ortTcreJ Ge ole(Sec.911f4.Puvimxs CO ER 3$ end Pmfcssioss Code:The Con",l.i.lax'dos our apply tow oyer M OU'rI.I:IS-SWITCfIES-I+IA NRI? Porpnv he rude,or irrifo,c,th tan an!who Jon.toch viors.haoself tor lhmaahVf his own canipariycc,iinnitirdNt ham re' Ir0ri or offered to NEW BESIDES'I'IAL HLEC!R P sUe If thoseveir.the Watching or innitimavoient'.veld wittim one ydar art mplcliom the SQ.IT.II.00R AREA LSQ.FI'. nwec h k II Iwvc th lim&,ruf pn v gµwt Be did v Po IJ ai fur pus, pose of ). 1 u nrofdic,lan,sert, m sivecrownngwthlicensed nrm corstroct thea(Seooa. nsincrs and!PndoriunCo- ) MCx—os. eco.LrwdoesmmepPymto. ofpmpcny QTY. PI.Uh1H NG PERMIT 1liE 2 wMrcomrus forsuch Projects with itcmmno(sl licensed ipmxtant .facontrrcvors J J License Law. PERMI3'I. O I am temp uMn Sm. .B&P C Re chis mxacm ALTER-PRA 'VE ATER(EA) VALUATION Owner D,"e WORKER'S COMPENSAGON DECIARATION HACK .DE � hereby rDlrm am c,pcnahy rf perjnry uric of 1h frlLwing dcdumtims'. I 1 have,mid" anammunaCetif rtof Cmwattos if-ins infer WtAcen Compo- 1 FL(q E O STORIES I Will:CONSTRUCTION Loam,w i mviolcd for by Section 37M of me lahar Codc,for Be,feruc rf Oe "Aforv,hahthisµmut Ink-1. EIX9'11RIr TRA I have itd will munmin Workcra Corycrocu n I.e.as rcquioJ by Serrano 3900 of the Labor Coce,for the perommo[e of Ne wrA fur xTich this permit is issued. GAB�er!SYSr 1 C.R S (ICC.GROUP APN My Worker�s�rJc�y-'�_�- xlyyn}pw cc creW Voltz Cvrticc ✓/ n/ RC rvm mr Policy Nolle/y- GAS-IiA. 1(l LAI CERrHHCATE,UI+EXEM PION MOM WOR K 1IRS' COMPENSATION INSURANCE GRLAM%INDI1Sl' .'1'I!I 11 k BVftef DIVISION ITiES (Thissemien mcdrdt,tcomplaNif nc!coat is fm mr buruhnlolWlm(51 W) GRIASETHA' - _ — mPIANCHECK lcv) II? /M I cenify lbt int a isrrmmv w'do,wok .w for which this pd.I is icd,I shall SEWER-SANITARY RM ' 'F1'. s not employ any perm in any manner.so ala to bccumc subject to the Workers Conpcn- 11 ENERGY ITE zZ wlionlawrnf C.1homia.IAto WAIERHEAFI!k WIVE,U SLCIR O A Vicom GRADING PIE y NO]'(CF'10 APPLICANT:It;aims making this Ccnifcmc of lucnnplion,you should WATER SYSI'FM/TRFA ING F > necome mhjal to the W(Aers Compenweun Provisions of the LaMrr Orde,you must SOLIS FIE! forthwith comply xilh such porisionsothis pout shallhddcmcd rtwrkaL WATER SERVICE = z=) CONSTRUCTION LENDING AGI'l:CY NEW RISIDIMIAh 1'Lh1H, SQ.FT PAID Rdccip♦ U O Ihercbynffrm th.dera is ammtraction lladmgugcrtcy far th pcff.of the wok fm which thin Pentads issued(Sec.])97,CIv.C.) . VLenders Name TOTAL Landers Aodruss a1 certify Out 1 have real this application a+d state ilwt dhe above Infeornwllon is BUILDING 1.: F' V) amccv lugrccmmmPly aim elldty lard county oJirerecn and sure taxa mlvingm QTY. MECHANICAL PERMIT FEE U Z huikl'mycvmamellrn.lard hcrehy amhrnro rtPmncmmivcsofthisciry to cmerugm the SEISMI F mxov'c-mcatio ed property fu inspenitn'r oac,' PERMIT ISSUANCE (We)agree a' save,indemnify and kap hvmis"the City of CuPmunio wimi F2ECIRLC TP mhilL6aajuolgnenu,muswdosprstx which nmy In my way accrue uguinV soil City ACTEK OR ADPTO MECH. FFY in corcequcrce ofdre R ,of Nis Permit. APPLICANT )r ."ANDS ANU WILL COM .V wRll ALL NON-POINT AIR HANDLING UNIT ITO 10,M)CTM) AL F SOURCE RT 3 MECHA FIRE AIR HANDLING UNIT(OVER lL010CITII CONST"RU ON TAX SigwmeofA =.e cntreclor Ihtc EX IIAUS9'HOOD(W4)UCI') HOUSING M111GATION III! HA%ARDOUS MATERIALS DISCLOSURE Will Nc upPlicum or fumru handingoau,nasume or hurtrllc hmmdousmuerml HEATLNG UNIT(TO 110,001µTU) rs deftcd by rhe Cuperuno Manicipal Code,Clarinet 9.12 and the Hcallh imd Sefay C de.Section 3531(¢)'1 HEATING UNI'(OVER I0II,(I0(1 BTU) [:JYcs L:1 Ni, PAID VFNI'l1ATIlIN PAN(SINGLE RPSIU) Unc Rcs6rA Will the a,icrm or fume handing occupant use equipment or devices which emit he eramor,tis o immorm,it,defrcd by tlm Nay At.Air Qual ty Management HGILIiH-CI-COMP(3IIP OR 100,()00 N'N) ` Disma t CJ Yes ❑Nu BOILER-COMP(OVER 100.000000 BTUy AIR CONDITIONER I have read the hatardsus h(sav I 5,Z5mrnx ureM[hamper,6n95 d the Eli- ISSUA CF,vUATE Leniu][earth R Safay Calc tie te-r tha i,25537 wu12s In is :mtd that If 1M NEW HESIUI'NI'IAI.MSCI I. SQ.IT. Cr of tf,gToren rR yo. e.¢run.Jw it In mks+ rwiM'via., . Cccemvpan ��f of this rtyuire 1s ( w t� iruc Occapany. ^ ' (>w pl 1 y LSSUEDHY: OFFICE