S2177-APPLICANT -TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO ILUMBING -MECHT MECHANICAL
BUILDING DIVISION APPLICATION/PERMIT rl.unuuNc.nrv:cunN,cnt.
ItUI1.DING PROJECT IDENI'IFICATI(N
'�13 'TINo . 2177
BUILDING ADDRESS
21330 NAI PVG
SANI'T'ARY NO,
AI'I'LICAfION SUlih11'TI'AI. DATE
�--((.q�
OWNER'S NAME; 'NE:
( L G A A 6 (AZPHO
CONTRACTOR'S NAME: LIC NO:
NIC
❑
cDNrRoI. x
7
ARCHITECT/ filk. LIC NU:
mos oa N C-7853
ADDRESS:
CONTACT: PHONE:
BUILDING PERMIT INFO
h 400 qq?-6464
❑ Ccunsultant Fees Paid by Applican((Initial)
BLDGEll T/ PLUh1y EC
rI/dh/ ltl rIL�I
LICENSED CONTRACTOR'S DECLARATION
of chapter 9 (comendns
1 hereby arrrin that I .,it haenecd end,, provision« m
wim 5cnian711110)ar Division 3a(lhe Buxine,. vnd PmraoionsCWe. and my Ever. is
in full force and efleci.
License Clans Pro to
Dare. Can felon
QTY ELECTRIC PERMIT FEF-
-
]OB DESCRIPTION
RESIDENTIAL:
❑ SFDWL ❑ KITCHEN RE,10DE1.
4DIlITION ❑PLUMRINO RH-PIPE,
❑ S RUCfURAL.
MODIFICA'I10N
❑ INTERIOR El CHIMNEY lilil'NR
IMPROVEMENTSWIMMING POOLS
1=z
:100
F-
=UU
Z W
aQL❑MULEPUNI'T
ooZ
e � ^
-
0Fw
rn
TURNil'I' ISSUANCI: / J
APPLIANCES - RESIDCN'I'JAL
ARCI I I'I'I:0 S DECLARATION
1 amleramnd my plor,:nau na hint ns nnnno moms
PANELS
UP TO 2fN) AMPS
J,cr,cd Pmfic"onal
201-1000AMI'S
4�W
4 Q
DyU
ywhich
y
Gip(commencing
c C
<mW
❑gym
'aSp
F•
L 3 L
OWNER-IBUII.DER DFCI,ARATION
I hereby afl'Imt (hat I ten acn "I fmm Ih. Coamcmts License Law for the
billowing ma,mr Section 7031.5. lic,ine,, and 11 fic,csiooa Corr. Any Cil. ... .aunty
requires a permit ah con,%rucl, alter. Intpmvq demolish, or repair any xwcwre
prior to ithancc,1o) minims the pPlt ior suchpermit rib, a signed stamen'SPECIAL
'hath dp n 1h pfth Conn.'., ' 1 e cL BCh f, 9
withSteri 7(HX)1 ofD,:-n31th P:' s.and Profession, Code) n,
'hal he's e e np''heretm n and'he has!, Re the alleged esem,din, Any vrotation of
Section 7031.5 by any applicant for a coni' subjects the applicant o v civil penallyof
no' more'han'ive hundred Jnllm 185007.
❑ L sown, of the poner rnty employees with rages as'hdrsolc compensation,
will do'hcwork. andthe xwcwre isnot intended or offered for sale Ser. 70kELBminess
and Profe,,ver, Cede: The Contractors License Law does not apply to an owner of
progeny o ho builds or improves'hemon, and who does such work himself or through
his ow m employees, provided that such improvement,, am not intended or offered for
salIf, hsmessr. the building or impnominat is mld within one yorm. com,dolum. the
�IlATII RIiMOOIt.IJRI?PAIR ❑DhiMGL1HUN
Ll LOT[
OVER I000AMPS
SIGNSHLIEC[RICA1.
CIRCU IT NO
TEMP MEI'17R OR POI.(: I NS"C
COMMF-RCIAL:
,(-]NEW BLDG/ADDITION Old; OPHION
❑TENANT El POUD SERVICE
IMPROVEMENT
OTHER
POWER DEVICES
SWIMMING POOL ELECTRIC
`b OUT LITS -SWITCHES -PIXTUkES C
NEW F -SI DEN'1'IAL ELEC!R SQ IT.
SQ. 17. FLOOR AREA
$ISQ. FL
build or impm, for pu,-
v s
er-builder will have the burden of Pm m, ilea he did not
pneeoLde.l.
I T, r owner of the pmpcny, am esclesively contracting with licensed contractors to
T TAL:
-
QTY. -UMBI -PERMIT FEE
i-
-seri the project (See. 70,14, ldmineca and Professions Cade:) The Contractors Li--
ns+Law docs not apply to ah owner of property who build, or improves'hereon. and
cerise
who commis for such projms wilh o con'maor(s) liccnuea purmtmt to the Conroe.., s
PERMITISS(1 NCI:
pl unJ. .B this rem
,`\
I .(h/�li�re,�n�w/erylfaJ�^%"
ALrLR-oRAINffi\ W1fEN (HA)
VALUATION
A /t Q Q
WOIt KIR S LOM( 'NSATION DTC( ARAIION
BACK FLOW I'It(YI'1 " U ILII
�DIh
II by'IfunderI llyfl IY (if the following -d I'(
,ulwllnonct ICendwneolC aun.,dfins tit, Wmkcrs Cempen-
1 V
DRAINS FLOOR. ROLE AR 1, COND'
ST(It Its
'TYPECONS 'f1tUC'IION
,lion,., provided for by Sec, i3700ot he labor Cade, for'hc perfatm;mccofoto
work tis whidr this cutin' its 16wnL
,
PIX'I'l1RILti-1,1:10 1 RAP
❑Ile' J Il naithain W'k .( p on"dom 1o,mance. as or,rumdbyS ,
370(1 the Labor Cale.Ibmbeperl'n'hulunf the work for which tAaperni''siamal-
GAS hA. SYS 'IICM-I INC .4011'fLIE15
UCGGROUP
- MIN
(1AS - IIA. SYSTEM OVER 41EA)
My Worker's Confirmalinn Insuranre cancer and Peh.y mmob.r, arc:
Carritc Policy No.:
GRI:ASIJINUUS I'RI. WAS'1'IiINI'IiRCIiITOR
CERTh'ICAHE OFpxFMPI'ION FROM WORKERS'
COMPENSATION INSURANCE
1 11.IING DIVISION
1717 S
(This section need not be rontpl®cd if' he peril is fortune hundred dollar, ($1 BE)
or less.)
GREASETRAP
PLAR ECK
SL'WER-SANITARY-STORMEA.20)IT.
ERF. C
I comythat inthe performance ofhe work for which this scram is issued l shall
not cnhploy any Person in any manner at us it) become subject o the Workers'Campeau-
WATER FIRMER W/ll"NUXLECTR
GR hEE
Z
Z Q
=
>become
Q
Z) z
U
[i.. F.
O U
W
�' 1
to
U
canon L.—of Califomi, Date
Applicant
NOTICE TO APPLICANT: If. after making this Cemificaa of Esemphon, you should.
subject u, the Worker's Compen.mion provisions of the Labor Code, you most
forthwith comply with such provisions or this peri' shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
thereby affirm that r%a construction lending agency for the performance of
the work for which this Nrnti' is issuul(Sec. 3097. Civ. C.)
LewersName
WAILER SYSTVMI REATING
SOILS [E
WATER SERVICE:
PAID Date Raccipl p
NEW RESIDENTIAL PLMR, SQ. ET.
n r
O T L.
lander', AJdm,,
BUILDING F'li
1 ecnify that I bre read this application and slam th d the atone uhm mint is
eemet.I agreemrnmply wilhall city and county ordinances and state laws relating to
building srnswetiun. suithereby authorise represuntativev offhis city'. enter upon the
ubwe-no, liuneJ property Gamgecfion Imposts,.
(We.) agree hl save, indianoify and keep Immtless'he City if Cupertino against
QTY. MECHANICAL. PERMIT FEE
SEISMIC 1:1717Z O
/ yam
PRRMID ISSUANCE: e �J
f 0q
ELECTRICF1I D
AL'I LIt OR ADD IL) MIECII.
PLUMRINfi II?13 O
habilihe,judgmcnl,c,cos,and capers,, which may in anywayvccmcaguins'said City
inconsequencett he clouding of this Permit.
APPLICAN" JNIIERS'I'ANOS AND WILL COMPLY 1VI'PH ALL -POINT
AIR HANDLING UNI '1'('10 n),hW CFM)
MECHANICAL PEI?
so t I QUI AI I0 S.
AIR IIANUI-ENG IJNI'I'll)VIJt ❑I,IHIU CI M)
CONS ON
Nurture of Appllcml/Cumruthu Dat.
LXI I AU ST I IOOD I W/DUCE)
I IOUSI NO M ITIG A' I ON ITE
I IALA RDOIIS MAI'LRIALS DISCLOSURE
Wllllhespelican' or bwum buildi ng cch:updm store or handle haaamousma'exivl
HEAUNC. ON I'1' (11011),into 11' 1' U)
-
as defined by the Cupenina Municipal Coda Chapter 9.12, and the Health and Safety
Cola Section 25532(a)7
HEATING ON[ I' (OVER 1000HI HT U)
VENTILATION PAN (SINGLE RESIDE
❑Yes 7 N
PAID Date Kteci'p
Will the applicant or future Nilding occupant use equipment or devices which
e mi' hazmJous ter ctunwminams as JefincJ by the Buy Area Air Quality Managemrm
If I T T. I.:
BOILER Illlp OR Iql, Bd0 BTU7
BOILER - COMP (OVER Ilp." BTl1E
Distrix!
❑Yes 0 N
AIR CONDE HONER
ISSUANCE DATE
purr
I bar. ¢ad the hmunlon, ma¢daBrcgwremcnu unda - Cha 6.95 of the Cali-
I @ Safety Gds elan, 5509. aru1 , undeownd 0a' irtbe
NEW RESIDENI'IAI. ME C11,
building does a iso., .11bil
of tdingd«e ent% hick hast moment.ior it) Butane of a Ciolpvo nodfylheoezupam
of hhe requimments which inlets M ten pinto issuance of a Cenihcac of lhcupancy.
ISSUED HY�
Owner or andommJ Igen' Dam
OFFICE Ib