S 2596 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
clTvoPcurERTINo BUILDIN=MENAMCAL
PERMIT No. 2596
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BOII,DING DIVISION APPLICATION/PERMIT 1'I,UNIIINS 2 5 9 6
tlUILDING.PROVV NJ �J
BUILDING ADDRESS: SANITARY NO. APPLICA'1']ON SUBMITTAL DATE
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OWNIiR'$NAME: PHONE:
CONTRACT(R'S NAMIi:`TJ C- N 97A) TlIE 57b vE NI` `ONTRDI,#
ARCIIIIECIENGINEER: LIC Mn ADDRESS: ❑
CONTACT: /� PHONI
BUILDING PERMIT INFO
/V�� l� TEae -b So ❑ Consultant Fees Paid by Applicant(Initial) HLDG ELLEECTS PLUMB MECCCH
❑ Z{ ❑ CLICENSEDCONTRACTOR'S DECLARATIOQTY ELECTRIC PERMIT FEF, JOB DESCRIPTION
I Mreby a.Iirm the.I am licensed under Cmvixion.x of ChgOmy who Sacean]1X)0)ofDl.isimt 3oOhr Business and Profnssio..0i, RFRIDFNTIAI:❑EOpPERMIT'ISSUANCE
infullforceand(0)I&D � �� ❑SFDWI, ❑KITCHEN REMODEL.V Lice. lass Link c � gPPL1ANC.S-NESIDIt TIAL ❑ADDITION ❑PLUMBING RE-PIPE
FZ{Vi1 Dmc��- Cnnwnor _17ARCHITECTS DECLARATION ❑MULTI-UNIT ❑STRUCTURAL
)'i I understand my plansshall be used a,publtPANELS MOUIFICAT'ION
OZ� sUPT02MAMPS [I INTERIOR ❑CHIMNEY REPAIR
Licensed Professional tt6aa'' 201-10100AMPS IMPROVEMENT CJ SWIMMING POOLS
�st�J OWNER-BUILDER DECLARATION OVER IIl01)AMI'S F1 BATH REMODELIREPAIR ❑DEMOLITION
6 1 hereby if,.Ihal 1 am exempt from the Commmor's License Law for the ❑OTHER
liuik
dry(, a V fallowing reason.(Section](131 L .Business and Professions Cute Any city er county SIGNS ELECTRICAL
tU'3 V.y which requires a permit to construct,alter,improve,demolish,or repair any structure iJ p
1C"u'f�n6
print to iaxuance,also requires the vpClicanl for such permit to file usigned natetnenl $PECIAI.CIRCUI'1'IMISC. L
That he is licensed p...am to the Canaisi.ns of the Connector's License Law(Chapter 9 COMMERCIAL'
Vapo (commencing with Section T(sho of Division I ofthe Business and Professions Cade)nr TEMP.METE2POLE .
p,y o y that he is exempt therefrom and the basis for the alleged ascmp.. ...Any......tion of ❑NEW BLDG/ADDITION ❑DEMOLITION
LLXl IaN.
Sentient 7031.5 li applicant R,.permitoila,,ts the applicant m a nail penally of POWER DEVEl TENANT ❑FOOD SERVICE,
not more than five hundred dollars($500). IMPROVEMENT'
X50 ❑
I,as owner of the property,or my employees with wages as their sale compensation,
SWIMMING IC
will do the work,and the structure is not Intended proffered tornme(Sec.]044.Business ❑OT'HP.R
and Professions Ctsfe:'Me Contractor's License Law doer nal apply m an owner ofOVTLITS-SI%TUNESproperty who builds or improves thereon,and who does such work himself or through
his awn employees,provided that.such improvements art not itened moffered for NF.W RESIDEM SQ PC
sale.if,however,the building or improvement is will within ow)car of cumpletioq the SQ.IT.FLOOR ARRA $/SQ.FT.
neromilder will have the buNan of proving that he did not build or improve for put-
' po,onrwe).
❑L.,,owner of the property,am csclton'sly ennaaoling with hated mmmetara to
am....ct the project(Sea.7044.Home,,and Profc,lons Calc:)The Cantmmar's Li-
tselaw Anes not apply it)an owner of property,who builds or improves thereon,and QTY. PLUMBING PERMIT FEE
who commas for such projects with eammechas)licensed pursuant to the Commons
License law. PERMIT ISSUANCE
❑Iron eacmpt under Sec. .B&P C for this reason
ALTER-DRAIN is VENT'-WATER(EA) VALUATION
Owner Dme 7 k ^
WORKER'S nderp COMPENSATION DE Ce folio ing BACK FION'PR(MiCT.UF.VICE?
1 hand woff ai under Certify of perjury one of the fallowingW declarations s Co
❑Is.have,and willmaimainetion ofCansant to Labor
Cod',sulf-insureW'forelfamearre of
DRAINS-FhOON,ROOP,ARF.A,CONU RIES TYPE CONSTHUC'I'101
,moor,as provided far by Ss issu 3]I0 nl the Lahr Calc,for the perfonnvnce of the
rk for which this permit is:.sued. FIXTURES-PER'fRAP
1 have and will main min Worker's Co ce of the w odor who us required by Section
rl]W of theWMrCWe.for the perl'ormanemllhe work for which this permit is issued. GA$-EA.SYSTIiM.I INC.40UTLITS OCC GROUP APN
My Wnrkvr's<'nntpmcation Invtr:m,ec rry Ind0. ny tiers/ 7
i Cartier:STA TB C.n MIP PIT icy
No_T. MS-BA.$V$TEM-OVER0.(f7q
CERT'IPICATEOFEXEM!"111ONFROMWORKE S' GREASCIINUUSTRI.WASTE INTERCEFTOR
COMPITNSAT10N INSURANCE BUILDING DIVISION LEES
(This section need not IN completed ifthe permit is for one hundred dollars.ES 100) GREASETRAP
or las'.) PLANCHECK FEC
I certify Wal in the performance of thework for which his permit is issued,(hall SEWER-SANITARY-STORM EA.210 FI'.
not archuy any person in tory manner so as to become subject o the Workers'Compen. ENERGY FEE
Z ,ation"oo.of California.Data WATER HEATER WIVIiNTII?LECI'R
OGRADING IEE
2 Applicant -
IA NOT ICH TO APPLICANT:If,after making this Certificate of Exemption,you should WATER SY5TEMORMATING SOILS FBI;
(•-' " become subject m the W'orker's Compensation previsions of the labor Cale,you must
forthwith comply with such pro.isia.s or this .it shall be deemedrevoked. WAT17R SERVICE
0
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLM O. SQ,IE. PAID Date e eiplp
L) 0 I hereby affirm that them is a construction lending agency fertile p,durrence of
IL .r the weak for which this permit is issued(Set.3097,Civ.C.) TOTAL:
O1' 1-cruder',Name -
ULenders Address TOTAL
I certify tha .Chin
t I have read this ico and Stam that the above information is BUILDING P.E
.tea Cc/") o.L l agree mcumply with all city and county ordinances and state laws muting to QTy. MECHA LP5 F SEISMIC
V Z building a...am,ion,and hereby amh.6e,reprewrionives of this city to entaupm the
above-mentioned property I impectior purposes. PERMIT ISSUANCE EhECI'HC Q
(We)agree'e seer,indemnify and keep harrnal,me City at Copertina Igainst
liabil'nie,,jampacnts.T 1,and capon,cx whirlincy irony way accmeagvima,aid City ALTER OR ADD TO CII. -� pLUMBIN PF
in coreciaamou.(,he gmming of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WI i'If ALL NON-POINT AIR HANDLING UN E(TO 10.000 CFM) MECIIANICAL -E D
$Otl?Ol1WT10NS
^l - 9 AIRHANDLINGUN Y- _ - CONSTRUM ION X
Si a mApplicanllContacusr �T K Date EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE.
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building sacupvn store or handle hamNaus material HEATING UNIT(T0110,(X)(I BTU)
f as defined by the Cupertino Municipal Cale,Chapter 9.12,and the Health anti Safety HIEATING UNIT(OVER 110.1X0 BTU)
Cola.Section 25592(0)'1 �//attaa
0 Ye, ""'° VENT RATION FAN(SINGLE RFSID) PAID Dam Receipt#
Will the applicant or future Wilding occupant use 04miument or device,which BOILER-COMP URV OR MEMO O BTU) /T\
emit Wooden,air communists Is define)by the Be,Area Air Quality Management T L: `l
Divine, HOILER-COMP(OVER 1 OTWBTU)
❑Yes c/
I have rend the hmurdoes manorial,requirement,under Chapter 6.95 of the Cali- AIRCONDITIONER ISSUANCE DATE
forma I Ruth&Safety Code.Sections 25505.25533 ami 25534.1 understated amt if the NEW RESIDENTIAL MUCH. SQ.Pf. 2 L y- 4
building surreally have Intend it is my rcspuneibilify to nmify the occupant � 9 /
.f ahem t,whichmusl "miss,- c ofa Certificareof LCcupency. C045 A G e
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0 or I de--al -�Uam ISSUED BY: ��
OFFICE