S 2245 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.ELEerRICAL PeIT ND.
BUILDING DIVISION APPLICATION/PERMIT PLUMPING MECHANICAL 2245
BUILDING PItmhuiIDENIIFICA'1'ION
IIUILDINGADDRI!SS; L. jSNIRY NO. APPLICAHON SUIBMI'ITALDAI
/D/// /-Eb'/F c7'� PK. G yi�e�
OWNER'S AM': / PIIf INH: _/ CON1'RAGIOR'S NAME:: LIC NO:
CON-I tOLN
RCHI'I'ECr/�l, EN V LIC NO: ADDRESS'. C/��
O 4 G 5' /
CONTACT PHONE: BUILDING PERMIT INFO
[JConia llanl Fees Paid By Applicant(Initial) BL�DvG/ ELECT PLUMB MF,CII
I.ICI!NSLD CON'I'RAC'IOR'S DECLARA'I[ON QTY. ELECTRIC PERMIT FITS
1 hemby o f inn(hat 1 um licensed artier prwidaro of Chaplar ,9 mon orcile ng 1013 DESCRI I'TION
�aO ZO wuh Sru(io.7mg)rll1)....lml3olRe ltu%iaesaund Prol'osbr,Coda,and my h1cree is r' PI!RMI'f 15811ANCH a \� RESIDENTIAL:
CWF- in full lime and effect � U ❑SFDWI, ❑KI'I CHEN REMODEL
QUU Liese,Clava Lic.p APYLLWCCS-RESIDENTIAL Q'T•I11ATI[lN PLUMBING RE-PIPE
FGW Dam Caatneor
V)Qp, ❑MUIM-UNIT ❑NEI RUM URAL.
AHCf1111i1TN DECLARATION
Fbpy PANC1ti MOIBECHIMNEY
OATION
Z—
and cr,road my loo—hall be mod nn public rcosm6'
v� lll"1'o 21XIAMPN ❑IN'I'IiR101t ❑CIIIMNIiY HIII'AB
.F'.W lioamel Profe„Ional 201-IgMAMPS IMPROVEMENT SWIMMING POOLS
1 hercb firm tM1m Ilam Ee e1mP(tr n e C n ECLARAtalc nr's licence Law fm the OVER HNXI AAIPS [I RAI'li RIiMODIiLIRlil4\IR DIiMOLITION
Q beach,
[I OTHER
axl3 LL F mama.following (Section 911]1.5,B "
usms anti Prnfe%sioos Cost,Any oily or county SIGNS ELECTRICAL
y
rn which mquims a Penni[is,construct.alter,improve,detnoli.sh,or repair any structure
�.�-�Q prior nE nn imum¢q aha rnlnlrm the upplinmt Bnwch permit to fticusignel smmmert SPECIALCIRCUI"UMISC. �]/�/77,:,
that he is license Pursuanno lheprovi .....nflhe Call Lican,e l.aw(Chapter9
W�QQ O Icnmmmmingwith Section 9lXp)of DivisionJofthe Bmine„unJ Pmfcsinm Codelor 'ILMI'.ME'1liR(1 .INIT COMMERCIAL:
t1 d e C thin he h,v,a,da,mmon and me hall,lin Rha:dlegcJ eacaminn.Any viol sire of C3 NEW BLDG/ADDITION ❑DEMOLITION
Section 703 1.5 by any applicant Ln a pemut subjects the applicant to a civil penalty of POWER D13V C' ❑TI!NANT ❑]TOO])SERVICE
oolno mthan livel odinduolla,S5IX11. IMPROVEMHN'I'
as owner ownerefthe property,or my employee%will,wages as their vole cnmperoadnn, SWIMMIN' O EC I
will Ill(he wuk,and he.uucwm ix vol ir,ohdor offered for sic(Site VDfJ,Bat it 11 ❑O'1'l1ER
H Z
3 and property
whob calm The Contractors aclreo loceme Laws does oat aptly m rot owner o ouT1.E!Ts—s r F uR .
Elope"'who boons or impmva,"echo,and who ate,wen work deed-or eled f K
Ell own nnpinycce.Provided thw such ingrnvcmcnO am nut in¢ndcA nr uRttcd for NE;W Rf-SIDI!NTIAI. :C IT.
isle.If,M1oxeveclhe WildingorintpmvenrnI kedd withinone yeroof crnnpInca.the
SQ.[IF.FLOOR ARCA S/NQ.IT.
owncnhoilder will hive the harden of proving that he did not hull)0r improve far pr-
of vale,[. 'I' r I.: q3s—�—
[ ,weer of the Sce,7 y,am c,cnsiveld contracting with licensed contractorsm
s to
m oust the project ISeo.9f414,liuxinc„and I'rafexsiun,CoJc'J'Ine Cmunusnr't Lk
trust e
nstLove deals not apply ,an owner of property who builds or improve%themIT
on.and QTY, 'LUMBING PERMFEE
who entad,far such project,will,1t cone:mea(,)reensed pursuant to the Contractors
Licenxe Law. 'i!RN Tl.. NCI i Q
lame It donde .B&PCR,rthismamn
AL” IN&EVEN'1'-WAILR0A) VNAAHON
JP ,net — Date o 0
WORK17R'S C(IMPEINSA'IION DECLARNI'ION RACKI ) 'CI'.DEVICE
1 hem-by affirm under penally of pe Jury one m the followmg decl:as0ona'.
ElIhavnmJ will nwirmin o Ceniticale ofConxcnmo lef-inxum far Worker's Groper- DRAINS-Il, R.R RIA.COND. 'I'YPECONS"IRUCfI(l
cation,as provided for by Section 3](X)01 the IaWr Cale,telt the he'rforcons"of the q - f"7
work for which this Ecrnit is issued, FIXTURES-PER'
1 have and will nntlnwin Worker,Cninpcolation 1-flenle,as reyuirell by Sellil n
3700of(he Lahr Code,for performance ofthe w'ork for which this panto(is issued. GAS-EA.SYS'I'ENI-11 4OUTIJ!II OCC.GROUT'
My Worker's Co"pmivat a Insurance
carer and Policy nuntbcrara.
Camcr. ' � "' Policy Nod GAS-I!A SYS]'1!M"OV ER 41.
AI
CR!RTIPICA'I'EOPEXI!MPTIONnOMWORKI:RS' GRI'.ASIVINIIUSIRLWASTGINIERCEPrf)R
COMP )N INSURANCE BUILDING DIVISIO_NI E!N
(Has_Oea nealrotWuompleed if the permit is before hundred ddhn if 100)
GREASETRAP -
a NIANCIIECK EEG 7�(J,oJ
Ecefify(hm in the perfomwnee of thework forwhich Ibispermitis issued.[,hall SEWER-SANITARY-STORM EA.SX)PC.
adrouploy any person In ane"tanner trine m becmne subjecnri the Workeri Counter- E!NIiRGYIr: a1
Z satiom Law,of California.Doc WATER HEATER W/VENTIELITCI'R GRATING FI!
z O Applicant
NO)ICE TO APPLICANT:11,afar nntking ih n CeNEcam of Huc lion,yoo.bodA WAI ER Sys ri:Mfl REAIINC, SOILS FEE
a; become subject to the Worker's Compensation previsions of the Ialaar Code,you must
W lon1wil6 comply wil t such pmvi,ions or IEi,pereW shut l he demned revoked. WATER SIT RVICt! W
a z y '07g 05
CONSTRUCTION LENDING AGENCY NI!W RfSIDCNTIAL PLMtl. SQ.PC ate Receipt N 10 e,
UC) I hemhysftitn thamherc lsa conaoue(ion lending agenuy farthe pedureaune-e of
m Fthe work for which this Permit i,i„ued(Sec.3097,Cie,C.) TOTAL:
C)U Izndr-More 'i OFAA
Ecnder,AJderc,
1 I certity that I have rend this apElice ion and cam the(he above information i, BUILT N
FN career lagme to comply with all city and county ordinansc%and state laws renting to QTY. MECIIANICAL PERMIT FEF SIT],MI 17
U building con,lmetion.and herebyauthorim reprcumtonivexof this city m enterumm the N
starve mentioned property for inspection paryvses. PIIRMI'I'ISSUANCE G (5O
(We)agree m save,indemnify and keep hamdess the City of Cupcnim against CLL, IC I lith
,,hilltics,jcd,uuen(I.cos..:mdc,pcnsc,which may in any wp arcual agnire(,uid City A:rER OR ADDTO MEECH. PL MIINO PER
in consequence(if the grolning of this pcnnil.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1.NON.POINT AIR HANDLING UNIT(TO 1(1,008CFM) MEL IANICALIBI! ([�
SOUR
GL{tl!GU I-A TIONS.
Jtr//] AIR HANDLING UNI'11fOVHR 10.(N0CI'M) CONS'1'RUCIION IEA%
,'ognatumof A,ificaTtCuotra nr Date EXHAUSI" HOOD IW/DUC'1) HOUSING MITIGAIION IBE!
BAZAR)(JUS MATERIALS DISCLOSURE
Will the applicanlorfuture holding(occupant swrcur handle be,tuaustnaerwl HL'AI'ING UNI'I'(To 100100 IO-IJ)
ns ddineJ by the CUPe"ion Municipal Code.Chapter 9.12,and the Health snit Safety HEATING UNI I'(OVER IfX1,gN1 HIT)
Code.Section 25532(0)'1
❑Ye, 0 N VENTILAf10N PAN ININGLE!RF_NIEI) PAR)
Date Receipt a
Will the applicant or Inure building weirpam use equipment or devices which BOILER (TIRE OR 1(%!0(X1 BTU)
nail hnanloa,nor cnmmninant a defined by the tiny Arca Air Qmlhy Management - 01A f
DelanOI BOILER-COMI'(OVER I(Xk(So it'I'U)
El Yc, ❑No
I have recruct he hemearknes ansocrialsmoduireariscrum unit,Chapter(YS of the Cali-
AIRCONDITIONER IN 1 CE IJA
lin.ra Health lth h Salary CrEJ,Serious 255(152,"33 and25534.1 fral,,oadflarfmc NIiW RI,SIDI N'II Al.MECH. SQ.IT .
building dtcume (lyW I nt uh t l:nY .p„dbiliq 1'I h Dtnl -
offbcrulutdrwhidt Ilw ntetE swanee on nCenil cote of(hcupuneY.
X autherimoll,cnt ! Date 'IOl'AL e, Po I ISSI1f;11 BY:
� OFFICE