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S 1738 (2) J APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY r1 CI YOF CUPERTINO BUILDING-ELECT'RICA], PER`p IT NO. �'- BUILDING DIVISION APPIACATION/PERMIT PLUMBING-MECHANICAL v 1738 BUILDING PROJF.CTIDEN'1'IFICATION BUILDING AUURESS. SANITARY NO. API' ATIONSUBMITTAL DATE 158 7 PoPP nlAY o OW EI'SNAME: 1 PHONE: CONTRAC'IUR'S NA F: STEMS INC ICNo NIC COWROLK 1 ANCIIffECT//AENGINNEIR: LIC NO: ADIIRESS: ❑ Ir 1 gN/ DNc )N'TAAC. L(-PH�ONE: t(/(L/ E BUILDING PERMIT INFO �0` C.FI tENNC� &4j-0 JJ PHV 4Igt 6�L� ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECI I LICENSED CONTRACTORS UECLARA'I'JON TY ELECFRIC PERMIT FEC I hfrchy drum mal 1 a d licensed ander,deekinnn of chapter 9(commencing JOB DESCRIPTION �d'Z with Smllon]0(IDlof Divlslon3oOhe Bminc„and Poorest 1,Cale,and mybeenseis RESIDENTIAL m O p I'ERMrf ISSUANCE CWF in full(aloe and eR Cl.`, / IA2- 7D5- ❑SFDWL ❑ TCHEN RF,MODCI. a U Licence Cloxs— 9CN! .K T Contractor pppLiANCE.ti-HE.SIUI?NTIAL ❑ADDfHON MING kG-PIPE `]•/70 ARCHITECTS UECLARATIUN ❑MULTI-UNIT STRUCTURAL F 7 y PANELS Public Richard, MODIIJCXUON 4Z Iundcr,mnJ my pL ns shall M:weed as X,�G IIP TO 2(M1AMP5 El INTERIOR ❑CHIMNEY REPAIR r 4 t:W Licensed Professional 201-1000AMPS AMPROVIMENT E]SWIMMING POOLS 4 f'2 OWNER BUILDER DECLARATION IY pgJ : EG 1 hereby aflirm Ihal 1 bin cxcinpi fmm the CnmracmCI License Law fur the OV17R 1000AMP$ ATH 1ODFUREPAIR D'M 1 T t amx 3 W F fallowing reason.(Section](131.5.Business and 11 1.sianv Code:Any city or courtly SIGNS 11LECIRICAL HI Oy which re9uires a Aconin m transport,alum improve,de bill,m repair any,mmmre .~.� Q a. p......ts issuance.uBom9uirexme applicantfar such ponal,I lileasigned maharani SPEC]AL CIRCUIT/MISC. Ihm he is Iiccn.wd Nmum,io he provisions of the Cotnramoes license law(Chapter 9 u5�-j Q� (commencing wish Seninn](XXI)of Uivisinn Sol the Bosinca,anJ Pm(enninn.v Codl,)nr TIME METER OR['01,17 INST. COMMERCIAL: that he is exempt Ihfrcfrom and me basis(.,,he alleged emmption Any violmion of ❑NEW BLDG/ADDITION ❑DEMOLITION ISXI I+,�• Section 7031.5 by any applicant for a permit orbefl.v the applicamm a civil focally of POWER DEVICES ❑]'ENANT ❑FOOD SERVICE ��6not name than five hundred douses(S500). IMPROVEMENT 1,us owner of the n.nrm In ees with wit es av[bulli sole enm cncntinn, SWIMMING 11001,FLECI RIC ❑ pmpc Y YornD Y g P will do the work,and the sample is not in cared oroLow forsanale(Sec. Business El 01 HER a'3 m and Pref..ions Cale:The Contractor',Liecuse w duos l apply to an owner of OUTLETS-SW DCU S-FIXiI11RES property who build,or improves hereon,end who Jnes,ach work Im acdf o,through his own employees,provided that.Inch intpmvemems ore not intended or offered for NEW RESIDENTIAL H R SQ ET. sale,11,however the building or i mprovemenl is sold Is ihi n one year of complmion,Om SQ.Fr..MOOR AREA S/SQ.F.. owner-builder will have he burden of proving that he did nm build or improve for pur- posc of,dr.l. ❑ L u owner.1 the pmpedy,con exchrsively ammmling with licensed couldomn to LFE mond the project(Sec.]044,Business and Pref„ios Call,:)the Con note',Li- P A 9 D ase Law does not apply to an owner of property wpm builds or iinprovesmcrcon,and QTY. PLUMBING P17RMTT who contracts fa such pd bet%with a nmmmmds)licensed pursuanuo the Contractors License Law, PERMIT'ISSUANCI tr'�1 F7Ianae,fords ndm Sec. ,Il&PCRnlhIlabon /Vee ALTER-DRAIN&VFW-WATER(RA) VALUATION Owner Date - Cni WORKERS COMPENSATION DECLARATION BACK PLOW PNOFIiCT.DEVICE? / 1 botchy all lonaunder penalty of perjuryane oelffumn,for feeWarkee.arin,Co Inkm k anJ will mninwioa Cmlh'me of CnnummselGinsum for Workers Comport- DRAINS-Il(WR,ROOI',ARfiA,COND. STORIES TYPE GGN$T'RGGfIDN 11 us which thi permit is issued, 3]101 of the Lmnr CnJe,for the peHnrmanee of the ark for Wnich Ihi.v permit is Issued. PIXTUBES-I'ER'1'RAP 1 have and will nwinmin Workers Compensation Insurance,as required by Section ofhc Labor Cede.for the performance of the will,for which this permit is issued GAS-EA.SYSTEM-]INC.4 OUTLF];S OCCGBO P APN MyW..kei�r.,'��Co�n���pens lion lmury aanior avd l'nllfy number n Cartier: s�f{s/e Policy Nn:' wigklIGAS -IiA.5Y5'fl?M-OVER 4IEA) CERTIFICATE OFEXEMPfION FROM WON n S GREASE%INDUSTRI.WASTE INfERCEI'lY)R COMPERSA'1'10N INSURANCEBU 1 iDIVISION FEES Ohio section octal ned berounlased if the permit is throne hundred delta,,Sl 0) GREASETRAP or less.) PLANCHEC I certify that in the performance of the Ism kfor which this pemnit is issued,l shall SF.WER-SANITARY-STORM EA.FN)F.. not employ any person i a any manner sit as h become,ubject to the Wurker'Compen- FyIERGY ?E O z salon Laws of California,Date WATER 11HAFER W/VENTT-.LFCFR GRAI i Eli[ Applicata tiNOTICE TO APPLICAN'P:11',aIle,making Ibis Ce lilicam of Exmndion,yea.faulA WATER SYS'D3M/FREA'1'ING 17- befome subject m the Workers Compensation provisions of the Lor Cade,yam muni SOILS FEE Wfonhwimidand,with,ach pro.kitallor his Fard,slall hedcemcd revoked. WAIT FR SERVICE z CONSTRUCTrd i...ION LENDING fr AGENCY NEW RESIDENT IAL 1'LMIi. SQ.FT. PAID U 0 Ihercby aflirm lhunhem isaconntmetian lendin6 agency limb,perlormmce of Dam Racipta the work far which his penult is issued(S,,,.3097,Civ.C.) (~ lenders Name TOTAL: O {U Lenders Address TOTAL: C 1 caddy that 1 have read this application and state that the move inhabitation is BUILD G FEE ► y cobrcul ngrecmcomEly wish all city and county oNinmmen anJ ntx¢laws reDling In QTY. MECHANICAL PERMIT FEE V � building eonstmdien.and lmrchy sulfuric,representatives of this cirymeml,r upon me RISM PGE above-metric ned property f or lropi...........as I PERMIT ISSUANCE (We)agree m save,indemnify eo koep harmless the City of Cupenino inian dt ELECT IC FEE habilitie,.judgmemn,costs and expenses which may in any way social,against said City AM ITR OR ADD TO MSCI I. in consequence of the granting of his permit. PLUMB GITE APPLICANT UNDERSTANDS AND WILL COMPLY WI'ItI ALL NON-POINT AIR HANDLING UNIT LTO 10pW CFM) MGCf1A (CAI.PF.E SOURCE I1EGUhA"FI 6 , Alt HANDLING UNIT(OVER 10,000 CFM) CONSTRI 1'IONTAX Sigmare dA paean ontracn �� Dare EXHAUST HOOD OVIDUCT) HOUSING ITIGATIONFEF, IIA—RDOUS MATERIALS DIS .OSURF. Will he applicant or home bu ddingoa,md, ivnrhandle haaardou,mmedal BEATING UNIT(10100,0X0 BI U) us defined by the Cupertino Municipal Call,.Chap¢,9.12,add the Thai and Safety Cale.Section 25532nd)] HEAPING UNIT[OVER IIXl,ngl❑Tell ❑Yes ) Nn PAID /� VENTILATION FAN(SINGLEN1SN) That, Recciplp 09 ( Will fine applicant or future building occupant use equipment or devices which I boa d...if,cnnmminam,sex defined by the flay Arca Air Quality Management BOILER-COMP(3HP OR 1(10,10X)BTU) OT ,cont sl° BOILER-COM P(OVER 100,0(10 B'FI/) ❑Yl,, "`J�,\��, (have read he lwaranuv'(I it,nalsrequirements under Chapmr 695 of the Cali- AIR CONDITIONER ISSUAN TE forma :el lth&Safely Code,Sections 25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL MI CH. building rices not omrcn0y have a tenm0.Ihm it k my ru,arisibility Io notify he svcupant of the requirements which must M mot prior to issuance of a Cenifiuro n((kcupamY. Owner or atnhnnewl agent Darn TOTAL: ISSUED BY: OFFICE Fa $_ Jp iIl � I- ,_rl r .. t I- I B 4- '- ���f�: I 7 f l trbK; ( iii" H � 4 �- . _I- _._ I' . _ ✓ S4.. STALL I I WGV I f so °'I ' T 1 kk J I I I t_ til-' ),I � ! ��, ' ! I � { „I _ II _ ► f � I II I I � = I I 1 _,.1- 4 f ... � � i ff I I � I 1 1 ! prl �i-4� J FJ 44 11 I _ I ' , II � Iril I II !- I_L..,. I I- � .I.i-'-I- • f-. �1 j � i .-_.,, � ��a� r'OPMy' Wf''n . c�►a�r�o ca9So1�- 4AH-Hil H' I I �. _. L.. 4 1 �. I I 1 . C I I kii —1 I t is V. I I io3i 14- - I ; .�. . .�. ` .. .. ,. L.L. i 7. 1. j-. � I lib— LL; _...i.l _ ... I 4 ' ' -. � �� '{' _.1 I I•.L. I I I � �,��. �._ II � I ' I � r - I I _ I I , I ISI ' i I 1 lit--- I � R�OpM LIII _ IIi �i . , i _k.l F I _, J L I..:I 1. 1 � �O II ' I L { li I � ' L4 l I J.4-1 1. r1 + I G k i i a l .. . �_• i �.( I I. � � ...._i I�.I ._i I i f * �I-i�-� f " '- -_.� 1 � _= j � aT, �--__� I�� • , I I , , I I Y.Y � lo� 'I j r I I7t- -4 1 N4 .. y 7-1 I_. 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