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99080105 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY G D I 10I BUILDING-ELECTRICAL i CITY DI GDIVISION PLUMBING-MECHANICAL BUILDING DIVISION APPLICATION/1'I;RMIT I -t IIUILDINCPROJRCr BENTIFICATION,' :PlG' ^,'II BUILDING ADDRESS.y' I - C.4J�l3TI F('O J SANITARY NO. APPLCATIO SUBM 17ALL DATE iC530 � tN.gt-Jo�2.TH ��T�E", cAgSols� CI "� 3" �/ PIPS NAME. PHONE.: CONTRACTOR'S NAME, LIC NO eNkA7 MAU'IGKAVl�j 'pA RI E{eR77$$:ZISI t�-1 LiV�Qil) j N/C CONTROL« ARCHITECT/ENGINEER: LIC NO. ADDRESS ❑ CONTACT PHONE, li't'i) %.fIRUILDING PERMIT INFOj ❑ Consultant Fees Paid by Applicant(Initial) I BLDG IILECL PLC)MB MCCE fl� ❑ ❑ ❑ LICENSED CONT RACTOR'S DECLARATION Q'pY;lj� j;r', rj.ELGCTRICPERMIT V' i,'t'It rt ilFEE+IryI I hereby mEn n rant l am tmmsul u➢acr,nwmoa+of(Toner 9(cominencAg r r � t ..anr.. .�1 : f �/;.tl� JOB DESCRIPTION FHZ with Section 7(00)nf Drvaaon 3ofihe Bummeasand Professions Cale,andra luedwe's RESIDENTIAL O{�O mftall forte nnJ effect y PERMIT ISSUANCE I R �jp,P ofuld recoa Inch ❑MaDWL C KITCHEN REMODEL road Dale Came,., APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE F=,� ARCHITFCTS DECLARATION PANELS' ❑MULTI-UNIT ❑STRUC'IVkAL z0"IZ l understand my plans shall be used m public records I MODIFICATION OZ4 q UP TO 200 MODIFICATION ❑CHIMNEY REPAIR Uecnscd PrnlcsstnnaI 201-1000AMPS IMPROVEMENT 0SWIMMINGPOOIS .,4 OWNER-BUILDER DECLARATION OVER IIXp AMPS El BATH RIiMODE1JREPAIR 1:1 DEMOLITION a Q I hereby offimt that I am exempt from the Contractors Lrema,Law for the ac50 O 0.U followutg trust (Section 7031 5,Emmet,and P,fesslom Cole.Any sty a cnun(y ( SIGNS ELECTRICAL I ❑OTHER ��/ryl 0++LL O H whwh re.mrt,a person m Co....dare improve.demolish.or of my muc ure � pp N� go tons Barre.alao«yurzes the applicant for such permit to file a signed damamm SPECIAL CIRCUIT/MISC .S At�a Y than he as bccnscd pursuan ni me pnWaaom nl Oe COmmemr+LOwnse,,m Cha,ter9 COMMERCIAL 0 L_ a is C.0 Wtfi Bcarman(add h Dividers.th theBmmess and Rnievons acac)or I TEMP MATER ON POLE INST. ` 6 0 a, Shat he 7 31.5 tht thcrdmm and the hasty for the C,, he eecmpuml Any I damn of ❑NEW BLDG/ADDIT10N ❑DEMOLITION _I+• Section]831 s err any appicam man permit wgecl,me appresano a crvd penalty or POWER DEVICI!S j, nos sin cded,five humiroddollms(5500). I ❑TENANT ❑FOOD SERVICE. F 7a 4 IMPROVEMENT pTd� wiLa+be odk,rodd hearay,or,myct mende+wnhwagmothe(Se 7044,rnwdon, SWIMMING POOL BLEGI RIC a dy,FO will JO Ne work,and the svuaure is not mtmNed on,Heretl hostile(Sec]IiW,Business e ^ DOTTER W�3 m and Prodo kit v.Cafe.The Contractors License Law does not apply to an owner of I OUTI.F.TS-SWITC HIES-FIXTURE S_ I property who h okk onmprrn e+lhe«on,and who does such work himself or through has own employees,pro odN Iha(such tmpmvcmcm+and no,amended minimal far I NEW RESIDENTIAL EIA!CfR 7S � _ ,aid If.hmvever.she boldingonm,am,arennswld wnbmnne year of cma"Cron,the � / '.pIdH1RZ�N "'^- $ISQ PT bile,rwdl have the burden of proving that he did no thuI impose for pm- TOTN: (Contratthe of thepee 70y,.Ramiro,and P Sessions Cale)licensednniccmr+mI t I I'AUG c nswaw doesyen(Sec]1anownerofpr p rty wa(lomds orIm ro convenor's nd , r" ' t• ' IT vt r 1 1 CCnSe I.➢W Jnei nOl➢ to an nWnar f n i 'npr rt grope rwhn noddy or amprovu me«ov,and IQTY:7' � PLUMBING,PERMIT I��i d tt ' 9I ' '3� n . t� .. .+t b kltr4" t�+lilisi License Law. I PERMIT ISSUANCE I B&1'C for this reason V C V �� Oate ALTER-GRAIN&VEN'P-W'AI ER(RA) ��yAi, 'TION wr WORT( '. COMI'ENSA IIECLARA'1'ION BACK FLOW PRUI'EC..DEVICE there a1Gnno rpenaltyofperjury ereof the following declared,as - - - - - - - - - 3 Q Iheve an flaunt nCemficme of Coa cis mself-lnatre for N'ork,r>Compem I DRAINS-FLOOR,ROOF AREA,COND. STORIES 'I'VPE CONSTRIICT'ION saunn,its Provided for by Sea a 3700 of sac Lahor Code,ter the performance of the weak fonvbch this permit ieaesued I FIXTURES-PER TRAP ❑1 have and will maintain workers Compensation Insurance,as rcyneed by Scen 3900ot t he Lahor Coda,for pefornarecof t he work lnr which this pernalfG,ocd GAS-EA SYS'11!M-1 INC,4 OUTLETS OCC.GROUP AFN / MyWO der+Compensation Iromeed tamer and Polk,numh<rare Ced, forty N- I GAS-EA SYSTEM OVER 4(EA) Z CER rificArE OF FXEMPGON FROM WORKERS' I ( © 1 Q COMPENSATION INSURANCE GREASFANDUSTRL WASTE.INTERCEPTOR BUILDING DIVISION FEES, 3 (Thawu'.bon noel era MatmplclW JlM1e pennu is lorono hundreddollao($10th CREASE'BAP err lens) PLANCHECK FEE I I dead,honorific paHonnancmlSbe work I which this,,minas iswed,Ishdl SEWER-SANI"I'ANY-STORM EA 200 IT ad,ewploy mry,eoon m may mamIr+o an m hecomd sohjen tit the Workers'Cnntper- 'NERGY FEE Z sabnn Laxs nl COifnrnm Date WATER HEATER WNENT(ELIiCTR z O APplicm+ „RADING FEE u fw'p NOI ICE TO APPLICANT It,after making his Cenafiewe of Es,r,aa n,you should WATER SYSTF.MfI'REATING a become subject to the Worker's Compensation pmndons of the Labor Code,you muss SOILS TEE Lfa forthwith comply with suchprovtsma,or this permit shall be Jcemed revoked I WA'1ER SERVICE Q az CONSTRUCTION LENDING AGENCY I NEN'RF.SIDENTIAL PLMB SQ FT IPAID U Q thereby affimvhet There isanmamcuon lending ogency for the perlonnanu nl 1 Doe c IM Fthe work tot which this Perini(is issued(Sec.309],Cc.C) C) U Lender's Name I I MAL LcndePa nam'aa+ 'rornL' / y1,m maI I have read tors a, ire aen and aa(e dam me abate mfnrmafmn is ,. •,A,I Duanlrvc.EFT: rn corzem iagrta mcemply with all car and mm�ry ordmanew and state laws relating to QTY MP,CIIAN[CAL PERkIIT I' d .y1;1FEliO � U� budding Caron ucuen,and hea'chy euthnnze represemm�ves of this city to enter upon abc + + '{ s u I SEISMIC FEE above-meahoned pm,ady for inspection puH+rses PERMIT ISSUANCE, / (We)agree to save,indemnify and keep hunnless the City al Cupertino ugautn( I ELECTRIC PFF IiabJlGcs,judgmenu,Costs and cxpen+e+wh¢h may in any way seem,againe+md City I ALTER OR ADD'IT)MECH. PLUMBING FEE m mnseyuence of me granting of this permit r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT I SOURCE REGULATIO NS AIR IfANOLINO UNIT(lO lB.IXO CFM) MECHANICAL Fill AIR HANDLING UNIT(OVER If0kMCFM) ICONSd'RUG9IGN TAX Signam fAppbc nuncmr ^ Doc I (EXHAUST HOOD(W/DUCT) �lIDG$ING MITIGATION FP,P. 1 ZA 11, T RIALS DISCLOSURE It Thu op inmorfuhwcbuildi occupant or handle hueealm,raferlul I HEATING UNIT(To 100,(x0 BTU) as defined by She ,mine Munatpal Code.Chapter 912,and the Health and Safey e,Scotian 25532(,1)'! HEATING UNIT(OVER 10F000 GO)❑Yc+ ❑NO IPAID I I VENTILATION PAN(SINGLE RESIDj -- Doc Reaapt Will ih,upphcuor or mtiue hmldmg occu,ant sac eympntem m devawn wmrla , ,ran hnmrJom ter contammsim as defined by the Ray Area AV Quality Managemem BOILER-COMP(311P OR If0,000 BTU) I 'T Did, i ❑Ye+ (]No BOILER-COMP(OVER IW.Ogl BTU) AIR CONDITIONER 1 h➢tie iuW m,h,awdnus t�SCnuls reyuaremenu under Ch➢pSCr e 95 of the Calry I ISSUANCE DA' C lama Health&Safely Core,Sections 25505,25533 and 25534 1 undersmnd d aS it the NEW RESIDENTIAL.MECH SQ FT hit Id des imcutrtndy hp,e a imam,flmn is my M, ,bititY mlwdS the uccupam �r] �� ��yn�5 of the ruyuar in w 'h as he me "I mo,ur,cot Cedaficom nl Oemap.mcy I -.7 L,t Ovade 4d, ofd its l Date I 7 AL: ISSUED BY 1• J OFFICE - i y i Ip I