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S 2862 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY - CITY OF CUPERTINO BUILD]Nil-ELEC'rRICAI, VERAUT NO. BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL BUILDING PROJECT IDENTIFICATION C/ ! 8_6 ( BUILDING ADDRESS SANI FARM No. APPIACAI'IUN SURMI[TAI.DATE 1o79--1-ppA1dA-,-b1-CX> Or. C/-8- 4Y � Q;. S PHONE'S? c4(rv�w Plb� L2g9_US N/C C'0N'IXOha AN1611TECT/ENGINEER LIC NO ADD 55 9 I G0a97 S- Yb g62-1 014 t CONTACT I1oNi I ❑ BUILDING PERMIT INFO �(yW� c--C-/3—C&18 - Y PP (Initial) I PLUG ELECT PLUMB AIEl IYT/f� O_/—J ❑ Consultant Fees Paid b Applicant(I 1J LICENSED CON COACT OR;S DECLARATION QTY CLECFRICPERMIT PEE I I hemhy allirm ilia,I nos licensed andr,..wn,.....to Clia,te.m mm�mencmg I _ JOB DESCRIPTION OC20 with Section 70A)ofCooa-3uftbe Bm,mevswhJ Prnte,amn,Cade,andmy hcemes 1`ERAIII'ISSUANCE RESIDENTIAL; it tall hoomandetleel ❑SP[IWIL C KITCHEN REMOD17L C V F I.acme Class Lm a Q V APPLIANCES-RIiSIDIdc IAL ❑ADDITION $iY1:AIBING RI PIPE X60. Dete— .- - Cnmmcp^ AIITE(.TS DECLARATION ❑MULTI-UNIT ❑STRUCTURAL RCI F D'/ PANELS z0yz-, Iunderstand my plans shall 6c used as public record, MODIFICATION 02.-0 uP'L'O 2(NIAMPS [1 INTERIOR C3 CHIMNEY REPAIR 1---ad Licensed Professional 201-1(N)AMPS IMPROVEMENT SWIMMING POOLS OWNER-BUILDER DECLARATION C Sadj OVER UnOAMPS ❑BA'1'll Rlih10DE1lREl'AIR ❑DIfAIOLHHON 3 Q' 1 hereby affirm that 1 1 s eeanpl from the Contractors .Any t... for the d FV-* hollowing inch rcnon orrat n 91U1 S,IL.anen ,nil sr,deem Gal,.Any city or caunlY SIGNS EI-EC IRIC.AL ❑OI HER '{l 41 LL yy wb¢'M1 ,,I...u permit a cnnarun,,da,a.mpmre,JemaL,h,sire a...r eny amemrc ✓rJC,�, F��`�6 pnorto nrt nwance,alarteywn,.he..ppheam lit.web pit nuu„IilcuvmgnvJ a:nenn'mt SPECIAL CIIICUI IYAIISC p." that he w licensed pursuant m the pmvwomof the Conlranur's l.mense Law(Chaper9 W--pOmien wait 7dif of Onv.eum 3ol the Incomes,and Prnlmvmm Gniclor / COMMERCIAL; Ica .xemp J TIIDIP Mf?Tlilt Olt lYll.li lNST d e C that lie 17031 5 b therefront apple:rat the co forubj alleged exemption.Any vialahmn of El NEW BhDGIADUITION ❑DFA10L1 EVJ LL^,y Sem.un]031 5 6y any applicant for a lernn,suhJCn,the applicant In a cnJ penalty of POWER DEVICES FZY m mmc than rive hundamdall.unt$50I11 I ❑TI?NAN'I' ❑FOOD SIiItVICIi 6 1,as ox net ofthe prmPeny,or my employees with wage+a,their nle oon"I'uon, SWIMMING 1'001.ELECTRIC IMPROVEMENT =O wJl Jolhu Burk,.mJa.uwucwmisnormmndeJorottnm,I forsale(See 7044,Ensues, /) ` � ❑OTHER 3 m and Pnde,eon,Cole:The Contractor',License law does not apply to an owner of OU'1'LIiTS-SN'I ICfi1S-1'IX'[URB.S ,,pony why bmli m imp roves th,00niand who due,such wool,hon,eit or through v`ls llli his awn employees,pnwWcd Dal such improvement,am not.mended nr offs d for NF.N'RESIDENT IAL ELECfIi SQ Irl' sale If,hnwocr.the hn.IJnng nnmprnvemcnl h,nnlJ wnb.n one year nl nunplmuhto,the Q.FT.R OUR AREA $/SQ ET ow crhuJde,x.11 haw the burden of pmnng,lost he did not build,,, mpm,e for par- ry.o of sale l I,a+owner of the propeny,am iodic+rvely cu uniOna,with licensed ca aracton te '10'rA L. stn racl the pra)ect(Sec WILL Bmim,,and I'rnf,,mm Cede)l he Cummclurs Ij- , e law does.mt."l,loan owner of moperly who held,or improve,thereon,.md [QTY I'ILUNIB[NG PF.RMI'1' ,FEE. mho contrac„for such props¢with a cummcurlq licensed punuenuathe Contractors Lmemc Law I 111710,111 ISSUANCE SQ ❑lam exempt under See. ,BgI'C for lhn reason C Der IAL ER-DRAINNVENI-WAIIlidiA, VALUA'I ION (1 WORKER'S COMPENSATION DEC'I.ARA'I ION (BACK FLO\YPRITTECI DEVICE 1 hereby.dfirm under penalty ,.d perjury one al the following declaration, I]Ihave and will maintain a Certificate of Con+enuo self-insure,for Wodcr',Compen- I DItA1N5-IgA011,RUOI",AREAL C'OND STORIES I"L CONSIRUCI'ION ,anon,a,pmmdcd for by Reeuun l]W of the Isobar Cade,fm the perh,nnanw of the odlorwh.ehthnpcmntnn,ueJ FIXTURES-PF.R'IRAI' ❑ I home and will nnamo.m Wod,cr',Cnnmcmahun Imun.n.e,a+mlmred by Section 1 3]00 of the MrC.,dc.for the of ace of them ork tor which this Permit is issued - :A SYS IM INC Y(�U�LE'I5 ` Of C GIt011I' ► ,\Ty My Wnr tmh ,au a.. mcfi . and Pul...y r> Carrier M Poly No Y7, �/ ?A S lihf F.R 411?T 1� t�/ CERIIPI:ATH OF HXA11'1']ON PROM WORKERS' QIi= 1��f4 COMPENSATION INSURANCE G VINII 11. It" FJ'1 ly (This axnam nred nol McompletcJ d We perms,a turone hundred dnlWn S lo)(1) BUILDING DIVISION FEES G Sra A or le„1 PLANCHECK FEE I ecufythat in the perfmmence ofthe work forwhch this permit is l,wed,l,he11 Ste H-SANITABY STORM EA 200 IT not eoo,do, ay personm.icymannermm m hecmne,whlecun the\Vnd.cr:Cnmprn- ENERGY FEE ,� vuon Lax..(California Date ---+f-� T° z0 Appl.cum h W'A 'g1r:_C "' r+++�M GRADING IT-E NOTICE 10 APPLICANT:if,after making Ihn Certificate of Exemption,yon should WATER SYSTENUTRHATING SOILS FEE a > Manna mhav In the Worker',Cunq,emu..on provisions tit lhr LaM,r Cock,you must W .... forthwith comply xmh such provisions.,,his p mm, hall be deemed revoked / [WATER SERVICE D•U© Z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLA R SQ fT PAID Dam ��Rctt.pt p V 0 [hereby a[fimuhal Nerclsa mnamction lendmgugcncy f..mo,ce,fom,ammol the wank Is x lu.h.h.,,sine.+w,ucJ[Sec 3097.Co, C 1 ' P. 1-` Lender's Name '1 OlAI. QU [Lend,,',Ad.�^ I TOTAL / }L� 1 corly d nt I have read this m,liceum and ,am that he abase udonnaunn hs [i UILDINIS PCI?f 0faq comet l.,me uumnp1,xnhold city and u,unry ord,ndmc+.Inof+.ate mwnmlating to QTY. MECIIANICALPERMIT FEE Uz huJ,hngwnamction.sink hereby.uthumeri�rcumati,ewfth.scitymenrarupan,lhc l ' � ISIiISMICFEE above canonical property for inspection purposes P R MI I ISSUANCES BLhC / (Wc7 agme m wvc,mdcmmfy sink Aecp hermle+.Ibe Coy of Cupenmo egnina '['MIC IFIi APPLICANT RLCUf then cdNU$ NUWII 1M1IPLY WITH ALL NON-POINT AMER ORADU'IOMECII �P1.DM1IBINGF1iIi Iiab,htic+,Judgio ems.costs and expense which may in anyway aurue against said City .n wnneyt ones of the granting of lhn pennhl. JJJ���f) AIR I IANDLING UNH'TO HI,INNICFMI MECIIANIGA1.TEE SOItRCi y/ l`—/A _ �-G qy NRfIANDLING UNI'I'IIyVF.R 10,1X111 C1'Ai) CONSTRUCTION'I'A% S,gmtum of a V .ntmGnr Doc EXHAUST HOOD(W/DUCT) HOUSING hill[CATION FEE !/, H IZI)OUS MAI ERIALS tISCLOSURII Will the applicann r future building occupant store or handle hazardous matenal Ifl?ATI NG UNII ITO 1N1000 BTU) as defined by the Cu so mna Municipal Gale,Chapter a 12,and the HcdW and S.JCty Code,Sccucn 255321.03 HEATING Oil OVER Ida,do1 B'I UI ]Ye, VIiNTILAI'ION PAN ISINGLE RF°SID) II'A[1r D,w Recapla Wilt the applicant of future building occupant use equipment or dm.m+xi It on.l harunhm,n.r,nn.n.n.nunl,a,dcfincd by the nay Amen An Qmoayhlan.gemcn. BOILER-COMPLIBPOR 100,00 BTU) / Unv,etEJ)" Rhish—. MOILER-COME(OVER 100.00B1'U) fIT6K NR CONDITIONER I have aadthe haznalmm 112555,1513 sunder 1famrbound the CuL- ['�,rISSUA ED1`6 Inm.x IICnIN ffi S.tlety Grade,Secuo 25505,255J1 and 25533 1 nndcnlanJ that.f the NEW RISIDHN'I JAI.ME.CH SQ.IT — / i Y bmldmgdrevna,cm y 1.hats is my mvry,mhbili,y Iona yOS oechghnm III ,h �.hne'p�r�h,aa.:m,e of Fy,_f���ancy Owny, auth mm'agem // 55�� Dae TOTAL: ISSUED BY OFFICE