S 2493 APPLICANT-TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
FBI
Y OF CUPRRTINO BUILDING-ELECTRICAL PERIvUfNO. "
n.nlNc uIVIs1oN APPLICA'PION/PF,RMIT rLuaBINGatEcunNIGAI. - n /Ip�jIIIBLDING PRe1EC1'IDENTIFICA1'!ON LYJJDING AD�I(0� r\W V_ —T 5� SANI'IAHY NO, AI'I'hI^ATION SI111MI L DATE
S Z'ISS N ME: . 4293 ONTRAC TlR':NJy\f E: �)`�L CJNq . NIC CONTROL p
'HITF.Cr/ENGINEER: LICNO. 1 ESS: P/��lA� GR. s�� ❑
C NTACC: ,A LT1 PHONE: BUILDING PERMIT INFO
,-V`5I 'S_ ❑ Consdahanl Fees Paid by Applicant(Initial) BIAG HLECI PLUMII MECII
LICENSED CONTRACTOR'S DECLARATIONQTY ELECFRICPERMIT FEE
I hereby al&m that 1 am licensed under provisions of Chapter 9(commencing _ JOB DESCRIPTION
OaZ with Secdon7000OMGRCHTTECT"'��'S
llal,ess anuprofess', ode.a3lmy licensee i. RESIDENTIAL:
won PERMIT ISSUANCE.
F W= in full ionic ons ❑SI'DWI. ❑KITCIIIiN REM110DEL
<_U ceAPPLIANCES-RESIDENT IAI, ❑ADOPTION ❑PLUMBING RIi-PIPE
dDontratoDIC. CATION ❑MUI:I'I-UNIT ❑STRUCTURAL
PANELS
',6Z I understand my plain shall lu used asl tb cru'nrds MODIFICATION
DPT0200AMPS
OZ�Q ❑IN)PRIOR ❑CHIMNEY REPAIR
4! Licensed Planet, usl - 201-I000AMPS I IMPROVEMENT E]SWIMMING POOLS
OWNER-BUILDER DF.CLARAI'[ON
J OVER 1000AMPS ❑BATH REMODFUREPAIR El DEMOLITION
IL` d I hereby ulBnu That I an encingt foto the Connoctnr'x I,cense Law for the
afollowing re:ann.IBeainn 9031.5,Broinexs and Professions Calc:Any city or county SIGNS lil.l!CTRICAL DOPIER
06 which I'ci,t...cx a gn'mil to conso o.alley improve demolish,or repair any xincline
aimmitviscuunce,alcn rcquircs Ne xpgllcant hmrmh penton Bleusignedouncom l SPECIALCIRCUIT/MISC.
f�} motheislicenwd puouannmlhe prevision.wfthe Cummcmrs License Law(Chaplxr9
W0 (rnmmming with Section 7")of Division 3 ofthe Business and l'Infessions Code)or TEMP.M2rIAORPOLBIN.ST. I L'
E:a 12 C that he is everqu therefrom and the basin for the alleged estmgliam.Any violation of N' 'BLDG/ADDITION ❑DEMOUR ION
X,LL• Section 7031.5 by any applicant for it p,arria subjects the applicant to a civil penalty of POWER DEVICES
W^m nm more lhnn live hundred dollam(5500). 'ANT ❑FOODSERVICE
IMPROVEMENT
6 ou Lasnwucr schandreddolanptoy,or S50pinyceswhb w:lgcs unthcirsole cumpensnliun, SWIMMING POOL ELEC'I'ItIC
C will Jonmwnrk,Code: heCom ianols Licamn Lawddl no,nl5co.7anu're,of O'ITIlil2
m and Rofessions CmmJc The Commcan'x I.iaense law Docs not apply m an owner of OUTLI!'I;S-SWITCHES-PI%'1'URIS
4' CA-
progeny who builds or improves thereon,and who does such work himself or Nrough
his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECT R SQ FT.
sale.If,however,the building or improvement is sold within one year of completion,the SQ.FL FLOOR AREAUSQ.FT.
mer loilder will have the burden of Proving that he did net build nr improve for gur-
❑ h as ow um H Ibe prnpcny,all,oxtlu,ocly eontmding wish licensed commons,m TOTAL:
construct the project(Sec.7044,Btuinexs and Professions Cod—How Con..111-'s Id-
se Law does on apply to an owner of propuny who builds or improves therm,out Q'I'Y. PLUMBING PERMIT PEE
who contrams for such projects with a conlmclods)licensed pursuant m the Conwmors
License law. PERMIT ISSUANCE
❑l am esenmpl under Sec. ,B&P C for thisrcrosnn
Goner Dan, ALTI!R-DRAW&VENT-WATER(EA) 'Al CATION
WORKERS COMPI!NtiACI(IN DECLAIIA'I'IGN BACKTH OW PROTECT'.DEVICE 7_I 'vQ I�✓
I hereby o1Brn under penally of perimy one of the tullnwing declarations; f�
I have and will maintain a Carihcatc of Comer,to self-insure iia Worker's Compumn DRAINS-FLOOR.ROOT,,ARRA,GOND. STORIES TYPE CONSTRUCTION
tylion,as provided for by Section 371X1 of the Labor Cale,bathe pclo romwe of ams
for x hich this permii is issued. FIXTURES-PER TRAP
1 have and will maintain Worker's Cooperation Insurance,as required by Sectio
Iii he LabrrCafo,fon he pcifuntawcut the work for whichthis pemmir is mucd. GAS-i!A.SYSTEM-I INC.4 OUTLET FICC.GROUP AI�Y
My Wnrk�ff7Btg i nr: arricnmd,No.:l ^ GAS-EA.SYS'IUM.OVEIt4(I!A
Carrier. 171 I'nliey No.:
CER'I'IFICA'IE Op EXFNIII'ION FROM WORKERS'
COMPENSATION INSURANCE GRGSPIINUUSTRI.WA'T. CI3
BUIIAING DIVISION IT:ILS
(This section need not be compined if the pemmit ix(onmc hundred dollars($IIMII
or less.) GREASH'fRAP NCI11!CK FEE
I certify that in the performance of the work for which this pennil is issued,IQedl SEWER-SANITAR'-S'1'1 iA.2B0Fr
nm emglny any person in any mammer na us Io Mcome subloct Ins the Wnrkeri icnil
Compen- A
HGY FEE
OZ smion law.cuf California.Dam WATER III!AII'. /VHN'1' i :C'I'I<,
y Q Apd,caut DING FILE
q ti NOTICH'10 APPLICANT:If,after looking this Camficale ml Exemption,you shoo Id WATER SY PM/IREAt'IN'I
1•' lecone subject to the Worker's Carp oration provisions of the La1xv Code.you most S I S R!E
Wform with comply with such pmvtsionsor this period shall IN deemed revoked. WAIT .HRVICE sl
aQ \
CONSTRUCTION LBNDINding a' CY NF HESIUIiNTIAI.PCMB. SQ.IT. PAID
_Uti Ihereby whichrmthat
parnatthere lsaud(So,.30 lending ogeneyror theperhmnamenf Da ceciplN
the work for which This permit is ixsoul(Sea 3097,Co.CJ
{f" F LcudeA Nnnic TOTAL'.
V Tender's AAJress TOl'A L:
1 certify that I have mad this application and state that the above information is - NUILDING SEE
rF h ,area.I agream...only with all city add eounty crrdinanens and smm laws relating. QTY. MECHANICAL PERMIT FEE
V Z building conswctlon,and hereby authorize mpresentatives of this city m enter upon the SIBSMI
above-memionul property for inspection purposes. PERMIT ISSUANCE /�
(We)agree m save,indemnify and keep harmless the City of Ca Krtinn against ELECTRIC QBE 'l/
I'mhillnts,johgnwnts.costs and wa,uo,s which may In any way a..rock rtim,o'l Cily ALTER OR ADD TO MSCI I.
in omostar sof l he gmnling oflbiapormh. I'LUMUI `FBE
APPLICANT'UNDERSTA' ND SILL COMPLY WITH ALL NUN-POINT' AIR HANDLING UNIT(To 10,0011 CFM)
SOVI 'I'I MECI IANI LFEF.
AIR HANDLING UNIT(OVER IB,INI)CF CONS'1'RUCIONTAX
Si re of ANficonVCammcror ate EXHAUST 11000(W/DUCT) HOUSING MI'1'IGA'I'ION ITE
HAZARDOUS MAI'HRIALS DISCLOSURl.
Willlin,npplicanl nr future hu i I'l ngoccupam mm or hunJle hozmdnuslnalcl'I:II HEATING UNIT(TO 100,000 If/,,
)
It by the Cupcoin Morailul Cn Jr.Chapor 9.12,anithe Health; (Sabot
Code,Section 255320)7 HEATING UNII'(OVER I Z-)
Ycs �No_ PAID
Vt�l'11.A'I'ION FAN GLE RI!SID) Dote Receipt Of
Will the ogplicant or turn.building nmupant use equip rnan or devices which BOILEk-COM iHP OR 1011,(Nkl B'N)
nil hazardous air conmminnn1.`as 1ktineJ by the Bay Arca Air Qnallry Management TOD
X.
liinictl /•yuJ^/ BOILER_ ' MP(OVER It111,gNl li'TU)
❑Yes
I have read the hazardous materialsre mend under Ch w,695 of the Culi- AIRC UI'I'IONER ISSUANCE DATE
folia Health&Surely Cale,Secdotu 25 .33 oud 2504.I understand that if the N RF!lIDENT[Al.MECH. SQ.FT. (J
but Jor,hotcu it haves smYreNato, iliyml Ilfymh cecup:mt —2— L�
nr tear. t ear It eenuia, arae.
Ow -n amhoriacd agent )ate TOTAL: ISSUED BY: �-
OFFICE