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S 2223 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL 7NIC PEIjp11T NO.BUILDING DIVISION APPLICATIONPERMIT PLUMBING-MECHANICAL 2223SBUILDING PROJECT IDRN'TIFICATION APPLICAI ION SUBMI TIALDATERUHAANG ADDRESS: 7''L�OWNERS NAME: PHONE,: - CONTRACTORS NAME: LIC NO: CON1ILOL# LICNO: AIIIII/ 7 C]D(N.Tj'nnCT�f a(� PHONE: 'BUILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant(Initial) RIA)G ELECT PLUMB MECH Y lj� LICENSED CO 'TRACTOR'S DECLARATION QTY ELECTRIC PERMIT, FEE JOB DESCRIPTION I botchy nllirm hour I an licensed made,,.....inns ofChapsr 9 ho mmeneing t Opp Zp with See,ion]0W)of Division 9.f the Business and Profcssinrvr Qndq and mylicense is PERMIT ISSUANCE RESIDENTIAL: Ft full force and effect. ryry❑�SF�DWL ❑KITCHEN REMODEL r 6VU License Clary Lis.# APPLIANCES—RESIDENTIAL TION ❑PIAMBING RB-PIPE FZW Date Contractor v,¢y ❑MULTI-UNIT ❑STRUCTURAL ARCH]I IiCT'S DECLARATION F�Z I maderxtand my plans shall he used as public records PANELS MODIFICATION UP TO ZN)AMPS oy�Q ❑IN'I'IikIOR ❑CHIMNEY REPAIR F .F.IrI Lieemed Professional 201-IOOOAMPS IMPROVEMENT E]SWIMMING POOLS gs�i-I OWNER-RUILDER DECLARATION OVER I0Y0AMPS ❑BATH RI3MODEUREPAIR F1 DEMOLITION a 1 reach,ufrimo that I inn exempt from the CUntmdors License Law fee the 0 d U folluwo,reaevn.(Section 7031.5,Business and professions Code:Any cony elcounty SIGNS ELHC UCAL �HEIi _P: g' wh ha9 Monll t t alta P demolish, P- toy somehow pro t , issuance,also th applicantf suchP II fl signedalement SPECIAL R TIMI d ��y' y Ihaln 1 Ipnrn tt d l) elan rd c o t L 1 (cnanler9 COMMERCIAL, f+1�00 (comps sing with Section 7000)of Division 3 of the Easiness end Professions Code)or fEMP.M?E POLE INS Fy e 'but he is exempt therefrom and the basis for the alleged exomption.Any violation of - ❑NEW BLDG/ADDITION ❑DEMOLITION iCm Section 7031,5 by anyapplicttnt for a formal ,object,the appheanUuaci.11 penalty of POWER DEVICES [I TEXAN'T ❑FOOD SERVICE 41yF m,mmv than rive lemdreddolo...N50T. $^50 E]1,as owner dDh,peopery,or my employees with wages us lhoirsoleem , npensmlon, SWIMMINGI E IF IMPROVEMENT will do the work,and the structure is not intended or olfercd for sale(Sec.9044,Basin ` ❑OR OUT E {t]3� and pension,' Code I he C I mfsU ) does hot applyl wsr of OUTLETS—SWITC S IT ITURES property Who boulds no improves discern,ound who doci such k himself th'ongh his employee,,p I d II',soon im,weractill me tlotinternal (loped for NEW RESIDENTIAL CLE"TR SQ 11 sale.if,however.the building or improvement sapid enhnone,error completion.the _ SQ.FT.FLOOR AREA $/SQ.FL eel Id illhve the burden of pn gthatM1 did act build improveforpur ( - pn 1: J. TO feral tct property,,m axes lycontracting,with licensed Imidan J- - t can does t(Sec to owner art f eb I itTh C tcanssL ae Law does tot apply t.an owner er,..pony con n 7 41 (I p thereon,and QTY - PLUMBING PERMIT - PEP.- who conmtcts Por arch pmjecb with n contrmme(s)I IeenseA fursuam to the Contraands b Liccnsc Law. PERMIT ISSUA Q I ant nsemp,larder Sec. .B k P C far his reason _ t '�_ �� D AulER— de 3N' — ATER(�A) VALUATION I� WORKERS COMPENSATION DECLARATION BACKFLOW O EVI 5 (goo (25,44 1 hereby affirm under para ty df Perjury one of the following declarations. ] I have and will maintain a Centimes of Consenu.self-mania for Worker..Compen- DRAINS—FLOOR.ROO COND. STORIS TYPE CONSTRU ION solids,as provided for by Service 3900 of the Il C.de,fm the perf.nnanec al the walk fWhichthis, le,i d. IlX'fURF.S PER TRAP ❑ I h J ill maintain Worker's Cr I :i Insurance, ryired by Section .3700 ffe jLLa�bor Cod I ,thee performance fib kfor h hill I lis'' -d. GAS HA.SYSTEM-I INC.4 001 LETS -OCC.GROUP APN Come, My W., has ce Bell,No 1 CAS EA SYST EM-OVER 4(EA) CCRH FICATE OF EX BM PTION FROM WORKERS' COMPENSATION INSURANCE p/ f7 , OR frhissecti.n needrah be c.mflcte4 Hope it is for one hundredBolpes(SIOO) - .R Clj)VI910N PEES peon RGASt Ll 1�1 nr less) PLAN .. P I comfy Farm thepe,fornance.fthe work for Which(Doormat is issued Isbell rWER—SANI'I'AIIY—STORM EA. 1 not etnployony person in ou,nalnecro,as m M1eeomdmbjedin the W..cars Coupon- UW,F l action laws of California.Dale ATH E W I, TR 7�7 Applicant t t )I ,FEB a NO fICB TO APPLICAN'I:If,at making this Call irisutc.f Exemption,you shmtld WATER SYS]EM/fkBATINC SOI FEE E"t N become subject t.the Workeres Compcnsalum pmvisi.ts of the Labor Code,yon must Wforthwith comply with such provisions or this Permit shall be deemed revoked TER SERVICE n CONSTRUCTION LENDING AGENCY MAI, .. 11N r AL It, SQ.FI'. PAI gcs I hereby affirm Four hem is a construction lsuding agency for the part nmounce of DmcRemifl# the work for wlacb this permit is issued(See 3097,Civ.C) Q U Londe.'.Num, ' _ ® IAh: O Lender's Address TOT aI c,nify that 1 have read Nor u,plicmion and stale atm Inc nbnve impartation is - - BU . G FEE F ti correct.logree m comply with all city and nnmy ordinances and stale laws ranting m QTY. MECHANICAL PERMIT PP.P, n U Z nnudmw g,ma. mtnn,and hereby authorize representatives of rom this color upon the s. IC FEE above-mrnticned property for inspection fnopwos' PERMIT ISSUANCE 3 (Wm sans,e)agree ve,indemnify troheartlessd keep heartless the City of CupeNno against r✓ 0 A RIC FEE ems^ Inhilities,judgnims,costs and expanses which may in any way came against said City ALTER OR ADD'TOMFCU © RING FEE / Q in eotnegnence of the granting of this partial, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNI TO010,oW CEM) CIIANICAL FEF. $DGRG. . I 6 AIR HANDLER!UNIT(OVER 10,0011 CEM) NSTRUCTION TAX Signature of Appluanl/Qmtractnr hale EXHAUST HOOD(W/DUCT) 10 USING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE - Willtheapplicantorfuturennildingoccupantstore(ir handle bamrl.us material HEATING UNI'PGO 10dow)BT U) av"darined by the CuperOno Mmucol ode,Chapter 9.12,and the Health and Surety Code,Section 25532(a)? HEATING UNIT(OVER 1)0,(1011 B'IT) El Yeto VP.NTILATION PAN(SINGLE RESIU) PAID Data Rcccipt# Will the applicant or more building occupant use equipment nrdevice'which ,oil M1azuednuso..comamivants us derined by the Bay Area Air Qualhy Managenmm BOILER—COMP(3HP OR I(IO,IIUO BTU) TO'fA llLstrict l Yes ❑No BOILER—COMP(OVER 100,000 BTU) ❑ I have read(1,1 mous anlcrials r Is underChn Chapter oI too AIR CONDITIONER ISSUANCE DATE cquiretnen p fornia Haan,R Safe, Je, a 115.255331md 25534.1 understand polar the NEW RESIDBN'I'[At,MEED. SQ,FIT �I�A builJing doe,a I I cat a ea itismyrerpnnsihltity m a, of In I ofthe mquircme ew�hn imb n or to in..unna:nfu r�f � en Owooroeamh gent •W Dnle T ISSUED BY: OFFICE