S 2387 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITS'OF CUPFRTINO BUILDING-ELECTRICAL PERMfT NO.
Ruu.DING DIVISION APPLICATION/PF,RMIT I'I-umulNc-.MECHANICAL. (+ X� Q 7
ItUILMING PROJEC'TIDEN'TUACATION J G v I
BUILDING ADI3RE55' SANITARY NO. APPLICAPION SUIIMI'I'1'AL DATE
4fa Se tember Dr, Cupertino CA 950/1/
0-2zAM
OWNER'SNAME.' I'H(INE: C'O '111A(tFOli'.' AME: LIC NO:
NTS AR/TA OP IS24259NIC ///}} CON'I'ROI,N
1? IENC R: I.ICNO: ADD ,'F El
26 Y3
CO^ PP �3-�2 0 ❑NTACT: A � PHONE: IIJILDING PIiRMIT'INFO
/ A{ w Consultant Tides Paid by Applicata(Initial) BLIIG - ELECT-- PLUMB � MEL'11 ,
LICENSED CONTRACTOR'S DECLARA9'ION PY. FLEC"IRIC PERMIT FISH •r-J''J `II-�I/ rL�J/ tL�-Jr/
I hereby sffimt rum 1 am licensed ruder pmcnion.of Chapter 9(ammoenting JOB DESCRIPTION
Z won section2rmHofdrvi......3otlire Business are Professor,Cwle.undmylicenu is RESIDENTIAL:
won 1'IiRMI'I'ISSUANCI3
QW-� Licens iCla and effect. ❑SFDWh KITCIII3N RIiM011lil.
,UU License Class 1.4c.N APPLIANCES-RESIDENTIAL ADDITION PLUMBING REPIPEFzln Dal Cnntrmror yy�
ARCHITECTS DECLARATION MUI:IT-UNIT XSTRUCIURAI,
F-O mPANELS MODIFICATIONZ O E2Z I tmdentand my Plans shall he axed as public records
OZ-O UP TO 200 AMPSINTERIOR ❑CHIMNEY RI?PAIR
F M Linmal Przdcsninnal OWNOVER I n0 AMY5 BATH REN
RCMODP,LIIt HPAIIt DEMOLITION
C6 I?R- 11111LDIiR D1iCLARAI'ION
C y��Q I hereby.W,.that I am nempt from the Commetur's License Law fur the
C C U hdlowing rea.un(Section 90315,Business and Profesxinns Code:Any city or county SIGNS ELECI'RICA). ❑O'fHI3R
W of y which restores a permit to construct,alter,improve,dennnldsh,or repair any xuucmre ,
Ipp" gO{nQ Prierm its i"mmegxlxo require,file applicant for such permit File a signed statement SPECIAL CIRCUITIMISC.
A�y" boat he is lii,owd pursvad to the pnrvislon.nf the Conlmclors License Law(CmPac9
W�GO� (commencing with Section 2100)of Division 3 ofthe Business and Professions Codd or TEMP.METER OR PULE I NST - COMMERCIAL:
d e' Put be I.cselnpI Ordefraln and the hat,fur me allegAl everunion.Any violation of ❑NEW BLDG/ADDI'f10N ❑DEMOLITION
m Section 21131.5 by any applicant far a pewit subjects lheapplitanrma civil Penalty of POWER DEVICES _ Ll TENANT ❑FOOD SERVICG
not more than five hundred dallan 15500).
[-7J.Y IMPROVEMENT
Q ❑k mawnerol file progeny.or my entPlnyces w'nh wages us theirxdc u.nyscnsntiun, SWIMMING POOL ELEC'I'ItIC
1=.O will Jo the work,and lee stmcmreis nm,Li ens Lawfdfor.nl apply 2U14.Busincss OOTHI:R
and Prnlesninm Code:The Cnntuctork license Law does nal apply m and nwnm of DUTLI?'I'$-SWITCHES-FIX"fI1RES
C• property who builds or improves thenar,and who does such work himself or fttnugh
his own employees,provided that such inlprovemcma are not intended or offered for N17W RESIDENTIAL.ELFCTR SQ PI:
sale.If,however,the building or improvement is.Nd within one yearo(completion,He NO Fr..FLOOR ARBA $/SQ.Fin
wnerbuilder will have the hurden of proving that he did not build or improve for Pur-
id'.).
I.rs owner of the rrnPenr,am exclusively contracting with licenxN rotameter.to
anslruet the E jcct(Sea 2044,Business Intl Pmf.ions Cnlc:)Tire Contuati Li-
uLaw does nor apply muvAccord progenywhobuilds urimproves thereon,;and QTy- PLUMBING PERMIT FEE
who eovmacts for such projects wish n cnmmaor(.)Recused pur.uanno the Coutmcmrs
License Law. PERM I'I'ISSUANC17
I am exempt under See B&P C for this rearm
Al:flili-DRAIN&VENT'-WA'IIiR I.A) VALIDATION
^� 1 hereby affrtn UKBACK FLOW PROfICT. IEVICP < N'ATIIDELAR
penaltyATION
of Perjury one of list following declaration.:
have and will mai train a Certificate of Conscm to self-insure for Warkees Courtin- DRAINS-11.0-- ROOF.AREA,COND. off
STORIES '1'YPIiCONS'IRUCI'ION
salon,a.provided for by St tion 321X1 of the Lrlwr Crele,for the EPM or c id he
work for which this permit is issued FIX9'URES-PER'IRAP q \ A
/ 1 /
h
1 hove and will maintain Worker',Compen.mlon InxumSecondale.as corralled by Second 4 Y
3200offhe Lar Code.fnnhepedmun
orce tithe work forwhich thispennit is d.vued GAS-PA.SYSTEM-I INC.4011TLHTN OCC GROUP MIN
My Worker's Compensation Insurance carrier and Policy another art:
Cmeier: Policy No GAS-HA.SYSTEM-OVIR4IRA) R. 3 3G2-/¢•Gi�,�
CHR'1'IFICATE OF EXEMPTION FROM WORKERS' GRIiASF/INDUSTHI.WASTE INTERCEPTORCOMPRNSATION INSURANCE ILDING DIVISION FEES
(Thin section needmn heo,omplamd ifthe permit is forme nundreddollus SI00) "---
Dans..) GREASE TRAP PLANCI ffe-E
Loy tiny that in the any mannce(11 rsitithewmk for which this the ait Wl.lvemedlaIralten SEWER-SANITARY-S'I'(IRM HA.2X0 PT.
urn employ any person in any manner sit its to become subject to WorkcrK Gmtpem HNEPAYF 3
,Z s.Iran Laws oiCalifornia.flare WAIVIt HEAIERW/VEN'DELLCTR A,Eflarml F
Clt D RE
pl NOTICE TO APPLICANT:11,area making thus Oo tifinte of Exemption,you shouldWATEII SYSTEMG'BEATING
hecane subject to the Worker's Compenmtiun provision,of the Labe Code,you trustSt .. FI4.H
Wforthwith comply with such provisions or this pormit snub bedeemed revoked. WNII:R SERVICE
d Q
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL YhMB. SQ.fT. PA]
D
� 'Z" Ihmrby affirm that n
there lnnnntin
tmcn lending agency y fnhc perfnrmuncc of Dm miptpaNer
V O rhe work fm which this Permit i..i...ed Isec.3101.Co.Cj O
Ik. ^ Lcodcr's Name, T 1.:
V Lander,Address Ti
}.I HJ 1 certify that 1 have read this application and state that the above inlimmation in BUILD F i
4 N eme"A.groemcomply with 111 city and rounds onlinuncex mN stem laws rusting n' QTY, MECHANICAL-PERMIT THE
UZ building emodurnistand herebymiHamm taptoxcuumvesofthi,city m enter upon the SCISWo vt 0
uhovomeirkand Pmptay batin.pcctin r Erni ` PERMIT ISSUANCE
(We)agree to save.indann ..
emnily and keep hlc. the City al'Cupertino against I:I. It -D 11,
liabilities,judgments,costs and expenses which may in anyway same againstmid City ALDRORADDTO MECIL
m n.nsequenn of the granting of this plonk. LNG ITE
APPLICANT UNDER.'1'A NDS AND WILL COMPLY WITH ALL NON-POINT AIR IIANDLING ON]'T O 0 U1.000 CFM) ME IANICAL PER
SOURCE REV1X5. p o
2�a - / 9 AIR HANDLING UNIT(OVER III,0IXICFM) rc; "RUC'1'ION'PAN
Signature of Applic Counselor Date EXHAUST HOOD(WIDUCP) I SING 'll A'1'ION P:
IA%ARDOUS MATERIALS DISCLOSURE --
Will lhutpplicamnrfuturehuildingtecupvnlloreorhundltlm/anlou.mwcrial HEAHNG UNITI'1'(1100,1X0 BTU
as defined by the Cupertino Municipal Com,Chapter 9.12,and the Health and Safmy t
Calc,Section 25532(a)? � HEATTI'
ING UNIT IOOO,IXBTU) -
❑Yn L.Nv.,t'u VENTILATIONFAN(SINGLE RISID) I ;,AID id 1999
Use Rneipt X
Will theinkno aa, lemn or future building by he Bayrn Area
Air a or lits M ns to Inch BOILER-COMP(3HP OR 100.NR)I3'r'U)
huvtNnus air cnnlaminavt.: dehned by the Bay Arcu Air Quality Managcmem
blct0Ycs o BOILER-COMI'IOVEIt IIXl,llflfl B'fll) 1s X
Ihave read the hnanki materials requirements under Chapter 6.95 of the Cali- AIR CONEN ITONER ISSUANCF DATE
fomia Health&Salify Cxle,Sections 25505,25533 and 25534.r understand that if the NEW RESIDENUAL MECIL SQ.PT
builJngd.e.n lily havn�tcnanl,that it lx my repwnsihility lnnatify the rcalpanl -�
of, mqui ! litho s Mme Ccnifinycof Oµvry
amhom. gem L-OD'ateISSUIiD RY:
�� OFFICE