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S2804 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUI'F;R'1'INO BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT PING R OJECT I.CHANIFIC Q 2804 O 0 A BUILDING PROJECTIDENTIFICATION J O U °f BUILDING ADDRESS: SANTFARY NO. APPLICATION SURMITTAI.UA'1'E 10366 . s�LC E. Q OWNERS NAME: P CONTH ( ryAMFCONTR(LX ✓ NIC - � ARCHITECT01ENGINEER: TIC : AI ❑ CO1PHONE ILDING PERMIT INFO 1 ,��07 ❑ Consonant Fees Paid by Applicant(Initial) BEING ELECT PLUMB MECHi [.]CI NSTDCONTRACIORS DECLARATION QTY FI,ECTRIC PERMIT FEE I hereby a Rnn th t 1 J J p f Chapter 9(commencing JOB DESCRIPTION az'Z mS fi 70gXEoID ' i fth Ba IP f. ' Cd dmylic ,e �j RFSIDFNTIAI' W o PERMIT ISSUANCE .-J FWD nfullflllaaa��a... I ttr� 2oX�V7� ❑SFUN'I. El KITCHEN REh10DEl. azw Litt :e T'cp a/ r AI'I'IIMCLS It F.51DLN"TIAL ❑ADDI'1[ON Ll PLUMPING RE PIPE p <t [)uR Cntvcto- m6y ❑M1,T1 lNll ❑ IIFPH AtCITI TSUhChARATION PANELS MODIFICATION �Z IundersumA my plans.hull b,.,cd as publte records ZOO^0 111"IO2110AMPS I ❑IN'I'BHIOR ❑CHIMNEY REPAIR F14tW Licensed l'mfcssiomd 201-1000AMPS IMPROVFMFNT LJSWIMMING POOLS z OWNER-BUILDER DECLARATION OVER IINNIAMI'S ❑BATH REMODEIJREPAIk ❑DEMOLITION C C Q 1 R7chy al'fimo that I stn exempt from the Cpnnsclura License Law but the �,oofU ❑UHIER X a following reason.(Section 9131.5.Tluulnoxs and Rofesalons Cotic! ny city m county SIGNS ELECTRICAL r�4 O y wh h 4 ps a t t It p J f.ch Y wdure r / E'— Q priors t I: requires thef inchpe tt fl g do cmeal SPECIAL Cl ROUE F/M ISC. \ �u}� firm he licensed pu, a the p of C t t L L 1 spirit ac o (Goth mgxnh Sul ]00111 f1) J fm Bus rtes dP Com0sur '1 Eh1Y hIfSfliN OR YOLF.INST. COMMERCIAL: tl 1 c 5 that he a exempt therefrom and the bass for the alleged ton n iolut on pl ❑NEW BLDG/ADDITION ❑DEMOLITION XmI+- Section 9UJLS by any applicant forvpermit mbjact mea oaemil penvlry of INJWEft DEVICES ca m not mom than five hundred dt ars(SSIXB. ❑TI'vYAN'I' ❑FDDD SERVICE SSC OTesnxnorofthcptope .ormyemploy xithxro er.decom1no.fma, SWIMMING POOL ELECTRIC ❑OTHERVF:AIFvYT E- willduthework.andthem clemis notimerde "He r. le lSc 70414,Basi... IW w and Profession,Cold Coal.t h L d e t ppI t an owner of OUTLETS SWITCHES-FIXTURES 4'3 property fi b Ida or p th on'f J ch k himself r through his employees p V d lk t such i t. notintended RemA for NEW RESIDLY TIAL F,LECTIt SQ FT :ale If h the IJ g , n 'thno y t pletion the SV.FT.FLOOR AREA 5/SQ.FT own h Id II h' b d h t h did build., p I p pa. t ' L AL:ry 1 fthp Inn : lycontracting with _ d contractors tt AAS amt the pj tp 900 N :: dPf 'CdJThContractors I' !/J=.`A' Gen 1 1 : t0pplyt fp pery h h 'M. - p m tld QTY PLUh1B[NG PERMIT FEF: D wh t rl 11 Jekv thus nn mrtsll eusw,p n dcLnnv t - ElI I'I:RMII'ISSIIANCI! JUN 18 1999 ❑ I ..ptnm. see R&rc n,nh'te u.nn ALI'HE-DRAIN h VENT-WATER(E.A) VALUXII N Owner Data WORKER S COMPENSXI]ON DECLARATION BACK FLOW PROTECT.DEVICE I hereby affirm ender pcnaltyof perjury one of the following deduraluar, E] Ikvc anJ will tnninlain.Ccnilicam of Cnnxntmsdf-Insure far Worker's C'maNm- DRAINS-I;LOOR,RWl:.ARF,A.COND. IYYF.CONSTRUCTION eumn.ai pnwided fin-by Seation 3900of the Lvhnr Gala,for perfurmmmce of the work for which this permit is koasi. FIXTURES-PEk'TRAP I haveamd will maintain W'orker's Compensation Insurance,as required by Section 3100.!the laMn Gsle.fonts prifiro once ofthe work for which thi.pemnd is issued. GAS-IIA.SYSTEM-I INC.i OUTLETSIR:C.GROUP APN My Nbr ompenveion lococc,-,, rand Po[icYn mM are. GAS-EA.SYSEM-OVER J(EA) CanierCFF Policy No. CL tII ILr L P ON INSURANCE I W GREASFANDUSTRL WASTE INTERCEPTOR COMPENSATION WSURANCE BUILDING DIVISION FEES (This section need not bemmp[ned Vita permit is foronehundreddullao(SIWI GREASETRAP PLANCII[CK FEE or len.) I certify that in the performance of the work for which this permit i.issued,Ishall SEWER-SANITARY-STORM EA.200 FT. not employ any person in any manner so as to become subject to the Workers'Compen- ENERGY FITE Z. cation Laws of California.[)am WAT17R HEATER W/VF,NTJELECI'R GRADING FEE C) O Applicant NOTICE TO APPLICANT':If.after making this Certificate of Exemption,you should WATER SYS'I EM/TREAI'[NG TA SOILS THE I'+ beconm w...d to the Worker'.Compsmsmion pmvisinnz.(the latvm ,olor , mm,' Fak1 � forthwith comply with each provlsions nr has permit shall be deemed ravokttl. WATI!R SERVICE. Q CONS'I'RUCTION LENDING AGENCY NICW RINIINI'ALPLMBSQ.Ir. PAID CU.)ti Ihttdmy ultinn th:n Thera lxnttmammtiun lentl ng agency fonhe purfnmmle"'t 11nc Rec np W . lmwcakf,rwhich0t,Tv....t his issued(Sec.JIM)],Civ.CJ , OU Lcnalcr'a Meme TOTAL ULeader Add : 'I'O'I'AL' W I mtydatlh 'd do,aPplcvon and some thvl lh M "f n'I'mis It, q? F". h conata.lustre I comply wish ll city and cau ty tndnzncez and state larelatingi In QTY. MECHANICAL PERMIT FEE C..) z, nuilding eunstmeminn,arta hercM1Y andnarire reprerencni—of that chym cater upon the SIJSMI - ulxwe-mantloncd Pmpcny lir insis tion putlnoscs. I'RkMI'I'ISSIJANCE ( FIX RIC I'lil" © 0 [We)agree to save,Iwnnnify and keep harmass the City of Cei'moo against liabilities,judgmenls,costsandexpenses which mayin any way accrue agvinet aaiJCit ACTHRORADD'IUMECH. PLUMBING HE APPLICANT m of DERSIA g of this permit. APPLICANT O[ 'd ONANU5 AND WIL1,COMPLY WITH ALL NON 1'OIN'1' AIR IIANULING UNIT(TO 10.00(i O S(JURC s REGUIi!:A A �(�\ �I tJI a/ � � J1 AIN HANDLING UNIT(OVER 10.(NNI CFM) CONS"TRU ()N'CAX Signature ul ph'ToVContmcmr to EXHAUST HOOD(W/DUCO HOUSINGMI'I'[CATION PER HA7AI WUSMNTERIALSDI CLOSURE Will the applirmof more building eccupent zu.re or handle hazardous material BRAT]NO UNIT H 0 100.000 BTU) as defined by the Cupertino Municipal_Cade.Chapter 9.12,and the Health and Sale", Code.Section 25592(.)? HEAPING ON IT(OVER 100.00(f BTU) D Yes VENTILATION FAN(SINGLE RESID) PAIIJ Dam Reaiplp Will theapplicent or lLotre building occupant use equipment or devices which BOILER-COMP CHP OR 100.000 BTU) emit hanadoun air ammamin:mts sz defined by the Bav Area Air Quality Management TOTA.: Diana? BOILER-COMP(OVER 100,0001CLU) Yes zi t I hove read the nantrdoun mmeri.A ue µ--rte under Chapter 6.95 amu Call- AIIi CON UI'I'IONf?H ISSUANCE DATE orna` ll a[l fE S.1trty C;)de.Secuous 2550525531 and 255141 t :e d'han it'ma N17W RESIDLN'I'I ALMECIL SQ IT. / ^ (/P}�[ —/n p bulrgt l'em t1y1 t th am, tl-: yealxmsblryt (fythu"past Gf/n I?/ .!Ther erns which ntust lc ct pnonoisxanw fa Ccn fcumnf Oc pi Owner m maluall ngcnt Car c 49A7, ISSUPDFY: OFFICE