S 2236 JAPPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL ma Ir NO.
BUILDING DIVISION APPLICATIONIPF,RMITPLUMBING.MECIIANICAL v 2236
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICARON 5111 MITI'AL DAO
%t7/O57 DE AZA i3cis/0• , GtIPERT/NO Z gap
OWNER'SN E'. PH( G CONTRACTORSNAME: LIC NO:
'5R PI2oPM7/L3 �G(o YSoB Nor KIUowJv Y&7 NIC CD O1.N
•ARCR4/WY
LIC O ADDRESS' ❑
y�9FC4/ Y F TSGH� G Z¢Z C031 ffOlVA92 H 5FG87kZ
CONTACTT, PHONE: BUILDINGIeRlorr IN
/• .?C'IJ.•--f 1 /�� TIMI--7i(,� ❑ Consultant Fees`Paid by Applicant(Initial) BLDG IiLfi 1'Luh1B MIiCH
C7 1 ,5Cif*N ` / 1 4 LST ❑ ❑ ❑
LICENSED CONTRACIOR'S DECLARATION QTY. - ELECTRIC PERMIT" FEE
1 hereby affirm than 1 ton licensed under incem,ns of chapter 9(eommencing 013 DFSCRIPTION
1.Secrdeand0)of Divisi�n3oDhe Business and Profession.Cala and my licenw is
PERMIT ISSUANCE
F W in full fora un.el�A reel 30 /AITIGN
❑KITCHIiN RIiMODEI.
�UU L` nseC sec Lick APPLIANCES—RF.SIDENTIAI. ❑PLUMBING RE-PIPI?
p.Z aq Cunlmcmr
F'd aJ• �•Zmm 1111HEt SOI?CLARATION PANELS UNIT El STRUCTURAL
Z O 7 3 I understand my plans shall be used as public rceoN.s MODIFICATION
DP TO 200 AMPS
OZ-0 MPROVk ❑CIfIMNIiY REPAIR
F.'�.,F"W LiccnwJ Pmlessinnal 2o1J00)AMPS IMPROVEMENT 0$WIMMING pro, '
W following mason.(Seen7031.5,I mar
Buninexn�nDntl he ssiom C s[kens.Law Int the OVER IIKKI AM1II'ti ❑BATH I '.IJIUTPOR ❑DEMOLIT ON
L p eel U I l mau. .(See that 1 nm exempt I}o:n he Contractors C
x arc:Any city os county SIGNS ELECTRICAL
y whichit,requires, a permit m enns.vre alley,improve,demolish,or repair any statement
ar
Od priortoits issuance also rcyuims the applicant for such permit to uxigneJ s.nement SPP.CIAh CIRCUIT/MISC. wv
9y y'' Phut he is licensed pursuant the provisions of the Contractor's Liccae Law(Chapter9 %14 Jld
Q� (cntnmencing with Section 90118)of Division 3 of me Business and Pmfessionn Code)or 'TEMP.MI?'I It It OR PULF,I NS'I.
Up that he is excmpl Incrermm and Tho rusts for the alleged exemption.Any viclutlon of ❑, jW BLDG/ADDITION ❑DEMOLITION
K"� Section]03 LS lay any applicam Bnapemrit suhjecu me applicam loacivil lnnalty of I'OW' )EVP
W^ ei ❑TENANT ❑FOOD SERVICE
not more than five hundred Jolla s(851X1),
IMPROVEMENT
=d O Lo the work and property,onnyemntended with wages as cam, S MING POOL F?LE TRIC
gg ggtO will Jo the work,roti meslmcwreis not intended oroBcred finsak(SecJl s ❑OTHEk
nines
�W 3m land Profwniore Cnde:The Comforter's Lmnse Law Jns nal apply .tt law cr eel OUTLLeIS-SWI'ICIiL'. F.TURES
propeny who builds or improves themes.land who docssuch workhi elf or Through
his own employres,provided That such impmvemenls are nen intent. r o1l'tead lin NEW RESIDLNHAL ELECTR
sae.11;however.ere b.ilding or ltn....couple irsold within one year rcentplaio¢the SQ.P1'.FLOOR AREA S/SQ,IT.
cnt uildcr will have the burden of proving that he did not build o improve for pur-
posc ofsala} 'TOTAL
E)1,as owner bill propeny,um exclusively cnmrletiog with licery coutmctnrs to O
camwct the project(Sec.]M4.Business and Professions Gde:)File tractors Li-
laselswdocsnotapplytoanownerofpropertywhomildsoran oveslhemon,ane QTY. PILL rPERMIT FEE
who ontruas Gnmeh pnjec¢withawntrumnrW lianseA pnraun "a s,Convector's
License Law. PE IS.' 1
❑ I am exempt under Sm. ,1l 1'C for this reason
AFTER—DH &VENT'—WA'IER(EA) VALUATION
weer Date
WORKER'S C'QMPEN$A"PION DEChAI1AO)Nd. PACK ISI. 'ROTF:CT )LVICIi {pIfDDO
1 hereby akirm under Pemhy of Pe jury lane of me following
?stations
0 Ihaveend still maintain.Ceftificatenf Consent loself-insure for &VOCbn,,l- DR TO R ( E GOND, 5'IORIIiS ' CONSTRUCTION
ratio )for he Section 3700 of the Labor Code Niter,,the Niten c of the
work for which this permit is i,1mp1 FI RES-PER TRAP
1 have and will maintain Workers Cmml:enmlinn luumnre,ex reymirea by Sv
1 )of lbe Labor Gale,lot late Performance of the work forwhich this permit is"'aAS-BA.SYSTEM-1 INC.40 LETS OCC. ROUP AI'N
My Workkl(s Compensa' Inciricu carrier rand Policy..
Coni { Y policy Nod' • OAS-EA.SYSTEM OVER 4(CA)
CHRO IICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GIi1iASI%INUUSTRI.WASTGIHCEPION
IILDINO DIVISION FENS ,
(This motion need not be cnmPleteJ if tato permit is far enc hmNral Anllum(SIIX01 CREA. .
or lass.) PLA C EE 0
I century that in the pcommicance of the work lot whichthls permit is issued,l sat' SEWER-SANITARY-S'fORM PA.2W Ff.
nm employ any person many manner ,soav m her nn:a subjea m the Workers'Com IiN1iN 6 0
O Z nation Laws lar Califomi.a.Date WATER HEATER WNENIDELECIR CRk) .PEE
O Applicant
y NONCE'I'O APPLICANT If,alter making this Cannan,of F.xentptinn,yn should WATER SYSTEMn REATING
I^ femme comply
to the WnddoCsions the, pmnoduld of Ibe Curare Gsdc must SOIL. 'IiE
fnnnwim comply with.wch provisions lar lhls lxnnil xh.11 he deemed revs Lou WATER SERVICE
4
CONSTRUCTION LENDING AGENCY NEW ItESIDEN'1'IAL PCMB. SQ.PI'. PAID
r�I Z Uata Receipt»
UO work
hafli his
,all,rcis.rn (S,l,.30 lending agency rotor urhntnunce lar
Ihew.rk fur whidt This pcmtil is issued ISec.909].Cie C.)
OF Lender's Name TeW
U Ixnder's AdJress TOTAL:
a1 certify Thal I hove re.J this lapplicainn and state matt shove information is BUIL C ITE D
N cousin.l agree to comply with all city and county ddiaances J stmelawsrclndeloo QTY. MECHANICAL,PERMIT FEE
U Z building mnetmminn,and aterehy awhorirc mprescmmiveso tixcirylamarruponme SEI Eli
ab ve-mentioned propeny.for inspection purpua.' PERMIT ISSUANCE
(We) me to save,indemnify and keep he...lees City of Cuperl'm.against E iCI CIEE
linalitim,]mdgment..calx land expenses which miry into way.,against said City AI.TERORADDTOMECH.
in c
nnsequence of the gmming of this permit. I Mf NO PEIi
APPLIC N'p UNDERSTANDS AND WILL CO .Y WITH ALI,NON-POINT AIRIIANDLINGUNI'F(TO 1F000CFM)
SOURCE EGULATIONS. +Cf ANICAI.IIiF:
AIR HANDLING UNIT(OVER 18,000CPM) TRUC'HON TAX
Sigmmm ofA !rola ant Date EXHAUST HOLD(W/DUCT) HOSING MI'I'IGA'DON FEE
DOUSMATERI S 'CLOSII ;
Will the applicant ormiure huildiog t rPonl stnru Ic a,
Will nnncrial HEATING UNIT(TO 10.000[11 U0
as Ace incl by the Cupettinn Municipal C .Chapter 9.12,and the Health and Safay
Cale,Section 25592(.)? I IBA9"ING UNIT(OVER 1(X1,000 BTU)
❑Yes ❑No PAID
VP,N'I'ILA'1'ION PAN(SINGLE RESID) D.Ic Recciptp
Will the upplicam
or
Ed.re b in'
occupam use equipment m devices which BOILER (JHP OR IIXI,fi0l1 BTU)
toil hueuNnus air cumanl:nanu as One)by the Bay Arca An,Quality Management (� ®"fAi: •tom
District? MOILER—COMP(OVER UQWOBTU) DT1..7
❑Yea
AIR CONDITIONER
I nae.re:W the hazards mmenals 7ldew ems under Chupmrl HS of the Cai- ISSUANCEITE
dread,!
Gsde., clions255115,25533and25514.1mederaandthatiftat. NEW RESIDEN'IlALMECH. SQ.PL /D /7�-C'/1(7
building does not currently no ateaanL mat it is my msrymsinifny m notify me occupant
of the requirements which n tix..retprior IoissuanceofaCcnificateof Octipancy.
Owneronnuhorizedege Dale TOTAL ISSUED BY:
OFFICE