B 0385 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO RUILDING-ELECTRICAL PERMIT N
BUILDING DIVISION APPLICAPIONFPERMIT PLUMRING-MECHANICAL SOOOI
o`IIUII.DINGPROJECT11)ENTIFICNI'I()Nr'�` irs'1 ` 'r
00385
RUILUING ADDRESS: SANITARY NO. APPLICATION SUIIMITTAI.DAIF
Rq � S G LVT% �—/3-
OW'NER'S NAME: PIIONIh 'a CONTRACTOR'S NAME: I IC NO:
7 E5 4 S NIC //11 CONTIRO�I.p
orCUT IPC'I/HNGINIiI!It; LIC NO: ADDRESS ❑ `s �Z
!G G/l e a d2 53 564 G 7 7 J
CONTACT.J,�) PHONE: `'BUILDING PERMIT INFO
eT/T W,6-5 15 1,4441 qt 5 7M qqz ❑ Consultant Fees Paid by Applicant(Initial) ' �In DO ELECT PLUMB NVIECH
/ 'r
Q, E L�
LICENSED COSI RACIORS DECLARATION QTY. r f alECTRIC PERWTp / .I ' FEE,.;
I hereby affino that 1 licensed ander Pres s er,of Cbaprer u lcomme g - I JOB DESCRIPTION
oaz .itis vo o)otD sun3 oRhe nus nese ter tofecsie ss Cnlerant nylme .0 is RESIDENTIAL:
1 W- I'LRMIT ISSUANCE 3
F-Iy mfull foae vul Rf A ❑SFDWI. ❑KITCHEN REMODEL
aUF License Cl o Lies
Q U AI'PLIANCCS-RF.SIDIiNT1AL E' j
RLPIPE
H zuJ Duce Cnmecmr
m6y CM STR U AI.ARCHITHCTS DEC, to ""HZ 1 unJenland my plaschat)he usedesPuhlic me -� PAN131,SMOD TIONzON— s '�f UP T02IXIAMPSOz� CHI REPAIRLicensed Pndesammil 3111-IBBOAMf'S [l$lVl. M POOLSOWNER-BUILDER DECLARATION �, E I ONOVER 1000 AMPS 1 hereso .(Dermal 1 am excml fromTe cotnmcmod License Law for me L 6Ufollowing reason.(Section]031S, t.alter and Profesions h,or Any city nr county SIGNS EIPCIRICAL
which regains n scald re constmct,nlmr,improve.demolish,rn repair any sweercpilartoitsi,.vuunce,alvn requires lhovisio,orlim Contrennll LicenceLawplapaclnl $PEGIAI:CIIiCI]IT/MISC.Lhabe"license,Pursvmnto me Pmvisioe or te contractors license laTw(Chpna9(commencing with Section 7000)of Division 3 of the Business and Pfnfessions Crde)or 'ICMP.METER OR POLE INST.
0.y e C mat he is exempt Ihenfmm and the havis for the alleged exemption.Any violation of - ❑NIiW BLDG/ADDITION ❑DEMOLITION
lull 0. Sectio 9131.5 by any applicant for u permitsuhjects the appllcam to a civil Penalty of POWER DEVICES NANT [I FOOD SERVICH
'IMa rn a than live mailmd dollars(S.100).
~_< I'tecanerafthe norm toees with wages rheinole non Linn, SWIMMING POOL IiLECTRI 1'BOVF.MI!N'I'
C these y YetriP > gems ,Buss ❑OTHER
will Prme work,and theThe
Isoat;,rendesorowe dos sale(Sec.term
Business
CLF-. OUTLETS-SN'ITC ES TURES
4 3� and innerly
who h Code.marc Conwctedv License Low Jax na apply m Tm owner of
property who milds or improves Oruunt,end wM10 Jaen such work himself er througl
his own employees,Provided that such improvements are not intended nr offeredIng NEW RESIDENTIAL SQ Il'.
sale.If,however.me builiingorimpowenuent is sold within one yerafcnmplenoo,the SQ.17.FLOOR AREA 81SQ.1'1'.
own
er-huilJer will have)he hurrien of proving mal he did not build or in.Pnno for par- -
pose of sulc.L
El I,as owner of the property,am exclusively contracting with licensed contractors to -
consumer he project(See.7614 Business and Pct C s Code:)The Commoms Li-
- - r i ,
ase Law docs not apply? tpony h b 111.nrimpnves tierce 1 �-y.l. ft 11 (jLUM11ING PE T I 1., )
who contacts for such pnjeoawith tuonaaemrWIncesedlir am to to Connaxnas
License law. PERMIT ISSUANCE
1 am exempt under Sec. .R&P C for this masers
ALTER-D ENT-WAI'ER(EA) VALUA IION
Owner Dao '
�
WORKER'S COMPENSATION DECLARA'[ON - RACK Il CCT.DEVICE I herchy amna under penalty nfperjury,one of the bdhwing Jcdnmtions: 0
j I have unit will maintain a Cenificate of Consent to self-inure for Workers Cnmsen- DRAINS-ILOOR, BEA,CONE. STORIES TYI'li CIINSTRUCflO!
,tion.as provided fer by Section 3700 of the Lrmor Code,rerthe anortuar.c.of the
work for which this permit is issued. FIXTURES-PER TRAP
1 have and will maintain Workers;Compensation Insurance,as required by Section
37W of the Labor Code.for the performance afros work for which this permit is woud, GAS-EA.SYSTEM-1 INC.4 OUPID, 'S OCC.GROUT' AFT?MyW �fk
Comer:r am�nsvy+n haayince sortie Policy Nlineyon � GAS-I?A.SYS'I'EM-OVER401A) 3OOS00Y
CERTIFICATE OF EXEMPTION FROM ORKERS' GREASP4NDUSTRI.WASTE INTERCEPTOR / [[JJ
COMPENSATION INSURANCE BUILDING DIVISION FEES
(111s,mlian maul in hecnmpleted ifihe permila,for one hundmddallars(.S lip) GREASE TRAP orless) PLANCHI!CK r 0
I cenify lM1m in the performaee of the work for.)rich this permit is issued.l shall SI2WER-SAN]TARY-STORM EA.200 I71'.
not empe
ploy any person in any manner so as I.hcrome subjea m Ne Workers'Compen- ENERGY 2 3
Z salion Laws er Calilnmia.Date WATER HEALER W/VENT/F.LF.CI'R
z Q Applicant I GRAD IY.
z V) NOTICE IT)APPLICANT.If,after making Ibis Certificate of Exemption,you should WATER SYSTEMn BEATING
F ^ hcomevuhjmt to the Wyrkce,Compensation provisions of the labor Cale,you must SO .'P•
{a L+ fanhwilnenmply with such provisions or this pvin ilshull he deemed revoked. WATER SERVICE. '
'Z) CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PIAS. SQ.PE PAID
V ► I hereby affimuhat there is ac mamction lending.por,for the afformanceo( Date Racdsta
Lks H the work for which this pemril is issued(Sec.3097,Civ.C,)
O lender',Name I.
rLenders Addrcxs
C 1 cenify that 1 h d this and use that the ba information T 1- RUILDIN Flit. e
to coned Iagree a comply 'm ll 'ry and county commences d state I I t gt QTY. r f •MECHANICALPERMIT r FFF •Ir
U Z bnldiay cr xtrucno+ ul hereby rThtrm mprvsc rmfvcx+I th'ecty nwmer upnr The 0,. / '� SEISMIC •C
7 2-
above-mentioned pnrycrty for inspection purpose,, PHRMI'I'ISSUANCE
(We)agree it)save,indemnify and keep harmless the City of Copertino against ELECTRIC
Iiubilitiex,judgme ts,e... anA expense which cony to ony way accrue against sail City ¢�' ALTER OR ADD TO MECH, PLUM IN it
in consapence of[fie granting of Pile permit. t
APPLICANT UNDP.RSTA'A AND WILL CO PLY WI,T111 ALL NON-POINT AIR HANDLING 11Nl'I'(T010.0q)ChM) MP.CHAN Al.pl!E
SOURCE kE L "ONS. �a-W � 1 /'
QCCII r'11
AIR HANDLING UNIT(OVER 10.000CFM) CONSTRU IONIAN
Si a Plicwn/Cemmcorr OTne EXHAUST HOOD(W/DUCI) HOUSING MI GA'fIONII!R
HAZARDOUS MATERIALS DISCLOSURE -
Willlhe stpliemat or for.. uildingwcuntsare paorientate hmaou
Jsmmerial HEATING UNIT DO 1W,"RTIH
C,drE ed by the Cugrnino Mannite)Code,Chapter 9.12,and the Heuhh and Safety
CMe,Swino 25532m? �/ BEAT ING UNIT(OVER 1041011 B U)
El Yes ❑Nn - VENTILATION PAN(SINGLE RFSID) PAID -
Dam RecuiplK ,
Will the appllcma or future building necupent use equipment or devices which ROILIiR-COMP(311P OR IBII,WB R'Tlp
iaeaxim,dr Ouraminne,as defined by)he Ray Amr Air Quality Management -
.,-Inc(? BOILER-COMP(OVER 1110,1X0 RTU)
Yes f5No
I have read The moncon,nuounal.rap:imments under Chupar 6,05 of Thu Cali- AIR CONDITIONER ISSIJANCE DATH
rmmia Heulm&Safety CNe,Sermons 25505,25533 and 25534.1 undcrstaod that Wife NIiW RESIDENTIAL MECH. SQ.F1'. 3-q 9
huilding doe,notct Iy hnveulenanh rico it is my rcspmsibilirymnrnify me«'cupam J r /
of yin i h r�ct prion,iouunee nluCertificate nLOlci'r y.
u m TooLd,gem 11�j��Dare . r ISSUE1,BYft.tl :
OFFICE