B 0605 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
BUILDING.ELECTRICAL PERMIT NO
CITY OF CUI'ERTINO PLUMBING-MECHANICAL / _
BUILDING DIVISION APPLICATION/PF.RMIT gQQQ� UTO /00.5
BUILDING PR(IJF;Cf IUENI'IFICA'1'ION
SANITARY NO AIPhICA'I'ION Sl111M1'ITAh UA'll
BUILDING ADDRESS:
OWNER"NAMF: /Dr COMBACfOR:S NAME: LIC NO:
O `�'I� NIC CONTHUL pts
,u 7`KA
,R HITEC I NEER: ADDRESS 0 9
CON'A 1.14 5 BUILDING PERMrr INFO)
1{� /_ /moi�-/ / ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB h EcH
5)&-- lL\^ (fib/s6(/-7I � b /Z f5- 4T -E!I- C�
LICENSIHJ CON'IRACIOR'S DECtARAITTON Q'PY. ELECTRIC PERMIT FF17 JOB DBSCRII'I'ION
1 hereby alli,m that 1 am licensed under provisiom of Chapter 9(commencing
0.'Z with Section 7000) Division 3,11 lot Professions Gila and my license is I'EHMI"f ISSUANCE RF TI
IU-0p full farce end anicl. .FUWI, ❑KITCIIIiN REMODEL-
CUIm
aUU License Crus Lich APPLIANCES-RF_SIDIiNT1A1, ❑ADDITION
t~ii
❑ U 'RL
BING -PII'li
6Cnvnm°r STRUCTURALaiDARCHITECTS DECLARATION IIANES ❑MUhT61NIT ]MODIFICATION
OZvn-'Z Iundecsemal plims,ball he used as public records UI'T021N)AMI'S ❑INTERIOR ❑CHIMNEY REPAIR
I:.�FW Licensed Profcommil 201400OAMPS IMPROVEMENT' 0SWIMMING POOLS
�y�.-...dll OWNHR�RUILDER DECLARATION OVER I(Np AMPS ❑BATH REMODHI/REPAIR ❑DEMOI.HTON
C C Q 1 hercby altino Ihul 1 am esempl from the Couricks a License Law for the
XOa U fallowing reason.(Section 7131.5.Business and I'rofeoions Cale:Any city al county SIGNS ELECTRICAL Of HLR
R13 W h which m,dres a)ronin it a mama,mel,improve,demolish,or repair any enm uce
0 prion I I: q 0 'ppf a fustiantpe lin fl 'g dImolnenn SPLCIALCIRCUITIMISC.
7y Ihalh 1 .edp a 'hep ' s fhb Cannot, L (Chapncrs) FR 1
=00 (vahmcnrng with Section 7000)n1Ov'.i n3 fllli asudl f:. .Code)Or TbMP.METER OR POLE INST.
a a ca C that he is exempt therefrom and the hasis for Ute alleged exemption.Any voolatino n(
El NEW BLDG/AUDITION ❑IJIiMO1.IT10N
Section 7031.5 by any applicant for aPermit subjects the applicant manvil penalty of POWER UEVICIS TENANT ❑FOOU SERVICE
rn more thun live[unification...1850X). IMPROVEMENT
fS0 ❑ I,as owner of the property,or my employees with wages as their sole compensation. SWI.SIMI NO POOL ELECTRIC
F• will Jo the work,and the structure is non intended.,offered NoVdc(Sec.7044.Business ❑OTfiER
L3 m and Professions Cole:The Contractor,Lsai me Law does nal apply Io an Owner of OUTLE'I'Sr SWITCHE S_FIXTURES '
property,who builds or improves thereon,and who dols such work himself Or through NEW RISIDE LIiLECI.1 SQ ET.
his own enhployees,provided that such improvements arc not intended of Offered far SQ IT.FLOOR AHIiA SISQ.FL
ale.IL however,the building or improvclncnl is sold within one yen of nnnplelinn,the
cr mutter will have the burden of proving that he did not build or improve fur pur- ��(�
pox ofxala), TOTAL
O h as—.a,of the property.um exclusively contracting with licensed contmnon to
construct the project(Sec.70,IT Business and Professions Code:)The Contrai Li- y
n haw n.nsnal�pplym un Ownerof pnapcnywhatmildsaimpmtcs hemon.end QTY. PI..UMBIN P IT FEE
who compares for such projects wish a contracmns)licensed puruam m Ne Commemr's Y l�
License Law. PERMITISSUANCE •2-
(]1 am exempt under Sec. .B&P C tier his reason a
ALTER-DRAIN&VE,NT-WATER(IEA) VALUATION
Owner Data
WORKHR'S COMPENSATION DECLARATION BACKFLOW PR(y1'EC'F.lar V ICE 9 / ® O O
1 hereby affirm under penally of perjury one of Ne following declarations:
i� Ihate,and witlmainlaina Cenlficao,ut Cansem m Ill Gincum for Worker's Compen- DRAINS-FLOOR ROOF,AREA,CONDSTORIES TYPE CONSTRUCT 101
alio,.as prm'ided for by Section 3]W of the Latah Cale.for the performance of the
wank for which This pertail is issued. PIXTUHI3-PER TRAP
0 1 have and will IZ ulam Workers Compensalion Inantool,as required by Scdom GAS-IEA.SYSTEM-1 INCA OUTLICI S
t7X1of1hclaborCWafonhe performance of the work for which this pennil is issued oCC.GNOUp AI'N q
MyWorker'e Compensation Insurance currier and Polity number am: GAS'_IIA SYS"ICM-OVER4(EA)
Canter: Pulley No.:
CERTIFICATE OF EX1IMON FROM WORKERS' GREASEaNDUSTRLWASTE INTERCEPTOR
COMPUNSAT10N INSURANCE ItU11.DING DIVISION P i1iS
(Unkseationneedn.11weanmpletW iflhe pelmil isforonehundral dollars(SI(q) GREASETRAP PLANCI .KITE 3
ar Ices)
I tenilythul i.the performance al thework forwhicb lhiepermlt is issued,I shill SEWER-SANITARY-STORM EA.200 FL ENI?R '.P
not employ any Pelson in any manner so as to become subject ,the Worker'Coopen-
V1 ve)
C Z union Laws of Cufifamia.Data WATER HEAT17R WNENT/F.LECfR G A G E
Z O Applicant
N(TTICETO APPLICANT:If,after making this Cenificam of Exempuan,you zhnuW W'AT12R SYS ILMG7RE U INC, SO
ecmtmpeF
boe subjec ,the Warkcn's Comni.n pnwisigns of the Lupeou r Gide,ymost
mi
andoilb comply with such p0000mor this perlshul lR ducmcdrevakcd. WATER SERVICE
PAID
z CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ,PC Date Receipt#
L) O I hereby affirm that them is a construction lending agency liter Ne performance of s
P the work for which this permit is issued(Sec.3097.Civ.C.) to L.
pU Leidcn's Name TOTAL:
} Leodc/s Address BUILDING FIE /•�
G I lenity Ikon I have read this applicalimn and ,all that the stove information is I
rualat.Iagree uuomply withall city and county ordinances and smte laws rdmingm QTY, M ECHANICAL PERMIT EFrESEISMIC FEF U Z building construction,and hereby authorise remesenmtvcs of this city m enter upon rbcihovomenlioned property for inspection purposes. PERM I'f ISSUANCE ELECTRIC FEF.(We)agreemsave indemnify and keep harmless the City of Cupenina againstliabilitics.judgmentu leotard espenas which may in any voyaccme against said City ALTERORADDTOMECH. PLUMBING ITE. 1
in nsequence of the starting of this permit.
APPLI CANT UN DERSTANDS AN D WI LT.COMPLY WI I'I 1 ALI,N ON-POINT' AIR I IANDLING UNIT IT 010.000 CFM) MECHANICAIFEE 07 21X
SOURCE REGULATIONS. AIRIIANDLING UNIT(OVER 10,000 CFM) CONS'FRUCTIONTAX
Signmuneof Appliamo/Comractor Dam EXHAUST HOOD(WIDUCIT HOUSING MITIGATION FEE
HA9.ARDOUS MAI"F.RIAI S DISCLOSURE
Will the applicant or future building Occupant Gore or handle hasnN.us reacted HEATING UNIT(TO I W,(NN)BTU)
as defined by In,Cupanino Municipal Code,Chupmr 9.12,and the Health and Safety HEAI'I NO UNIT(OVER I(N10fN1 BTU)
Code,Section 25532m)?
❑Yes ON. VENTILATION FAN(SINGLE RESID) PAID
Dam Receipt x
Will the applicant or Won,building Occupant vat equipment or devices which tlO1LCR-COMP(31{p OR 100.000 BTU)
mit harurdous air contaminants as defined by the Bay Area Air Quality Management TOTAL:
OistricI? BOII.1?H-COM It(OV ER 10011X)0111 U)
OYca ON.
I lute mad the M1mallous tions 2ls 5,Z53 au under Chirpier Indi n.95 0l the C+Ii.
AIR CONDITIONER ISSUANCE DATE
Po lm Health&Safety ley I' Sections ,lea 125513 and 25534.1 ua{crmnd(hal if the NEW RESIDENTIAL MECB. SQ.Ff.
huildi ngdoesnon swhic y hast n,.1Ith;n'n ismYrusgmsibiliyl ramify nucoccupant
of the rtquimihrms which most he mel prior m issuance of a Ccniliwm of(Xcupancy.
Owner or authorized agent
Uao, 1 1 TOTAL ISSUED BY:
OFFICE