27535 (2) AYYLIUAN 1 1 u rH-L im mrunmN f tuff ver nu.nCv s.rr.co-xaoC orsu r Vere r n v—r
BUILDINGCITY OF CUPERTINo PLUMBING-MECIIANICA6 I'GRAII I'NO.
BUILDING.DIVISION APPLICATION/PERMIT
,pats!aRU1LDIN0 PRO F.CT ID IPIC TIONox+;+a++'ani�'
B27535
UILDING ADDRESS: �� SANI I'ARY NO. APPLICATION SUBMDIAL DA'11'
I //SILa UNIT'0 LOTN —' 1;
OW
ERS AME � PI IO CO ACTOR'S P{y{F.:� LIC NO: NIC C(1NIROLN
ci
CHIIFC`F"UINF,ER: LIC NO: AD ESS:
CONTACT: PHONE: W. NI ap""�Ea(Wiry1RI �PHZRylM�I"'� �,h}{t �}elf" ,A-� 'S=iBU1LDING PERMIT INFO '
_ qrc }-N:fq�.. .-rera+lv�^"'Clq gel',' Cr BLDG ELECT PLUMB MECII
PERMIT ISSUANCE / -
LICENSED CONTRACTOR'S APPLIANCES-RESIDENTIAL JOB DIL9CR11'IION
Od'Z IM1m
rbyaffnnlnal l am Licensed under prnvisiom of Chep¢r9(mmmmencing with
µl00 Sectirm IlxxB mf Division 7 of IM1e Business end Pmfessiom Code,end my licenseE in PANELS
FmC fullforceandeffect. t Y'fA W i�
F,Zua ,Lions,Clo.as Lic.N UP t0200 AMPS I—fWFw\I
PaQy Dam Commnor NI-I00OAMP5 SO.FT.R.WRA0.1iA SIS0.19'.
ZF yZ ARCHI'IF,CTSDECLARAIION OVER IOW AMPS
Iunocmtamlmyplainshallbe..d as public reco is
ty SIGNS ELECTRICAL
QyE� Leaned Profecsirmal
'KYfr-( OWNER-BUILDER DECLARATION SPECIALCIRCUIT/MISC.
px�j,OaU 1 lorehy affirm Nat 1 em exempt from IM1e Contractor's License Lew For IM1e
'ta73 arra following reason.(Section 7031.5.Business and Professions Code:Any city m county TEMP.METER OR POLE INST.
t�'oo which requires a Permit to constmn,slier.improve.demolish.m repair any structure POWER DEVICES
S;!fYf prior or its issunnee,uborequires the applicanffor such Permit file a signed statement
paaQO that he is licensed Pursuant to the Provisions mf IM1e Contractor's License Law(chspler SWIMMING POOL ELECTRIC VALUA'I'IUN
dao ff 9lcmnmencingwiN Section 700m.1 Division 7mf Ne Business and Professinnscods)
W^y arthar he isc aemNNerefmmendthe basis for the alleged ascription.Any vlonmel of OlffLl!TS-SWITCIIES-FIXTURES
C Z 2Section 10715 by any applumn rte•Icrmiuubjecta Ne applicant a.civil penally of
inn norm than Bvc hand ed dollen D5W).
5 O NEWROIDFNIIALEL.ECfR _SQ.M. SIORINS TYPE CONS'IRUCIION
,�:L ❑ oche wr ttof Neprnperty,orm of intndenwiNwegcusNeino 704,1.minion,
y3— will Prfesions end Nemru Contrapues,in notintended
Law ffered does
applySee 704,1.Business
of
aro PmfasMm cndr:improves
Contractors License law docs rot apply lf m owner or
...crtywhmhuihovi improves Nereorovements weell Nmughhis IaCC.GROUP RIi..UNITS
employees,providednoonversimpmvld wit inanns e yimOndcomplfttaf rte sale. r.
MilderwNe bvetie burimprmemOminmt he withinonebuild
of annotation,the owner. N
Fuildcr wJl have the burden or poving Net he rid tax buik m imryove for puryox fQTY .A. RAxIDZONIi npNI,asowner ofNe proprty am exclusively crminethngw N licensed conic eto m Iconswet Ne project(Sec.7W.Businw end Protest Cde:)The ContractorspERMIp ISSUAI.icen.alawdmexnmapplymanownerofpropenywMWildsmimprovesNemm.endvhocrmvocts fmxucn projects with.co mensgs)licensed pursuer,to the Contractors RAIN&VENT-WATER(EA) FEESUMMLicense law.❑ 1emeaemmuderSec. ,D&PCfort1dx rt DEVICE SANITARY k' N_RECEIPT'X
Owner WORKMAN COMPENSATION DEOA0.AT1 DRAINS .AREA.CONSCHWLTAX Y N_
❑ Iherbyoffinn Nnt l have.certificamofconsem toselbi m,maceni0cateof RXTURFS-PI RAP RECEIPI'N
1 IIB Leh C, which
PARK FEE Y N_
Wudm'Crmperamin.Insurance a cenifed copy thereof cc. ) RIiCEIVIN
\�- nett emloee'suMer Nis t. GA STT!M-1 INC.xO✓II.EIS
Polv P Y Ix^n' BUILDING DIVISION TEES
coir,N
Cmmpmry A -CA.SYST:M-O IIA) PhANCIIIiCK IIiL•
❑ Cenill,denpyi.sherehyfurs, .
❑ Ccnifted ropy is Eld with Necity innpmtion di isimn. IiASFII WASTE IN GRADING FF.f;
CERTIFICATE Op EXEMPTION FRU WORKERS' GREA ETRA .OILS FEE
COMPENSATION INSURA E
(Thinumion red nal hecmnrpletd if Ne permitisf onehundrddollan(SIM) -SANITARY-STORM FA.200FT. t IiRGY FEF,
m less.)
-reify slut in the performarxe of Ne work fm which th -limit isinud.lshell WATER IIEATER WNENT/Fil.cm
employ any perms in any manner ar n�m beermx 'ct to the Warkcri P D
nmpenati of Celifomia. Dole _ R- WATF.RSYSI'E!'I'TREA'IING Dam ReceiptN
O Applicant NEW RESIDENTIAL PI.MB. SQ.FT. TOTAL:
7 NOTICH TO APPLICANT:IL afro makin Nb Ccnifrnm of Emmp nays sMntlJ
L--iN flUI VINO FEEhcaanesuhyw. ,,be Worker's Cmmpensation Provisions of Ne labor e,you must
FF"" �"" fonhwiN emmply with inch govinionam Nlo permit nhsll be deemd rev eJ. .
a >
CONSTRUCTION LENDING AGENCY $Fa. IC IFF.
r:j
z I hereby affirm Nm there lee construction lending agency for the pcRrmm f TOTAL: Ii .CIRICITI:
rM1e work An which this pe.it is isao (See 157
7 .Civ CJ
U d laodcrs Nam- rJ r a a + v'+{...-, r, t - . •".'
W "'' 'r hI6CFIANICAL PERM a lir PLUMBING nsE
O Under e tifyflAddress— (y i4y< { ,..m. ry ktl�.dlkas'
1.mite that 1 have rod Nis ap anal- u ty sine Nat the stove iws rmning r MF,CIIANICAI.IIF.
D.s neer.lagree to<mmply with all city and county ordinances AM stale laws relating to PERM RISSUANCE
building con.ahudion,end hereby inNndm rtpresrnutiven mf Nle city to enter upon the .0.O OMECH. CONSTRUCTION TAX
U Z atnve-mcmiund pmperty for inspectim purposes.
(We)-gree m save,indcmniry sod keep harmicss the City of Cupertino against
liahili'es,judgmenn.costs end exoenuswhichtwyin any way accrue eg id'ily AIRIIANDLINGUNR'(T010,000CFM)
sequexe n(@e gfamingof Nix Permit. `lgb
AIR IIANULING UNIT(OVER 10,f1(gl CIM)
CZit,c�c.
Signature of ApplicanVC'onimcmr Dam EXIIAUST II(>nDfwpNCtl PAT
IIAYARERI
DOUS MATALS DISCLOSURE BEATING UNIT(TO 100.0011 BTU) lame Reacipt X
Will the it,livam or lame huilding occupant stem or handle bcrmulle,material IIf:A'I'INO IINII'IOVIiR IWJxKI Ill U)
a drflnd by the Cu,s,mor Municipal Code,Chapter 9.12,and the IIca1N and Safety
Curie.Section 25532(.)1 VExIIIATION FAN(SINGLE RESID)
❑Yea 0N IS ADICIi DA Ili
Will Nee licamor lmurt huildin Luse mrdevim wM1icM1anit BOILER-COMPp11POR 100.00 BIG) N'i D
pp gnby the Area inn
M1aenrJnus air contaminants n AcfirreJ by the flay Area Ai.Quality Mnnegcment flfID.ER-COMP(GVER I0(1,(KD BTU)
Ui.ev n1
❑Ven ❑Na NEW RFSIDFNDAI.Ml-XII.—SQ,IT.
I have rend the Imsnrdous mmerials rcyuirenmnta under Chapter 6.95 of the Ga r Up - 1995
Califmmia Ileahh&Safety Cde,Se<tiom 25505.255E end 255Jy. I uadcmend Net LV f rNe.�t�
ifthe huilding Jrnxnotarremlyhaveatenet,thenh Ie 1. is...crof. cramify the lR1�1y/y/moi
warpnm of rhe myuiremcma which mint he met prior m issuance of a Certificsm of
G4eupency.
Owner or emhoriseJ-gem Date TOTAL: ISSUCD BY:
OFFIC