S 2771 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BU RAING.EFECI RICA 1, PI7RMTf NO.
HUII.DING DIVISION APPLICATION/PERMIT PLUMHING.MECHANICAi, C
IfUILDING PROJECT IDENTIFICAI ION J
Ii UII.DING ADDRESS: SANI'T'ARY NO. APPIACATION SU9hf1"I'1'AL.DAL Ii
l Lam% 3— 26 _g
'WISER'S NAME,. PHONE' _ CON'fRAC I'ON'S NAh11!: LIC No
NIC `/-Y'' C(lN'IRllhp
RICHE CDEN INFER LIC N'O, ADDRESS: ❑ 7 z 3
CON'frACT. u) 13U II,UING PERNIFF INFO �o
G . ! ❑ CanSUllUnl Fees Paid by Applicant(Initial) If.DG EClPLUMB MECII
LICENSE CON7RAS DECLARADON (J Ly ELECTRIC PERMIT FEE JOB DESCRIPTION
I hone,affirm mat I mu hccprovision.of CGupmr 9(a'mmcneing
a=, hhScninn 7000)of thnd l'rn assinns Ctxlc.and myllmnxc is RESIDENT'IAI:
nlpp °' I'IeHMII'ISSUANCIi (S}SFDWL CKI'TCHGN REh10D131,
FE W.- full lorce and effect.
License Cl ass
Q APPLANCES-REST DFN'DAI, CAIID'I'ION PLUMHING HIiPIPIi
FZ otc m y ChIULTI-UNIT CS1RUCTIIRAI.F-- m ARCIII'I'IARATION PANFI.SZ Imalcr malmYplan.shall bblic record.
MODIFICATION
=Z;o UPTO200AMPS Cl INTERIOR CCHIMNEY REPAIR
F h,F]lal i-herroeJ Profel,hnal 201-HIOOAMPS IMPROVEMENT ESWIMMING POOLS
y.X Ya OVER I1nd AMPS C BA'T'H REMOD171JR17PAIR 0DEMOIATION
OWNER"I3UII.DER DECLARATION
C C I heron notion that 1 ani cxc rEn Gam the C'nnmac or'a Liacn.c Lnw lar tine
X6 U following mason.(Section 7031.5.Boniness amt Professions Cale:An,city or county SIGNS I!LECIRICAI. ❑(YI'IIE:R _
�¢n which red m conxwcl,alter,improve,Jcrolish,or repair troy slmcmod
LLl'+WH yuirsa r.Ill -
f.�]pJ mics issuance.dmm tura licam l'or such no flea vi dsl:ncmcm J
Iquires pp pcnni Enc SI'ECIAh CIRCUIT/MISC.
�LLN that hclx lieso,edpnmuanfm mcprovimonnf an,Conmumors l.i«—Lats(Chapter9
W5�0Icommencingwim Section]Wlno[Divisian3 tame Budncssadd Professions Code)Ill 'I'I?MI'.M,.1 OR I'OI,Ii INST. COMMERCIAL:
a pt o Z that he is exempt membon,and the basis for the alleged exemption.Any vinlmian of" [I NEW NLUG/ADDITION C DE,M01,1'f10N
W_y Sminn]031.5 by any nppllvam fora panni'xunjccu tnc uppllcam mucfvil pcn;Jty of POWIIIt DI!VICES CTENAMI' CPOGD SERVICE
nm mum than Gvc hundred ddmts IE500L IMPROVEMENT
O I.as owner nl line pnywrry.ar my cntpinymn with wages as mcirade commendation, SWIMMING 1'(101.ELECTRIC
E.- will dothe work.and the structure isnot intended or carrot for sale(See 7044.lousiness COTIIER
3 m 2
and 11rufdsiom Cade.Ilie Contractor's hent:Law owa
aw does not apply I,an cr of OUTLETS-SWITCIIFS-FIX'IV RFS
propvny who baildN or imtamer, hereon,and who does ouch ,,,it Monett or through
his awn cn"In sY'ex,powided 0m such imprnvementn me nal intended or offered for NEW RISIDIINI'IAI,ELFC!R SV IT.
SQ IT.ITOOR AREA St.%FT.
aalcll:hnweviceare have, he
intprovenmm ithalhedid non Wild
lmproor ian,mc y
mcol odder will cmc the burden of purring mm he did not lwild or in'prmx for par-
polo a vo%ne It O zw�1,
I,as owlet of the See 704,am ndusi and contracting with:j,tic c mmmcum..
mstrLa tine pmlccl/sec,]nano wneiness and End ill)ha Ccdti Tina Commmon.I.i"
em
es,law does not apply u'an owner ofpmpenY subs mtiWsmimprovex memos.and Q'I'Y. PLUMBING PERMIT I'FE
who uinaucrc for-ch projects with n commcwr(s)licensed pumuam m me Comment's
inane Law. I'IiRMI'1'ISSUANCE
I am exempt under tics. .B&P C for this mason
ATTER-TRNN&VENT-WR'I'ER 1' .^ VALUATION
Owner DNe v
WORKER'S COMPENSATION DECI.ARATION RACK FOW PROTECT'.UEVICF 2 9 d.a
Ihcrthy ul3lrm under Penalty(it one of Wclollnwing dcclumlmns ..J
hxveand will mainmina Ccnlfic:neof ConsennnsdGinsunlin Workers Compen- DRAINS-FLOOR.ROOF.ARBA.CND. STORIES t1l LION
. tion p d J for by S 3]IRI9f 11 Lah r C d,ltl E I' •of thework f J h tins per t . d. FIXTURFS PER TRAPn IG J Il mai IN k s Chi 'I I tu dby Semon3701 ofine labor Code,ffoor thhee perfo�rm}ance ofthe work for%Each this psmJusswnd. GAS-hA SYS 1 FM-1 INC.d OVILizIS OCC.GROUPI'NMYWorYytd' .,:y{,ae '-"re arm'F l'9lyNar and ynumbcr nrc: /G
Cartier \\�dll o. GAS-13A.$VSTBM-OVERJIBN
C:RTIMCATIi OFIi%BMI'T'ION FROM WORKERS' GREASEJINOUSTRI.WASTE IN'ERCEPTOR
COMPENSATION INSURANCE R DING DIVISION FEES _
(Thisscetion need mEsecomplemd irde Ntandi,asmenundn•Jdollurs(4Hp1 GREASE TRAP ` oO
nr lens) PLANCHIiCK EL
I certify that in the performance nfthe work for which Nis permit in issued.l shall SITATR-SANITARY-SI ORM EA.21X1 F1'.
P Y any person in coy tuanncr su as ENERGY LTE
net e.., In to hco'ns.danjocu„me warkerx'campen- e
Z .mina Fasts of California.Date WATIiR DEALFit W/VENT/FI,ECfR GRADE 1
zC) APPlicant
iiiiI E,,, NIUICE'D)APPLICAN'L`.If,altermakingThis Cenilicutcof I!xeay,tlon,You should WAI'1!R SYS'I ENVI'REALINO SOH.S I'
East ad sabjeet a,the Woders Compemmiun provisions of the labor Code,you must .'
forthwith enmPly will'such Pnniaon.or this permit shall nedecmcdrca Acal WATI7R SERVICE
d
Z) Z CON -ENDING LENDING ACENCl' NEW RESIDENTIAL I'LMH. SV FI'. PAID
g agency- per Ilam Receipt a
U O k Frcbydlinnmauhercnsuedconstruction(Ser.
lilcnCior lbr Innnancc of
he weds Na wh'mh❑cis Iwrmil is Issued($cc.309].Co,iCJ
0 U Lender's Name
Lendcr'I crimy Co
I ecnify Ibul I have read thio applicmiun and atwu that the nhovu inGnmaunn is PUILDING Mi1S
U o emcm.lagmeusmmply with all city and county ordinances and citytoatrelating he QTY. MECHANICAL PERMIT FET; SEISMIC 3
UZ nauah,g dunda„rdm,,amn'rrrny aadmd,e repmdeantfirn socio city to act upon he
raise mentioned Propery rnr impeeian laHeses. PERMIT ISSUANCE 1 CIRC( iO
(We)agree to save.Indemnify and keep handless the City of Cupertino against
Iiabilitic,judgment,cosisand expenses which may in any way Deane against said City ALI Ek OR ADD'ID MICH. 1.1,11 F
a.¢gncnee nl the Turing.l his permit.
AI'PL.ICANT it ST IS AND W1I.1,COMPLY WI'fll ALL NEIN-POINT AIR HANDLING UNIT(TO III,IXll CFM L A TB
OU GOT A
AIR LIANIIIJNG UN I'T(OVER IQialic CONS U, I TAX
R
mono I a ea"”'
'air EXHAUST HUGE DUCT) MOUSE. MITI IATI(lN Flili
IIAZARDOUS MAI ERIALS DISCLOSURE:
Will lino applicant nr lumre building wcupwtsmrenr noodle harnrdcu.material HEA'L'ING UNIT'ITO 100.00 Ill Of l
as deGnedl by We Colonna Municipal rJ'dc Chupmr 9.12,and the 11.111,and S:dmy HEATING UNIT(OVER 1000 )111'U)
Code,Section 25532 a)'? _LA.^J/
C Yes VEN'ULA'DON I-AAN RHSID) PAID
i Uutc Ncaclpt q
Will the oppliei for clone hmh1u,g,.aEem ane equipncon,devices which BOILHR-COMPCHPOR IW,00ORTU)
mil naiuNnus air annaminunt ad Jcf net by thr Huy Area Air Vu:dity Managcn,cm ' '1' A
District? ��/ BOILER-COMPIOVER 100.000H1U)
Yes Cyto
II' JOa1 't viol '. Hund OMI n ultheitth-
AIH CONDITIONER ISSUANCE DATE
u 11 Ins&SafeyCdc Sections 25505 25531uad2553a I indent de bar it NEW RL•SIUFNI'IAI.MIiCH. SQ,ITT
istat
of the g 1 tutu ch T he nt.tE YI'. n >pms h l ty t E ly thcsrsuy.
of the requirements which nmol he nml poor to issuance mlaCanilmum offkeupancY.
Owner or authorized egos' Dme �y1 a ISSUED BY:�+-� •�� �•
OFFICE