Loading...
S1859r - APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELFCFRICAL rRITNO BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL � f8 5 9 BUILDING PBOJE,C'IIDENTIFICATION BUILDING AD I S. SANf IARYNO. AP PLICARONSUBMI"FI'ALDATE LX© PARKWkq ^� „F OWN '.S NAMIi: PHONE: CUN ItA 'I'(R NAIJE:I ' LIC NO: �� NIC CON'TROLk •ARC TECf/ENGI .ER'. II I' l: t DIIkF,SS: El G CONTA T: PHONE: vBUILDING PERMIT IN-0 170 2 ❑ Consullanf Fees Pail by Applicant(Initial) BLDG ELECT' PLUMP ' M1IIiCkIl LICENSED CONTRACTOR S DECLARATION QTY ELECTRIC PERMIT FEL 1 h chy aRrm th t 1 licensed J p sof Chapter 9(cameo ting JOB DESCRIPTION D0Z wire\ t .70(UofD' 3 fthelo JY � ..ions Code.and raylve re is �� RESIDENTIAL ,0 C, - Il lorec unA clfca M_O �' PERMIT ISSUAKCIi '�T'TT ❑SEDWh ❑KI'I CIIGN RIiMODEh License Cl... Lica I APPLIANCES-RESIDEN'1'IAI. ❑ADDITION ❑PLUMBING RIS PIPE m¢inam�M acomacwr?I M. A1.:11 F�,� AkCHITECFS DF,CLARAI'I(lN �— STRUCIFURAL I'ANEI ti ❑MULTI-UNIT MODIFICATION Z O t Z 1 undcrnland my pl'anr,fall be axed ox admit rcuud.. OZEn-M UP7020UAMPS ❑INTERIOR [I CHIMNEY REPAIR [=v_s 17 ac Licensed Profrr,ionol 201-INXIAMPS IMPROVEMENT EjSWIMMING POOLS Z a4 OWNERBUILDERDECLARATION OVER Irwin AMPS [I BATH RIiAfOUCIJI(IiPA1R ❑DIiMOLITIDN C C d I hereby Indoor that I am excinpt t a he Contractor's License Law or the X 3 a O fullosvm,.,I (Section 9091.5_Biome,and Proff,clons Coal,Any my I,,county SIGNS ELECTRICAL El OTHER E nF, Ishich requires a permit m construct.alter,improve,demolish,or repair any.wcture fLL Q prix to its.. c,also re, the applicantfor such Lenard to file a signed statement SPECIAL CIRCUITIMISC. to thatlicensed pt III the p fth Contractors Livensc L (Chapter 9 �CLC� (or anemia,withS Y t](NX) fD " 3ofthe :'n.: d Isold,don,Code)or 'TEMP MIITER OR POLH INS"E COMMERCIAL' C,d e C That h spl them I and thebasis theRegal exemptionAny oidia of ❑NEW IihDGIADDH ION ❑DEMOLITION X m LL Seaton 103 LS by any appheam fur a perm t bJ rax the appl t t I'd"mity of OPER DEVICES •W_T+/ rotor than five hundred doll...(S500), \NT ❑FOOD SERVICE F Z�• IMPROVEMENT ec6 0 eSn will it,,the work,andthestrnterro,nar wnJdornRrcd fmride($ce,Il044,Bumr, SWIMMING POOL Iii 'CfRIC - ❑OTHER a, w and Profesions Code:The Comrader'.Licxnso Use Joos min apply m an mane,of DOILF,'LS-SWI'ICII %'TURES 0'3 property who builds or improves th n,and who does such work himselfor through his own a nploycc.,pr 'I d that sh improvements t: a a...it didd m offered for NEW RESIDENTIAL FAC SQ PI'. sale if,It ...or,the hold' , p n I IJ within one y f' plcli,n the SQ.P r#1 ARpR1A SISQ.ET9 p,.erboilder will have the burden of proving In.,he did nal build n,improve for pur- "'// /1 r 1 z � ❑ 1 f theproperty, I : lycontracting with licensed t t .to ul 21 ......t met the p-j d(S 7044 B : dPoor Cot')The Contractors' 1'- n b e . La does. napply t weer fp vey h holds thereon, d Qry.. PLUMBING PERMIT PIiE y�� who contract Lear suchprojects nh atom t (v)Icensed pe aam to the Contnemrs //�� N Litems law. PERMIT ISSUANCIi / AJ OF L�•`f t l l(� [ I am exempt under Sec. .B&P C for this reason LJ Owner Data ro ALTI;lt-DRAIN.4VI:NT-WA'1'I3k(FA) /� o p VALUATION oy 3 55'OR KFHS rarft, ENSAFION DELL,\RATION PACK FLOW PROTGCf.DEVICE D O O I bareby affirm under penalty of perjury one..the following de Oke(', tr,: Ihave andwill mom mina Ccnific'00 of the Labor Code fora for Workersad akin DRAINS-FLOOk,ROOFARIiA,COND. $TflR1E5 'TYPECONS'T'RUCTION ,➢ling,omeh,hd fm by is I... 3)IXI of the LaMrt C,de,for the pctiormnnec of We - Fl I for which this permit is orker, FI%TURES-PER'IRAI' 1 have and will ode,for ,perm.Compenvainn kfor ose,as inquired by Section ]91X1 of tkhee LnM+r Cryod+e,fur the pnrfom(wncc ofihe work for w�hcJb,t{his ,pennil iv i,meJ, GAS-IIA.SYS'I'EM.I INC.40UTLLTS DEC.GROUP TPN /C➢m+corp Onoin.Ifl s'f n+IywrYM NL olio,Nnorarr and yin&" JI —II GAS-IiA.SYSTEM"OVER 4(HA) Y 1 CERTIFICATE 9 TION FROM WORKERS' GREASUINUUSTRL WASTE INTERCEPTORCOMPENSATION INSURANCE BUILDING DIVISION FEES _ Ohissc,.ion need not tmmmplend lfthelnnniliufmmnehnndreddnllars(SI(N)) CRP.ASI?'TRAP y nr lc"J qERGY HECK ITE 4 O Icenify Earache performance oftne work for whichthlspennit....ssued.I shall SEWER-SANI'T'ARY-STORM E\.200 FI'. not employ any Person in any nmnneror arm Mxome subject the Worker:Con+pen- hili O O Z ration Law,of Califomiu.Date WATER II EATER W'IVEN'I/ELEC R ,kADING FEE 0 Al,plicant N N(TfICE TO APPLICAM:If.af¢x inakinF Nis Ccnificme of Escmpnon,you Should WATER SYST HMO R iATING (•' ? become subject to no worker's Compensation provisions of the Labor Lowe.you must SOILS PliE forthwith comply with...E pmOsma,nr this permit shall be seemed revoked. WATER SERVICE Q Uz CONherei—'IONLENDING ACi,ne, NEW RESIDEN'I'IAI.I'LM13. SQ IT, PAID Dote R...Elk C.JQ I forwhicBmnnmand esisued(Suationlenddngagency li,rthe performance o[ W f-( the work Lende-for which lhL.ppnnn rsissucJ lScc.309'1.Civ.CJ '1'A O la tddx Add k Lnuleh AJdm r TO'fA 1 1 certify that 1 have read this application and stmt That the nhnve infonnanon is N 'ILDINC Il?E F to comet.i agree to comply with all city and county ordinances and stare laws relating to QTY. MECI IANICAL PERMIT FEE O Cl IZ building construction,and hereby authorize representatives of this city to enter upon the {/) SEISMI 'abnvo-mnalnned prupc.y ha'mspstimt purpose,' PHRMG ISSUANCE / / %,/ 1 9 (We)agree 1.save,indmnnify and keep here to,,the City nl Cupenin,+agaioH EL 'k ' IEE / habildie..judgment,costs andexpenws which may in any way aectaeagainst said City AITER OR ADD TO MECI. MB 'G FEE in e on thegmto of this permit. APPL A F UNDERS 1) ANTI WILL COMPLY WITH ALL NON-POINT AIR HANDLING IINIT(TO IIk(XN)CFM) C ANICAh R to j�b Sot' CB Idem TIO 5 e' O AIR HANDLING UNl'I'(OVER 1(1,000 CRM) C 5'11(I ) TAX Sig o .\ learm.onto 't ate EXHAUST HOOD(WIDUM IOUS I h11TIGATION FEE AYARD S MAIFRIALS DISCLOSURE WIIltbeap -ant ur future M/ddrogoccupant store or handle harardnus material HEA'1'INGUNI'TI'r01(X).O(X)If1'U) as defieW by the upcnino Moorei,.I Coda Chapter 9.12,and the Health and Safety Code.Section 2.5532a):' BEATING UNIT(OVER 100.000 BTU) ❑YesBY VEN'I'I I.ADON IN N(S INGLIi RF.SID) Lk XNn • e Date keaipt p Will(lie applicantor furore Muddled occupantuse eyuiir Gould) JManawhich BOILER-COMPI111POR 100.00LBTU) mit hozvJous ter connminanl.a.Jclincd by the Ifay Arca Air Duality Management Du..ict^. BOILER-COMP(OVER 10(1.010 BTU) ❑Yes + I have read the harutdousnmmrials requirement.unrdeChapter 5.95od'the Cali- AIR L'UNDI'ItONlill ISSUANCE UA'I'E foie,Health k Safety c m ^5505.2553)and 25534.1 mtJersmoJ that if the NEW RESIDENT LAI.MECH. SQ.FT. 77—%(�/ hmIdm ,w. v. tal,haveam sm ,responsibility to notify the occupant r a of lh nlutn n�nn whieht kern of o CenlI en , tRo eye �Owne Lha' (iced agentI Da TOTAL: ISSUE,fly:��b OFFICE