S 2997 APPLICANTTO FILL W.INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY r5 is •
LAC
CITY OF CUPERTINO BUILDING..ELECTRICAL ( PERhU'I NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL Q 2Q97
BUILDING PROJ ECI'1DENTI FICA(ION SANII)\Hl'N'U API'LICAIIUA 9:uM1lr1'I'AI,DATE
BUILDING ADDRIi.
<, Ale `t Otis S 21- �a
I OWNIJCSSNN1A /'fP/}IONP J [(IMfRACI'.O..HC'S .,N 1 hI(�jN.0 NIC CONTROL"
/�r://.1 A_1 S�^ry/��p ADDI2/U/{�y ¢�/]jA ('�K zo-�lgyp✓
�.CIIITEC'rl1iNGINLI:N 1( �!J( �<ll `J%` b r (J'/\- / - a l ❑
CD C'r, / 'ilo�N1/L� BUILDING PfiRA11T INP0'
— I/"� / /.� - , / �Q ❑
Consultant Fees Paid by Applicant(Iniriaq I y, I7IL(QF�}C1 PLUME MI:CII
1.ICENENSGu CONTR~ACI OR:S DECLA A'1 IIN ' - ' 1
QTY / ELI:C'I'RIC PEI3h11T I°GI3
I arch,aina m,n I.0 T been.ed under pnnmmn..of Chapter g(cnmmenang _ J013 DESCRIPTION
�Mez an Section pgXB ol))is n3Tot thefoldncs+and Profess:/rnn Code,and nghccia, > 1 RIE�'IDF;NTIAI:
4a'W O Llcen+o CUssnJ cflnl.ter "I« '[1'7"' `'/_ '�' � AI'PLIANCESA RE'SIDF.N'ilAh ��I w LJIAIDDITION O PI UMI{INC RE-PIPE
PIh
h<i Dale--rye-r.-.�-/�(-�`� �c:�nuucror
H5m • �' —TNCMTISCTS DECLARATION PANELS ❑M1fUL'1'I-UNIT ❑STkUCI'UItAI.
Z O rn Z 1 understand Iny plans%hall he used as public r<conh I MODIFICATION
� UPTU 2q)Ahf AMPS []INTERIOR ❑CHIMNEYITIFFAIR
P4LW Licctised i'mfe+..nal 1 201-U)SOAMPS INITROVEMEN'I [DSWNINIINGPOOLS
OWNER-WILDER DECLARATION outfit luOU AMPS [I BATH REAfODIiIJkEI'AIH ❑DIiM1IDLITIDN
IX 6 1 herehy of ina Ihal 1 am en<nipl In,.the Comracmr'+License Law tar the
kC1U Iolhosngre.,on lScnTOe)1111 S,Ba+ic— ad Pn II++"n+GNC Any coY of caul 1, SIGNS ELECTRICAL ❑OIAL'k
W 3 0.N which regmre+u permn m um.nat,alter.Improve,d<moh it,or repair any.maure
st poor io us issuance also mgmms the r"IcanT fnrwlh'enniuo Idle a""o-id,cu,nanl SPECIALCIRCt ITINI1SC.
f�}, IhA hu.111111+111 punn.uvn ln,plovl+Inn+ofthe Conto¢mr'+Liceuse Low lChap¢rg
waapOfnvnmennngwuh Secuun]gN)lnl Dlvi.nn3ofihe Bu+mc++and runes+iomcodc'ur 'l ITMl'nn I HR OR PULL INS I, COMMERCIAL;
t1 d y Ihul he n cx Pl fi crellmn xud The na+n Lis the xll<pcd cnemplac,Any umlauon of ❑NEW IiLDG/ADDITION ❑UIi1fOLITiON
��(( LL• Secwm"1131 S by Tiny applicant fnr a PCrmn wb Ocn,hc appluanun a nnl penally of POWER I S
yl�yt ❑TIiNANT ❑r(lOD SERVICE
FZ} Ton mnrc then live hunJrcJ Jnllan 1551Nt1 IM1IPROVEMF,NT
�] I,a+owner of the property.nr lay emPioy.cs wuh wag.+as theireole compen+anan, SWIM1IMIN TO IH
^� will do the work.and the structure is not intended or ahead or sale l Scc TISJ,B—or, LL ❑O'1'HIiR
63� ad po'lm+Ion+COdC The Ouardlo n Llccmc Law due+nut apply to an owner of OUTLETS-SWITCIIE TURPS
pmpcny who holds or unpmres tnemon,and who Jucs+uch work himsell or through
nn own mnpluybm,pmmdcJ Thal web Inipro cool h+arc n"I aluRded uI ullemd Inr NEW RESIDBNTIAL'Mi'ICI k SQ F'1'
sale IChowewothcbuddmgorin......nnl is old ohm one yearn(cona,duurr the r SQ FI'.FLOOR ARE S/SQL FT.
udder well have the ,do,of pmemg Ih.0 he did nut with a d contr ,Inr par- `7j'�,L V� i 40107. 3381 �
Paw adI I
weer of Ins Sc� 704,am j,aus and Proo dons xnh nfThe C Gtr ncomn to
,cl,c construct The es nott p,ly 91FSa, iu+Ine++anA I'nd who build,Cate)Tireoc,Recent.LI-
e +e ouraO,E, OTplymao oulmndpnLWTIy xhnhuddwnmpmves Recent. ad QTY. PLUMBING PERMIT, FEfi
who ennlracl+inr such prolecn wish a mninu¢n1+111tenseJ pul+uam to the CanTra.hrr+
LoInsc Law, 1'ERNIIT ISSUANCE-
❑Iameaempl order Scc .R 81'C mr this reason
naT. AIdIiR-DRAIN d:\'ENT-WA"I IT II:Ay �-x VAIAJAlIIO«N
Tone/ WORKER'S Ct INIPIINBADON DIiCLARAI'ION HACK FLAW TROT EM..DEVICE
I herchy affirm under penalty of peryury one of the follcasmag declaration+ 7
ihmcand wall mamOln aCerWicmcnt Current to,cli nsu11fin Worl.cr'+Qunipen- U RAINS-FLOOR.NOOF.AIZEA,CoN. STORIES / 1YPECONS'1'RUC`HON
atio..as Pow.Icvl for by Ice.on 111111 of the LaMTT Cal,for the pCRonnan, of the v
Irk for h,ch,hl+pemin nnsuN FIX,Cops-I'ER IRAP \
1 hmc and w 11 talnmll Wul Acr'+l'ungmna I o Inwl,mtc,.o rega red by Se hoe
3]1X1,1 thel nnwce of OS work forxhmh this Mrmni+nwcd GAS-FA.SI'STENI-I INC 4OII'I LIi'IS t OCC GROUP AP
Nly W'orAcr' 'o an ul Irygr,are carric Poac point,TTtlluh,Tore ��r'L_`
Canter F GAS-EA SYSTENTOVER 4 WA) 2
CIIHTIhIC`IMPEN.SATION111S 1 NC�5,IS 2- GREASFJINDUSTRL W'ASI 17 INTERCEP I OR D 7�
('Ho,ccum Ice d nut becnlnPlvteJ lithe"emwi,to.one J IS,SI N1) 1 BUILDING DIVISION FIiIi.S _
or I...I GREAS EIRAP PLANCHECK I M: �V'
Ic<mfythatln the pedomunIcoflo,x orl fnr which Ilak,cimn l+....ed,I+h.11 SEW'Ek-SANITANI'-STY)kh11iA 2BB Pf
n.Icmphry an,Person m any manner"o.VObcumm+Tibjel.- the Wod.n'Cnlown. (ENERGY TEE
zz +no Iowsotcaliforn, Date \VA'I'IiR fIliAT17 W/VENT/IiLECTR
Q Applicant GRADING FITE
5 NOT]CE TO APPLICANT' IC Ile,nuking this Ccr ou.nic of Eealpuon.You should I WA'I'ITO SYS'I ENVfRFAPING
a 5 betac u],ON to the Worko"Compeusnuo.Pmvi,u ns of the],No Gale,you n o. SOILS FEE
i nthwuh.air ly with wen pro......n.r Wa larmn ehdd he deemed mv.AOJ SAT I:R SERVICE
I L Q
az CONSTRUCT ION LENDING AGIiNCI' NEW IIESIDILNI'IAh 1'LM1f{, SQ FT LAID
U O In... allirnl❑Teuborl l+a cunamcunn lending agency rn.the performance of 1 Unl< c q v
- the work for which this pi is issued(See .Ayd/,Cn'.C 1 - -
Q(~ Lcnder'+Nunie ,« V L'U'1'AL:
U ;Lender'+AJdrc•^ C 1favJR`.t,\•�li�—
d1 eenify out I fusee read Ihn a,ficm 0 and me that the abuse mf'aar'ln I+ BUILDING i E 1 1
LF. p] amm� IaprccmcmnPly wish all coy and county OrJlwnw+anJ+win taus rclaingm Q'rY. ML•CHANICALPERMIT - FEE
U Z building....notion,aad h,uby authnnnrepres<nwuvcsofthl+Illy"eno.cupnn the �' SEISM1IIC PEIi C� �
nbowmtennonerl"'Illy Tar uep<cuon p adall` PERMIT'ISSUANCE
(We)ag o,w,c,indemnify and keep harries.the City of Cupenlno agaly. ELECTRIC PIiF. / �^ �`♦�
Imhill....co,cofbeurac,ngofdenms which may many xtryatervcapam.salJ Cuy AUI'IiRORAUD'IONIECU PLUNII1NG FEE
ou con C IT O (the gmIANof IA Perron
APPLICANT I TANDS AND WILL COMPLY WITH AEI.NON-POINT' AIR HANDLING UNI I'lTU 14utxO:TAt1
MECHANICAL THE/
Sl1LIRCE I1EC Jl.r\ILO S.
AIR HANDLING UNrTIOVER 10,000CI'MI CONSTRUCT ION fx
t Ipnawre ppl anVContmcp Date EXHAUSITHOODIW/DUC'C, HOUSING MITIGA}}}�I��r,,,�C�
pPbI OU3 MA e, UISCLOS
'riNG UNIT I'IO IIx),IXNI ITIU7+ant or finite hmlding ccupant.urc or handi e hmdiousnnceal HITA
de. eJ by the Cu,.a.N unicpal Code.Cha pter l 12,and the Health nnJ Safety C Je.Sction '
"
355321ai' HEATING UNIT(OVER ltx),gxl BTll)
❑Y,, ❑NO
' I VENTILATION PAN(SINGLE HPSID) (PAID
Ua¢ Hecelpt«
III .,at,p orate or future defiong anleaB y A eyulpmcnt or devices which
( Jim fur nmtammanln.n Acfnedh the Nay Arta Air QuaW Is or¢,Inert I{OILEk-CO\11'(3f11'OH Ig1,gN1 BTU( I
uml° - BOILER-COM'(OVER flidWOT BTU)
❑Yes 0 N
AI It CON DI I ION ILK
Ihnvercadtheh ode,S,oun 2550515533 do Under 1 undersold Thin Call ISSUANCE D^T
famm Hdos &Safety Code,Se, otnI it 1,:5531 and 25531 IundenstanJ N:n II The NEWRCSIUIINIIALMECH SQ FT.
bnIlJing,Lmvom is nil eatencIh.n It l)my rc+pmxbllnyumoefy Theooeupam � .
fth ICgmmii¢na hm ahe ntcltlr/nyrlsvuapria.Tfa CenJicard of Occupancy i-� •_y^
tnnumhnnz <nt,•i / T Date �f�I">
IssueD BY�
OFFICE