S 2960 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELE.C'1'RICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT FLOMBING-MECHANICAL.
BUILDING PROJECT IDENTIFICATION:} 77
IiIIILDINGADDRESS: jj SANITARY NO. A�/PPLICATION SURM 19 DXI'F.
lct041 F6a r-,kUrl' 4,-r, l -Z d ( l
42COWNER'S NAME. PHONE: CONTRACTORS SAME_ LIC NO:
Y NIC CONIItOLN
HITCCT/ENGINhIN LIC NO: UDRES ❑
coNTnc r., PHONE ' 1, ,+BUICDINGPF;RMITINFO -
S �O l j 60r., Consultant Fees Paid by Applicant(Initial) REDO Iih�hCTT PLUMB MECII
GY 3Y- til _ ❑ d ❑ ❑
- ICFNSI D CONTRA )R s DI t l ARAI ION i
QTY. CLECT. PEI2M1'I'_I FEE
II nyr1 I tl; 1 � 1 1 p , Ic1olt 1( � b - �� � ' � JOB DESCRIPTION
❑C) wims E 7ouo tD ren 30 tire Bir ndPr<m5' c te,,ndi, acme . RESIDENTIAL
W o C PCRMI ISSUASCF.
~wu+ nfullf ;ecuulof ❑ADITI ❑KITCHENRI?MOD
F-UU DaaAcer, "P'N CcN APPI,IAN('N.S-ItESIDENTInL ❑ADDITION ❑PLl1MRINC RE-PIPE
pntc QmEL L Y
ARCHITECTS❑ECLARA'IIO ❑MUhI'I-I1NI'P ❑STRUCTURN.
OZNz I,mdoramnAmy,ino- ill entered nc Pontic re cord; PANELS
MODIFICATION
UPT0200AMPS .. �o ❑INI'EKIOR 1]CHIMNEY REPAIR
� L111n;ed Proo,ional 201-1100AMPS IMPROVEMENT E]SWIMMINGPOOLS
OWNER BUILDER I3CCLARA'HON OVER (100AMI'S ❑BATH REMODICJRHPAIR EI DEMOLITION
C Q I beer,affirm InW I ad, zrnyd In in the Cononcle,h renes Law for dbe
rnllowa,be ,.(Section 91131,5�Bnaino and Pmfc.N inc,Calc Any city or m,mtySIGNS ELECIRICAI.
a ❑01'HI R
W�W y
which y :a 1 t d t t the, P c"fir I:M1 - 1 - Y nuurc
Eqq'.wd pro tell, I. th a"l 11 1 p lit a -g 1.1'tcmcnl SPECIAL CIRCUI'I/MISC'.
1111 he I : Ip a the P f1h Critical t 1 L Chapter
rG d
w �� than b 'th4 '100111 the
l Idh e 11 oCd),r TEMP.METER OR PDL131N'S 1, COMMERCIAL
W c
that M1 D,tl vat I N::I dl II gbe 1 p1 Ary I' „ .I ❑NEW IiLpNADDi'NON C DEMOLITION
lar, Slelon 91AL5byany applicant fill a pem,lubl ti;ln..uppl .nd .'vl perly of POWER DEVICES ❑TENANT ❑FOOD SERVICE
AZOno, d' 1 d d l ll '(X500)
01 f0 p I>Lry y PI y lh "b "Ih ' 1 ( SWIMMING POOL ELECT RIC IMPROVEMENT
p. "d1 thek and the d d 1intended radiall Se,9nw B : OTHER
14 and Y f..'nle Co la Ih Co 9cii] c Lw ds,col 1,11y , all filln,of out ThIS-SWI'roE5-FIXTURES
4i 5 nfoncrlY who huildv o mpm ev thcrem,.and who doe;wch work hmuclrar 1M1mugh 7.1
nn, ply .....dedt t.ach donfleci are for' i I R W G, NEW RESIDEN'I'I Al,FI.DCI[I SQFT
vale however the Ennoble or bil'o ten nsold with'n neyev 4.....peace,lbe SQ.17 FLOOR AREA $/SQ-Fr.
erbWer will have the Horden of proving diel he did nor httlld or improve for Pur-
pa w"teal').
O 1,m owner lit the properly,em exdnatvely coneecling with Iicen;ed ooidn,alor,or d )
CrvsraOlhc project See,7044R - IIr -. 'C,)dc:)I he CrectionctLi-
lerbe1 1 I 4"lly to it owner IIIl 1 y%ha holdpieves Barren,and QTY 'PLUMBING,PERMIT i, i ;).FEE
I• , -�""''��.�
who ,ecu for v,ch Hill'-elxw lh'.,v c (;l fceneW n, u , o,leComraemrn ' "
❑ccnecLaw. I� , 11
LI I an,csednpt under See .B&P C Er nhix obeen PEiIt MIT ISSUANCE Irl
wn
AI:LIR DRAINRV N'I WAT13It(EA) APR VAIAZI -
�)wn - Date
WOrIKERSCOM1ENSATIONDrCLAR FION BACK II.LOW PROIICDEVICE I
II by ff I p 'lIY fP Ery f0 Ill bit buE �1
E]Thaveand,dflon..., 'C 11 , IL a If' f W k - C npen- DRAINS-PIDOR,ltOOFAItI.A,CONII. 1 STORIES TYPECONS RUC'T'ION
whorl, ;onevaled lair by Scefon 33OOolthe Lai aCar to t "ll"'i of the
work lin which Lai,pennu in mined ITS TURES-PCR TRAP p,1J
❑ I have and will mnin,ain Weaker;ConlacIarain LINnnner,m occulted by Section - -`
39110ol he Labor Code,lon1,1,11onnnnccol dhewnrk for whEch,hivpernin"i"ned. GAS-CA.SYSIFM-I INC40UTLETS t)CCGROUP AIN
My Wake,,Compensation Insud'unce carried',,,it Poll,mdmher ore:
Carrier Policy No: GAS-HA.SYSTEM-OVER 41P.A)
CERI I19CAIE 01;EXEMPIION I+ROM WORKERS'
COMPENSATION INSURANCE GREASPJiNDUSTRI.WASTE INI'F,IICF.P'1 OH
BUILDING DIVIS10N WE
BS
('I hix;0.'dlnn newt nail becnnnplded if thepem,id iN fnrodde hundmol Jollan fSI0U1 GREASC TRAP
orlwed A :CK THE
Ie,air,,M1atI the anny'rand, nfdhewnrk lbrwhlch dhie phe W rker,0,INnn SEWER-SANPIARY-STORM FA 200 FI'.
Hat Il y air, ,,I Y t b fl he Worker,C npen P.NH ,V PFE
Z eaEo I 1�('�11� fee O+f/� O/�0— VAI'1 k 111,A]FIR WAIN'fl1iLECCR
z O Appl , E�"� �1/lam O D GRADING FEE
.Zig NO]ICE TOAI PII u TIf 'k' gdl C t'I -1 fF 1E hould WA't1R SYSI EMff IU TINO
F^ bent"ne v,hjeel lu t W e4. Co ,pe ,r, , pct.e o nN ill 11ho Labor Code you n,q SOILS FEE
wI thwiN comply with wch p,ovie'ians or ibis Permit nhall hcdcemed revoked. WATER SHkVICH
a Q
CONS heROCfION
fallon NC AG i've, WiN'ItFSIDRN'I'IAI,PhMB. SQ,fT PAID
'7 z nremny arh„n,hmn,era iF acnnundcundn lendidns esenty mnheperrnnnunceaf Dade Receinlw
U O the work for wMch tan pcnnh-vi(See 3093,CavC)
W (~
brodr.:Nanc, ATOTAL:
(, Len 1 Addre,, TOTAL:
Haeerily that I have readthis ap1' ta ind dareffialth bove orkson,11.11-1 , i,. BUILDING FEE
Zr correct Lg t II wild all city 1 ly f I.ri lrelatingt QTY. ?I MECHANICAL PERMIT
U dbovey n;reuo Ihcrenyadhorze Pe n,l vunfdn Glyn everelect ne SEISMIC FER11
ubuve-d(We)arenned to
forininiv an keepNba. PERMIT ISSUANCE
(We)agree to save Indnnnily and keep h,dmdov 1M1e Cry al Culwninu ugnimt HhHCIRIC Pi;i
habnal,ludgmcnu.cosaend cxpcnsen which mdry in any way awmc ugainet laid City MA UUR OR ADD TO MECH.
,o;eyuenccof the granting al ddN petrol. YLUMNINGI -E
APPLICAN'IUNDERS'LANDS AND WILL COMPLY W I'III ALL NON-POINT' AIR HANDLING UNIT'Ifo 11,11011 CPM)
SOU(}1(�'�P.RFGUI,ATIONi MECIIANICA SCE
yI�- _��� AIRIIANIl1.INCIINI'r10VERIO,O(X)CPM) CO!J S'rRUC'IY 'rA%
SK-lo nu +VEm onwemr IJeic EXIIALS'I HOOD W/DUCT) HOUSING MITIGATION FEE
AIAIiDOIN NIM HRIALS DISCLOSURE
Will(he eppliumt or frier,building occupant N ore or handle betted—nmmnBl I I1;A1'ING IINI'P(TO 100,0II0 B IU)
ac droned Ity,he Cirr idm Municipal Ce dc.Chanler 9.I2,and die Hw11M1 end Safe,,
Code,Section 25532(a)? I]EATING UNIT(OVER 1(X/1100[I'IU)
E]Yb, V LN II IAI'I ON PAN(SINGLE:RES]1), PAID
Pat, Recent
Will he rapier tat force h 'dding overran,ne,crOy , device,which
not haroadere,anear 1:te,di,fined ley the Bay Area Air Qalily Mmugement BOBT7 -COMPOHPOR10010ORTU)
piNbtctlO'IAL:
Yen NOILER-C(IMP(OVI?R IfX1,I1IX)B'I'U)
AIR CONDITIONER
II' Id n N 't -I y ' t. 1 Clnpt 6 9 fdeCG ISSUANCE IJAI'P.
boria,II hl,&%,Ea,Circle,Sc,ya,25505 25533 r 1255341 orderavold,loil'fha NEW RESIDENTIAL NIECE. SQ,ITT
buil l' bd rcnllyh've'uew0.dh t: n,,onsblty n anddyhe,mp,ill
of nyniree-non,which dnta he metpct rail,Cecorlee of Occup' cy.
Owner or eel Ode TOTAL. ISSUED BY r
OFFICE