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S 3917 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY a 101iWNER ITY OF CUPERTINO BUILDING-ELECTRICAL bill,IikMIT N� BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL S 3917 BUILDING PROJECT IDEM lPICA'1'ION �DD ADDRESS: �� ��� O � /-�� ^q SANITARY NO. APPLICATION SUBMITTAL DATE ArR 41 WA(4, II n '.'NAh .: PHON:: C NTIT ORS \A .. I.CNO, Wi U L-() NIC CONTROL AWHIT '1'IEN INlili R: LI NO: ADDRESS: ❑ 5- r Zzg 2 sG y2 62 r 6An V., CJ CONTAC E. / „ IPIf is fl ,c) O BU ILDING PFRMITINFO U,( o1ul� V O ❑ Consultant Fees Paid by Applicant(Initial) u.OG ELECTPLUMB MIiCH ���CCC.._.... LI 'IiNSED CONTRACT OR'S DFCLARA'f10N QTY. FILECTRIC '1?I2MIT' IrEf? I Inart aamn that 1 ml,liven+ed order pradshms of Chaptar 9 mommeacils JOB DESCRIPTION d•Z with Sechort"I")of niviriou 3onhe Business and Pndesainrs Cdle,nndnly license is 0 O p PERM]T TssuANcr: 0 SEDWINTIAI: h a e Class sal#Reel. yr R1 F' OSPDWI, ❑KITCHEN IIHMODIl. aF.V U ].allose Clx.c+ Lal N APPLIANCES-RESIDENT(IAT. NQ4 ❑me Cnmmcutr ❑ADDITION ❑PLUMBING NE-PII'li ,�o, ARCHI'I ECTS DECLARATION PANELS ❑MULTI-UNIT' ElS'I'RUCI'URAL Z O y Z I understand my plane"hall be user ns ablin records MODIFICATION OX O UP TO 200 ALLIES ❑INTERIOR O Cl IIMNL'Y REPAIR F�.F.LL1 Licensed Prom......I 201-1000AMPS LMPROVEMIiNT < ,�.J.l OWNER-NUILDIRR DECLARA'I ION OSW'IAIMING POOPS z C¢ 1 mor by ffl Into exempt Gem the Comruclar'v License Low far lora EVER IOno AMPS ❑BAI'11 REMODEUREPAIR 0 UIiSIOLI'I'ION LLa�LV fallowing mason (Section 7031.5.Business and Pralc+sions Codi Any city or county SIGNS ELECT"(CAL ROTI BER 31a,vF� which requires a III to enn<vuct,alter,improve.Jelnolich,or mpmr any lard,d rc pl ianohs innttani almror,...r Ihcoppl.cant f.r,a permit b FJe uai,ma,temmenl SPECIAL CIRCUI IIMISC. ono be is liennsednnnrure to epmd6inn.+of the Central Lucas,Los(Cull 9 uIC00 Rommencing will Swlo.]010pd Dcision3oflhe lotinu+and Poofes+ions code)of 'TEMP MR.I ER Off POLE INST. COM 'R IAL,; 11 la; that he ie elva t therefrom and the basis for the atlegW even Any violation of 0 ONLiW BLDNADDITION DIyEMOLPI'ION ds Sn,a Ir L5hy hundred doll Gtra pannil vubjuls lho uppli.anl In ncivll Pnoln IT ('OWI?It EI3VICE$ `" tmornhan Ree hundred dollars l55(Nll, ❑TI?NANT El FOOD SERVICE F•=< I,as owner of Ne m .,arm Io les with xv es as Ncir sale rem tion. SWIMMING POOL ELECTRIC IMPROVEMENT f D ❑ th w Y Yemp r € pens. Fo l [lot thesweore.....r, endoo nr ole di Insider,l.90 14, caner ss El OTHER eo and all who C.ALa The o,o,inmrs L.ccme Law d.ex nal apply nl un owner of UU"I'LL?I'S-SWITCHES l%TUBI?S �' progeny who nu9ds pr imded that t such i Imo ed lwa rvebt me intended o f f lhnmgh his own ampteren,provided)I r 1c impulveme w are not inmrded nr offered lar NEW ItISIDE 1' , .LECI'k SQ IT. sale.11,bowuvaq Wcbuilding nrimpmvancnl is olid within ran yctro(eninpletiun,the SQ IT.PLOORAREA S/SQ.IT. m hlJ 111 the1 1 fp gthat l did lb e f 1 ) i�� �-�—$ 3 i y s�7 1 Tilt p pnY I :' lycontracting with licensed< In 1 TTM.. a ttsl 'l ll I j t(S ]1110H :.— IP I :Cal )fl L I' t I Ou c e La 1 t ppl 1 nfp pony 1 tnu'ldst p .....th lin d QTY. PLUfv IN PEI2 'rl FEE who t t f hp ) t lh acomract rOI' nsW Pu II l C to t Y Licerso I' PERMIT'ISSUANC. �Ultu �^ It,ll 0 J ❑ I an extnpl under Sec. B.@ P C hr th'am.n'I II y AI;1'F.k-DRAIN R'.VENT- A (IiA'1 VALUATION r yule WOIRKHI'. a M Ivrjuq Lo Dl the BACK IsL(1\4 PItOIIeCT.UC ICH y:—: © O Ihcrcnyalliun un erpenahyorlarfort rnerrine rruawinseemamdons: rU t-J.have and will muimainv Ccnifcam of Conserv mselLinsulc lar Workels Compel- DRAINS-FLOOR.R00P,AItF.A,COND. �qT kI65 TYPE CONSUVRC ION svli.n,Its provided for by Series 3700 of the Labor Code,for the performance of the wor k for which thin Prrialit I x I vvia 1. 171M UBES-PER'I'RAP 0 I have and will not Workads Cantrel line lnsmar ns....Inco by Section 3700 or the labor Cad,for performance ofWe work for x hick thislmnnit is issued. GAS—HA.SYS1'EM IINC.40UTLEI'S OCC CROUP APN My Workers COnrtym'alan Insurance carrier and Policy number are: Carrie# Policy No, OAS—I?A.SYS I EM OVER B UTA) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASPIINDUS'I HE WAS'T'E IM'ERCEPTOR (This scnian recd not be vn,mplewd if the permit is foronc hundred dollars(S 100) BUILDING DIVISIOYS- N N#FEES or I¢s) GRE ASH IRAP PLIML IIGCK PEE /S .f\ I cenipde,in the perfnnwnceofthe xork farwhich Ibis permit ixinsueeIshan VV D natcm t. it) erne SEWHR—SANITARY—S"IT)RM EA.21X1 FT. emptily any parson in any earner awls winner can the Workers'C.mpa'l- lert FEE F � Zi xalinn Lawsnf Callfornln'Dom WA'11. III:ATId3 WIVEN'1'IIihEC'I'IR Z Applicant GRXIII FF.Ii py NOTICE'IO APPLICANT:If,.flea making(his Cerl dente of Evera,unw,you h ild WATER SYS YEML R5ATING alwc.me sub,iect to Phu Workers Compenxatian pmvi-dons of the LabtrCodq you nnmt SO EE I Thvilh cwnply with such polleall+anhir pennn dnall hcdvclned rev"k'L WATER SERVICE Q UZ CONSTRUCTION I11N'DING rigAGENCY NEW RESIDENTIAL PLMII. SQ.FII PAID U 0 k t...hy which II ural I ix sued 11.(See 30 len Jing agency fnnhe pert rmanco nr Dam oipt p � P the work for which thin pennn ie issued fSs.309"!,Co.CJ C) U Lenders Name Y T TILL: Leader's Address 'TOTAL: 0. I cel tlfy llml l have mud ],i,application mid hal"I'al Wo rbevc inlmn.miun I, II OUT rl! a �� y correct.III m'amply wnh all city mol county ordinances and+tam laws tela ng to QTY. MECHANICAL FERMI I' FEF U Z building consdrn ion,and hereby aulh.rim representatives al city m enterupos the '15 'PEE shave-mentioned property for inspection purpo.ves. PERMIT ISSUANCE (We)ugrec In nave,Indenaify and kap hunule.+n Ibe City of Cutofin.vg3tinst FCI'IRIC FP; Iiabilities.juJgmems,niasanAcepenus whkh may in any xay umrueaguinn said Cin ALTER OR ADD'TO MSCI ynI. 'StPLUME. in comcc elf the graining of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(10 10,000 CFM) SOURCE REGULATIONECI CAL FINAL g. i / LAIR HANDLING UNIT(OVFR 10,000 CFA1) CON tl Sisalof Apncu'r 1 Date EXIIAUS'I' HOOIy[W/DI1C'I)VIIOUSIN I'I' IATION FBI3 ARDOUS MATERIALS DISCLOSURE Will the rpplican rfaalm hallding.ccupten.vore or handle atollmaerial HEATING UNIT NO HOLM)BTU) as defined by the Ctgwnmo Municipal Code,Chapter 9.12,and he Health and Selgy Code,Section 2553200T [TEXT IN(!UNfl,I'll Illl,Too 111 lit Dyes ❑No PALD VEMI'ILATION PAN(SINGLE REST[)) Dote Receipt# Will lha applicom or finnre hnilding.colpam ucc upiipnmm or devices wllkh y01LL'N-COMI'(311P 01211M1,Og111'IU .it M1avanlnua air contaminants av defned by the IAIy Arca Air Quality Manegvrent ) District^. 'TOTAL : O Yee ONn BOILEH-COMI'(OVF.k I(MLIIW ETD) Ihme-ad the Nocrdousnateduls requimmcos under Chapter h95 eflhe Coli AIR CONDITIONER ISSUANCE DATE Wmia Health&Safely Code,Sections 255(15,25533 and 25534.1 understand Wal if the NEW RESIDENTIAL MF,CIL SQ.FF. blliea.ore+ant van nyhale}�+�anh nllr.d,rayrepoasihlily l)nnrlfrme."'Psll a the rcynircmcnlsu'Linch , ;lt�l+c t�a_f paal�.iss •l"2-le:nerf Oecu Ovcon,alhnR'! � ' Dn TOTAL: ISSUED by, -f OFFICE