28372 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO IIHIMI,NF-ha.h:CI RICAL PFRSII NOI 837
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RI11LDINC DIVISION APPLICATIONAIERMI.1• II•Ilnwwu-MECHANIC L c L
BUILDING PRO1h:411'1111:NI'WICA'IION
RIIILDINI!AADDRI!SSS:� /r/1 '/ ` .J.,, SANI IARI'Nil. AITIACA I ION Null10,1II Ir"I.M.UA IIi
IV L' ' I• ' VC /1 ca u4 UNI l"X J.11/l. L'l.' I-,Iit *1 r2 k. J
S NAME' � I 10 I:: - �. IHC
AO)RO
'S NAMU: LIC N ;
V U i_ ` NIC ('ONIHDI.x
IIIiCI1 NIANITR: .IC NO: ADD FSS; Y L J _ O
]?3 nercAug. S
CON'I'A"I': PnDNI; BUILDING PIiRMI'1'INFO
QTY. ELECTRIC PERMIT IFC
OPPI11.0 19,F('1' 1'IdlM1ll) nlCCll
I'IfltMl'I'I.SSUAW F f-1 ❑
LICIiNSli41 t'DN.I Isn"R'SDIiCOrI( 11(1N APPLIAN(:IiS RESIDRNI'IAI' • \ 1 11)1111 I" 1' nN
OCZ ILv.rM til lion ln;nlandicrnmA underpmviaimm�f(tmplcrn LLan....rncinpwish
ploo❑ .Set'Own NMMI of Diriainn)o111,"srints,I ll'n.lelaivn,Cr.n•.r Iney liken-mi I'ANFIS `
TUU IIdIINCrnrxl ell A. 1 l'k
vFi'<vy Uma.nu('Iva.r� L. �Ila'.Orp"�1(I'.'( HH'1020DAn11!S
-Z-y Con,...Innyla..N�. 2111-IXMIAMOS
ANC')HI'IX I'S UFC....... 111N S0.FI.I'LOOP WAR HA USV,FI'.
(OVER IIMXI AAII'S
»yo 1eemPenn m1 -n:rr pl.nhe rcenn.
SIGNS 1:I.Ftfl HICA1.
CyEj Liken"d Hatea,i....it
KI ,, O\X'Nl:k IIIIII.DER DECLARA'I IDN SPECIAL(ARQ9I/M1DSC,
iOaF 11neh5 Illi on Ih:a I mn eannp,Irnm 117 Clnnaon"Live c Lnwfor Air
% y Inllelinp"a,nn.ISevlian70115R
, aainca led ltnlicninn,CnJC Any eillnl a nrmly 'IliM1ll'.NilO
I I'll R IM IIA:INS'1'.
LL0
NJ while Imp.ire,x pencil In,.nacre_ ,Iw.improve Annoli,l.,nr mp:ur meY.In¢mrc
WYE IPrivmin.i...e:mrr.:d.n¢yui n 11,ca,14:mf lncach rivi.is,Die aaignr.l axlmnvnl POWER DLVICRS
COC) Him hem lirenwd.... nnnnlhe pnwi, of llm Co..caclo. Liamne Lnwrt'nnlecr
Ofenrnmm.einp wilLSa'linn 7lNNII nfOiv^iminl11m Ulninrra:nxl lhnfe..ianc l'rNIk.I 4WIMM1IING 110111.FIXCIRIC VAIA IA'IL IN
os.W-N S,li.11701U Islpl@ereplic...Iorri,ncnitl..lha•xlleged eo•ny4in..,s vyvinl:nirnud
t?Y Srcrirrn LO a Shy an I Ilona KnniLuli I ALe:lpplimnn lna nvil,y,inda, a1 uun.rlS.Swnrluw.Plsl ultl LS
Q Ylep icon 1 Ire.
Oil,mnrc,h:m like bander.)Jnllnr.164 X11.
K F=-'p� ❑ I...orwnred11,.pm.il,.a..... Iuyrelwilbwegcv..vALl.mlcua.yrn\:nlrvt NIiW Rf5101iNIlAI.IfLIC1H -SQ Is]. SIORICS 'I'1'1'P,(I MSIItVvll.rry
a3'= wllldnllr w+ek'l Wiestmnum n..m ionndrdm allcnrllm•:del3cr.7ut4.Iln\Irma.
41 Ill IInIII ,is,(:rxlc'I Lr(Innrrcton,I.weOn,Line Area Or..I.qq I Ina ..1
pugrcrly who Middcnr InN+nerev Ihnernr.:nrd"li-lecs sit(Is work Mnr.cll an Ilnrnep1.hi,
e nyJrryhnild.vidn111nna"nic Tm visalnen,,,rnl..urollnrd lhr a:dv.IL
GCI'.6NUU1• XI S.GNI IS
IxNwc r.ifIh i1rris.gur inlpluu .111 ivm1Awilill..oI bnH.Inlai,rollinn,ILvawncr- 'l(I I'Ah:
neldn7n will have❑er neeenrl.111 pe�ing Inn)ur vin mn L1dm n Lopnn.r Inn p..npn-til
mlr.I,
❑ L:n.worn e.I dee prr. n).mn eaulravmynn11nxfing wilt licensed nnuum, nr Q"I'Y. PLUMRIN(I PERMIT REE Punru zGNl nrN
Inanmt me po4ret(Svc.7Dh1,Mariner%%and Plmreairm.(.11)1:1 Ilm Cnmmcun'a
rvnleIawd.ra ni,a,ll,naoowneral Is...Frclef build.nriaepn..v%jrr.ern.and ITRMIT ISSOANCE
11i'll Mnmrl.ln .Is I.hmfrr 11 w ins a rr ti,...nnla Ii,,n-d Fnn,,iI 1In Ile Cnmm"o"
Liccnac Lor.. AM 11!;_1tRAINh VENT-WA'I'FR WA FEE SUMMARY
❑ 1 nm erempt under tire. H h 1'C lar❑.ia.cu.nn ) 'I:SIDI 9aiS
CK PLOW nll!CI'.01!Vltlli SANITARY 1' N
,,aver Ume RECHII p
GRAINS-Il IN1R. 011F,ARBA,CONU.
WORKM1IAN COM1II'IiNSA PION OICLARA'I'141N SCII(N)I.TAX 1' N
hereby.))iron ILa,Ihme:renifir:nc of.....amm1rl6inmm,arIrcdifr°1 FIX rURIS.ITR'IR
<C'mnlw.vlian lna.ln...rr...I lialr�py dec¢nf lSca.SXlxl.Leh C, kh PARK FEE Y N
ov
nvn..11 cnTSI nmlcllli, eni'. (AS-HA.SYS'IUM-11 '.O)UH-A-IS Kli ITN
I`nlic)'x IL 11FIVISION IT S
fun'I^tiY GAS-I:A.SYS'IIiM.41VIIR (EA) I'IANCIMCK I: 1.
❑ C'enilivdcnlg is hrrehY I ii,hed.
Q (FAlllr.l copy i.IilrA wish lhr riry-imprrAimr division. CREA.SI'/INDUSIRI WAS Ih NI(RUMOR GRADIN' d!E
(TR'I'IFICA'11:Gln I:Xl:kll'I'ION IRO WORKCR.S' GRFASH IRAI' SUIT
, II'F.N.SA'I ION INSOItA CE
1l bin aekl inn herd tint h enmpleled if the,emiitI for ane lnmdmA J.d1u.D11x11 S FIV-SANI'IARI'- ORM(! 2MI-1. ENE G ITI
It
I rafilY ll.:n in the lydnnnonce til the work fora irluhi.prrmil it i¢ned.I,LaI� Nikit IWAl'OR rr /FLITCI'
riI nnpin)'any n in I Inmvr n Or, ar M. r ...Prier, In he ON Ani PAID
z C...olroaatio..I,nw,n1 Camic,I III., W'A'l)ill$ '1111Q/I l i IN(' am Honig)N
A,kv,a
rNU'IICI;I0AITI.ICANI:II,..hrnnakinRlhilf'cItifica -fGun. i,. Or nhr1 III ' I:WI'IAI.I`I,Nll Sp,14. 101A1.:
rIx'er .nnjv,l lI,the WrxAn i Cnrnlrcc-i mpen ,nn.. Ills l.:e r1
, Inniwinlannply wins....),prneisinc,or As,prnmil',hall l •demo "I. IIIIIhUI Ilaili
CONS'1 Ill 1C1 PON I.ItNDINt;AERN Y .SIi15M111
z ILrrchy:I l ioa 111.111 hem iI n a n.11101irm lending.gmnr lar lbe I.. nkr til
Ilse warA for wLiJ.110.1.+min i.i.,nnl Sec.yMr7.('iv.C.1 '1 OI'A L: 171141 HI('19:1.
I.v let,Name
F Iv Is,-Adde.v Ql'Y. MECIIANICAL PERMIT FRE PEGS m•G rel:
V I crony 1h:n I have mad 11.1, ."'IF,"ir,n I I alms nem Ibc A v imi n....i,
d err MI$IIA "AI.111;
eel. lognv unnngrl)uilh:dl oily u.xlrnunly ndin:uu ry nnJ ax Iowa rrlalI"'.I :NMIIl550AN('1'.
M.ildinf nmvIII ,lrm...nJ nrrrly muhn.in nTrczrmaliveard)Liv rityl emmr9rm.lhr ONS RIIC '(IN TAS
'7 Alxm ryom.nl reld,er,rg len in,prv000.pxrlXe-r. AI:I IiR OR AIID'I O NWA 1l,
1Wel ogles ae.ave,ind.inily and keep hmntlexr Abe City of 72x"1
Iobililire indgvrenn.n.sla:mdrapcn...which rc.,cllY w..y Icor...npain,1a001y AIH IIANDIINtI❑NII'(191 V.11(x1(TM)
in .nrccgaenve til tire .Ill.,of❑d,permit. 1 r/y /) I(
C.LL"!-.� / -1i.- /' A I R I IANULI NO I INI'1'IOV F.H I I ION I CFNO
.ignaavenf APFlicn 1111nnoallnr mn, ICCIIAHSI'lIfN111,Wfl)UCII
PAID
IL\7AIt000SMA'IIJIIAISIIISCIOSI1RI; IIIiA'IING IINII'('0)tIKIIXX111'I'IR 1111 1(, Receipt ON
Will ILugrplic:nn on I..Irr,n..ilJing rencapm4 vine nr handle Lunn don.m:ani..1
.'defined try I.,COI At mill 00'.Chapter 9.12.rind nee l leallh:md Salmy IIHA'I ANG II ND'InVI1t I IXIAXI 11111) '101'AL:
('ndc.Srainn ZSSRIaC V IiN'I IIA PION FAN LCINGIJI ReSIDI
❑Yry Nn
ISSUANCE I fli'4'
\Pill Ilse n e,licxnun lnu.m nuilAin �grxarp.rre lose er nipmn Inr Jevicrruhichcnfl ❑OILI!N-COM11P IdlIll OR 00.0(111Rllll
I m
.❑1'ea a...icon a,drlined Pry fire Ray Arne Air Qn.tho'Mxmlgeincnl MOII.I!R.COSH'(OVI:R INION)POP') JUL (J[5
RNo Nl;%'Rl-SIDIiNI Al.MITCIC SQ.FL L 13 X99
I ham rcaJ II¢h:vmduu,nuneri:Jr re9nircmrnlr amlcr('hupfn 6115 rf Ill, _ F- , ' I
Calienni:r I Irnllh R Sawn CmR.Sectio..c 25$115,25511 nnA 25514, 1 Indcn,nnd 111m
it the L..il.ling der.not alncnlly nave n mn:ml.lhnl it is my reNMm,inilify m nufily dee
regrnnl of ehr uvini nr.nv xhiJ1 moa Ir meA tui n m iau.nncc til n('rrlilin¢r.f
lkenpnnar.
Ownr..nat'll ud agrrn lime '1411 A1: ISSI IN II,':_ _
OFFICE