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S 3139is APPLICANTTO FILL IN INFORMATION WITHIN RED LINES • USE BALL POINT PEN ONLY CITY ON CUPF,RTINO BUILDING - ELF,C"I RICA BUILDING DIVISION APPLICATIONIPERMIT PING pRol:DENDF C BUILDING I'ROJEC"f IDEN'rlf'ICATIUN Z Q Q rte/] Z PP, fIT NO. 3139 BUILDING ADDRESS.. SAN I'ITRV NO APPLICATION SUBMITTAL I)A'CE k ©ss� �o w� 3�d % OW iN;SN ME: PfIONI3: %3 CO�fItACTfIR'S NAME: LIO:� Sr X11 NIC ❑ CON"CROLN A RCH ITECT113NGI N IJ! R: LIC NO'. ADDRESS'. CON'IAC'I` PHONES 6UILDING PERMIT INFO ❑ Consultant Fees Paid by Applicant (Initial) RLDG EL- EQT' PI,IIMB ECU p q2S fio2 O 1 t ❑ l}� NJ LICENSED NTRAC'roR:S IiCLn NATION I hereby ai iron mat fear licensed ander pmviaiona ofchapter 9 Rtiettnemmng QTY ELECTRIC PERMIT NEE JOB DESCRIPTION ISSUANCE with Section 9oW)ul Divinimn lhhhe Refiners and Pm@..Ions Codc, and my LmnwTs 'n full fnrennA �gPFItMIT ESIDEL TIAL: DWL ❑KI'I'CHI:N REMODEL APPLIANCES - RESIUENTLAh Liccao la's Lic.M Sib/ U:ee Cannot' 1 (.1—'�'-'�� ARCIII113CT'S DECLARATION 1 understand my plates shall be used e, mhlic record. ❑ADDITION El PLUMBING RE -PIPE ❑MULTI -UNIT ❑STRUCTURAL MODIFICATION El INTERIOR ❑CHIMNEY REPAIR IMPROVEMENT SWIMMING POOLS PANELS UPT020UAMI'S Licensed Prolcasional 201-IWOAMPS OWNER -If UILDER DECLARNIIOR I hereby affirm Ilial I am auntpl Imnt lie Cnnvanor'x Lhenw Law III, the following ..on. (Section 7011,5�Rusinc , and 1'mfensians Calm Any city or chanty ❑6ATII REMODEI/RIiPAIR El DEMOLITION ❑ QrFER OVER 1000 AMPS SIGNS ELECTRICAL which requiresa r.'rtnil to constrict, alter, Innpmves dcuwfnh, h repair day ewcturc SPECIAL CIRCUIT7MISCL pdormitsissuonA,alanrequi:u the applicant for such plan', In tire u signal smtemcat that hu is Leaded phcwmt to the prev wt the Conmmmrn License Law (Chirpier 9 (rommcada'anah Section 7000)n1Id,itind3el the Bn.ineax and Prefefsioef Code) or that he a unman Need rmn and the basin for the alleged caanption. Any violation M '1'LMP. Mi I'F.ROR POLE INS'f. COMMERCIAL' ❑ NEW BLDGIADDI'I'ION ❑ DEMOLITION Saatchi 911.315 by airy uPPllcnnl for a permit mbj¢ts the applicant m a civil penalty of POWI31t DEVICES ❑'rl?NANT ❑ FOOD SERVICE hilt more than five hundred dollars (S500) ❑ I.a.ownerof the Mopcny� army unpinyces ar war Il Decide renpansatimn, will do the work, and the swamre s not intcndel orolfeM Ra sale (See "1144. Bu.ieer. IMPROVEMENT OTHER SWIMMING POOL FIECTRIC and Protea ry Code: 'rhe Conerchrs License Law docs not apply ()an owner of property who Eudni or impmvo Ihvenn, and wino docs ,each work himself or through OUTLETS-SWITCHES-NIXI'URCS his own employees, pmvlded Nal Inch impmvetneah and nal intended hr oRured tar ,are lf, however. the hnilJing ontnpmvcnrent is xoW within nneywr rl mmnplcnlon.the NEW BESIDESrFIAL ELECT Or SQ Il". SQ. FI', FLOOR AREA E/SQ.FT. u -budder will have the burden of preing tbar lin did nm hard hr Imam c for per, AL'. eel saleL he properly, a selmlvely contracting with IiccTssed amtrecod to mamtct (heap Jcm (Sed. 9044, Bu.ines.a and Pmfassioh. CudC:)'IhCCohh,wamr G- mcLawdocsnag apply tnannwnertil'pn,cri, who Fund. or .... Phil, tit ... n.and QTY. PLUMBING PERMIT FEE who catmn1, hnsudn ,ecll .,In a amhuetor(n)hccnncIf nocan m the ContractorI, PERMIT ISSUANCE, Llan It Law ❑ I am cecmpt under Sm. It are P C for this nave ALTER - DRAIN.c VENT' -MINCER (EA) Owner Data VALUATION ��� WORKER'S COMPENSSI ON DECLARATION BACK FLOW PROTECT. DEVICE. I herchy affmn under penalty of Ishillry one of the following declarations: n I have and litcaintainaCertifcate of Crawler msclf-Insure fur Worker'.Compho patio a, provded for by Section 37( of rhe Lubar Cotler for the pedomwele of the work far which the, peranit i. Issued. DRAINS-FLOOR,R001FAREA. COND. STORIES 'I'VI'EC(INSTRUCTIO.Vr FIXTURES -PIR I RAI' and add undentip, as ection Cn p Ikfor which lineurance, or 'sation 33700Eave fdh LaI,orCtd h pkf sp ollie saucd My Cuoricr: �ie h. y�l CAS EA.SYSI'HM-I INC. 40UTLL7S AIN GAS EA SYSrLM11OVERd18A) GREASEIINDUS'HIL WASTE INTERCITIOR ldNrll!ICA�.-�4=•y�OF HXHMPI ON NI(M1NIih.' COMPENSATION INSURANCE (r his section need nut la:compleedit the planet is orore hundred dollars ($100) orl¢.J •1{UILIJIyN4G DIVLU t13E5 GREASE TRAP PI r (IriECIFFEB Iyy SEWER -$ANI'1'ARY-STORM1I EA. 2P) PI'. I ecnifY nh:n In the pufomcanccolWework forwhich this permit is isnucd,lshall north, any pen any m cwrsommOcatme.ubjm m the Worker' Chmpucc ENERGY FEE WATER HEATER W1VEN'19ELECTR GRADING FEE nation Lact California. Dam, Applicant NOTICE TO APPLICANTS If, after making this Cchidcaw hf Faher,a ,you xhould prow Drautsle.n Enhance subject m the Workers Com tion f the Labor Code, you nnlsl WArIiR SYSTEM/TREATING SOILS FEE WATER .sautes tannwdn wnnply who Intrn nm.ilmes err ma permB thou he dnoa,ed revoked. NEW RESIUGN'11AL1'I,MB. SQ, FI'. CONS'PRUCTI(IN LENDING AGENCY Iherchy of Brtn tbauMmi..aeon.Runinn lending agency for the per(omnancn of PAID Ude NmciptX dm work fm which this pelmet L. issued (Src.3( Clv_ Lmulers Numa '1 OPAL Dada', Address a 1 cattily than I have read thin upplindimn and nmol thea the alarve into rnunion ip A, BUILDING NEE QTY. MECHANICAL PERMIT FEE SEISMIC IFF, comet. l agree m euhply with all dry and county oullh:mm. and stye Iuws mlymg to building construction, and hereby aumenae repre.enlahve, tithes city to cacrit the PERMIT ISSUANCE FIECTRIC PEE above-nmwioned property for reflection purpose.. (We) agree,, save, indchnity unit keep humdms Ibe City of Cupertino against ALTER ORADD'10 MECH. PLUMBING FEE liahili e,jealgmcdstests andripsaw, whlcheray in any wayamru, ai,pin.lsuid City in sequence hf the granting of the, Pcrmil. AIR HANDI-INGUNI I GO Io'(Pro CNN) MECHANICAL Fr.E APPLICANT UNDERS'T'ANDS AND WILL COMPLY WITH ALL NON -P INT SOURCE HEG .ATIONS, AIR HANDLING UNIT (OVER 10,000CF14) CONS'ERUC'DON'TAX Signaturenf AppLoaHAZARDO Dale E%HAUSI'HOOD (WIUUC'G HOUSING MITIGA'CION FEE IIAderinOUSMATERIALS DISCLOSURE HEATING UNIT (fO Illfl,flIN1 BTl11 WJllie ands EpalCoe, apteh9teor End Health anmmce ytepCephr lnforum the the Chpernlnn Municipal Code, Chapter 9.y, and the Health and Safety as defiled Chapter HEATING UNIT (GYIiR I00.0111 RTU) er Cede. Swaltin 25532(,)" El Yes .CFNo PAID _ Data Rccci,,# VI?NTILATION FAN (SINGLE I1 x:SID) Will the applicant (it Luum building occurred use equipment.. or devicewhich C mithae,rdoa. air idetanunanh hs adult by the clay Area Air Quality Munagcmcnt BOILER-COMP(3HPOR 100,000BTLE TOONE B(IILER- COMP (OVER 100.000BTIl) Dlstnnu Ycn NYNt AIR CONOITIONER I havcmyd We bamrdhus rearrial,n L. under Chapter 6,95 of the Cal e- q ISSUANCE DATE. NEW NF_SIDENTIAL MECH. SQ. FC fomiv Ilcahh & Sufcty Coda, Sectium 25505, 255JJ and 25530. 1 understand thud nibs 25533 a at it resito'iidiny to realty the oceupard buiMngdosencrear (I hw aI I, Om of qui mann which moa tie pd arm tanuunec ofu Crniliceuc Gccu Owr rr Nor tlabem I Dat OTj ISSUED BY: OFFICE