S 2270 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OFCUPERTINO BIIiUmNC,-EI.E.CTklCAL PE1j\{+1'1'N0 //�7
xUU,DING DIVISION APPLICATION/PERMIT PLUNGE ING-MECHANICA L v 2270
1 O
BUILDING PROI IIIENTIPICA'IION
BUII.DING ADDRESS: SGNITARYNO. AP%.ICATI(1N SUBMITTAL DATE
/0000 cf, 9-3a-,,F8
(1W : 'S NAME: I'II(1NIi: C RACTORS NAMI LIC NO'
la+ne.. /i na I.c i 1'(n17� i Uw (�j Ntc CONTROL x
ARCHUDICTA NGINEE:R: LIC NO'. ADDR•JIS' ❑
la; 7S-"kms
COM'ACI': PHONE: BUILDING PGRMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICENIED CONTRACR'S OFCIARAI'ION QTy GLECTRIC P
TOERMIT FET?
I Helsby amnn Ilea I am Ikenwd mndcr ooki oa at CM1tpmr,9lcmmmencing JOB DESCRIPTION
X00 'm Stethm 71g11BofDivlximn3 mfthc Buvilecsold Pmfa.i�na Cldl,totality loecnrr is RFSIDENTIAL
COO wt PERMIT ISSUANCE
SF In fullfarcard Rol. ❑SFl)WI. ❑KITCI{IN kEMODEL
aVV Liccnac Class Lit.# AP%.LVJCGS-RISIDRMIAI. El ADDITION �i'tY1MB1NG RE-PIPE
N'Z a
Date Caarxox
FQQ>� ARCHITECTS DECLARATION P\NFIS ❑h1ULT1-UNIT ❑STHIILTllRAI.
Iurvknmwl my plums dull be used as public lea'wda MODIFICATION
UPT020BAM
OZ— IN O ❑IMPROVE ❑S IMMiNG PDOI
u3 LianaW Prmfnalmal 3111-11x1UAMl5 IhIPftO\'EMENT QSWIAIMING POOLS
C Q I hereby atfiml dbut,OWNER am eaemq Gum h Ciminero,Licen.m law Tar me OVER 11x1 AMPS ❑BATIi REMODEIIREPAIR 0 DEMOLITION
x O G Vy. fulho,ing¢>wm.(Section 7031 5,Bu.sineu aW i'mteuima Gde Any 61,^r,—Iy SIGNS I!-ECTRICAI. [I OTHER a
3"N which oc,ita'a ptmul m coronad,alter,impost,tkntmlish,ca ytir m, trociur, yi
C) prior lm its iveluatc.also r,ulme lM:applicant Lu such pnnit to filo it siglod nlutcmenl SPECIAL CIRCUI'I'IMISC. T
gg ylY� hal hcnlicenxYl pllrvtunlwl Itepntvinimm,,f 11.Cannelnr'x l.,,os,1,1 IClulpmf9
aaci Icnnn11—1118 w III SnIon 70gp of 0111/10111 of hi B 1111111/rIJ I'ofvsaiom Ctdc)or 'TEMP.Mt.-I I!R ORIY)LIi INST.
d eC
Si
ho is csmlupl It on4om u1M the htiais ver IW ullegad Ucntpllnn.Any vinlvlinn of N13W ,IADDIT� 01.11RVI
-,N nonim1703L5hy homo scumrapermi1 e11hjn'IS the npplicunn ucivil pcwhy of m>WIiH DEVICES (].PE IIIJJJJJJ r( )SERVICE
not mmc tMn fisc hmuhd tkRlws(SSIyJ).
E.ZY OT OV EMENT
FSa (] I,uamwlernf the%tm1=ty,wmyemphryeeawilhwagas..heir Mdecompenwion. SWIMMING 151111.R,ECDFIC pTHE
Nps wllldn the wtrA,nml rhCnmcmmislorintCtd lmmRlrtJ for.ak(Sa.]f11i,0usirc.�s
a3 and Profusion,Coale:The Con.torli License law dtrea,rut apply m an nT of s eOUTLETS-SW%CIIES-FlITURE
Rs owsm who builds or improves t such
on. ,amvem drlca such ime ixi or-Or llwugh
his tart emplyecs,plmidN Eat such impmvcrslmw o2 fix intrralW a oReml for NEW RF'_SID1E1aTInL EE.I:CfA SQ
uklf.hnwewx,Ile WiWingmimprmmlrem is EI withinarc year ofcmlpMinw me SQ.FT FLOOR ARBA S/SO IT.
ons er-builder will base tfr W Nen of Ievvin6 shat he did not Fund or imitation fix par-
paw mf akJ. BY
❑L as matter of tho pospeny,am exclusively nsmmeting with licensed amrrmma to TOTAL
unnrucl the proj¢I(Sm.71144.Bushes¢and P-ofusions Gde:)The Co Emooru IJ-
Mwwlsw dies wtapply to 111 mwrermfpopmmywM Will.tx improves meleon.and QTY. PLUMBING PERMIT hili
comtrucl.fur cath Projects with a conma,om11 IiccnwJ fwwuam w the Ctxvmcnrc'.c
Liconu:Law. PERMITISSUANCE
❑ no—si,lnpI I...kr fico. ,Bit,PC hx This lea
AUFFR-I(RAIN h V ENT-WATER(EA) VALUAI ION
Dw1er Dal, Ov
WORKER'S COMPIN.SA'DON DI!CIARNIION BACK 11-OW PR(TI'I!CI'.DEVICE
1 hcrchY allinn uNrr Ielully of petjury txc nT the tullwin8 ded:wlitxu: p
�Ibave std wllllvinminuCenificcamfCwarnnn wlbinwrtlilr Wmke/a Cnmpen- IIRAINS-Il.(1(1R.Rf%11t.ARF.A.COED. STORIES 'rvl'E CONSTRUCTION
f wi.n.v pnwide!for by Secdtu 3700 W the I� Cole,for'be perfocrol of IAC
wools For which this terror is iau
aed. /v FIXTURES-1'ER'THAP
n I Max caul will maintain a1'ohels Co npentanion Insurance,as required by Sohn
3701 lshx Cole.faaeperf.e.f Ek wort Est this pemril it Leased. GAS-IIs.SYS-IEM-I INC.S OUTLETS OCC.GROUP APN
My WorAe Com cmop auc end Poky pyq [. ;
Curie g Policy No. �r`4C,0/ GAS-G\.SYlTLM-OVER n
C13R'TIIYI ATE QFEK 1PIlON IItOM W11HKIiRS'
COMPENSATION INSURANCE GREASIYINIIUSTRI.WASTE INTERCEPTOR
BUILDING DIVISION RIGS
Ohi1 wzrnn nett not W emmpineu inhe Ilsrma i1 fix m1e M1UIndmJ ddlan al at)
or Its.) GRIASE THAI %ANCHF,CK FEF.
I codify tlwl in the perf.cefncc wtxls for wM1ich this P:miii 11 ixwd,T shill SEWER-SANI"FAIRY-S'ITIRM P.A.NMI FT.
nm employ unY Ec-o m 1my mn
an ,v1 as m Ixm vnnwlhioll to so Wort,"'Cempen- ENERGY i
� Z eminl l.uw.s vet Colic'mitt.Two WAIVER HHAI'IBE WNIiNTATI_ECTR GRADING ITE
O Applicsnt
I SITE lCEBE APPLICANF:If.aft,making this Ccnilinnc of l ixcolplmn,pu should WAI'HR SYS'IINfIBEATING
hecolts, hjetl 111 the III Cmnpensntinw pmvirioaa of I W lubx Cock,you mum SOILS FEE
^, Bmhw'ith comply with cath prmvhiolu or mix pcnnil shill he deemed revtkul. WATER SERVICE
a �
5Z CONSTRUCTION LENDING AGENCY NEW RCSIUFNTIAI.PCMB. SQ. PAID Dam Recti x
U.
I necc y affirm IMAs Bore is a constructions ending agency for the IerRtmurce of OO••'� pl
Roo wad.foo which this Pemdto,ia.vixJN.(Se,UCiv.C.) pO
U. I"' larded Name 'fI1TA1.
U
1<mkr'a Addllss TOTA V
1 cenify tha om I have rd this li'licatisn and mu11,u the those inforn mm BUILDINGFEE
is '
Ffn coot l ugrtno comply with al)city anal tummy twinanaa and mime laws mhangto QTY. MECHANICAL PERMIT FEE
UZ building cnmtntetim,awl hertbylimbasVa repR.¢ ivR nncfmildlY m emer,mor tie SEISMIC FEE
almvummmtiored pnlpcny for inspection putparea. PERMIT ISSUANCE!
(We)ague(I)case,iMnnnify ad lsccp hanalc.cs tnc City of CuNrino againn ELECTRIC PEE
Iilhilliu.judgmcnll,nnB urd expenses whi,h,I,ty in illy any uceme ug amt aid City ALTER OR ADD'11)MECH. p/
wyceleeof the granting
his penlnil. IY.UAIHING FEE �W y1 a/y''r�11
AVPIACAN'I'UNDCRSIAND AND 11 OMVLYWHII ALLNON-POINT AIµIIANDLINGUNI'I'T1T11f1,11(AICFND
S( RCI!RE 1 S. 3 MECHANICAL Rsl:
AIR IIANOUNG UNIT(OVER 111.a1B CIM) CONSTRUCTION TAX
S WComoucor J V Dare EXHAUTT'I IOOD UVIDUCT) HOUSING MITIGATION FEE
HA%ARDOUS MATERIALS DISCL(AURE.
Will the applicant or fuom Willing mitt,am Mae or hustle Imoirdltu lnca l HEATING UNIT(TO 100.1100 BTU(
as defined by the Culeninm Municipal Code.Chtger 9.12,and ax,health and Safety
CMe.Sectio 255321a1^. HEATING UNIT(OVER 100.000 BTU) /
E]Yes El No PAID le6a 570
VEMILATION HW(SINGLE BESIDE
•
Will the t licam or forum hat"o t use ate Receipt x
Pp !by thoen Area
Air entmtka'ianagemi ROILHH-COMP OHPOR IW.0011 BTU)
mil hauJnua en nmlOnnniwmc a1 JefireJ by rhe Hay Arta Air Vuality Mtnagrnenr
fm unci l BOILER-COMP(OVER 100,000 BTU)
E]Yea ❑No
A I R CON DI'I I ONEN
Ihusc S.Itl M1armdmlmai25SP, irmrcma11155.Oupvo.95mf Ota Cvli- ISSUANCE DATE
fonsia llydtnk g'nlrsiCnk,vuliw25A15,25511 w,a,i31.1mwlmlatd that ifIW NEW RIiSIDI!NI'IAI.MILIi, SV PI'.
Ilitho11gdcamet sshich hawaIcnenl, Ill oismy vNA naiblllty In1.1Urmculnnt
ollW miulm11en1a wnim mum Wlmt pour to iaawmce tJ uCcnlliru¢of<kcuryrcy.
Owler fir uutMxinnl agent Date TOTAL ISSUED /l�7
OFFICE