S 1687APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
CITY OF CUPERTINO RUILDINC.-ELEC7FRICAL Pl tl'I'NO.
RUILDING DIVISION API'I,ICA'FIONfPFMIIT e, FLUSHING c SMECHANIL L „ 16 8 7
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1'HUNIi:
t1U1.mR. LIC NO
CUNT CfOkS NAME? LIC.�O:NIC
A NESS:
-
❑0297
CONTROL0
PHONE.
BUILDING PERMIT INFO
Covultnnt Fees Paid by Applicant (Initial)
11LDG ELO PLUMB MOH
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1-00
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NSI!D CONIwsCOR;ti )ECLARSDON
Inanny nfmttout I am Ikensd cover pravi,mn.. a CnPtcr 9 (i oarro ne
siWSectim7(00)ufDivisinn3dne Busitlexsard Pufcssims C« .wdmylianwis
in full he¢c rand dFect.
hoev"Chat, LIaN
Contract -
QTY HLECfRIC PERMIT FEE
JOB DESCRIPTION
RESIDENTIAL:
❑S17DWL ❑ K❑ KITCHEN REMODEL
El ADDITION 19t9LUMEING RFPIPH
❑SIRUCNRAI.
MODIFICA'I'If
El INTERIOR ❑CHIMNEY REPAIRFhF.I
IMPROVIiMENT (]SWIMMING POOLS
❑HATH REMODEI/itEPAlk ❑DEMOLITION
OTHER
PERMITISSUAIKCE
APPLIANCES -RESIDENTIAL.
ARCHITECTS DECLARATION
I untkramd ao Plum Dull M ro sl o, Pohle,'crods
PANELS❑FIULTI-DNIT
TO
UT IIID AMPS
Laecit Professional
OWNITR-BUILDER DECLARATIONOVER
11tently anion Ea 1 am exempt front the Cmlmctur's License Leaf f« dee
Pminns Cade: Any city or county
hollowing mmave. (Smtitm 7031.5, Rushes mandmfe
tahwh m.1Wre, a Parma m calsrma, after. improve. dconhsh, - ,nit any amlcic
prior to its icsatrce. also rrymres de applicant f -such lennit to File a signedsumnem
Wnt h< is licemd Prison, to the prusisian, oftneCmtracsoJs Lien.. Law WnalnerH
(cumuencing w to Section 7") of Division 3ofthe Busiors and Pmfcssions Code)
thtt he k excntp Trachoma and the basis frac be allcpcJ exempriun. Any violation of[IA
Section 7031.5 by my app6cnnt f -a el subjects ole epplicaru to a civilpmahy of
201-HWAMPS
Ig10AMPS
SIGNS E LEC RICAl,
SPECIAL CIRCUITIMISC.
Fi
TEIVIRMNNORPOI.BINS'I'.
COMMERCIAL:
NEW RLDCi DDITION ❑ DEMOLITION
0TENANT ❑FOODSERVICE
POWER DEVICES
f S��LwuwncrnfrhePmpany,
t�F.
A'
not more Earn Lite, handled doll. 510).
nxmycrnployttncairnwlgc as JnWrsolccompensor'um,
Ju de wsxk. maid thcstrucmmn nut notenkJ «oReeN final 7f W. Braor s
willi13� maid Profewom Cede: The Connmasnor's License Law doe, trot apply to an owner, of
pmpeny Ta, Wads or improve, Ilensm, and will, doer such rat himscIf or thnsngh
his two ,mplsrymx, pmvitkd drat such Impnmmrms art not intendedor nlferwl for
ark.lf.haa'ner, ole builJingaimPnrvemcm iswWwithinmeyrnrofeumPMim,the
IMPROVEMENT
OTHER
SWIMMING POOL ELECTRIC
OUTLFTS-SWITCHFS-FI RES
NEW KF_SIDENTIAL ILA;C R SQ PI'.
SQ. IT. FLOOR AREA
SS Q, FT.
n -boiled will boorrhe burdenof pm'iogthan he did not Intid or mpov, N a,-
,cAe of.mle').
1, u owner of the nivIfeny, mart caclusively contacting with licensed ..t. to
TOTAL:
mgrvct rbc pmjat (Sema. 7(W4. lhoireccs Brad Pocifi— ar, Ctde:)'11i, Cmttaclnt(s Li-
xLwdac, not applyloan owoor of pony wed, huilde-inoprovc r iteren. and
Q'FY. PLUMPING PERMIT FEE
who cetmtt� for such pojects cairn a mtwxa.(s) licensed purww w the Cudrstur s
PERMIT ISSUANCE 0
L.iceb,e law.
F1 I Bill excntp mdur Sm. ,If&PC for this reason
ALTER - DRAIN & VENT- WATCR TA)
,•
Owttm Dat,
VALUATION
O O
WORKHH'S COMI'CNSA'TIIIN DECLARATION
HACK FLOW PROI'LCK DEVICE
I hereby a1Hrm under pcnWry of perjury on, oflibel following dccialro av:
_
I Mve and will m art a Certificate ofCrvr.rentto lelf-insure for W«tr(s Carroll
,train, w pnrviJnl f« by Seninn 3700 of rhe Whit Code, for rhe pvidaboo ,c of the
sari lin which lair Pemdr is irsn,J.
DRAINS- FLUOR, ROLE AR E.A. COND.
STORIES
TYECONE
FIX7LRE5-1'IiN TPM'
I have oral will marina. Wrd.er'a C-nperuarcir Initial .-ari mN by Scen.3700.,the LaborCtde.f-the pcAtrmvue uftk work f- which this pvoran os isswcd.
GAS -FI.. SYSIEh1-I INC. a OUTLETS
OCC CROUP
A
My Wo Cm q 'n a a In. mune• osier and Policy nu n
C. Policy N".:-� Ti`�46DI
GAS- EA. SYSTEAM)VER a(HA)
GRIL\SI%INUUSTRI, WnSTF:INTERCII'H)R
CERTIII'AT.OFI% fITIONFROMWORKERS'
COMPIENSATION INSURANCE
JFK/`
BUILDING DIVISION PEES
(Tris -•wren real ore be avnpktd if dre prnnit is lororic hundml Jnllvs($1W)
or �,)
GRKASETRAP
PInNCHECK ITE
_
I,cnifyrMt in tic perfommrec of1i, work fi—loth his femtit ie ie wed, Uhull
not eirroy any Piston in any manner sr ns w tecome au m the Worker' Contpcn-
SEWER - SANITARY - STORM HA. 21X1 p1'
EN17ROY FEE
WATER HEATER W'NI1.T/EfJ:CfR
GRADING FEE
ZZ
union 1<w, of pima. CidifaDate
Apflicam
NOTICE 'I"APPL1CAN'EIf. oHermaking this Cenifcwenf Pempnoo.yeasboWd
become subject to the, Workcee Ctmp,nenitm Provision, of the Later, Code. you tmtst
forthwith cal who sucM1 rovinal or this pcnnitmahmall be deencJrevol,ed
CONSTRUCTIONuctim LNCAGENCY
Lfit, aHimn thentherei isoccl(S 30lendingmagemy for Wefetrnnm.nmd
nn: wank for wmmh icor Itcnmb i. Load (Bra ]rH7, ciy c.)
WAIVE SYSI'Hhl/FRL'ATING
SOILS FEE
N
aQ
� z
UO
u" E•-'
O U
} 0.
WATER SERVICE g• J
PAID
NHW'RESIDIlJI'IA1, PLh18. SQ. IF.
Uatc Reccip g
g
'ITITA I.:
BUILDING hili
Leader, Nems
1<tdc/a nddr,ar
TOTAL:
rJ v
i
1 rani,, liar I have Bal Na1c Wet enc above iw, reiaunn o
lhisty
QTY. MECHANICAL I'F,RMI1' FRE
SEISMIC FEE
(r
y
U
aarl,aaa
eterect. 1 avec m comply wish all ,'ray and trent, ardnnan«r aw umr laws rtladng is
ilh
Mtildingrrwrvrtien. oral M1embi aurhm'ae rtpuseWasivndWucirytncmmupmthc
PERMIT ISSUANCE
ELI!CIRIC dill
above-mentical prnpmy for inspection pagoses.
bocsx the City LCupeninw apotba
(We) agree to save, malkrrmfy and keepmd
ALTER OR ADDTO MECH.ry
PLUh1RING FI!li
O k
liabilitin.judgmcnos.awvarde.apmreswhich tnay in anywayaccrveakaiw sail City
in m%b,raaaafthc ranting oT thin Pernik.
AIR HANDLING END ('1010.IX0K)CFXU pA I
MECHANICAL TEE
APPLICANT UNDERSTANDS AN 11 COMPLY WITH ALL NON -POINT
SOURCI!H' 'TIG
AIR HANDLING UNIT (OVER In.000CFM)
CONSTRUCTION TAX
o
cnDmx
Siynay ppT arlw«WYM
MATERIALS DISCLOSURE
EXIIAUST FOOD(WNUCI)
LNG MITIGATION FEE
HEATING UNIT TO 100,008 BTI)
Will the appliant or furan, brisling occupant aoreorhamlic brontkns numnial
is defin,d by dic Cii,iiao Shoa11U Col (:Wall 9.12, and red Hcoltn and Salcry
Code, Seib. M32h)'!
C1Y„ ❑Nn
Will the licial - furore M1uldia tar devices which
MP g by In,, Area, 1pttrn
emit hvurdans air contmamiwnts a deOreJ hY rbc RaY Area, Air Quility Mmagrnrnt
Di ricR
El Y,1 F1 No
PAID �--"'� �.
Date ReceIN 0
r VVf n,
HEATING UNIT (OVER I W." PTU)
VIEN'I'IhATION FAN fSINGLIi HPSID)
BOILER- COMP CUP OR Ig1.0(k9 BTU)
.,OTA I,:
BOILER -Cf Ii1P (OVER I00,(01 PTU)
AIR CONDFf10NER
Ilwvc ruxl rbc hua:msnn momrilJs rnluircntcnts nark, CTaptcr 695of doe Cali-
ISSUANCE DATE
NEW RPSIDF3fIAL MECH. SQ. FT.
Retia IaIW & tiofny Crdc, Salsxss 253115.25333 cad 2911. uMcmwJ nW If not
m it y osteo nability to nadfy Ice aasrvlrart
rntly have, a serol. thb so
buiklingJrcr rex art
W the mjairerlMWr which lru4 6e met prig it) ivaal W a Certificate of O cul9ner.
ISSUED RY. L,K)A-L,Cc- I
TOTAI:
O..Wiuthori,dagctu Dec