B 0372 APPUCANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-RLF,CTRICAL PERMIT 'O. 0 3 7 2
Bu1LUlNc DIVISIONAPPLICATIONXERMIT PLUMBING.-MECHANICAL SOOOI
BUILDING PROJECT IDENTIFIGTION
BUILDINGADDRESS: SANITARY NO. APPD,ICAT[ON SUBMITTN.IIA'IE
O N'S NAM P G OR'S NA LIC NO:
/_ NIC CONTRULM
\ be� V
�ANCHITIICTIT E.EW LIC NO: ADDRESS: �'LJ ❑
COMA'1`. PHONE: BUILDING PERMIT INFO
-051 & ❑ Cw Itant Fees Paid by Applicant(Initial) xO I E PL M IEC"
LICF]JSEU CON7RAC")R5 DECLARATION QTY ELECTRIC PERMIT- FEE
I hatch, a
by awl 1 am li,m,,:d ander froo,'iviws of chaper u Icammcming JOB DFSCRIP'I'I N
WOO wlml uml cnud cRecr ivi,ianJofthc Bushes.and Rof¢tiaru Ctdc.vN myianseis PERMIT ISSUANCE: RESIDENTIAL:
1F-.• m A /1Q ll�s��/ ,. ❑SpWL C3 KITCHEN REMODEL
QFZUUj LurA
Daw�Cl•n Cunwrrnr APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBINGRE-PIPE
NRrs' �ARCHIT]i DE N ❑MULTI-UNIT ❑STRUCTURAL
ZOrOn� Iutdcnwal my plans vM1all ln^wd H.vp^MRAII N PANELS MODIFICATION
OZ—p 1 UPTO20(),AMPS ❑INTERIOR [I CHIMNEY REPAIR
a�f"w Licen.wd P,yfc,,iolwl 301-1000AMYS
IMPROVEMENT �SN'IMMING POOfS
ipW U 1 hcmhy aR^n Ih�I mor cx BUIL-El fr Dr th Cann nemep L nnio,law fir the •' OVER Iqp AMPS 11B,VHIH PJ�rjDlil^G 1��Fnb101.1'I'[ON ,
s fd41wine roan.(Scaim 703L5.Rmim.a ami Pmfcsiimv Cock:Any my or cwmy SIGNS ELECTRICAL o�JiE -�(J)f L1n+1"/1eYM"lyl�pyl'T'
a LL which"mres a prnrdt in construct,alter,improve, imtoli,b.or oTsir any vuucma A I G n A d nrj
Cpriurn imiswunce, bo"cimvme fcart forwch pmmob,flea ugrcJswlamart SPECIAL CIRCUITNISC. JSO
tu�Y� tMt he i,li mad pursuant or ire pnlvision,ofdn Cniounwrra Lianw law(Ch:lpler9
,QO (..If,with Salion]IXM)^fUivi,,ion 3ofthe Bmina.mal Pmra,bmn,ClMe)or TEMP.MIlTER OR DOLE INS. COMMERCIAL:
d a e that he is cncmpl Ilurcfnrn uml me b ix for co,allctted cacmpfian.Any violation of ❑NEN'BLDG/ADDITION ❑DEMOLITION
&ction]03LI by any appliam for apmnif sublaw the m[Ailall m v civil Pnwlfy of POWER Dh1ICF_S 0nNANT ❑FOOD SERVICE
wm nwc Run fisc huNrN dollm,(5500).
F Z Y OTHER EMIIJT
E] SWIMMING ownernfec tha mucan mycmplgeo wlmwagaus aia(Sca. 0l1.H.vtitm, SWIMMING PUOh IihECTRIC 11 OTHER
F• mills of.'rtho rk.'acore:he Cor Etntint alaal i'mr, offmfl wc1casfor sale,I, ,,nn Husire,s
01
a� and Itnfaxiw,Gdc:'Dm CnmrmvTiv Liconw Law d�nm apply ei on owter or -SWITCHFS-FIXTUMI
his two
win builds or,irld t s t bch i ural win encs xach w'mk alai f of duaugh
his awn cmpliryaq pmntkd than swh inlpmrnmenia arc int intcmlN m uffcrN lar NEW RESIDM^IIAI.F.LIiCfH I'
ule.lf.how'c,<r.IK buiWlnBmimpnrvm,inrudd wlthinae Ycd—nitat,c f,r ar- Fl.
[¢r-bulhb will M1vvc the M1uNcn nl proving Owt he did nm build m linpnrvc Bx pur-
nrwe.,. ��N
❑ I.vn owner of the pntpcny,mn ,inn.vcly Potholing with nT,a Cancestors i- TOTAL: a
cerswa the pmjecl(Sec.]0.W,ensirofi and rtowon wichui Cadc:) po Ca thma rc ncl 9 799
' u wLawea:.rw arMY to an owner of pngcny won builds mimpnwev thrrmn.std Q'fY. PLUMBING PERMIT FEE v7 v�
wMamuxla far wch pmjms wilt•mnrTxl«(a)IianvN purxuaef to 0e Cwvvnm's Qy
I,lansc law. PERMIT ISSUANCE 0
❑ lam eaem(n aNa see. ,B&roar mix eawn
ALTER-DRAIN&VENT-WATER(E,n N
Own Dae
WORKERS naBy.fCOMPENSATION DECLARATION HACK FLOW PROTECT.DEVICE '
1 hcrthy aRrm am4+pcnelfy of pajury tmc of de f^Ikruing dcclorvtionntE
❑1')
,.pWwilllforbynantso Saw ofCtxiuntto se"-iwtrt for Woxk..... teen- IIRAINS-FLOOR.ROOF,ARI STORIES TYPE CONSTRUCTION
,to pmvidN!m by Sccfim J]Ip of the Labor Ctdc,fv IM1c perfnmwtec of the
Imwhich phi,permil isi Aar' FIXRIRES-PIiR TNAP
.fth roll will maintain Wider'♦Cnmpcnmfim Ir,for,c,as rapaN by fi c rad.
on
of the lahtr Coec.r«Je pert'wmerce of the wuAf�Ir, which lhn pmnit is iawcd. GAS-EA.SYS"I FMI INC.4OUTLEfS OCC.GROUP APN
Wark,' Co 7��ai.y�I�n� carrier and Poury nu rv'
ul ftp-ITS=—Policy Nu: GAS-EA.SYSTEM-OVER d(EA)
CER TIFlCATE Or EXEMPTION FROM WORKERS GREASF/INDUSTRh WASTE INIERCEPIOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(Tbis:nlir,e ag bcsmpcurdd Jn s til idnrmc hmdml dollen D lW) GRPSSETRAP
PIANCIIECK Flil?
I citify mat In the peritrnwauf1h,wak for which thin panni,is i—W,lalall SEWER-SANITARY-STORM EA.200 FT
int cmpby any I�'o in any manner w ax m bacons,sWlacl to the Workers'Campen- ENERGY DUi
O ,•Z, mli'm Lawn of CWdtntia Duro ELE
WATER HEATER WNENT CIR GRADING FEE
Applicant
y
NOT ICE In APPLICANT:If,alley motmg thin Csrdfafc cf Eacntlnics,you should WATER SYSTEMITREATING
E-' benrne wb*l 10 Be Wade,Co rrfamation pmvismsm M the Mbar Code,you mux, SOILS FEE
fmbwifh comply with such provisions or this pnmil dash Is,Jeanal mvokad WATER SERVICE
LA. z the wad CONSTRUCT]ONLENDING AGPNCY w
NEW RESIDFlTIAh PLMB. SQ,17, PAID
Ihaffirm that lbcra isacnnumction lMin8 agency ray Je per(mrrce of
hfc Hr"xilx
U O ba, ♦
which mix pcnnil u iawN I.Sm.J09],civ.C.)
U lsrdatc Nvmc
TOTAL
U Lcakr',AtWrnx TOTAL
1 anifY Ihaf 1 M1avc rend Thi,application and sfa¢Ihaf rn:aMrve i b.no^ie HUILUING ITE
r/aj rnncct.l agra maTnplywithall eityatdawnfyordimvee aryl sutelawa alvingm QTY, MECHANICAL PERMIT FEE
U building caulmalinn,aml M.lty uufh^rim repro enwtivc,of thix city fn emerupm the SCISMIC RE
mm,annemitnN pn,reny fm invpcciioo pmpowc PERMIT ISSUANCE, g O ELECTRIC FIRE
f We)HgNe m rave,itdcnmdy and kcp harm W,ac City of Cupcnim.gams
liabililia.jud8mrnts,mus and eaposn which nuyin anY wnY accrveagumtsaid CilY ALTERORADDTOMECH.
amsyamc of me 8rantin8 of Thi,pcmtil. PLUMBING ME
APPLICANT U ERSTANDS AND WILL COMPLY WITH At,].NONPOINTAIR HANDLING UNI'T(TO io,H08 CIM)
SOURC' EG S, MECHANICAL II?E r
AIRHANDI,INCUNIT(OVERIU,ux)CITD CONSTRUCTION TA%
Sign tic rens V-1� 1 �I EXHAUST HOOD(W/DUC l HOUSING MITIGATION FEE
11"9 RDOUS MAHIR1ALS DISCLOSURE y ^
Will mcapplxnml m fumrc building tKcupwl 4acm MnJlc bam
arod av afcoal I HEATING UNIT FpO 100,000 BID) /00
v&fio t by do Cupeniml Municipal Code.Chapter 9.12,and de Health and Stiety
Cak.Smlion 25532(a)] HEATING UNIT(OVER HID,(KIII BTU)
L]y- 'XNo VENTILATION PAN(SINGLE,HESI)I RAID --
Uam Hcaipt Y
Will d'oPPlicam or Ithaca building by
B are a Air Qu or devices which
rmit hvaNwn air amtwsiwnrs av dcfinN by the Bay Area Air Quality Mmwgcmcm ROLLER-cUMP(311P OR IBfI,(pfl B1U) TOTAL:
DfvrcR BOILER-COMP((EVER 100.000 BTU)
I❑huuc radthc nar> iva•nWs nNuimnxmv umlCT Owpmr 6 93o de Cali. I AIR CONDITIONER Z/gK4) -So ISSUANCE DATE
Rmia HmIT&Safny Calc.Saticurni 5.' 533 and 25514.1 crac tv l mu if the NEW RFS IDENTIAI,MECI I. SQ.PT �O
buildingdic,mwcurz ly havcvemm�,fhw it is my mnpmnibibty to naify lbe pant
Of Blet�Y l.nrt NIISLLLta ofa Q
grnt (IIYY/�t / Ihl TOTAL -1 ISSUED BY: —
OFFICE