S 2029 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRIC L PEfyyIT No. 2 O 2 9
BUILDING DIVISION APPLICATIONFPERMIT PLUNIHING-MECHANICAL
J L L
BUILDING PROIECF EDF.\I'IFICCTION
BUILDING ADDRESS: ro /y 9,1/ � ��. SANITARY NO. APPLICATION'SUHMITTAL DATE
OWNER'S NAht I?' / ClY t4a ill PHONE: CONI ACIUR'S NM1E: LIC No,
3 9 0, r 9 G Y NIC Go rnoLN
WWI
AN1911TEC'1'IFNGINI!ER: LIC NO'. ADDRESS El
A2 70
,r< / v�• �m G❑
CONTACT: PHONE; ZBUILDING PERNUr INFO
❑ CUnsul18n1 Fete Paid by Applkard(101(181) B.LR. ELECTPLUMB S1LOI
�hPs 4 $or7Z. ID ❑
LICIiNS'IiD CONHtACfOR'S 1I!C IION QTY. ELECTRIC PERMIT FEEI bereAy uErm tw I am laen.rd ontkr nmvmmn.of(Tape,9(,1 Nrcing ]OB DESCRIPTION
WOZ wall Seaian7000)of Division l ofthe Busacss vw l'mfeamns Cuk,ad my lian.,ek - RESIDENTIAL:
L+IOp PERMIT ISSUANCE
Falx enroll forccud c�Zs pT 9 ❑SFDWL ❑KffCliFl:RFb10Ul!L
wUII--�� IJc Clnv Lr.I •XA
Q U AI'IX,IANCES-RLSIIOLNIIAI. [I ADDITION ❑I'LUMBINGMPI%i
Ilntc 7`SD r
ARCHITECTS DECLARATION ❑MULTI-UNI'T ❑5'IRUCTURAI,
I..,ptan PANEIS
' ZprnL IuWcrwutJ my plan.swlMusduµblic nemtl I MOD(%CATION
OZ`"0 UPT02DIAMPS ❑INTU[OR 125�HIAINEYREPAIR
F4t:w Licensed Pnaevdmal 201-1000AMPS IMPROVENIiNT E]SWIMMINo PoolB
OWNER-BUILDER DECLARATION
OVER TELU AMPS ❑HATH REMODEVREPAIR ❑DFJ.fOI.TIION
dQ 1 hcmby eBlrm nor I am nmmp from the i,,wh,lCo,License hw fm aly
U which re realm, enhut t 9H.n1 s•B ether, ed Pml'cvsions Cuk.Any city is racturY SIGNS ELECCNICAL ❑GTHIiR
41�+al which requires sramal tecmumtt+hecimpose,h c Tish,artivigally ncemec
�l sior IT heixhewwmgatoi,cr Jcvisionon,for sochlmoesikenw Law(Cbamen, SI'IeC1ALCIRCUTnI15C.
(namei.slianwit,Section tone,,(Dry ion3.f Cm.,inc(s l.icena law(Cnaper9
C y.da (cammsm inpwitnSmion]IXnd)of Ulvlsinor the a Huvircwvvld Pr.Any vi CMc)or TITIP.MGTER OR POLFSINSI'. COMMBL AI:
u:_pO
a a ey hat he is Hemp,herefmnt and IbC hues f da:ollegd cacmption.Any violation of [:1 NEW BLIH'i/ADOITION ❑DP_NOLRION
W_N Salim 7031.5 by vnyepplicanl forapera lsobjc.thcapplicnnrto a civil pcnoth,Of POWER DEV ICES ❑TENANT' ❑Ru)SERVICH
f,Z} nR mor,than five hondtd JolWs(S5(N)). IMPROVFJJFNT
d ❑Lat.w'rcr oflle pupeny,umY ernrlyxs with wagcaudetirwk rnmpcnmior,. SWIMMING PAIL ELECTRIC
Fp will do the w.xk.and lM awuum ie nor mmmkdunacml fu,alu(,Sec. wnmcm ❑OTHL'R
vrd PAI I—CME;The Cwlmctors Liamc I,w des.,
apply w vn trrcr of OVH,EIS-SWI'rCHFS-%XTURES
�' pntpcny w:boar,or impov¢ihercon,and wN,Ms such work h m¢If or,hmugh
his own ,r,loym,phoOdec fiat such imrrovchn is art an.imennrld m olfcrd for NITW RESIDENTIAL ELIiC'R S
sale.ILhtnevcr.thchaddingarie,wrcmcnt iswtW w'ithinwc Yarol ctrnpk,iunac :Q 1'.FLOORARE- SIS().FT.
builder will have he huNen of h oving that he did sur lvild m impmec lrµr-
pm
1,m twmnnnf the pecten,,.B c3 affil
omtwcaing wan nahe Ccnnwao, - 'C(I'PAL: L
,c.w Ll de poject(Sec.]DLL RocrorI surd Pr .ho ors i1b, The c,Thar,'.li-
w� ,chia.camanpPlo I,ilhcndoacolywlrnnn lel ahrrnthe meth-t e,d QTY. PLUMBING PERMI'C FEE
hu mn,lans for web pojcc,a wish a emarctrr(0lianadµnuannn the CommI
License Le, PERNR ISSUANCE
❑I sun camp unkr Sec. ,H&P C for this rcawm
VALTER-DRAIN&VIEW-W'AIER EAI
Owner Uw° l VALUAT'IUN
WORKERS CONUMNSATION DECLARATION HACK FLOW PROTECT I)M- CE
I huchy ooirm suck,Icnulty or%jury TO—Ino tblluwing Jttivm ears, V V
❑Thaw surd will mail4ainaCmifcateofGmscnl msclf-insole fmsNodwr'x Crnpn- DRAINS-FLUOR.ROUP.ARIA,GOND' STY IES TYPE CONSTRUCTION
of m pnrvldd for by Scntm]]Ila oCne Labor Cole,for the Icdboranc of be
wni,h thisµmol is iuucd. FDITURES-PER TRAP
IJ Invc vnJ will maintain Workers Coon III ran hnofaoee,us Iryuicar by Scetiwin
3700 ofac Lc"Cde,for lncµrfmmuncenf the work for which this tenni,is iuoc,l, GAS-i!A.SY,STHII NC.40UTLLTS (ICC.GROUP APN
M1fYW aC sutra conic,annul Pricynun r
N rn b
Carrie n Poll, GAS-IiA.SVSIIiM OVER 4(IEA)
CERTUTCATEO E- 1:sU`UONFROMW cKrR9
CO,M I'INSAI'ION INSURANCE GREASEANDUSIRI.WASTE INTERCEPIUR
BUILDING DIVISION FEPS
(Bois aecum acrd not be crsPlud i06eµ,mil is fume hmdrd SOPI(SlfMll GRIIAS17TRAP - ---
or Ic.o.l I'LANCHECK IEE
I amily that in the pc,fm,uanaof frI forwhich nisµrmi,is ren.I 1a11
pSEWER-SANIARY-SURH .aIT.
nut emloy toyµuin any manor,w eobecome w1,cOo the Wmken'Compcn
ENERGY IEE
OZ, -,ion law,of Celitrniv.Dorn WATWJ HENDTX WNENT/ELECIx
Z O ApfQicTr GRADING FETE
I
rte+
WHICH PO AVVLICAO r.If.after naki,duv CrOdwatauf LNemptim,ymshimld WATER SYS( VTRFATING
a > bee wI to de Workers Canfcas,tion pnvmons M the Iwbor Code,yvu maw I
nnti m-E
fnnhwith can.ply win sun pnrvlm c,it this Kron,ioll the dmntd,uwkd. W'AMR SERVICE V
Q
CONST RUCHON LENDING AGENCY NEW RESIDEN-HALPIAlft. .fT ID
Z R.vci N
Uo IlmcbfTmn
yvlhmms
them is agcnylonhcµrinmtonacnf Asuwok J N 2 p
e fu whichis Per-frit iv (Sec.Ja9],Civ.C.)
� '� 1<nde/x Nunu 9TOTAL
yO LUL7 Icne,,,AJJrss eTOTAL:
C y 1 acr ify that I have read nix ii,ilown and sone fan,he recall,informvim is - IIUILI 'L'
currtck l agme mmmply wile all city eM,wary ordimnas and stale laws minting to QTY. MFCIIANICAI,PER Y FFE
U Z SEISMIC It
��
building nnsl,ucran.and hnehy vulMrilc rcpewntuivn ul thus city leaver ulr'n do
abovemenliioeJ poµ,ty fu insµctim rumrex. PERMIT ISSUANCE
(We)agree 1.evve,indemnify mgt kap hurmka+the City of CuPenioo.gaunt FEh
lianilnio,ludgnwnts,nnm'mAcapervsc whish may in any wary accrue ngoinst said City ALTER OR ADDIUNIECIL
in arseyucm of the granting of this pc let. PLUMBING FEE
APPLICANT TIN OERS' )S AND WILL COMPLY WITH ALI.NUN-POINT IAIR HANDLING UNIT(TO 10,000 CITU MECHANICALFEE
SOURCE RF ATIO 5.
'AIR HANDLING UNIT(OVER i0d"CFM) CONSTRUCTION TAX
Sigrw, oArMiantnmu�mr Due CXHAUSTHOOD(II II HOUSING MITIGATION IEIT,
IIAIARD OUS MATERIA(S DISCLOSURE
Will are upplinntu future buildingoccupa,u.s8rcor hanJk hmmdms mowed IIEATWO UNITfTO INDW)
as d4Ernl by the CatNI Municiral Cd,Chapter 9.12 and the Dsalth awl Safety
Cock,Sectim 25532(a)'! HFATV G UNIT(OVER 100.000 BTT()
❑Yes Iuiliff" VFX TION PAN(SINGLE RESID) PAID
Dvm Rvccip N
WIII arc air conch m future hue Wing by the B um cyuipmenr m dMarta which
emit hmarJws air nmlaminnunl.u Jean•J by the lioy Arra Air Quvlity MamgencntLimal
ROILI!R-CONP(IIiP OR 110,(0,1 RTL) �-
T-1 Y" BOILER-COMP(OVER IWON)HIT)
1 flew rctd sur hw:mfoos amt•` s«.....mcars mtrr CTepla 6.95 or the Cali- AIR CONDITIONER ISSUANCE DATE,
forma Hmlth K5 cr,C Smi 2S, 7}antt5534.1 mda,4abI irlhe NEW RESIDIiWIALMEC11. SQ.1'1'.
hutldine m..,n.N ea ywvca n2I I. .my�pm�niraylonotirya.uc.�al�v /- 2 (n,
,Bae y� en maN sun cora 177
C,icyyo Cre.'I v'
rnvnero,aohodcdvgem G Omc 77 T(rrAl.: ISSUED BY: —
OFFICE