99100051 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY q R I Ooh
CL TV OF CUPERTINO BUILDING-ELECTRICAL /�(� PE MITNO,
cam
CAL
BUILDING DIVISION APPLICATION/PERMIT PLUMPING PRojEcT inEvrIFIC SO\R/I
BUILDING PROJECT'IDENTIFICATION
BUILDING ADDRESS: SANHARY NO. APPLICATION SURMUTN.DATE
090 . v - /0—
OWNER'S NAME_ PHONE: CONTRACTOR'S NAME: LIC NO:
�- NIC CONTROL
CIIITE T1 GINI El EJC NO: ADDRESS: ❑
I n 8 Cl 1
CoND\CT: PHONE: BUILDING PERMIT INFO
❑ Com u11ant Fees Paid by Applleant(Initial) HLDO RL PLUMB 611201
Rolan 60 tjCIS- -.9-Sa6 ❑ ❑ ❑
LICENSED CONTRACY)R5 DECLARATION QTY ELECTRIC PERMIT FEE
I hereby affirm Hat E am h.enad meter pm Loons of Chepter 9(cnmmetulny JOB DESCRIPTION
O=Z with Statim 7000)of Dao,im3ofthc Bminm wW Profcuionx C,. .aml my license is RESIDENTIAL:
WOO I'CIIMO'ISSUANCE
wul Infill�aveassd cRcct. ❑$FOWL EI KITCHEN RI:\IODIJ.
¢c.UW Licosa Class IICY APPLIANCI-S-RESIDENTIAL []ADDITION ❑PLUMBING RE-PIPE
NQi Dom Gnnrecun
4,Oen ARCHOELTS DECLARATION PANELS ❑MUhTI-UNIT r ❑MODEFIURAI.
ZO'nz l uakormul my plena.hull be anted as psNk remNa MODIIICATION
oy„-uI UP TO 3W AMPS ❑INTERIOR ❑Cl I IM NHY R EPA IR
Q�F.J lieermbi Profeseioeal 30E-I WU AMPS IMPROVEMENT �SN'1 tfif'G FIX)IS
Yf OWNER-RUILDER DECLARATION OVER I"AMPS El HATH RIEMODELREPAIR LMOLITION
C w' 1 hearty effeen that 1 em vamp nom the Cese—mar"Lies—I-w f«the
k 0 E V following muwm.(Section 7031.5,Bu ms sv wJ NMcv+inn.Cade:Any citY or camtY SIGNS ELECTRICAL ❑OILIER
YI'31i(-� which re,im a permit to comma, cor,co ,alearnse,demolish,«mEver any muclum
I�LL0 prim to its iveuarce.al meaaw me epplicam for"6 Pernik in ia signal statement SPECIAL C I RCUITIMISC.
fen then he ie licensed peamar,m the pmvisitsne of the ConmetoYS ljccnse law(CloPer9
I+1�00 (mmmuncing with Section TXXp nl Division 3 of otic Basimvr and l'mfies inm Calc)or TEMP.METER OR POLE INST, COMMERCIAL
Q.y o y meat the is exempt tMefman trill ilse base,fa the alleged emmltion.Any violmitm of ❑NEW BIAGIADDTUON ❑DEMOLITION
4411 a' Seen.. 3]Ji hYony aPWM.faopsmtit wbjcct.Ise epplicam m a civil lrfuBy of POWER DEVICES [11ENANT ____.P4a0X!tSERVICE
FZQora more Henn rive tumbled Jullms(SSW).
1,es nevrmcr of me pnmprnw«my cutployecs wllh wuRo•a.Jeir reale cotttpenmlioq SWIMMINGPDOLELEC'l
�pZ.O sill do Je xsrk,east the umtum is ow inmmld an oFertd t«sakSee.704e Hu>ircw OTIIISR,
3 aaf Roressiau Coyle:The C.tor'r License"w Jos not apply to en.of OUTI.4TS-SWITCHES-IIXTURFS
pmpmy III huildx«empmvcx Hamm,end on Jas mch vow him¢Ir«tlmugh
his mm omployees,pmviJcd Rat each impmvcmcno uc not inmmlod or offered for NEW RBSIDENDAL EUCM SQ
sae.if.bax'eeer,be Witting ar ma,mo arm is"it within one you ofcomplmim.the /L571.F'f.MOORARi I LSQ-Irl.
� iltkr will hnvc the baNcn of Proving men k JiJ td Ivied m impruec fm pen- lJ\J
my I,m orwmrr of be,I'tM'eesY•alit eaelusively cmnnming with liccn.vrl ccnuamctx to ID
eomhuet the Project(See 7014.Busincu trd Protmires COJe.)The Comrxvors 1-
,,. W as-a.,.,I,to...ar,of ra,amy Wo.build,
-
melnwJecwtupplytoanowiterofpmpenywhnMrild,orimM,,,,hermt.mail QTY, PLUMBING PERMIT FEE By-
wbu comma,fen sock prcjecas with a umm-111111)li'moreal Puauum le he Commel-'s
Ijceme law. PERMIT ISSUANCE
tem uctnpt ueJer sec .H&PC for this.
ALTER-DRAIN G VENT-WATER Hit) VAI.UXUON
p n
WORK[R'S COMPENSATE IN DECLARATION HACK FLOW PROTECT.DEVICE
11hershy aRrro under IetalLY of Ierlury me of th rNlox'inR Jeelertriens:
I beveuml will nainenina Cenifaatcuf Cnnwmuowlf-inmrefm Wt,kanCnnyen- DRAINS-FLOOR.ROUE.Al CONE. STORIES TYPECONSTRUCfION
wits,es peuvidcd!«by Sectim 371M1 of He IaMr Code,fm me ferfurmmec of the
work fm which that permM i br ,dr T%'NRLS-PER TRAP
ut
1 M1ave d will Ivintvo n Worker'e Ccmpcnwaan Insumme,u ealuital by SccYian
3700 IfIM Iawr Celle,for the perGwomee of the work for wh'eh th, emet is issued. GAS-EA.SYS'RJv{-1 INC.d OVI'LEIS OCC.GROUP AI'N
MY Werteh Gtnpenuthn lesurarce earner sed PMiry number see:
Cortico talky No.: GAS-EA.SYSTE OVER 4(IIA) yQ's,
CERr11lCA'18OF Ee'EMFDON PROM WOR KFMS' v'UU
COMPENSATION INSURANCE GREASFANDUSTRI,WASTE INTERCEPTOR DIVISION EPPS
Tbis.arbn aced rat he mnMmm dthrpemdt is f«owchur.hn1d01Lvx(SIW) GRCASE'fRAP
AR0{ICK FTai
I comfy that in the pcAanance nfine work for which this permit is ionsE.I hau SEWER-SANITARY-STORM Paanrem CA -2(1(1 FT.
my employ troy amen,in any nr ai to lVe mbjeeumh
to WnAcri Cme'n- ENERGY FT.I?
� Z ramviawsof Cafi mie.Date WATER HIAT1ER WNENTMLELTR GRADING WE
Applium
z N NOTICE TO APPLICANT:IL otter making this Ccni&mc of Cxctnlnion,yon should WATER SYSTEM)TREATING
t•" "" btcome subject to the Wmkef's Cornpt maneom provi.i«o the M Labor Code,You coma SOILS ILII
1 Q f«Nwitheomplywith such pmviomesa Nis pe.,still be deemnl rtvaked. WATER SERVICE /d_
CONSTRUCTION LENDING AGENCY NEW RESIDINTEAL PLMB, SO,FIT PAIDI
7 z N
1 Date Racept N
hereby lD
vrm u theme is a aarumrucrim IrnJinB egetxy far the perfomm�a of
Vt0 the wmV,for Ishim,his Permit is irwed(See.31)9],Civ.C.) �4 2
F' 1 mJer's Name TOTAL,:
O:LJ TOTAL:
Lcmlcrl Atldrtu11
} la1 BUILDING FIiIi 7 �
1 oznay that 1 have lies.IWs epplie I..and Alin dm the ehoee reliant,
es
s-F.) Z emncl agreetconmawl withelldaymal re,re eaiw ofthI4 state Wwawiring e, QTY. MECHANICAL PERMIT FEE
V � building cnnatruchat.anl hereby nutMxira reprtrcnmtivcx of the coy to cm.+uptm@c SEISMIC FEE
all awarioned pm smy for im{tection pmt'mn. PERMIT ISSUANCE
(We)agrcc m save,int emniry end keep barrel.He City of Cupmhw.Ra;nv ELECTRIC FINE,
halbilities.jalgmme,nms and eIs,mWswhich may in any way ucrcagmr.seat City ALTER OR ADD TO MECH.
PLUMBING FEE
in con"manse of the gmoming of this prmtil.
APPLICANT UNDERSTANDS AND WILL COMPLY WTII ALL NON-POINT AIR HANDLING UNIT(10 Hfl11X)CITU
MECHANICALFEE
SOURCE I(ECULA'I'IONS,
.. 'O 1q,I Al.HANDLING UNIT(OVER IO.g1U CLAP) CO
1q,
S of AgdemidConaeam Dene l EXHAUST HOOD(WMUCI') HOUSING MITIGATION FEE
I IAVARDOUS MATERIALS DISCLOSURE
Will the aWlicam ew future Molding nacupace acre alwnJle hvarokus marrito II EA'T'ING UNI T(r0 I Afl W H'TE)
m AefnnE by the Capenim Muni i,l Code,Charter 9.12,and be Health and Safety
Cole.Section 25533(al? HEVHNG UNIT(OVER 1010,000 BTU)
Vet No
VENTILATION FAN(SINGLE RISIDI PAID
• Date Remrytl
Will the alglkmt m future building acupam uu equiPrrcm m Jevirex which BOILER-COMP OHP OR E W,0(XI It TO) /1 �J
'n,EvutWm air emmurdtul..nu Jerred by me Hey Arne,Ail Quality Moragemcnt 'I OPAL'
DismicC BOILER-COMP(EVER 100.000 BTU)
❑Yea ❑No
I lave ted the f az blm may iab+ corms utdc Ch'a,695 M me Cali- AIR CONDITIONER ISSUANCE DATE
rti,L5
Tania HcJm ra sure lyha Saone.255115,is any W 25534.I utak.cud them date, NEW RESIDENTIAL MECH. SQ.17.
building day ndeurmatlYltavicetmunh mtritismy to achy Jearupant
Ntk teem which moon be mel prkrwiswnree ole Cenifcx of Occuparey. / [l
xiacJ ager me TOTAL: ISSUED BY; ,
OFFICE