S 0989 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDINC-ELECTRICAL PI, IT NO
RUILIJING DIVISION APPLICATION/PERMIT P1.IIMHINO.NECIIANICnI, V 0989
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO APPLICATION SUBMI'rrAL DATE
150 Duma% DR .
I1WNF.R'S NAME: .� yE _ ryo� COOT] Ii n !Y 11�-5X /I,IC O' NIC Ct1Nl'R(ll.p
�RCHITCCr"GINI!ER: LIC NO: V11 AD/DD`eAlj O ,TV IYl1, D 1IO- ❑
CONTACT: PHONE: BUILDING PERM O'INFO
❑ Consvllant Fees Paid by Applicant(Inidtl) BLDG EIECT PLUMB MECH
❑ ❑ eAN ❑
LICENSIB)CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE
1 n,,by affirm met I arm hent ea ander provkiral of chapter 9l,m.neing JOB DESCRIPTION
Oa'Z withSmion]gM)nll .irmluf the Busimw 1 dcaiunsC nnd mylacnw i. R SIDS
W 00 ^ PERMfI'ISSUANCE
5 [- infullfo'c« ff � i} A ❑SFDOVL ❑KITCHFN REMODEL
6VU �O°'c O'N Lm.X 111 1 APPLIANCES-RESIDENTIAL ❑ADDITION C1 PLUMBING RE-PIPIT
FF Z' lute Cmmtnn«
N6a ❑MULTI-UNIT ❑STRUCIURAI,
ANCIIITECTS DECIANATION
F 7 N PANEL ti MODIFICATION
Z LukmmrJ my pWnasMll he wNapublic rtcmd
OZO wUP TU 2(IOAMPS C3 INTERIOR
_1 CHIMNEY REPAIR
w Liccmxcd Prof email 1111-IOINIAMPS IMPROVE MINT E]SWIMMING POo1S
OWNER-BUILDER DECLARATION OVER HWAMPS ❑NNTI REMODEUREPAIR ❑DEMOLMON
=o w 6 I name,effibm Thal l am exempt from tM Control License Law f«orc
XO L V In lowins leewn.(Sm ion]OJ 125.Basil ad Professions Coale:An,en,or Nanny SIGNS ELECTRICAL ❑(TDIFlt
which rtwirtx a fell to a.t'aNel.rilml inall-1,drlmoliN,or befall nny"'m !
�LLO mora,it,l.auarec,dwmyuitesthe epplicamm bur such p[nmit w file ro,c,1 emmrmmt SPECIAL CIRCU I'rw LSC.
�} that he ix licrn.ipv\tunl to He pf"imm;of tnc C«uruclal Lic.far- ptcr9
OO lrnm.nencin.w.mSe«i«t]gNn ofDiviaiun J afthe Busineuaral Pmfosuob'CNa)rm TEMP.ML: IR OR POLE LNST COMMERCIAI,
a yllwl he i\uump therefrom vel the heel.Inn Fe abc,,d caemptim.Any vinlwion of EINE BLIXNADDITION ❑UEMOLI'I'ION
uX1 1+• S aol,7QI.5 by any upplimtn f«epermil wbjnls lhcvpplkunl mucivil pxmltym POWER DEVICES EITINANT ❑1;t DSERVICE
ros mme than five hmdrtd d�lI.,Cr50(B.
F Z} IMPkpVG1FLT
fG [] 1.¢,mmcr of,M1c prupcny.«my cmFRrym x'im xagc,vuhcir wk nutpenwtitn,
SWIMMING PWhGLECBIC
wdI da hew«k,awl oro atmcmrt Is not inmaded«uttered f«sale(Sc.7(U .B..inesa ❑O CI IIiR
W^ aril Pmrex im,Code:The C« 1or's License Irw doe,not opply to an oxvc,of OUTLETS-SWITCHES-FIXTURES
U all
a3— wrroeny was Wilda«impm.es Btermn.and won dnex,aen w«M nim.elr«,Ilmain
Nix nam employee.,provided Ihel mh iO,,ovencnte art box intrntlM«o0emcd fur NEW RESIDENTIAL[LEq'H SQ tT.
wlc.If.Mwm'eo nu hullding«IntPmvemenlnuAd wilhmiOy='ampMiawlW SQ.F1'.II.WRANIA SBQ.FI'.
manner W iMler.B1 W m the nwkn of I*oviny mu M did m nuiW cr impmrc for pm-
pwe of uleJ.
h ax'wner of me properly,am aclwivcly commning wilM1 licenced nMllracblrr m TOTAL: PAID
cnnVrv[I the project(.Sec.]OW.Nurine,s end Rotev\inn.CNeO The Cnmrectar's Li-
an,clswdoe\tt«applytoax%ithaonarrea r,Y IiA,r Jd ornimpmva lnarmrl.end QI}', PLUMBING PERMIT IEE
xWcm,rvetsf«smh Pojecis wile ec«nrltnoafO liccmr.+l punuent to the Cunuamor's
I.iccn,c law, PERMIT ISSUANCE Nov 2100
I] 1 am exempt«l Sec. .H&P C For Nis real y
ALTER-DRAIN&VENT-WAWA IIs11
Owner Him YC,Yr11� }l ON
WORKERS COMPENSATION DECLARATION BACK FLOW PROTECT DEVICECITY �Y tNU fs
I hereby a(fimr all reary lty of perjuone M bel folluxing dslrurMsm: V
LharcaWxillmaimalna Ccnlliateof Crnssnttosclf-imumf«N'ohdsCmNn- DRAINS-FLOOR.RWR AREA.COND. STORIES EAIPN
CONS)RUCTION
worm,ab pmvidcd for by Section 3700 of Ile WMX QMc,r«the perioromuuc or the
r fur whkh mi,Fermi,bi ssued. PKTURL'S-PiR'MAP
1 harc arJ x'itl nminuin Worker's Conycmalion Intentional a\rtqubW by Section
Nlof tW kahm Cmk.fmticp��c,f..��ee�T�,r}�M thfe soul:farwhicb mos Ir,Tial GAS-ITA.SYSTEM-]INC.4 OUT.:IS OCC.GROUP
My Work sRa
rtetLFg 1'alie I fart croft 3-73 GAS-HA,SYSTEM OV17R 4 OA)
Cortiee � Y IR
CERTIIICAIEOFEXG77PITON FROM WORKERS GREASMNDUSTRL WAST:INTERCEPTOR
COMPNSAI(ON INSURANCE RUILDING DIVISION FEES
(Mixxti'u muL n«W a«nplinahl hcpcmril ie forum hurdred nonan D II NO GREASETRAP
«leaa) PfANCIIECK R?li
I cmify that in thepMiXnmrec oflhc x+xk forwnicOffik Fennit i,i.esuW.I xiell SEWER-SANITARY-STORM ES.21X1 FT
«N employ any Pul in any manner w ax to bAsac euhjwlm IM W'orkeri Cool IiNERGY FEI!
O Z .ration hm of C.Inar ia.Dale WATER HEATER WNEMAi1.ECPR GRADING EEE
Z Applicant
E•" � NDIICE TO APPLICANT If,after making Fix Certificate of H.acmptina.you should WATER SYSTEM(MI1VfINC
hccurm wnj«1 to Ile Woke,'.Campcnwli a.provkinar of Ile IoM Cooke.Ina moa sons PER
ball comply wim nava Im^vixima,«this pml J all he dccmbl rtvuked. WATER SERVICE
lit
Wiz. CONSTRUCTION LENDING AGENCY NEW RESIDEN'L'[A],FLAIR. SQ.Fr PAID Um� H �iptN
U O Inereny atBnm mat dmre ixacnnaruc,inn lamdmg ageney r«Ino peHnnm,m,<ol
(L 1" Glc xM f«which this permit is i,steJ(Sec.J09I,civ.C.) TOTAL.:
Lcmhrx Nvmc
UIcnd«'s AdrM,m THUM,
�0 131 BUILDING
[r ZI I coil mar L M1vve rend 1111,aFFlicaloun mld nate that the above It.,real
i.
Z nertag eonsi mal wim.11 city arW rnumy«dirurmnarrd eve laxsrthaing a QTY MECHANICAL PERMIT IEE
U Z Wilding nmsrvnMn.vW bcmhy namod,c rtPc,cmativo ofmix city wcmcr uPm lbw SEISM1IIC EFF,
r-. abrrve-mmn o'"P'Tcny for n.pecuon po'loa,. PHRMU ISSUANCE
(Wel agree Or wrc,ialem'fy and keep In le.0 tW City of C.Nnim,ogaiml ELECTRIC FF:E
zoliabI li ,,jut mx.emuerde whicM1 lmyinany..ywmmm.sximI aid City AI,TERORADDTOMECIL PLUMBING FEE
in'tra"m eo IheA�GAND
til.
APPLICA "U DEWITH ALL NON-POINT AIR HANDLING UNITORD IO.AYCFM) MECHANICALF h
SOURCE GU I
AIR HANIRdNG UNIT(OVER 10.000CIM) CONSrIRUCIIONrAX
SignetmcoA o te cmnUCmtrmt« LuEXHAUSTHWDIWIDUCI' USINGM
) HOM" ONIEE
HAZARDOUS MATERD,LS DISCLOSURE
Will theapplicaru urfuture building«cvPanl store orhandlehatiou emat HEATING UNUTITO 101,001 BTU)
ax d:Orcd by IS,Cupeninxa MunicipnL Gale.Charter 9.12,mal the Health and Safety
Coma,.Stiction 25532(ity' HEATING UNIT(OVER IBB N)O BTU)
E]Ta []No VENTILATION FAN(SINGLE RESID) PAID Duro ttciptX
Will the a,dwiln,«fvnm builbbng oa lural use ryulpilent«de+lce.xbich I
TOILER-GOb1P pIIP OR❑NI,(X]p It DUO t narankars air contaminant,Or,definnl by the Bay Arta Air Quality MarbagemclH TOTAL:
v Donna❑Ya ❑Nn HOILa-COMP(OVER 10I.000 BTU)
I have mM the M1aannlaus roma dsquirtnn real Chptcr, 6.95 of me Gli- AIR CONDITIONER ISSUANCE DATE
Terme Health&Safety-,O Crdc,Saline 295115,mr, end 25511.1 ,,dawn'I Ihg if tk NEW RILSIDFMIAL MEC11. SQ.FI'.
huila,mdice a rvnewly Nevea ralptow it i,myce offs bll'my anotifythu'avy.
ofthe rtquirrnrnt\whkh,ma be met phi«mi.asuanx ofa Cenifxvc M(4t,rpancy.
fNmu«aumnmN ugcnl Dam TOTAL ISSUEDBY'.
OFFICE