B 0360 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL M PERMIT I 0 3 6 0
BUILDING UIVINION APPI.ICATION/PERMIT PLUMBING-ME,CHANICA11 SOOOI
HUILUWG PROJECT IDEN'I'IFIGTION
BUILDING ADDRFSS: SANrfARYNO. APPLICATION SUBMITTAL,DATE
ON'Na'.R.S NAME: it] 1_0��� CO 1tA a_'t ' LICKies .
y",Iv_ nom+ NIC IX>NfROLtl
NCIi1TEcT/EtJGINPl3R:C EJC NO: ADDRESS: ❑
D� E
CONTACT PHONE BUILDING PERMIT INFO
P v CN��� �� _9g8�� ❑ ORuvltantFeesPaid byApplicant(Initial) BLDG ELECT PLUMB MECH
❑ ID ❑
LICENSED CONT'RACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 beio>r am,l em lkemca mala provisions of Chains,9(cwt Ia,, JOB DESCRIPTION
QCZ with Sermon t(MMgofUi ili,m3mtbe Buxineswmll'rofev'itws Geo.sell my liea.m ill RR SIDENTIAI.:
W O,, �'S r�( � PERMIT'ISSUANCE
1— — in full fora ar,dl Porn m �a`,js ❑SFDITI ❑KITCHEN RF120DE1.
aVU Iscme IJc.N AVPLIANfIS-RFSIUI3NI'Inl. ❑ADDITION ❑1'l.UN1i1NG RE-PIPE
ai nem cm,towmr
F>,� ARCHITECTS DECLARATION PANELS
❑F1ULT1-UNIT CI STRUCTURAL
ZO�Z l undermad my plans Ann he meal al public.& MODIFICATION
CZ-O UPT02(MIANIPS ❑INTPRIOR El CHIMNEY REPAIR
ts L,,emabl Pmf.mal 201-1000AMPS IMPROVEMENT 0SWIMMING POOLS
Y
OWNER-BUILDER DECLARATION OVER I(MAMPS ❑BATH REMODI?URIEPAIR ODEMOLITION
6' Q 1 hereby apron Ibut 1 am Rump]tinm the fe mncmh Liccnsc Low for the
K 6 V vvhiehfoll.ml,ui—. IS-aion ttIL3,Bum e,. and RMairorm Cade:My city m cwmy SIGNS ELECTRICAL CI OTHER
3 C)�<' which rcquiaa a pemm at mmnaum,pace.i 1mem n flenndt.fi rcFs,r many memum
OJ psi«wits issuuec.elnrt uirts me licwt fm such Iwtika dgmistarcrtumt
y app permi SPECIAL CIRCURINIISC.
'� met,aae.igen...lars,un In the pmvia'vu of Be ConoecaMx lieeme Lew(CTupa9
DIaG�O loin
e,gwilhent anei the hisinn3 the
the Burinaxandon An,lScotlsl« Il?MY.MHIER OR POLL'INST COMMERCIAL
a a c C tlw io is 31.5 b therefrom am oc bac fir the s ths, esemgi to Any videtwn of ❑NEN'BLDG/ADDrr10N O FOOD LMON
SERVE
y am no 7031.5byspyapplicant l(apermit whjectx Ne npplicem to acivillrnalry of POWER DEVICES ❑'IMPROV ❑FOODSERVICE
not more Non five M1urvlmd du1Ws[SSW). OTHERVEA1PNf
=Q Lsshe., of the Fro,,m,,m mYosimenmwimwagcnmdeirsMe comFemarinn, SWIMMING POOL ELECTRIC
f�0 willd essi«k,endure he Cominmti Liceme,Lae dae, wle(.,ly 1.e4.Bovines. El OTHER
and%de.ui«u Gale:The Cmwctors Liam Law arcs n«apply to w owner M O11T1.F rS-SWITCHES-FLCIVRES
a 3' p y who(wild.«im(no.es mere«.arta who does sock w«k hitmeu m Imough
hw own a nph, ,nmvithal mat such I amaletenu w:not inlentkd nr offered rue NEW RESIDENTIAL ELECIR SQ FT
-1R.If.hsweaxr.Be building or improvement at sok!wabmute Yrs of completion,the (Sf}FE 1lRvA G EI'.
r-M1uilJcr will Mac the harden nt proving mat he did tin Wild mar imlmve fm Fur-
pm a of.rele.) U
❑I,m reamer of de F open,,—eadtaii cly bbsare'ting w'i n beemaomrctors
l cto TOTA
ecremuO the I"raja,LSa.,(HJ.Biom.n,�%,de..imnx Cooeq The c,mtmap:,l,- MAY 0 7 19.,9
nse law dura not appy pntwowna of PnmatY who mild.wimproves maem.eml Q'rY. PLUMBING PERMIT FEE 4 0'
wi,o conavets fm wch pmaD with.emmenemrD)lire d Ivrsaant to tltc Com.a,s
License Ww PERMIT ISSUANCE
0 1 am eaentm t mkr Sa. .H&I'C formis mamm
ALTER-DRAIN&VLNI'-N'AIER(FA) M.UhTI(
O r Date
1 WORKER'S CONIPEIJSA'%a DECLARATION BACK ROW PROTECT DEVICE
11 1 haehY affirm un,krpenally of perjury rote n(mc.....im W¢ erim,s:
ion.In uamikhomsintsineCcin37M a CmnsnttmCodenaurefin W«ke eo of
DRAWS-RWR,RIN)I,ARFA,GOND. STORIES TYPE,CONSTRUCTION
sada",as hkb Oil for by Sachs"3]W M de Lsb«Code,fm me Fed,munc<of me
M fm which mis'monIx issue,]. %%Tl1RIiS-PER TRAP
p«I will maintain N'uhCx Contlenwam Im,vance,to,rtquiml by Seel ion
AVa ul de labor Code.for tkypt�af�m°n,m�e�c of the work fmppwhic�'�h mis p��ea.mtit is issud.
GAS-EA.SYSfF_N-I INC,JOUREfS (ICC.GROUP AI'N
MyWoCurrier e Cnm n minryn,uffElday No.:�l��'��—� GAS-EA.SYSI'EM-OVER 4 TAO
CERIJEEATF,OF EXEMPTION MOM WORKERS' GRI:ASEINDUSTRI,WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(Dtie.seaI.red mut bent"pktal ifthe pmnith fmwe hundr ldollas(SIW) GREASE RAF
«Icu.l FLANCHECK FTS
Iccnifydw,in me p afumwnee ofthc work liar which mispermit umuet).]shak SEWF,R-SANITARY-STORM FA.2W FT.
not motility my penoa N any menarcmt
r.o to to hete subject to me Whets'Conten- ENERGY FEIi
O z wham law of Cnl rxnie,Date WATER HEATER WNEN'/CLE:C R GRADING ME
O Applicant
NOTICE TO APPLICANT:If,ane,raking do,Cenifu se at P,scmpoon,you sh dd WATER SYSTI:M/IRFATING
hecunc sub'mt m
hu W«keLa TCmo ,innruv,siunsu f the lahur G -,'allale,I--,'all SOILS FEE1 pens
� Q fforthwithcomply win sucM1 pmvisiuml
mthis peamitsMll be llama..rtrakN. WATER SERVICE
�Dz CONSTRUCT ION LIiNDINGAGENCY NEW RESIDENIALPLMR. SQ IT PAR) R¢dpN
u O I heathy affirm ban mere is a sorWnction lensingegcri fm the Eamon ec of
w .- mew«k for whichmis pemnit is i..swd(See.3AO.c..C.)
O V Lumber's Nam rfrrAL'
TOTAL
LL7 4Mers AJdms HUILOI ( F E
1 coni by met 1 have mol hi" ,I a cion puri state Ihm the ohne inGertaliun Ls
tail mtr.cr.]agree w comply with ell city mall cwmy uNlmma wd aa.law mlaing w QTy, MECHANICAL PERMIT FEE
L) z buildingaruweto.end hereby vaNmiae aeprtsenwiscs of this city to cater upon the'"o'fm inspcctloa Fort s,. %iRMI'1'ISSUANCE
(We)egtre w seoe.indaonify mal keep thimbles,the City of Cupenino apa itELECTRIC -F.
Iiebilm ,judgmem,copra ata esprnses which may in any way accrue in.aid City ALTER OR ADD TO MECH,
in nseguenee oflhc granting of mis pemit.
PLUM FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POIKf AIR HANDLING UNTT(TO H0.00(CFSI)
SOURCE REGULATIONS. / MECIIANI FREi� l[S[L AIR HANDLING UNIT(OVER 10."CFMI CONSTRU ON TAX
Sigm,tme ofAFplieanVCm erne �) FXHAUSTHOOII(WIDUCTI HOUSINGMITIGA'HON FEE
_ 11ALY1 DOUS MATERIALS DISC S IRE
Wll thcaPplirnnt«future huildingrcaFJnt stat to a,Ac haraNtvstmtaiel HEATING UNIT(TO I011,000 BTU)
es dcamel by the Culmina Munleilul C.k:,CTmpler 9.12,eM the Ileallh and Safety
Calc.S ioo?5532(a)': - HEATING UNIT(OVER)01000 BTU)
❑Yes )(No PAID
VI?NTIIATIONIAN(SINGER RISIII) Done Rcbbin
Will de eir coaRorfre.a Wilding th,lNe guseea Air ant«dMme,which BOILER-COMP(314P OR I(MI,000 BTU)
�it haienkas sir eomemimnu as defined M1y me Boy Area Air(Juallty Mamgcnent 'l lYI'AI:
Dasher!E] BOILER-COMP(OVER 100,00i Yn
I hate tvd to hi,ant.'msnorma,rtqu'venrnts unkr Chvper 6.95 of the Cali- A]R CONDITIONER ISSUANCE DATE
fmnia Helta&Safety Cod,.SsOom,255TH,2533 and 255.t.I aMvsrmd that if the NEW RESIDENTIAL MFCH. SQ.Ff.
budding 1xn rot baorecmly lwvca ,me,a irmy respeu ality lm notify the o,en,ea, 7
1 Irttnmaa which rw avmrce ofa CeNT f
w.
O.vterw soman sgrnt TOT ISSUED HY:�
OFFICE