S 0749 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING. ELEUMICIL 1'17RM"No
_
BUILDING DIVISION APPLICATION)TERMIT PLUMBING MECHANICAL Q 0749 7 A 9[1
BUILDING PROJECT IDENTIFICATION J I 4
BUILDING ADDRESS: SANITARY NO. APN,ICATION SUBM1I I'I'IAh UATF
713aFr-JI Gf Lit 0, ) 3 6(o- 1 L V. 41
OWNER'S NAMF� PHONY,: CONTRA(.TOH:S NAME: LIC NO:
GD✓rIlho- r.1. yo836L-rs y n pl a r. coNxOLN
Le ARCHITECDENGINFI!R: LIC No ADDRESS:
K % 9
CONTACT: PHONEv BUILDING PERMIT INFO
Ka+o u I i SI�S3�—T T y ❑ Consultant Fm Paid by APPIkar1t(initial) Hj DO 1.1 PLUMB n1ECH
rnayyk
II�Aal_ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 n[mby affirm dim I.m li wd mukr m.M.ions M Cloi ner 9(L..nn Oeing JOB DESCRIPTION
O d'Z Il,Sectim700BofDivitiml3nflhc Brod.aM I'mleasimLa Cook.and my liana i. RESI)ENTIAL:
WOO al PERMIT IS
FELL-, intell cur�.v.l eRn�l. N �J7 1f ❑SFDWh ❑PLUMKITCHEN REMODEL
FUW DaILJOrn�Cnv, 'WillJ . �Cmllx—wf "I"' AP1'LIANCFS-RI3IUENTAL ❑ADDITION ❑PLUMBING RGPII'li
'l, d rr/f �ANCHTFCGS U[CIAHATIO ❑MULTI-UN'I'T ❑STRUCNRAL
p.,D w PANELS MODIFICATION
ZOn)Z Imdnd it,plan"loill he must nvpublic rtcomds
OZ—O UPT02MAMPS DIMT:RIOR ❑CHBONEYREPAIR
{✓t?Ig"JLL L'Kensld PNfeaimW 201-1000AMPS IMPROVEMENT C]SWIMMINGPOOLS
CY j OWNER BUILDER DECLARATION OVIR I(MM)AMPS ❑BATA REMODEIIREPAIR ❑DEMOLID
X,
C I herchy mf0nn too I am xcmpl trom 11 C CmdraL'la's Licenm Law for th[
O d U folbwin (,Sectio]131.5,Bmsinae ed Pndasio is Colic'An tv C1 OTHER
1•- 1 1 J"P�
Sd3 gmn:%a Ylily mfnnn. Slclvs I:LECItICAL
u1 LL a111[fl rtyul(6 a Tlcrmil to[�XUInKI,aIle!,imrr�rve,dcmnlixll,or lfpair any[INclur[
FLLO pedheisrcciv CP.Wsontto de Novisiocvmufm wch P[nnittOfrkatigrxvtstmcm[nt $PECIAI.CIRCUR/MISC.
F,�Ny Ihmmimoin, itpuo0mnt l0lheprn),kio MJs Cmlrxlne,Llcmnn la...Cot erg
,L (catlo,kingwish Snnion nors anIIofDivJ.for the.1,OdOs'no,iorOd r, Anyli Chkl of 'cEA1P.METER UH POLE IN51'.
a a c K that he is amrq Ihcrtfmm emW IhE Baia for the ell[gcJ.xcmptim.Any vinlmirm of ❑NE ADUGION ❑DISh10LIT10N
�y S,eoan]031-5 by any uppRcaru fee a pcmdl.edse Bthe applicant to nsil penalty of POWER DI:VICFS T' ❑FOOD SERVICE
not mom Than five hundrtrl dollar,s500). ROVEMINf
SQp ❑ I,as caner Uflhe ProNny,or Illy cmploycn will,woga un their u,Ie Lnmpenwtor, SWIMMING POOL ELECTRIC [1HER
p.. will OR,the waA.and fl E mmcimE is nm inlcMd oroffn-cd fm sak(Scc.7f .Buimem
W and PABOW.s Code:The Comracmrs licemc law dm rot apply m an carer of )UH.EtS-SWITCHES-
IIXTURES
pnlpcny who huibb m Inmpruvcs Ihfmm.and who dot,,, ,,,h work h'maclra also ll
his Own[m ,plo, frosidod dollash imnpnrvcnwmm�mm mw meodd m nBfNd InTI
I,,, NEW RESIDENTIAL ELELTR SQ F1'.
sat.IL howevcc the bulWineaimpnnmmnt is sold within rum yearofeomph im.Il,[ $Q 1r1'.1'L(x)H AREA SISQ.IT.
wrxnhoilder will have the burden d pn,n,IMt he did ml build m mi m mo,for par- Q
poor of vrlvL
❑ L a rvncrMthe properly,am exclmisnly eonmoeting with licvnwt nmtnemmm lo TO fAL:
,,Womac,BIC pmjwt Pte.7011.He6m,O,ad ProB.ims Cd[H The Corimall fs Li- Al
.law the mn applymwwncr of urnpcty,wlw buildv«imlmvr:I ,am QTY, PLUMBING PERMIT FEE
who L.nnm,Ls for Im.h projects with a cammx'Iods)lifcnid prwanl to IhE Cmlmctsr's (�1
c lPERMIT ISSUANCE
xmq eutakr Sec. ,11&PC for this reason
[l ws
ALTER-DRAIN&VEST-WATER(EA) ` VAR A'f10N
Owner Date 60 vS
WORKERSCOMPENSATION ATION DfthrfkATION BACK FLOW PHUIECT.DEVICE
1 beTEhY allium undn perullY of pnjury mlf of die following declaNtims:
❑ Ihav[a,g will EsrbyneCemi6cne MComantm wlf-inf thO, N'ff GOmI Eno TRAMS-Il.00R.RODE,\RU.COND. STORIES TYPE CONSTRUCTION
,rim,un provided ffo by tifLtiim 370H0 of the faM Ctrl..for IhC pErfamurcc of 0e
wool for which this pcmnir is issued. FlxlvklS-PER IltAl'
1 havE Di will mint,r Wakcr'.s Comp.f,Mm huunrchi h his Nrl by SSlinn
t]IMl ovum Labor Cak.for the pmflanmrcx of die caul,for which this pcnnil is iasrd. GAS-EA.SYSfFJH-I INC JOIIfI.F.-1'S (KC.GROG ATN
My Work.ee Comp[nsaraw Insonrce cumin and Po1ky number are:
(am'm FOE,No.: GAS-CA.SYSI7JN OVER 4(PAI
CERTIFICATE OF EXEMPTION FROM WORK ERS' GREASI%INDUSTRI,WASTE INTERCEPTOR
COMPENSATION INSURANCE BUILDING DIVISION FEES
(ITis"mon neat notb[corOPOOti ifdepemdus mrmE hlmadJollws(SI00) GRPASETRAP
Tor Ir'.) his
FEE
Omit
limit in the p,B tlm - !which A'p,mit cmldmm hII SEWER-SANITARY-STORM U.200 17,
not y ally pvwn in^9 ENERGY 1411
.morn laws of CalifomiE/I)We I WATER HEATER WIVENTLECfR
licem !/ GRADING ME
'x y NOTICE.TO APPLICAh . ing this C rmr.a of Eacmryim,you sduld WATER SYSTEM/IRFATING
F ? heart.whject to do wn tees mp
Co ,mad n Provisions of tady he lCode,you mum SOUS FF.I:
UXfonhwith nxnply wish such pmvisiuns or this{emir skill he dcclrcJ revokd. WATER SERVICE
7 z CONSTRUCTION LENDING AGENCY NEW RESIDEM1TIAh PhMIi. SQ FT. PAID Il,¢ m pIN
L) l,fosr h.h Or,it then isamnsonedonk.Cine a.) for Ne prRmmnrcc of
F-' the work fm which Itis prnnit Ir i.cmd(Sas.l09].Civ.C.1 TOTAL:
Irnskes h'ans
� L) Lcraln's Addtas uTOTAL:
yI.unify net I has,reel thin applirdinn and smue Jut thiohosx info------- BUILDI FF.
h urmct.l m�rtc ro comply with all<hy ed county oNirurrce erW are dws mloting to QTY. MECHANICAL PERMIT FEE
C.) Z buEdinsm'nanoclum."henchY+mdrri..reprercnttlOvLx oflldsdtyln corn upmlhe SEISMICFEE
"-' about-mrntiwarl prOpcny for inspmimm purl'rtsa. PERMIT ISSUANCE
(We)agree In msa indemnify mJ keep lumina;the City of Cop irw again,, ELECTRIC '
helslnx.' A¢*a,c L�md xpvuaw son - any cavy laNE agwn�vW City ALTER OR ADD TO MECH.
menti fthisp a PLUMB] rFGE
AP S A IL :OMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.0110 CFM) '
MECHANIC LfEI?
5 'GUI
AIR HANDLINGUNR(OVER 10,11(IOCFM) CDNSTRUCUI I'AX
Sipinurc Ikanvu.nicoor Onto EXHAUST HCOD(WMUC'D HOUSING MRIGA ION FEE
HA]ARDOUS MATFRFALS DISCLOSURE
Will the a,rdllar vfulurtivilJing occupantuae orlemOlc lrorodoe mim, li HEATING UNR(T010f1,0ro BTU1
as def d by no,Cupeninu Mrmicild 011e.Chmplfr 9.12.middle lcmlth and Sofcty
CdO.Sccdon 25532(a)? HEATING UNIT(OVER 100,000 BTU)
Ya ONO
VEN'1lLA'fION FAN(SINGLE RESIO) PAID Rfccipltt ,
Willtha il,lieom or from Wilding mLvpam met ryuipnsnl ur dvioce which
Ihvnnhus air conumiruno a,.Mired bytb[Bay Arta Air Q..IOy Mmil,.nt BOILER-COMP(3HP OR I(IO,f1006N) TOTAL
Uilrocff BOILER-COME'(OVER 100L000 BTU)
❑Yes CNo
I love mad dr haaydous nlraials t.suda Chi 6.95 ofllc CA- AIR CONDITIONER ISSUANCE DATE
msmirt mn
(Luno Health&It Code.SLcrirm I.
25531mal21511.11.olt11b tec Ifdo NEW RESIDENTIAL MECII. SQ.IGT.
Wildi rerkw-s morn, hwYom.vrrnmt.dot itinmy rapaeibilitymrlutify de ofcufwt '
ofda:r�uiNlrcnls which lnust he llMl prior!i.saumlce!Iron CfniticnlE of(knysorcy. '
Owrcr m vrdxiral a8rnt Dmc TOTAL: ISSUED BY:
OFFICE