S 0952APPLICANT TO FILL IN INFORMATION WITHIN RED LINES -USE BALL POINT PEN ONLY
CITY DP CUPERTINO BUILDING. - ELECTRICAL
BUILDING DIVISION APPLICATION/I'ERMIT PhIINIBING.-A4:CHANIC,U'
BUILDINf. PROJECT IUP.NTIFII'ATION
PEy`E1 H' NO
SJ 0952
flUBDING ADDRIiSS:
SANITARY NO.
APPLICATION SUBM/I'I'�I'/(,y(QJAI'I!
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OWNERS E PHONIi:
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CONTRACfORSN LIC NO:
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CONHOLR
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ARCH 1 / GIN;ER: I,IC NO.
ADDRESS:
PHONE
BUILUING PERMIT INFO
BLDG 'ID PLU- Isl@ \1� F:Cry I
❑ ConwltRnt Feet Pald by Applicant (Initial)
❑ �``--tom
I.ICENSEDCONTRACfOR:S DECLARATION
firm tut 1 em li<cnred Oder I.uvuims of CUPer 9 (mmrrcrcing
nr Divisi3JNe Businnr vnJ PnrcwunrGdeeld my crena inNESIDENTIAL:MpZ
Ffzc'
Dwc Conntiaor
QTY ELECTRIC PERMIT EEE
JOB ESCRIPTION
❑KITCHEN RIAIODEL——Lic.I
[]ADDITION ❑ PLUMBING R6PIPE
❑MULTI-UNIT ❑SIRUCNRAI.
MODIFICA110N
❑INTERIOR ❑CHIMNEI'RIiPA1R
IMPROVEMENT �SN'IMMIN�G I'/OOfS
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PHRMIT ISSUANCIija�❑SFUWI.
APPLIANCES- REGIDEbITAL
A RCHITECTS DECLARATION
1 uldctwml my plmn sMll M ursJ u<PUNic rtrnrS
PANELS
l UPTO:. AMPS
licenrd NMersimW
NII-1000AMPS
W U
LL3. LL In
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IYO�
OWNER-BUILDER DECLARATION
1 Mrtby ri fitm IMI 1 vm ncmpt frum IM Gmtmctnr'I Licrna Inw for IM
rdlowing ni (Scctiml ]031}. Business and Pmfnsiom Crds: Any City m rnabty
which requires . parmit to lmnstmCl, alto, improve, demolish, or repair tiny s Iurt
prio""t's aumca, ulw lcquirnr lW appl"frot for mah "rino Man n ng«J emmna:nl
IMI M in liccm dpunamtto the provisions of the Contractor s L'Ianse L,iw lChWar V
fcommcrcing with.1Brsn]OXIIuf Division J oftM Husueas and Pmfnrionv Cak) Or
Bad ha is oemP thmefram atvl tha ,td, f« Ibe allaed ascmMion. Any siolatiml of
Ss,,luor 7031.5 by any upplii ll Lrapmit eahjwutM.,dBam m a evil partially of
❑BATA RLN( ' t ��ti�
� ER
OVER ION) AMI'$
SIGNS ELECTRICAL
4'P.CIAI, CIRCUI'1'IMLSC.
WARMElER OR POLE IN.ST.
t
(]TENANT ❑FOOD SERVICE
IroW1iR DEVICES
FZN
SQp
E-
W
^°I mart lMn five bti a dtditN(5500).
❑I. ar mmer N tM proi or my aovl� with wax tis Nair" a eonya'nsaliml.
wdl datM wnd,tid the.arvcmrc ie notmmmkdwelfcldf«.le (See. ]1114. Haviros
and Pnrfeuians Corfu: TM Cowtmorr's LLeme Idw doer air apply w an owrcr of
IMPROVEMENT
❑OTHER
SWIMMING POOL RLEMIC
hiOwnloathhu own employee, pvidd tout wen irtrylmvelrclur x ng imndd m oRmd fm sura If, MwavcntM Wolcng«impmvcmcm is rind wuhmowc ycnrfcolnplction,IM
will oars Blc hooJcn M Posing Thal M did mx uild or itrylmvc for pus-
SQ. FT, BOOR AR EAp
P Aoe
LSQ.14.rcr-buillkr
tttgi
of Wa.l.,BtiaIsF.uo",o"nest U Inc pruj«I ,Py to(F4k Basitcfv rtydanim d, or or,r1c Cnnlracmr•e oldFEB
drys tial apply to tinowrcrofplrycny who MilJnm improve tMrtom. tial
77
(S'�Lew
QTY,-E
wnomrltrnctr for wch Pojcetrwitnecantrvnln(rl licen. iPr—to lMCarro—ot"
Liacna Law.
CITY OF CurtH
I
PERMIT ISSUANCE
❑ 1 our c.acmpt umlor !Na. . B & P C lis IM1M "son
INO
ALTER-DRAIN A VPN- WATER (IA)
VALUATION
(Trmcr Drte
WORKER'S COM 4 p rjurION DECL frdo'I ug
I Mrtby alfinn under pcwllY M perjury time of the fnll�wing Jae Wrvionr:
.Missal •CMi37W fBwv farWmko'r Comfsm
HACK 111100 PR(TfIiCL DEVICE
DRAINS- Fl.00R, ROOF. AREA GOND.
STORIES
T1'Ige CONSTIXUCTIO!
als.Colfor
.tion, as pmvkd fm by Sedan 5]00 of tM IaMr Calc, fa tM peHrvntona of tM
O, foiby
work for which Or, pentyliv i(v
PI%TIIRILS-PER 'THAP
I Mve arW will mainsin Word:er's Crmpenswion Irvwrmce, v rtquird by Section
T'
J]BBa(de labor Codc.f«Oa perfmmnrcc oflM w«L for which Ibis pclmil i. i..wnl.
GAS - EA. SYSfF1.i-I INC.a OIIRtTS
(KC. GROUP
APN
GAS-PEA. SYSIiiM"OVER 4 (FA) '
My WON Co p em IPaanrxrt rrkr tid Policy nu rt:
Carrico Polly NO:
GRFASP/INDUSTRL wASR!INTERCFJTOR
CERTL C E F (FJ.IPIONFR061 ORKERS'
COMI"SATLON INSURANCE
BUILUING DIVISION ImnS
fHus.nod nn nonog McmnplmcJ lftM pmnil is foam,hudreddAlan(SINu
�x la,".)1'IANCIIECK
GREASE IRAP
FEB
SEWER-SANITARY- STORM EA. LMLO FT.
ENERGY IEE
I noisy Nat in Ne perGxrltnntt a(IM wort far which Nis permit is instil Trull
clot employ aN, person in my IlumKf w as to bona wbj«t to IM Wark Coo an.
WATER I EATIER WNEN'/HLECTH
GRADING ITS
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D
C.1p
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tan
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.ration Lwsnf CaIifrnlx. Dole
ApO"Ot 1
NOTICE TO APPLICANT: If. an, making lou Ceniflcve of Ercmpion. you should
Marrs Why, la IM World, Cnmpclr Oiun pmvisio rr' of tM I.abm Code. Y. roost
forb ithcnmply wilh.wch on,ioco,,ril i, prnnit nh.11 Md«nid mvuknl.
CONSTRUCTION LPNOINGAGFNCY
IMranyvBirmthenMrc i.uac!(.atiowlctdis. tigmcyfor thepod�xntml«oT
the work lar which Chir permil is Irsud f.S¢.9Di], Civ. G)
I<r�erx Name
WATF,R 5YSI1J.VfR EATING
SOILS FlB:
WATER SERVICE
.
PAID Lae R¢6,,4
NEW KI?SIDENTIAI. PI.1P. SQ. PE
'TOTAI.
TOTAL
1<MYI r
BUILUING. FEJ;
1 anify Nvl 1 nave read Ihir vpplkotiml mJ swte dNl Inc aMve intinmvtitw is
ctrify
nimwt Lagrte maxnply wim ull dty mJ awmy�xJintirce unJ.rtme luwr relating to
balWing cOrstruriun, W hereby valloriae rtlnerentwves of du city to anti upon tha
QTY MECHANICAL PERMIT FEF.
SEISMIC FEE
PERMIT ISSUANCE
chose-rasa ld pmpcny for irrq,e rt PoTi
(WO) tigo- m 1-11InJemmwJ lot,fylot,harmless tM City of Cupanino against
EI],CfRIC FEE
ALTER OR ADD TO MECII.
PLUMBING FEF,
Luhllilln',judgtnwr, costs and C,I,nws which III in any way acme against said City
in m qucmc of tM {Imtin, ofthis pn u.
APPLICANT ONDERS D. WILL COSA'LY 1 Al NON-POINT
SOURCE REG ATI '
AIR HANDLING UNIT CIO 111,1100 CPM)
MECHANICALFEF
AIR HANDLING UNIT (OVIiR IO.Op CFAO
CONSTRUCTION AX
iA
EXHAUST HOOD(WR)UCP)
IIWSING MITICA'fION FEIi
Sigmw a u ApplkcriuCanuy Doc
HAS DOUSMAIT:RI L DISCLOSUWi
Will IM aPPI tm future building« t gone or b•oda Mrardous mntcrid
HEATING UNIT (101(10,(0X) BTU)
Inith ed Safety
tia Jefiml by-o" ar"OoMainci,lifusla.Ctfarruarg.12 em)M H
Ca, S«5512001
1tin HEATING UNIT (OVER 101,000 BTU)
VENTILATION PAN (SINGLE RESID)
❑No
WII tM.Mlicmt or fulum MiWtng «C ptinl u.re egair n or Jcrvice which
l Mrmdaus aircanlnmirunts as dcfimd by lbc Bay Arca Aur Quclily Manugcnenl
PAID -
Dare Receipt M
HOLLER- COMP(JIIP OR 11X1,00 BTU)
'DYIAI,:
BOILER-COMP (OVER 10.000 BTU)
-
D'mda4
❑Yrs ❑No
AIR CONDITIONER
1ba- read IM Mrrvdxs nu¢dalr nquiremmote undo CLaPar bits OfIM Cali"
ISSUANCE DATE
NEW RESIDENTIAL MECH. SQ. PT.
Eunu Hattith & Wily Cala. M1Ccu. 25540, 25539 erd 25SM. 1 undcmard Tut if IM
Wilding Jos, luc o'ti a,,.m that it umy J�'or'yr� fik'. loli(y lM m,Y.
ISSUED B1':