29746 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. LNVJ^^7 4
LVA
BUILDING DIVISION APPLICATIONJPERMIT PLUMRING.MECHANICAL
BUILDING PROJECT'IDEXHPICATION
BUILDINGADDRESS, / SAND'ARYNO. APPLICAD NSUBMITTALDATE
7$y5 L/c, ("nI �?^
OWNf,R:S NAME V PHONE, CO CIDRS IIRSME: LIC NO:
MM (I NIC CONTROL
RCIIITYCGEIJGINEER: . LIC NO: ADDR ISnn C/J El{�AJJ5.2c
CONTACT: PHONE BUILDING PERMIT INFO
❑ Consulumt Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
❑ ❑ ❑
LICINSED CONTRACTORS DECLARATION QTY' ELECTRIC PERMIT FEE
I Irteby air mm I am kernel under prowi,iee,.of chapter 9(curmencmg JOB DESCRIPTION
0cZ _with Smion]000).&Dmim3oflfe Bmircasard Podw.asim,Codc.end mFSID i
y license is RNTIA0 nfull fume un ,flee. PERMIT ISSUANCE — —
�W� ❑SFDWL [I KITCHEN REMODF[,
UU Licence Clm Lk.N
W Date Cunnaam APPLIANCES-RESIDENTIAL ❑ADDITION XPLUM1IBING RE-PIPE,
ARCHTLECTS DECLARATION ❑MULTI-
z C) Z l mdnstml my plans"I he used.,Public recnrda PANELS UNIT ❑STRUCNRAL
MODIFICATION
O Z—� UP TO 31X1 AMPS
Licensed 1'ndcuianal ❑INTERIOR ❑CHIMNEY REPAIR
201-1(")AMPS IMPROVEMENT
OWNER-BUILDER DECLARATION OVER IOW AMPS ❑BATH REMODEIBEPAIR ❑DEMOLMON
x5 Q 1 hereby]Bim that I un execopuBUILDt front theCL RATIONla Linnen Low fa the
W3tL fdluwietressom(Section 7031 J.9uireu and Profeuinru Cade:Any city or county SIGNS ELECTRICAL DOTTER
u1 wltkll w,pti O n pumll to construct,alto,ImprovedcmMl
. ah,cr rtpolr my cool
tL� Inner to its issuunec,also requires the epplicunt far such recruit m File a signed rtucntrnt
SPLCIAL CIRCUIT/MISC.
Y that he is licemN pursuant to the pros sieew of the CamrclM.Liceme Law(Chaper9
W�pO (.seio{with Section7")a Division J of de But-.end Prafessims,Code)or TEMP.METER OR PULE INST. COMMERCIAL'
a 1 a pf thu he Is ese i thertfmn ours]the buia fou the NIkgN esemgime Any vinlmian of
LL• Sectirm]OJI.S by licent(ore pt petWy ❑ WBLDG/ADDFU0 ❑DF1.10I,I770N
^y my pctrni JaTa the,sppli.to a civil r of POWER DEVICES ANT ❑FOOD SERVICE
ret rate Nen five hundred doll—($Ser)). 11 -
t '�a0 ❑ Lns owner of the n,nr mY ani to acv with wu cos rM1dnok cont _ MPROVIiMPM
pole y p y g pemattm, SWIMMING IYl01,EI,ECIRIC
will do de wah,std Ue Nrmmreis nd intcmkU eeaffered fur ale[.Secs]tk4,Basions ❑OTHER
send Profession,Code:Tie Ceeussourn Licenm Law Jres'mt apply to on owner of OUTL.FTS-SWITCHES-FIXTURES
ponco ny who builds or impmvu drtrton,artd who docs such wart hirmself a through
his own employees provided that such improvements now ret imas]e i or oRemd for NEW RESIDENTIAL ELECIR SQ FT.
seek If.however.the building orimpnwctrcm in.sold within one yeu ufcompletion,the SQ.FT.FLOORARFA $/SQ.14.
wtrr-MtilJcr will Fave he burden of proving shat he did not build or improve f.,,.,
pose
orpar-
pose.tale.).
❑L u owner a me popery,am eselusivcly cvmtrsting with IieenseJ ren.,—to TOTAL
corowswo Jou pmjm(Sec.](Ili,Brno.us]Pmfdim,Code:)The CmBgc-ors Li- q
arm law does nes elmlym an owner of prorsmy wink build.m improve,thuni and QTY. PLUMBING PERMIT FEE Fi
who contacts fa such Inojecis with a contmetoos)licensed punusnt m dre Comacto-
Licenw,.co,co AR 1
I.Low. ttMo Sec. ,B&PCfm this PERMIT ISSUANCE rramn
Own", Dae ALTER-DRAINBVENT-WATER(EA) • all ar VALUATION
WORKER'SCOMPENS tyOco DECI RATI�Ong tlalamtirns: BACK FLAW PROTECT DEVICE Y Y Vr kUrL-r1l UVU
I neeby aEmt mdr It f
❑ Ih siddl will meitudr.Ceorf ucnlCmvent4ard6imum for W'eetcYa Compcn- - DRAINS-FLOOR,ROOK AREA,COND.
garden,u provided forty Section 37B)of the labor,Cat,for de perhtrtnuee of use - STORIES TYPE CONSTRucrR N
wort far which thu permit is iutni. 9 FTl('IURES-PERTRAP
have.N will mvmvn Workcl.Canpmuuian Imumnec,a rcquiral by Saban
]W ufthe laW Cttde.feetM pmfnrnierta nftle week feewhicM1 this pemtit is domed, GAS-EA.SYSTEM-IINC.4011'II,ETS
L9J
OCC GROUP APE
MyWie_YCpnrtey � �vL GAS-FA.SYSTFM-0VER4(PA)PdieNo. 0
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE, GRESSETNDUSTRL WASTE INTERCEPTOR
(Ibis section need nm he cocurdeced Iftle permit is fmae hundred ddlan($1W) BUILDING DIVISION FEES
or toast GRFA SE MAV
EANCHECK ITE
I cc my that in the my rrnwna of the week for which this dee W is issued,l shall
not employ oust pcmnin an mbemnrc.uhjarto Jou WorkviC SEWER-SANITARY-STORM EA.alp FT.
Z aetion laws of Catifmnla ee wu Coalition- ENERGY FEE
O WATER HEATER WNET/ELECfR
O_ Applicant GRADING FEB '
NOTICE TO APPLICANT:IL alta making this Cmif.w of F cmption,you should WATER SYSTE TRFATING
a ' become suhjest to the Work"Compenmtion Provision,of the talo,Code,you must SOILS FEE
SDonhwith comply withsuch prowisiongm this Poria shall he deterred revolusi WATER SERVICE
Oz CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL.PI-MB. SQ.ET PAID
V O (hereby affirm that dere is a cnrnmtetion lending agency for the perfomurce of Due RaciptN
LL — the work for which this permit i.iuued(.Stt,3097,Civ.C,)
O F' Lotle(f Name TOTAL -
U LadeY.Ahlrt•.c. t L
IQ 1 anify that I have read Nis.,,kation vd.tate that de shove Infanutim is BUILDING FEE
y comm.1m f tommplywirhelcityaedc tymdinu me guelawm1 ingm QTY, MECHANICAL PERMIT FEE
V Z building mnsrructim,rnJlertby eurhtm>c represcnunivcn of this citymmto upon Rte SEISMIC FEE
above- solo ed property for incpectimt pnrpows. PERMIT ISSUANCE ELECTRIC FEE
(We)spore,to on c,ittdcmpnify end kamouless the City of Cupenino egwnnt
IiabiBritt)udgrrcnLg.cmU and capenms 'hich msynrny wayaccruesgauwsaid City
tingofils it ALTER OR ADD TO METH.
auequexe of the ntPLUMBING FEE
REPLICA 'ND STAND. W L COMPLY WITH ALL NON-POINT
0 ONS. AIR HANDLING UNIT(TO 10/000)CFM) MECHANICAL FEE
AIR IIANDUNG UNIT(OVER 10,M)CFM) CONSTRUCIIONTAX
Si arc of ApVlianUC rar time EXHAUST HOOD(WMUCI) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will the sisdicutt or Future building oceii sat sort or balk hzvsrdoua mama! HEATING UNIT(TO 100.000 BTU)
u def red by the Cupcniro Mattkipul Code CheMer 9,11,end this,Beall and Select
Cade,Section 25532(s)'1 HEATING UNIT(OVER I W,00()BTU)
❑Ye C]No VENTILATION FAN(SINGLE RFSID) PAID
Will Se applicant or future building aant peuse o Air Qb m dewing which Due Receipt N
vrd
t hooue air amtamin.nts u defined by Oct, rw Bey AAir Quslity Managemrot BOILER-COMP pHl'OR 100,000 BLU)
•DisWctT TOTAL:
❑Yes ❑Na BOILER-COMP(OVER I W."BTU) '
1
Ihags rad Jou ha�hus mucrials rauirtnew trMw qupter 6.93 of Be Coli- AIR CONDOIONER cs—
ISSUANCE DATE
scolding
Hahh R Safny CMc.ecc oat 25303,253JJ attd 255]4.1 a oucifavl Jou if the NEW RF_SIDEINI"IAL METH. SQ.FT
huiWing Jun neecurrcmlyluvcoteam,thus it lamyrcund115 ,I mndifytheoccupant
of the rei.incosco g which mus be met poor m Lamwrtec or.Cenifi.w of tkcuIs
Owner m authon�agrnt Uwe TOTAL: ISSUED BY:
OFFICE