S 3232 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO - I BUILDING-LLKCTRICAl, m: IT No
BUILDING DIVI$ION APPLICATION/PF.RMIT PLUMBING-MECHANICAL J 3232
l BUILDING PROl IDENTIFICATION
IIIIILDIN(1 AODHISS SANI'T'ARY NO. AP'P'LICATION SUIIMI]TN,DATE
03vs" 1/o Ji= ar� uc� 4�� I
61 /l 2G-
OWH'S NA IT! I'll^)NCG3..�03 O�{(.TOH
U-r M5 +T+ Nil Cl1N'IAOhM
ARCHITECT/ENGINEER: LIC NO: ADDRESS.
fpart cA ❑
CONFACC PHONE: BUILDING PERMIT INFO
❑ COnvullitnl Fees Paid by Appllcanl(Initial) IIIJ G ELECT PLUMB FIECII
AR'l r 3' ❑ ❑ ❑
LICENSED TRACTOR9 DEZll ION I ELECTRIC PERMIT FEE
I oral notionn that 1 all l ceawm order Innvidon,of CluRier v(cmnmcat JOB DFSCRIPTION
�aZ with Snlion7l)( IIuf Mo,ion l ufthc llusircalarW Profc.viom Cesi and any licnwa is RIESIDENTIAL:
X 0 0 WRMTT ISSUANCE
F telt .n full face vtd/, cydwT/_ �, ❑SFDWI. ❑KRCHIIJ REM
ODFI
License Ch.
hk.x APPLIANCES-RESIDENTIAL ❑AUDI NON ❑FI,UMHING RIi-PII'li
F W Disc �'�f—� Curl c
ARI:HITECTS DECLARATION �,(f_a• PANELS ❑MULTI-UNIT ❑STRUCTURAL
ODIFICTIO
Z O'er Z l undtnluul my pals shall be tad u pubic rcc«d+ MODIFICATION
OZ��m UP TO NMIAMPS ❑ibmFl POR ❑CIIIMNEYREPAIR
F�FJ Lictmol Ylttfavinnal 201-INtn AMPS IMPROVEM ll ❑SWIMMING POOLS
�yfJ OWNER-BUILDER DECLARATIONOVER IOIXIAMPS ❑BATH REM(1O1-JRFPAIR ❑DIiM01(TION
OC d'Q I bneb,alarm that I and eVern,fmm the Conical LicenC law t«the
��('O G U hdlotwing rearm.(S¢u'mn]Ip 1.5.Badnoss aryl Dvfcuium Cort Any city moony SIGNS ELECT RICAL ❑ Illil
4131+. which leyuiles aµmil In construct,eller,imprave,det«tli+h,-teptlr any.1. �b
r
I�"1=fig pior to in ivwasrc,dso rcquim tote eppliamfta wch ltmnil to lkesixttd stxlriuu SPECIALCIRCUITMISC. 6' �
� n� eL_Al
qqC� that he i.rcersra Cnteunmmme prttviabna anhrawra<tn/x Lannw law(L�ptrT9
thatheis walIScalirnnaW of is nJ of tal" inary t,nim.rrnmvi Codel« TIiMP ML'll?H OR NILE INST. COMMERCIAL'
a a e C That o is exempt tlelefl fi ata the t Flan i, ile elkged u himan, .Any l rally of ❑NEW NLDG/ADDITION ❑DEMOLITION
HYcction 7011.5 by any vpplicant Ino vµrmil whjaya the nµolicvm In a civil rally of IYIWHR DEVICES
tall nbrd than live lwndmJ dollars(550(d, El TENANT FOOD SIiNVICE
MI'ROf:NT
=6 ] 1.vzownn of theµoµny«my cmpbytts wish w-egev n.heir vie rntryelo+atinn. SWIMMING P))L ELECTRIC IMPROVEM
olld.the.o rnJthcstwciwei:tt«inlevded«oneledfial LSec.701.1.Brad. ❑OTHER
aQ 3wam Prokwunav Gde:The Contractor's Liconw law drys not apply ,an outer of OVD.HfS-SWITCIU -FIXTURES
hii o ny who bell nr dideavts Ihemn,ultra who obes.won work deal)or
f h
bice own empl Tec..µoviddl Ow such itnpmvclrtrnw arc mR iot. .-,«oBelai for NEW RPSIDENTIAI.F.LECTN CQ FT.
+ak.IL latwevcr,the huiWine ort imprwemcnl is vid within note Year nfnwpinim,the SQ7ALIATION FI'.
crbuiltkr will have the burden of proving that M did ixa build or improve our pur-
µneofwle.l.
❑ 1,-Duan of the Trial sm exclusively cod renin,with llcemed conmuyom to TOTAL:
malmnl tln C deed,(Sac.]IW,Friars.wd Pmtcl ns C.dc)The Conlmcmr'n Li-
selawcou.nolaWlytounownerfpn airy,wbt Wilds«itnpeuvex themsn.and QTY. PLUMBING PERMIT PHP,f«wch polka+with anNH ractor(v)Iicenved purwutt toole C«tra,to tis /'�Liceaw law. 11iRMIT ISSUANCE 00 I um emtlnmtticr Sm. ,B&I'C fm this novoAhTER-DRAIN&VIM-WAfF.R(FA)
S Oux Date
WORKER'SCOMPENSATION
r,on DT:CIAHATION RACK II,(IW PH(Al!CT.DEVICE
alfind antiutakrpenally Mperjuryteeofthe Labile gokdantiotru /1
❑Phase wlwillmor by eCmif¢of CmrCmto Cortimu¢for W«kKv Crxnpen- DRAINS-MOOR.RODE AREA,COND, g'f(IRII!S 'fYPEC0I65TRUC11(IN
stmt,as hie idei far ro Saliur 1]Ilf)of tom lab+r Corte.fortheµUoxrmna of dtc
work fur which illnpcmtit iv orke, Il X'1'HHILS-PER TRAP
I have wJ willced.itInsulation Worker C s.ftm'xn Insindi for
ate.which
h rtt, for by Sectiao
1]OOMrat Labor C«k.1«theµrfornunce of the wmkf«which thisµmut iv ivute4d. GAS-EA.CYSITAt-1 INC.i OVTLEI:S (ICG GROUP AIN
My WnrkJA��onrinsutpncc vn rend Policlp_nbv,gr.}„v11pIV (: )
Genies NN Te l'ulicy Nu. UU MM--CG��.W�/''� GAS IA
CERTIFICATE OF EXE sIMON IItOM WORKERS'
COMPENSATION INSURANCE GREASDINDU.STRI,WASTE INTERCIHTOR BUILDING DIVISION FEES
(odsc li....n«drot he tttmplctnl ifNcµemit fe Haond humored Ill 1910111
or allCNEASU I'RAI' P NCIIECK FEE
I mafy If in theµAmnuna ofltle work for which thisµmoil is issued,I sha11 SEIVER-SANITARY-STORM IA.21M1 FT.
rve employ any Cemmin enyncarroo nato s In the Wurkcn Camper- ENHRGYFTT.
OZ cLiunlaw�lali-�v`� 6-1a•'I� a • WATER HFAfLR W/VINf/EIYCTR
z Q Applkanl {. 11— T GRADING FET:
N NOTICE TO APPLICAM':If,all amling this Carificetc of Icad n¢yon clxeoW WATER SYS11-AVIB1ATING
a ? 14
benne suhjccuo lic W«krlClan"ov:nin i pmvieinm of do Lbn Codd,you roust l I1?E
hmhwilh col ,in ouchµnvtrtoxu or due permit shall he deetnedrevekal. WATER SERVICE \
a �
CONSTRUCTION LENDING AGENCY NEW HESIUIiNT1A1.I'Ih1 B. .tiQ.le1'. PAID
U O l hereby affimuhat thele is acrnanation lauding agency for theµrf«nunac of Da HcceipM
the,walk foe wTich thi+permis is mill(S«._f D.Civ.C.)
F" Lenokls Na. TOTAL
y� [U laukh Aodrev BUILDING FE
1 I certify that I have read Wis upplicarion and:;,o•thw the above mrorra ion u
111•••"'
Tel etareel.I glee to comply with all d y and c«rnry twiestal and stns laws relating to QTY. MECHANICAL PERMIT FEE
U � htaiding mnstrumion,and hereby uulMxiie repmwnulivva ol't his city m ems.uµm the MIC1
ahmomemLard Pr,ddy for ir.P%lionµttµtmc PERMIT ISSUANCELJ
TWO Naf to save.INrnutify aral al hennlaw Ile City of Critical Rol IC
bab hnnerjudgolent coal)Id cxµtsw•+which may inany way accme again+t said City ALTFRORAIDTOMECH.
illnn yumtcc afOc gr�P tg oft is
non. 'I. MNIN
APPLICANT UNDE IfAND f4 WII 11'L ffH ALL NON-P(IINI' AIN tIANDLING UNIT(TO IO.feMI CFhtI
SOURCE REGI ONS,
ECI{A ICALItii
/a -i6•F9 AT IfANDLING UNI'I'fOVEH If1.lXM1 CIT1) CONSD
I'HUCON'I'AX
Si,.;k114A,Ia,ant/ arila� Bate EXHAUST HOOD IWA)UCT)
HAZARDOUS MAT,se,ii,an I rdo511RG
Will ithic Cu'llfuwm Wildingd,Ch lnr9.14o the hv.'mbuxlloida l HEAI'INC UNIT OLt I1M11Mp 111 U) -
m okEteJ by the Cuµnitw Municiµil Coale.Chapter Y.12 sold the Ilcdth colloidal
Crh,Scnion 25592a)? HEATING UNIT(OVER I W.000 PTU)
❑Yes Ell V12N'I'IIATION FAN(SINGLE RESID) PAID
Will ole applic I«future boiWin Dutc Ne«ip x
g bldreByA Air
ROIUR-COMP(BHP OR I0(yNX)BTU)
emit hernrdns yr anlaminenu as def tura by tM Bay Arta Air Quality Mawgemem O
0:11.119
❑YmELN � BOILER-COMP(OVER IOgIMK)BTIII
IF
AIN CONDITIONER
I olb lead ole h ovelsd Itif.1 i 5.5 ny LS-5.3.3
umkT(.Tapter 6.95 o(a Cali- ISSUANCE DAM
haildi 9119
slwlth� l mu rnCG Ill lu.of lcr�ibiliiyw nobly be rmoI pnl NEW RfSIDII.'TIAL MECH. SQ.FT. / �]
p__ unrrce , I, TOTAL Y
Uwltn«vuthariud vgcnt/n/U // Oac 7JrP ISSUED,PI':
OFFICE