29359 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL . . PERMITNO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL �(J� C (]
BUILDING PROJECT IDENTIFICATION J JJ
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DAT
O � Q
OWNERS NAME PHONE CONTItACIDR:S NAME LIC I ��� LIC NO� ` NIC CONTROL#
12
ARC1A qt—
/ENGINIiER: LIC NO: ADD S: — ❑
CONTACT. PHONE BUILDING PERMIT INFO
U I L-/ _ ❑ ConsWtonl Fees Paid by Appdcant(Inlllel) Bj Dei ELEf}'pt. MECH�
Pq
LICINSED CONFRACH3RS DECLARATION QTY ELECTRIC PERMIT FEE L�1JL `�dSL• ;y--(\f
I hares'affirm argil I am liamN order provisions of Ch.per 9(co rvamas ing JOB DESCRIPTION
00
MOZ with Senim](00)ofDivi.sion 3 ofthe Bastion and Pmlmms Coda,arm my license is RESIDENTIAL:
F O iofullfaceurdeRmt. PERMIT ISSUANCE ❑SI'DWL CHEM REMODEL
�FU j Licem,t Class Iic.N
-Zw
Dve Comrtelar APPLIANCES- SIDEN`FIAL ❑ADDITION 11 PLUMBING RE
-PIPE
ARCISDEATON []MULTI-UNIT ❑STRUCTURAL
„� PANELS
ZOZ
1 und.ntand my Paris shall be mel aes public retards MODIFICATION
OZ—a UP TO 300 AMPS
El INTERIOR ❑CHIMNEY REPAIR
I"N1-"i XII-IfpOAMPS IMPROVEMENT
�
OWNER-IN frDECLARATION OVER IWOAMPS [I BATH RENRDEURFPMR ❑DEMOIJTION C 1 hereby affirm that 1 M escurexcmq Train the Cunwclor'n Licence I�w Ins We
nlgt U fallowing.,(SaMn]0313.Bu.unessand Proraekm Cde:Anycity maoaruCr
y SIGNS ELE1UCAL [I OTHER
41 which ea i im.'moil an..t.Eta,impfova,rlrnwlish,or"van uty strunurt
pda to its issuance,also rtgutre.the appllcanl for auch Moor to file a signrof statement SPECIALCIRCUITNISC.
rtrt//yy��
that he is lianoal purwuwllu do Moisture,nt'the Conituunrs License lsw(Chapter9
eG G0M P.(ttmnlercingwiN�`n]OW)of lTvuknJ of Na Business a,d Pmfaskm Codc)m TEMETER OR I COMMERCIAL:
d a than he is es ry Ihuaro
lm aM the basis fe,roe dkgcd eaampim.Any vialuim of ❑NEW BLDGIADDITION ❑DEMOUTION
m
%'4ro Secti ]0315 applicant G
by any r a pemli l wbjeeta uo POWER DEVIthe apps aana civ it Penally of CES []TENANT ❑FOODSERVICE
W I mora Nan five huaLed dollar(35W).
SSD ❑ I.av mraf propcny,mmycWt ymwilhw.grs.sthcirwkmmpe m. SWIMMING POOL ELECTRICIMPROVEMENT
y'
will&tie wel sad the untcturt is n,ot intandml mo0artd fm sNe(See.]84,Business ❑OTHFR
aand Poresums Cock:'Tho Cormcmofs Use..Ire corn'not apply to an name,of UILFTS—SWITCHES—FIXTURES
his ons n asho ea i.pr imlaovc.0 thrrmn ofd who doer wch soak hi,d.sf W for
his awn however
he povidM taw such ural is mints art oil incar ofem M(erad for NEW RESIDENTIAL ELECfR SQ FT.
sdelLhoweva,Nehui donor ten of proving
it subwiid noreycud'sone lon,thc SQ.FT.Ft RBARn SISQ.14.
rcofsaled.will M1nvn lie hurtlan afpmving lM1m he did not bmWaimlormvc for Pur- G CY
pma of sale.).
❑1,as owner M the pigmy,un acluusxly ronuxtNg with licenud mntrctas to T
Com et de P veo(See.1`0N4,Business.nd Pmkxaimu Cava:)The Centra lrMs Li- FEB 29 (�96
cause Lew Ntcs not apply in an owner of propeey who build.or iniprnves thereon.and QTY PLUMBING PERMIT FEE lA
who criminals fur sech'rnjals with a cco.r d licensed pmsllwt m the,Commissariat,
� ^Try -
U.. PERMIT ISSUANCE CITY T Uf-
mLUQ
0 1 am exe 't under B&Is C for this reason eH I INP
Data ALTER-DRAIN&VIiNT-WATER(EA7 VALUATION
Oamer WORKERS COMPENSATION DECLARATION t �
Y 1 hath affront
under ienally of BACK FLOW PROTECT.DEVICE ,
ya perjury me of the fnllnwing dcdamtims:
]IbeveerW will maintains Ccnillale ofCmscm mxlf-insure fwWMCSCwtpen- DRAINS-FLOORR0OF,AREA,COND.
11 swim,u povidal for by Statim 3700 of the Labor Cute,for the pe,f..a d tic ISTORIES TYPE CONSTRUCTION
work for which des permit is iive 1. FIXTURES-PER TRAP '
Fl I have end wo11 notation Worker.CumPcneatim Imumna,m o tri by Section
3700.Dha lade Code,for l perfomlarcaofthe warts for which this pemd,aa issued. GAS-EA.SYSTEM-I INC.A OUTLETS OCC.GROUP APN
My C tt�ry1'ppprrpptr{{��..�Tr W Policy/�1—
mricTFLr)�LPolicy No.: (!/ GAS-FA.SYSIEM-OVERi(Fw)
CERTFIC O OF SATION'IINN FROM WOR I;RS'
COMPENSATION INSURANCE GRGSF/INDUSTRL W'A.STE INTERCEPTOR
(This sumim reed ria be rompktel if the PmndOs re ass, a6N6dlan(Sim) 1 INGD INION
m lav) GREASETRAP PLANCHE F .
1unifythusinin aMomwneedNesoakfor moseerrh Nie prem 11isie.svC ,hall
most employ any Perot in any mmnerw aswhcvwcsuhjatto the Wonkns'Canpeo- SEWER-SANITARY-STORM I:,1.X10 Ff. ENERGY FEI
0 O Appliant x��H�LL WATER HGTER WNEM/ CFR GR EE
NOTICE TO APPLICANT:If,alto making this Cendri,al 1hcrr,mm,yno,houid WATER SYSTEMOTLEATING
1" bacen a wsjeet an the Workers Comprnsarim Provisions of the,Iehur Code,you tlsust S01rS FEE
fmhwiN aomgy with such povisiumm Nis pemutdWl trceenoN revoked. WATER SERVICE.
Q
U0 CONSan,I,. ION..i.INGAGI4.'CY_ NEW RESIDENTIAL NAB. SQ.FT. PAID
I hemhY�dor these inarnnunctim lcMiry agacy fm taepMmmarla of we RaeipY
W r.r the work fm which NM 3(19
Nis permit is icw (Ser. ],Civ C.)
0 U LaddsN.. - OT.W
r !U Larch's Access
y 1 croupy thu 1 have rtl Nu applicumn and some that the Nome irmarnution is IPA BUILDING F
F to mrtay.I agree to mm'ly wdN dl city and matey«dinorca and ansa laws miming to QTY. MECHANICAL PERMIT I FEE
UZ huilfa,angmnlm,rmd hereby tudhmb<rtprcrnativexof Niscityml entnrurym the SEISMIC FEE
above-m,ri iuted property fee iow,sta ins purryeea.
(We)ageaatoave-irdearody aced beef,himmkan be City a Culertioo agnirm PERMIT ISSUANCE ELECTRIC FEE
Iiebilitics.jtdgrlumts,ronsgird apen,e.which may in my way accrue agdnn�iJ City
in nsegtetwc of tM granting of this permit. ALTER OR ADD TO MEC H. PLUMIIING FEE
APPLICA UND STANDS AND WILL COMPLY WITH NON- NI qIR HANDLING UNIT fTO I0,030CFM)
SOURC.RE U TI INN. ' MECHANICALFu
�� AIR HANDLING UNTF(OVER O,UIOCFAD CONSTRUCTIONTAX
.tg umof ApplieamlCmvxt« f e ENHAUSTHOOD(WMUCG HOUSING MITIGATION FEL
NAZSRDOU. .1ATERIALS DISCLOSURE
Wilkie appliantmfutun iWing oaxupmtnaeorherdic hvalloun malarial ITFONG UNIT(TO I(M.(Xk BTU)
es dell by the CuPcn'mo Municipal Cod.Chaplar 9.13,ua1 the HedN and Napery
Code.Satkn 15531(a)P HGTING UNIT(OVER 100.030 BTU) -
❑Ya [I No VINTILATION PAN(SINGLE RFS?D) PAIL
Au
Dwc RaaiptI
itWIII the applicant ar Tamm bullclmg by de theBay AaBl um ryui n Q t) or dcvica which BOILER-COMP(3HP OR 100.030 BTU)
heaanhara ur tvnumiomus v rkfinlM by ra uaEry Mamgnrcm TOl L.
]
❑Ya 7N BOILER-COMP(OVER W.W)H'rU)
I hasxe tetl the hvandun mveninlaAIR CONDITIONER ISSUANCE DA
nequ'vcmcnts order Olgrtcr 6.95 d ole GE-
Is Health&Wauy Calc,Smiom 25505,25533 scrod 2551f.I unecnta,W 1hw iftle, NEW RESIDENTIAL MECH. SQ.IT
handing T„^not currently awve a teem,flet 11 is my ms orsibility to notify the oecupwt
of the nes,m c.whish muss he mel prier to unuurc a a Croufitaa of Occupuey.
Ownermaut retoradagcnr Deter TOTAL: ISSUED BY:
OFFICE
S WIIIJ'r .`
- '— gyp•,+_ �'• yr�i �� '•��
. • �-moi �7 �� .
O � ;'1�� �1 hem!! ��ii�'.'• 50
y4•�j'r�'�,,,
�nrt':ca:.:. - + :•:•:•: iii " •_. [ sV:
ILL
. i�l'!EF'ii;.;'• �' '••iawr "moi CF v �"" .
i l .•kB
+� :. . ..
Y .
og
.{y
I10• iF
� .��� ?Jc. � � :'.Vic.'. �.. .... �� -L• .�
jig
ARE
.-i� 1L•=iLL-�:;t�I�: �'�� �rS.!.CL; �'it� � • ,. .{ V�.
e , �L�: � �•��•L�iJ1�clQ7b-�yypp�r- ���
'... ...E .;. .�'1% � �A. VOjI' n .�.._����"' . � •
•�,. 'l®2% �, i - �...�p.l ti�, � .a.: yam,
s
N
el
T g • a
m N J E V,,GGLL
O ^ N
1�• I N c
E
u
c _
m ! I ¢ m O
_a
N
H
N c °
ttl j �v q
I BS m c
. Or �LA• a D
m �
^
o ^ 1
�pp d O
l7 Nm �I m N ,% W m .
c °
C U U
to m C
E m L u
m m
m A v
c Q a
c g m p
L
10
aL ucDmOuppO� y'DVL�owo
c E m m °
EOo-
Ire
m War
mC
_ N0
0 0 Eo man ¢ cmmmp
mUm`�3m
o
a
N
I
Alma&size dea rolbna calk 2 Scab:Ve'. I' dwipn: 1,111,
b This Is an original dmbn end mual
job. ere v f,dJ. to.M Us
O on not De Iblee.d or coped aldo r C°I°
job aka aM eduahnaM b Ilt fob applkable lee Ma been paid a MoD Scarf 6 done CeNed
c .fiona. order placed. IM5 Ferelrona Dealpner
._-- I— Cupetno,CA 6III Reid
a®Q CNp
v 1 _ C e7UpN
m GC O m
^ c p m y c o
m N
e..
(�.• N C h
LL
G m I c m
pl
N .
N
n °
� a
a'-
m �
n
p� (
N N C
U L C
m
m m C
m 3 a I
c Q O m
' A � E
c g a
C '
c
C m L Q N U
m C U Q L m
0 L m A U C
O 3 m
E `m c u
En 2 8M m ; m
ai
o m m m c rng a
E m � '� an ma Z '
C �
O
U C m m
c a o
c g � E v
N m I
m m p
M %O ^O Q C = d m
m m 0 m C
c am c m °
a m iJ `
as
All tlimembne 6 fo rll l on
ne AM l b en wtpinel C plil entl must W kc2 •'tie I Weip" t r
N7r95 D. no
elven era au bled tr.Ar w jo on not be releeeed or copletl unle �etp
pb elle erW etllumnem IO m job So,d 6 pane Cahn
epoloebb lee tue been peW w fob _J
cwWitbnt wtler,decetl. 10525 Feneomlpner
CuPeNno.CAA BIII Rein --i
•