24556 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CITY OF CUPERTINO BUILDI G-ELECTRICAL PERMITNG. 24556
APPLICATION/PERMIT PLUMBING-MECHANICAL.
BUILDING DIVISION BUILDING PROJECT IDENTIFICATION
BUILDING
ADDRESS. F. ' SANITARYNO. APILCATD
ONSUBMTALDATE
VVratxow w • UNIT. LOTH
OW ' SNA PHONE: RACIORSNAME: LIC NO: l
N S_ hi CONfROLN
MflFiITECf GINIiFA: LIC NO: SS: ❑
>n AL O Di ` b
ran-y CONTACT: PHGNE: BUILDING PERMIT INFO
+ � r r ^, (44)'114-267"
�) 26 QTY. ELECTRIC PERMIT FEE
GAyw.\/y (�{wL✓1/ Q4- 7tJ BLDG ELECT MF. 1
I PERMIT ISSUANCE NIdI
LICENSED CONTRACTOR'S DECI.ARATON pppLUNCES-RE91D L LE
OCZ IM1aeb/.IMnduO vnllcenxd underprtwisians ofCTapler9(canmrncinB wish JM DESCRIPTION
adF fall formandlcffaivulm3oftheBusiltwanWPrcafeuiaruCode.and mylicrnuuin PN
QI_Z, License aau Lic.0 2 A
rn�y Dare Colunclaf 201 I IA
ZFON-L ARCIIIIYCTSDECLARATION I AMPS SQ.Ff.FLOOR AREA S/SQ.4T.
O"L_O 1uMcmtmdmyplanasalIMuwdaspublic Ic s. A
F.yf_lL S NS EJ-ECIRICAL Z. l,S (J 3$
Qyf� I.iamN Pmfcvimd
lYoane< OWNER-BUILDFADECLARATION SPECIALCIR
�xx' IO. I Ilncby vffirm Jur I am caempn faun the Cmlrxl«.Livrnve Law ran IM1e
0
W3t; fdlawinm
g..(Sion 70313.Burvi enPoid PCode:Any city or county TiMP. .R R EINS9'.
LLwhich rtyulrn a Pemtit 10 rontrvct.ahc,improve,dctmliah.or nryein miy slrunurt
WiS prim to Its lnwamz,also rgmre,dm applicant Tot Pcnnit to filo a sigood wrcmmt POWO DE S
�TGO thvkia licensed prrwam to Bat provision.of theCmuut«n Limrue law lChapncr
1SxpOC 9(mrmnercing with Secnion T000)ofDivi.im Jddx Budnlns mid Pmfeuma Cafe) SWI POOL FU/RIC VALUATION
Way urlhv Fels eacmpl lllocfecnnrd the bi for the dkgcd acmptian.Any vidulond
F iSa Sectim 7031.3 by any uWlicanl fur a permit subjau Ne appheant to a civil Pewhyof .- S-SWIT FS-FI%TI1RE5
$ nal rrlarc t1 9
han fico latitudinaldollar,(5500). V
�FC ❑ I,aownerofde praperty,mmyemploy®with wgnaBatirsokcompersation. NEW RESID AL ELECIR SQ,FT. STORIES— TyVIECONSTRUCTION
a 5C$ will dothuwurk,Curb, Thai
Clumisnd i,Licons, ,i.doer ade(Sa.1. Busircof
and Dofcaskm Cale:The Connran«s License taw Joos nm apply In an owrcr of '
Puferr>'whobuildam impravn lheram,ard wMdoawch wak himulfathmugM1
wnempbyepovidNdml.ahunlavvcm rlat d al(mule.M11f,
OC.GROUP RS.UNITS
hvxevalataimpmvenxnusddwillunan iewrofatdotideow
baildcr willhav,li, mMJid nobadd a irn,,vo for PuOwo.f
ulc.).
❑ I,.s owratrdtM1c progeny,arneacludvely conn vngwilh liansM,wnctmm QTY. PLUMBING PERMIT FEE n.00D ZONE nPN
omlrucl Oro pmjco(ScC.709N,Basin.lad Profnsims Cade:)The Co.,-,
licentelxwdoes not apply to.n nwnatrofpmpcnywMbuildt air improvcn Ihl,—,.,d PERMIT ISSUANCE
wbocmuacu fm such pojens w ffi acrnuacta(a)Beata.puuwm to the Cmtuct«s
Liccn.w Law. ALTER-DRAIN&VENT-WATER(PA) FEF,SUMMARY
❑ I am e.00Te carder Sec. .B&P C for Otis rmxn BACK FLOW PROTECT.DEVICE )E Es
"+ SANITARY Y N
PT
M aOwD+u RI:CEIN
��� not
DRAINS-4LOOR.ROOP.AREA,COND.
WORKMAN COMPENSATION DECLARATION SCHOOLTAX Y N
❑M I hcrcby.Rrm lha,I have.ecnlfice¢of..,e,alf-inuue,ars crnificediRE(7EIPT.
WakenConlprnserim 1.macmifcd baby datrmf(Scc.J800.lab C.)which PARK FEE Y N
(cdve..11 cmplaya'.uMNu
cr Pcnnit.
l'st>PblicyN GAS-EA.$ S'f I:A1�I WO BUILDING DIC
rSION FEGS
coiiiiiiiany GAS-EA.S ) U PLANCIIECK
coifed apY i,bncby furnisKd
Cenificdenpy is filedwilbthecity impecrimdivision. GRFA
EATFlEXFJINDU i,� G DINGF '
CCAT?OPEMPIIONFROMWORKERS' ORI:A ' IIS ♦ O �..N
COh1PIINSATION INSURANCE L
(Deis victim rcM mA be carrplcted flhe Pcnnit ii faraat hunsit dolW,(Sim) SEWER-SANITARY-STORM EA M[IFT. ENERGY TNE �.
m Ino.) LV
Icmify Blv in thcpMmmamz affix wmk fa which Nis pcnnit nlswM.l.hnllWATER HEATER WNENTIELECER
not employ any pcoaan in my mauler so a to bcavrtat.ubjmi to the Wakrn' T PAID
Z A;pcnsmim lawn of Celifanw. Dere WATER SYSTEMO14EATNG pole RZa Los
zO NO CE TO APPLICANT:If,eftor making this Cmifiou d E.cmpdon,yon should NEW RESIDENTIAL PLM B. SQ.FT. TOTAL
(^' btt'mx subject to Dat W«ker'a Cmoperustim povisiau d the Iabm Code,ym moa
> fmhwith comply with such provision.car this permit shell 4 dban,M rtvokod. BUILDING FEC
G CONSTRUCTION LENDING AGENCY SEISMIC FEF
U
1 lertby affirm urin ane arn
dial brace. orctroagcy fa fiat perfonmmc of O The work for which this pctmlt is iuued(.See.3097.Civ.C.) ♦ EIACIRI
Lntlel.Name
Q U Lm
ckr'.Address QTY. MECHANICAL PERMIT FEE PLO LNO E
1 cmify than I he,.rod this vpplicerion",mo then the above infomueml it
cane,,Iambi c.TA"Rh Wl city end county nrdinun<v and,are,law oelse.,m PERMIT ISSUANCE A C ICAL FEE
Nbuilding cavuvctim.and M1crtby wihariae repaenutivaol Nie citYwmtn upon the CONSTRUCTION TAX
U Z rIr o nsmiaxdpmPeny,fm Wpatino Pmposa. ALTER OR ADD TO MEET.
(We)agree to save,indemnify and kap herndcn the City of Cupedlm agdru
Iubllltia,jMgrrenb.emu aM sperm which may in.ny wry eacmeegdria,i City AIR HANDLING UNIT(TO 1.01)0 CFM)
in caswquerce d fiat grulYrrg of Thu pami
AIR HANDLING UNIT(OVER 10,000 CFM)
I
arc of App- mbacter Iter EXHAUST HOOD(WOUCT)
PAID
l I IAZARDOUS MATERIALS DISCLOSURE EA'TI NO UNIT OO 100,000 BTO) Due Receipt N
WREN,aPplicanit afutirre
e building os,oti soor Li hebacteria]rasksasbacteria] HEATING UNR(OVFR 100.000 BTU) l
es cofincd by that Cupordm Munklp.l Cade,CT.prer 9.12,and rhe Ilcalth and Safety
CoAc.Sminn)5532(.)1 VENTILATION FAN U4NOLE RES
11 yet ID No
Will Oe Wplic.etafulrvebuildirlgacvpanruxcquil+rlmtmdevlm whichemh BOILER-COMP(JRP OR IM."BTU) ISSUANCE DATE
�irWm air cmwmirunts as delired 6Y d¢Bq Artn Au Qadity F1anaSeveot BOILER-COMP(OVER IM,k BTU)
Di Ni P
1 t/ 5 ❑Yn ❑No NEW RFSIDINTLAL MECIT SQ.Ff. D
Irl'/have read the Itneeculcuu,arch lai rtywrtrrcw under Chagv 6.95 of the
CTlifomie llenith&Safety Core,Sr hues 255(15.25533 and 25539. 1andcmrand Jud JAN 20
if the building doa am currentlyiv
he.a.co,Ihm it is my rexpvuidlity to notify the
occup.nl of dsc rtquumatnu which must be non Prior to j.of•Cmifiese of 99.3
(kcupancY. VII V``�w�
Uvrera.udm.N agent Dane A S ISSUED PY: v'_— _'\I.sNV
OFFICE