S 1186 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PFSIGE NO, c
BUILDING DIVISION APPLICATIONMERMIT PLUMBING-MECHANICAL 1, 1,86
BUILDING PROJECT iPESfIFIGTION
DUILI INGADI]RESS: w� SANITARY NO. APPLICATION SUIMll9'AL DATI'
ll////AA// le) A2AY I -2ggt
OW P. 'l AM?' r PHONE CON; IOR'S NAME LIC NONIC'' �CO/N�fROLN
` U 1CIII'NGINEER; LIC NO'. ADD ISS: ff /
r � �
(f r Y• (,L 24h L) - ❑ ((JJ��((JJ
CO CT: I NP U v ILDING PERMIT INFO
r ) —b % ❑ Conwltsnt Fees Paid by ApplkaN(Initial) BL� El PET MUMB M[OI
GL//J LICENSED tONRACfOR'S DECLARAHON QTy ELECTRIC PERMIT FF
1 Mreby alrmt tMt l am IianwJ amkr prvivau ar Chaprr 9(rmmrncmg JOB DESCRIPTION
with Salim 7000)of Division 3 cf Ohe Hf,inn,coal Pmfcraiom CMc.md my lioc is 7 I
in lull force end dial. PERMIT ISSUANCIi
��- WL Ll KITCHEN REAfODEI,
QZUZV Lirrnm Clea Lk.N APPLIANCIIS-RESIDENTIAL ADDITION El PLUMBING RF,-PIPIT
¢'W DanCo.,.,
Conlx
��777 art ARCHITECTS DECLARATION PANELS ❑MULTIUNIT ❑STRUC URAL
Z O IVT Z I urdcward my plan,00 be fort v,public record,
MODIIICATION
- OZ-CI O OP T4l0AMPS ❑INTERIOR ❑CHSINEYRF,PMR
1-r?~41 I.iceosN Pmfeuiaul ?01-10(10AMP5 IMPROVEMENT C]SWIMMING M%)IS
. 4 OWNEorBUILDER m CIA RATION OVER I000AMP5 HATH REMODEI/REPAIR ❑DEMOLff[ON
K�J I hereon ftrom m. 1 1n,cacnlpt from Ik Cfmracloos,:A.,e law to the
V which ing uice,a (Sabo,]0313,B,rihcaa oral oc,ts,iona Code:Any dry imunlY SIGNS[LLCfRICAI. F
3 P.
which myuiro u Nano ri construct,dee,.o feacur h penmrit or repair sail wmclurt
prim toluivueal sa�.nim,lba Emsmlieentf c Conmarinillo Ek a,Law stmetreeet SPECIAI.CIRNRIMISC.
fp( } Thyhemr,iSexwm tothCpmvirim.n of Ctm119eri,Lieen.m Lew(ChapCr9
W X 00 tco Pre,is astrih Section]00)a basis for th lM egeBucct etc aPtion,Any
vi lmon or TEMP.MEYER OR POLI(NST.
d e y thinSec he in cacmpl Ihocfnxn sand cr hmia it the JEeN compo,.Any vbWinn of ❑ K',rQLDG/ADUff10N ❑UIiMO1,ITION
m.w Section]11315 by any vppllanl ftx a psmmit euhjms tk upplicam w a civil pcwlly of POWI:N DEVICES ❑TEN Ap'I ❑FOOD SERVICE
Z} ret moa Item Bve huoJml ddlon($5110).
k^Q ❑ I.as mvor M lk porocy.cx my mnployer,with wage,a.r lkir sole ampenwtinn. SWIMMING IY)OI.LLF,CfRIC IMPROVEMENT
wiR&Ne work,artd the wucom,i,m imem4d or offered for.1,(.Sa.]643.Bminea ❑OTHER
W sand Ptof.ion,Ctsle:Tic,ConaeclNs License law docs not e,I,in an owaaT of OVD.IIS-SWIMHES-FIX-TURES
pntpeny who build,or impma tkrtem,and who does such work hitnmlf or Ihncgh
his own vmploycn. war kied frim,uch itttprwrnhenla me nor inaemlal or offctN for, NEW RESIDENTIAL CLECTR SQ IT.
safe,If,hwmer,dc haildingtr crrpoo'ocent in mod within—yotmfcompletitm.the SQ.Fr. I.OGR AREA 5/SQ Fr
r-bbdtlto will Mve the bathe,M pmvine that k dial nW lueW tx inrpnwe for pun- al. e
wrc
Passe o,soe).
l
❑ 1:us avncrof tk See nen e,elueivdy mwvading Co,Ihol,,unseal m-tor s m
catlw La 0r prztjecl(acy.]OW,wm of and ry who Ins Coda TTte conraClon's Li-
,clawdm,nacpply to an owtherom.nony wcemaciJ.nr.of 1.B,Cioon.md QTY, PLUMBING PERMIT FCC
soba mnlN[u fnr.rw`h pn�}'ell wi111 u c(NrvclUf(s)Iial14M11 pumlvnl to IM CanlraelCrs
1Jcense law. PERMIT SU CIH
� Imn cacmIA rosier Sec. ,H&1'C for this reuam
ALTER- NR VE -WATER(FA) VALUATION
(Tuns, Donc
WORKERS COMPENSATION DECLARATION HACK FLOW .DEVt - e I
( I thereby ellimt order pereahy of"mr,otr of free following declmuion,:
IJII Mae and will main u.in a Cenificam ofCoaatm ,,self insure Lx Worker',Com,,en- DRAINS-11.008 R P.A,COND. STOR165 TYPE CONSTRUCTION
satin,,al povidN for by Seetion 3700 of the Labor Code,for Bic prrftrnwtta of the
wool,for whrh Thi,permit is osuM. n%TITRES-PERTH
M 1 Mac and will constrain Wotkcr,ComPensmion Imu,ure,sag"airi by Section '
J]0)o(tk later Code.fox dr perftxmure of the wrxk fm which lM1u pumit is isuhed. GAS-EA.SYSIENPIINC.YOIfILETS (ICG GROUP APN
My Worker',Carpe ti Innurwac�mer and Pnliry numts,
CsarticcQ Policy Nn.: GAS-IA.SY.SIEMOVER3(FA)
�Q ('fCl'(PIC''ATI:OF I!XI;MPIION FROM W , F,
COMPENSATION INSURANCE GREASIIINDUSrRL WASTE INTERCEPTOR
BUILDING DIVISION I '
_ (Ibis wa6m ocN nor kctmpktN i(frr pmnil is fa tmc hunhcd dollms(5110) GREASE TNAP
or ecu) PLANCIICCK FEE? ".
Ianify that NUepMomwaoftM wakltr which this pcmutiocrsC.landl SEWER-SANITARY-STORM CA.100 I'f.
mt employ any pstmn in vnY mantherooHn kcmceubJm to ter Wotker%Compcn- ENERGY FEE ai—
0 Z mote law,of C.Iifumia.Date WATER HEATER WNEN'DELEQR GRADING FIUi
Z 0 APplicant
y NOTICE 11)APPLICAW:If,after mating ins Cemli,ale of Esemprc,you should WATER SYSTBAVIREITINO
F become subject m the Wori Cotrtpmm neer Provision,of tk Wer Cts,,you mow SOILS FEE
{ LaS1 > fsol,soh comply wide wch pnvisiomor this p.erm,hall k Jcsmcd rtvnkN. WATER SERVICE
a �
CONSTRUCTION LENDING AGENCY NF,W RESIDENTIAL PLMN. w.FT PAID
UQIknty rditm eMOM1arc i,attinlANClinn lending ogcaY for the purfmnerea of vacs RLIptp
tk wurk for whim Nix Lnbms;Laos (SCC.JW],Civ.C.1ak
0 F' Irmlak N. is TOTAL:
Iirs cr'a AJthar A
I unify ttw I hc.c tM1rc applicetitm vml,tate That tk aMvc inRrmetion Is BUILD G FEE
1 Val corm.InOrtemcomply with all city and county aJitxrcc,nal some law,rtlmingm QTY. MECHANICAL PERMIT. FEE
V Z building corurvclim.ural hetebyrtamonae rtprcmawives of this city to rnlR upon the SEISMIC FEE
above-mentiard prupmty for impetion Pcr,ows. I1iRMI'1ISSUAN6'I!
Olde)etrtt to mac,iMenmefy sand kern M1mnedu the City of Cupcnino egeiw ELECTRIC iE
Iiebililiea.jMgmems.cops areal eapentes whkh may in any way accrue agaittn said City ALTERORADDTOMECH. PLUMBINGTLE
can.. tienceofthegmntingofthi,lmnit. 0-7-i6 IS
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR BANDUNG UNITGO 10,00 CFM)
SOURCE RF. S. MECIfAUCALI J?
4A0 �9� AIR HANDLING UNITIOVER Ia.I DChM) CQN�UC ( TA%
Signmurc ofA ecvnt ommsrr /Dole EXHAUSTHOODIW/DUCT) HOUSINGM ATI lE
HAZARDOUS MAH RIA1S DISCLOSURE
tk epplicem m fuwrt building mcupwt,tore or haMlc hvarkc,malcrial I IF V 1NG UNIT(TO 101.00 BTU)
m Jetim by the Cupmiw Munkifml CMC.Clmpl[r a.I],and frse llevlth rend Safdy
Cole,Schon,25532oi)] HEATING UNIT(OVER I(O.OBB HTII)
❑Yr, FI No 1I1vV _
1 pcv
P�
Il fineeplimx or nature building eue eia dices which VFNTH.ADON FAN(SINGLE RESID) Dorm Recei a#LaMs airrea,hfinN by uneBay Area Air Quality Mewectrcnl BOILER-GGAPP111GR 110,0X1BN1
Distinct, TOTA
0Yr, E]No MOILER-COMP(OVI3R 100)(I1TU)
I have real Nc hvvdest,no iala osEirettrms utuM CTeperh95of the Cali- AIR CONDITIONER ISSUANCE DATE
formic Hctlth&Safdy Cealc,Ssomms 25505,15533 aM 255:M.1 umkmtnM If.if the NEW RESIDENTIAL MECII. SQ.FE
building Jts,not cummtly harc v lemat,frvt it n my mpoeittility to maty tk trcupwn ^ -3
cffrc a,mmncom wh.h court kercl miofmiswoamd a Crim mof0.vpmcy. l T
Owner or amhci agent Dmf 0 Issulil)BY: kY "r,_�
OFFICE