S 1187 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.ELECTRICAL PERMIT NO.
BUILDING DIVISION APPI,ICATIONfPERNIIT P!U\U HIND-MECHANICAL O
BUILDING PROJECT IDENI'MIU1,1IUN o
BUILDINGG ADpBESS.. / SANITARY NO. APPLICATION SUtlM AL UAI'I!
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OWNE 'S M1tl!' / _ Pf10N'L' COKfRACIT)R'S NA LIC NO�
Z A�,►.L_Tr L NIC C//O,Yf��RO//1((.♦����
%R In POM'IFNGINBPR. LIC NO: ADDRESS: ///� ❑ ]1LJ91�
OP/ k 64
CON cT: CA
❑ Coaualtaat Far Paid by Applicant(Initial) BIXIG HUI e�PER PLUMB
MICH
G LICINCONTRARSD[ QTY ELECTRIC PERMIT FEE
I hereby afamt liter 1 a l Rcerad under ftfovinms of Cluryer 9(crrmrereing JOB DESCRIPTION
Z withSestion)(XFBol Ilm,ra 3efthn Busine,,and mrcuione Gdq nw my It,'—11 WOO PHRb1IT ISSUANCE;
in full fora ad affect. )WL [I KITCHEN RIiMODIih
❑acro Clau Lk.0 APPLIANCES-RESIDENTIAL FkADDILON ❑PLUMBING RE-P11117
Z Dale Corh nx
C ARCHITECTS DECLARATION ❑MUI.TL-UNIT ❑STRUCTURAL.
Zp!�Z lundersmw myplann,hdl hd e usm public rtuvdv PANIHS MODIFICA'DON
OZ=J, UP'10200AMPS ❑INTERIOR ❑CHIMNEYREPALR
F•HEt�+ ticarsed Pmfe.siavl 201-IO TAMPS IMPROVEh11NT []SWIMMING POOLS
OWNI!R-HUILDIiR DECLARATION OVI!R IW)AMPS ❑BATA RE,MODELcNEPAIR ❑DHMOLfT[ON
I hereby of ino that I um excmp lium ile Cunttncmr'n Lice—Law for the
a 6
k O a U following teas,.(Scow]Orson,Btvrcu toldPfolnw.m Coca:A,city ur caun7 SIGNS ELECTRICAL
❑OTH'R
whimrtgwmac.aim)reIn mnsdindalter.it for
[t errrepair any d! •�eol
ure
�g tannuilx iuuwahan urcyairea thoappnvnt Br mchwcn,fBic La. rmtement SPECIAL CIRCUITMISC.
w 1yY Rarro i+licrnuil Sceli.70thia)(I.Liamnxofthe Commctt-id,l gree lawlC relor
(cot lie j,inewnth Sectio lB ori dr Diviai to,ria r abed a.a.,ron feuiws Coon.f TEMP.MFIT:R OR P(JI.E PINT. TNEWRLDOADDIHON
I
i Ny O that le is ucntpl IMrefnXn utxl the basis hr tat alleged cxcmpiom.Airy vinlainn of ❑UEM(ILITION
X^� Section703 lS by any afidwia'for a rental whjects the nialwvu to n gill letulry of POWER DEVICES T ❑FOODSERVICE
Cycot.9hatn Rvc hutxmd dollatx lSSUI). VEMENT
Oltlutie worl(adthe srtwyturt umtintetdd with wage,err their vile eoinlv:nraww. SWIMMING 1'001,ELECTRICo0cm1 for-ole(Sc.TBbL,Budaand DmIreuora Coce The Coaster,Lucei sc law do.cot aAY to m ovncr of OITI-ETS-SWITCHES-EIN"NRFS
,ocdy who haulm or 1 MoesIncreon,and who docs,uuh wr.k b oosc fer thnaghhit ower emiflo,e,,fmvWCJ dw',clan imlrmxmen,H nm inlcalnl or offered for NEW RESIDENTIAL ELEC it SU FEside.If.braear.the building or hrtpmsemen'ix sold-Or. n,yew o l'.1le.vio.the �FT.1///ttt.UORARES SISO.FT.tr ncr-wilder will have the Mader of proving tMl he did not wildor improve fix rya- �pugn[sok.).❑I,a mxrof ue 1r4enY�vm exclusively mntmming with licrnsd contrstors'o TOTAL
wstmct the M,,,,(Sce,41W4.It-,ii,,X and Prol ,siorm Code.)The Cont mcml,Li-
rnelawdoesmrapplytomowrerofpsgcnyonowild,m imlawes tFerton.andQTY. PLUMBING PERMIT FEE
ww contraca for rveh frejets with a eorr a den l)liceoua puosuent to the,Coruna ods
Liccnv Lw. PER ANCE
❑I am exempt under Sec. .B Rt P C for tbu mavm
A I.TER--'-XreVF - TER IPA) I VALUATION
Owren W¢ /�
WORKER'S COMPENSATION DECLARATION BACK FLOW P T. )EVICE -2570,
Q (nC( �
I Internally et under penalty of tedmy hrw
one of the ful 'ing A�laraa: V 0rion
❑ I havcand will mainvir,a CeoifcwcofCwcent To ef-hoatvc for Wurkcr',CotnTer- DRAINS-Rf10R, R)P, 1?A,CONDSTORIES TYPE CONS'(RUCTION
wrier,is ptrv:ld for by Sction 37M of rite Iabur Curie,for the ftcHmmnc of the
ark furwti it this permit is isswd. FlXNRF_S-PER TRAP
❑1 Mac and will nwintvin Wodo, Coorlm.mw Imurumcq as rryuited by Section
3700of the laver Coda.for rile partontwrnreof the work for which this permit;,ncsucJ. GAS-EA.SYSTEM-I INC.J OUTXTS (ICC.GROUP APN
My Wtr4e( pcma'wo lmwnmrt certirroll Policy nurttb GAS-HA.SYSTEM-OVER 4(FA)
Cemcnh 1Policy ROM W
KI I CAMPENS TI NINSURANCE KI!H.S' GRE1SFlINDUSTRL WASTE INTERCEPTOR COMPENSATION INSURANCE BUILDING DIVISION HIS
Qbi,sashoreatMnc completed lithe pumit i,for one hunlrtd dollar,01 Nil GREASE TRAP
w le.aad I'LANCIIECK PIT.
I certify that in the pforrouree uftework formbich this permit i,imidL l dull SEWER-SANITARY-STORM EA,2()O FT.
not employ my petwn in any trwnrer so u to b (,iac subject m tie Wnders'C'orolcr- INERG\'
ZZ sdon law,of Culifomia.Date WRIER HEATER WNIWUIH.F.CI'R
O Appkw G IG E
NOTICF,TOAPPLICAM':If.aHn+making Nis Crnifca'c of Eaunynion.yw,houlJ WATER SYSTI:M/IRI;ATING
F bccntre smbjccl to dh
¢Wocrs ContpcnWion pmvi_dro,of the Ldl,r Cde.You must SD111 EE
ftnhwith comply with such pnvuiwn or'hi,pout stall be deuced rcrokcd. WATER SERVICE,
a0
� z nar CONSTRUCTION LENDING AGENCY NEW RFSIUI!NIIAh PLSttl. SQ.FT TATO Date caipl
(hereby off Bur lilac isemnsacls9wlctdin8 agenry for tie pcHunwca of
U O lie wod,for which this 1cr'nit is issued(Sec.3(194,Civ.C.)
C)
U IOTA
LQ1< 's Namc
O IcMc/s Addreu TOTAL:
1 crnify the 1 have reN this almlica':n ed use tMnhe vhove inEtmmtion is 1 ENG FF,E
t0., correct.l agree it)comply with all city and county trditaax,and state M.+rtwing m QTY, MECHANICAL PERMIT FEE
Uz dlJing cvnumctio ndI berebyeatnarirp
e ree.n
euriv¢ofthi,city memerapon to SEISN"CEEL
ewvetncn''tnreJ pnyrny for inspection luHxuo. PERMIT ISSUANCH
(We)agnc lu erose,itdcmrify ave keep Mmsku the City of Cupertim attainedI;I.F.CIRIC F
Ii Wilitie,judgrtema.eWs aW e,pnva which they ie wy vey.egaitar aid City ALTER OR ADD TO MECH.
ircomm,riiaceofibegmnlireoflhta permit. Fl.UMBENO t]i t
APPLICANT'UNDEKS'TANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO IO,IXX)CFM) MECHANICAL
SOURCE REOULaSl 'S. '
?G r AIR HANDLING UNIT IO,INXI CF3IJ CONSTRUCfI(IN AX
Sigttwure td cant/ own« Uwe a EXHAUST HOOD(WMUCI) USING MITIGAT F'EE
HAZARDOUS MATERIALS DISCLOSURE
I tl lwu,licwnorCuwrebuidingtuupmt uumorhandlchvnnMa,material HEAI'INC UNI'I'(TU 110g0HTD)
as def ltd by the Criterion Municipal Code.Chafxer 9.12,wd'1'e Heath and Safety
Code,Section 155321.14 HEATING UNIT(OVER 1110.01))BTU) ���
(]Yat 0 N VENTILATION FAN(SINGLE RESLU) ArK 00
Doc Rarity M
WII'w app icant or future bei lding occupant use a,lifotcr'or tkv ices which BOI LHR-COMP 0111'OR 1()1,1X0 H'IU)
clot bmafdous aU cnntamirentn a.,tklittd by Ibe Bay A.Air Qua ly Manugnrcnt I F .I a t t u../ TU AL:
Dlnaict4 BOB.ER-COMP(OVEK IttimillHBT'U)
E]Yes 0 N
I Rove reed in,nwurdtu,tak rGumer
its .autder ChyW gcr 6.95 ne Coli- AER CONUH'IONER
toedISSUANCE DATE
frena Heath k Sdoy Code.Section 35115.15533 wd 2 YXL.1 utdnuand'Mt if tie NEW RESIDENTIAL MECIL SQ.FL
building dna mtt carramly ho—irmnL tMt it is nry,es,—i1,h1y,,m.i,lie oacuptm
of are,try ich otuu be ton pro to i.umrce tti a Ccmftcwc of Ceculawy.
Oona,ora ',ed Tan, Uvte TOTAL: ISSUED HY:
OFFICE