30217 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL %iRMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 30217
BUILDING PROJECTIDENTIFICATION
BUILDINGADD CS SANITARYNO. APPLICATIONSUBMTITALDATI
1. t �-q6
OWNER'S NA fE _ _ PHONE: CO NAME TIC NAMLIC NO:
"J'r\v\/o Z NIC CONTROL N
•ARCIIIII: MNGIN'E LIC NO: ADDRI S� \ }I
CONTACT: PHONE: - BUILDING PERMIT INFO/•
te; — — _N. ❑ Coluvlten[Fees Paid by Appllcanl(Inldep BID(: Fl� %.UM ME❑CI I
IJCENSF.D CONTRACTORS DECLARATION CJ'f(wv"7 QTY ELECTRIC PERMIT FEE ,L�yJ` r
I l�by.fflrm dust 1 am Iimnscd nitm pm�,isions of Chapter 9(rattnercing JOB DESCRIPTIO
O0Z th Section]000)of Division 3 of lh Buur.,.sad Plofexsias Codc.and my livense i. PERMIT ISSUANCE.
We,00 WI RE.SIDENTIAI
full face amid n y ❑SFUWL [I KITCHEN REMODEL
V�j Li[eR,c Clan IIc.r
�<i Ihle Contracsu AP%.IANCES-RFSIDPNTIAI. ❑ADDITION El PLUMBING RE-PIPE
p.Om CHfILCTS DECLARATION PANELS ❑MIJUMUNIT ❑STRUCTURAL
Z p1�Z 1aiJnntand my Plans stall hurN u+CuH'e lccvnh MODIFICATION
OZ—O UPTO200AMP5 ❑INTERIOR [I CHIMNEY REPAIR
F 41 I.tccn.scd I'mlc.catoml 211-1W)AMPS IMPROVEMENT
OWN[mr.e LDERDBCe CombrON OVER IW)AMIS ❑HATH REMODEL/REPAIR (]DEMOLITION
d' U I hmw a(Sect thus l v.5 amine s an the Cnntru'loor LiAny city(Section or cwnrySIGNS ELECTRICAL [I OTHER
44!!W O whobi raluLm a la'mtil at crnstrttcl,alter,im,ro,its iW,or er,si ens vtructure VIM
/
lines to ins ivuerccelso rcyuiru the t'licant lx sada'emn lils.,,scli amoso, SPECIAL CIRCUIT/MISC.
y Jwhis lrrnoed punuant lu ole pmviaku.s oftM Cnntru:uu'a l.ircnK lawlCM1yner9
—00 (C4°mrrcing witM1$ecllm]JW)of Division3ufthe❑usinas and Pndc aiuna Codc)nr TEMP.FIETER OR POLE INST COMMERCIAL
6 ty m IY then M1e Is exeropl Ihaefrwn ud tle bmia for the allcg W icn m,,ion.Any violation of
X m ENL Satiow]031 5 by any Wraieux for a 1 wh is the ❑NEW BLDG/ADDITION ❑UEAIOLITIO.S'
ul Fund jcc elrplirunt wecivil Penalty of POW[R DEVICES
[:]TENANT 0FOOD SERVICE.
an mrnc Ntenf model llalhera(35W).
� 0 ❑1,aamwlerol the IMPROVENIEYT
pa, moron,on,is bas
with Nmpctuiness SWIMMING POOL
ill do Nn wnrk,turd obs be Cors isere s stand aro w dr f«ale*Y o sm Business ❑OTHER
L Pot crtyPrivwho
h Calc:TIL C es sholtor's I.iaaue law arca as appy to f r brought of OUf1,ET5-SWITCFIES-FlXTURES
In, on wlw huilds p inlarovea t mach ,and will Jou such work hisnsclf di Ihmugh
his on icily he pnrvak'J Na each intpmve eld w am not iyi,ar fc es oHeeJ for NEW RESIU IAL FIECIR SQ 14.
sak.ILuilds,e9thcs,s,lbngnrimpmvcnna ismlJwilhinlmKyCarorcmlplelior Be SQ.IrT.FLUOR AREA S/SQ.FT
ws,o i1Jar will havered burdrn Mpnniny that In,and!Iwo bWld or improvefapur-
poscof a.kJ.
❑ L m own of th pnyCay,am nulusivdy aantrvcting with IiccRaN convmtr to
comm. al the Pe (.S e,]BH.Huaircxs end Pmfa.obata CodcO The Contrmtar's Li-
calve Law dm lam e%alym an owttu of properly who builds m inali thmin ,end QTY, PLU PERMIT FEE
whocmtrensf«aucM1 FmjaD witharnnuaetm(xl lirrnseJ puoauant mlhc Conwcmr'a �/ k Y ��
Li.Law. PERMIT IS;
[IIumexemptulderSec. ,Bk PCftrtnisrtavtn
Owrcr RA
[I
Dwe (PA) XII
• WORKER'SCsbyof mjT am DECLARATION BACK FLOW PROTCTU VIC 11,r
I hemM1y vfWO uKER PCW COMPENSATION
NSAlY mm N ole following dalvuim.s: CiIA�
O IM1avc aM will maintain uCenifxa¢mf Comem maelf-imort tlx Workdn ComFcn- DRAINS-FlDOR,ROOF AREA.COND. STORMS "TYPB CONSBULTION
.motion,to prcritical for by Smtion 37W of Ih Mbar Cock,for th Futon of the
work for which this Permit is issued. FIXTURES-PER TRAP
1 have mW will mamain Wakes Cloo,cnxalimn Irtxumtea,ee ba aiad by SecGao
Wof the Lahr CNc.forth Fuformana of the work for which shiapmtdt E isweL GAS-F.A.SYSTEM-I INC.4 OUT-GIS OCC.GROUP APN
M)WorkyY�gRiye[yuion_ 19aurvtr rri' en. NicY� atg,^�4� GAS-li.SYSTEM-OVER 4(EA)
Cavkc 1 T4-I�I� cramd No: •�•L^y
CERTIFICATE Olt BXBMP`DON FROM WORKERS'
COMPENSATION INSURANCE!. GREASrANDU.STRL WASTE INTERCEPTOR BUILDING DI 'ION FEES
Writes rtml abs h complied ifde permit ufmr me hiondi dollars 151 W) GREASETRAP
or tcaxd PLANCHF.CK IE S
ley anythatinch anyamnaeccofNto becaes whicM1sho to,Wilda, Iehall SEWER-SANITARY-STORM F.A.2W FT.
m1n.Law any Cannon in any manner ro es n bcNme wbject m ole Weskai Compcn- ENERGY FFIE.
OZ A,Iicawa olCWihmie,Date WATER HEATER WNENT/ELECR
Z O NOIR am GRADING
h NOTICF.IT)APPLICANT:If,Co making thio Ceniftcete of ExemrNion,you u mold WATER SYSTEMOREAI'INO
? rV
becomewalmlmthe wch l,emon,or his µovlI"of de Isborcafe,you muss TOILS FEe
� ronn'w;tn ommFly wish morn rtm.'Knan�mr his pnrtNl whWl hJanral ln,okea. WATER SERVICE
a �
u z CON'STRUCDONLdionleGAGENCY NEW RFSIDENTIAI.PLMB. SQ f4. PAID
V O Chore hkh Ism,eem rarnit i is nuanaluct3N7.Cie.ageoey fa lhµr4mmna of 1 « ReceigN
� �' the wortfes whicdt NLapmnit is issued(.Sec.3119],Civ.C.1
O U fsMer'a N. t TOTAL:
ISMeIs AtWrms I
1 1 certify that 1 hevc mad this upplisniman aril roam That ole.1 ove information L, BUILDING
ZZ) cani l egme to empty wish all my and Nuny wdiweu and one laws relit ing nes QTY_ MECHANICAL PERMIT FEE
U ,Z hildingcle.sRn.sural buebywthoriec mprescntetivm of tM1i.city mcmCoµn the SEISMIC
ilaavc I(We)aid pmµny lr immly,m Pa s,,Im
(We)agora to uvc,itweoaJfy,Brad keep humlux th City of Cupmim ageing PERMIT ISSUANCE ELECTFUCkEE
liabdaies.pdgmenu,emus and expenses which al in anyway sante a6aitut wid City
luance of the Pooling of NLa t. ALTER ORAW TO MECII. ILUMtlIN
in n,a
Permi
APPLICA ' UNDE ANDS AND WILL COMPLY WITH ALL fNj1IN7 AIR HANDLING UNIT(TO IB.000 CFM)
SOAR B EGULA )NS MECHANICALITE
AIR HANDLING UNIT(OVER I0,01k0 CPm) CONSTRUCTION TAX
Asi
Si ,mean uc V0 EXHAUST HOLD OVMUCD HOUSING MOTTATION ME
H RDOUSMATBRI SOI LOSURE
wJl Ne applicutt afuwmbuilding arose urhualk hmWuus atcnal f flNGUNIT('IOH)0d "BTU)
u&ArRal by the Culertim Municipal Code,Chapter 9.12,and IM1e Hath and Safcty
Cade,Saalon Z532(a)". HEVDNG UNIT(OVER I W,000 BTU)
C]Yl, ON.
VENTILATION PAN(SINGLE RF_SID) PAID
moll the applicant inume;ae building by do,B u-e is Air Quay devirea wnscol Date Rariµl
Diol M1 ,"^ouv air ccmtamimnu v JeHreJ M Jm flay Arm Air Quality Managcmcm BOILER-COMP(iHP OR I11b0()U BTU)
DiavidP TOTAL:
❑Ym FI No BUTTER-COMP(OVCR IW.IXp BTU)
I have rmJted FWzNoux mameim,reyulrtmerus underChalamr 6.95 M th Gli-
AIR CONDITIONER ISSUANCE DATE
Imia Health iafay Co ctitnu 25505.25533 and 25534.1 under.....!Nu If the NEW RESIDENTIAL MECH. SQ.ET.
buJdirg ate Nncnl have InNml,tFat urs my FalaoaRsibilay is I)'IIIC
due swhid to c t lxioxlniauunce MacMin e
owner 17=gc Dar 'TOTAL: ISSUED RY:
OFFICE