S 2475 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CI'YY OF CUPERTINO BEILIHNG-ELEM RICA I. Pi NO.
NUILbING DIVISION APPLICATIONIPERMIT PLUMBING-,MECHANICAL S 2475
BUILDING I'ROJECT IDENTIFICATION
BU11DINGADORCSS'. SANHARYNO. APPLICAHON S/UBMI'IT'AI.DA I'IT
11\' /4/FI� _ '/ tff ('HUNG:U CONrkACfOR'$NAME: LIC NU:
/
�� /'4 _ �z/�///P// PHoN.it/r S O NIC CUNfROI.M
CIifIT:CT?eN01N�� /w/Y/ /7�Y •�/IICCN+OV ADDRESS: ❑ r
CONTACT: / PHONE: BUILUWG PERMIT INFO
/ f46,3 ��g/ ❑ Cons trim Fees Paid by Applicant(Irt BLDG; ELECT PLUMB MIiCH
/T lY' � IJ CMBJ B/
LICILNSIiI)CUNfRACOR:SDIiCVRATON QTY FLECTRIC PERMIT FEE
m it.,herchy affirm 1 am liccnral male, an,nner tri Claw,n(Lommencmg JOB DESCRIPPION
Matzwiln S�oranlnH)nmi.'Ta'mn BnrurxaafTand Ptnr��nitmnetde,and Tnrrcemeia
W 00 PlikMnIgguANce Ce. R SrDWI. TIAI:WF in full foxce amt erica. I [ISPDW'I. ❑KTfCHF.N kR\10001.
aE.ZU D"e Clan ccm
FOGY Uma Cmlmclm APPLIANCES-RPSIDEN'I'IAI. ❑AUDRIUN El PLUMBING RB-PIPE
'MTA ARCIII'MCPS DECLARATION I PANELS ❑MULTI-UNIT ❑STRUCHIRAL
z tr�z IuraYararal ny PUnnshall Wi al.Wide rea,,ad, MODIFICATION
Oz—n UPT011l0AMPS ❑INTERIOR [I CHIMNEY REPAIR
F rGt F-W Licrn.sal Pmfies"raul 20I-1"AMPS IMPROVEMENT SWIMM[NGPOOIS
aWNlik-HUILUER DECLARATION t OVER 1000AMPS ❑BATH REJMODEIIRITAIR ❑DEMOLITION
wa 1 hereby amrm Jim 1 nm n.e.N Dnm air Cmilran a,Liecn¢tan far me
x�pU folhwing eumn.(.Seaiun]IU I3,Iluxiraax acid l'mhWnm Cole:AnYciiymewnly SIGNSELEMRICAL ❑ HER
which reyulms a Pk+mit m amomcr,after,Impnvc,dcma bh.or repair any niccwre
F�C� Prat md,issumce.alw rmt ap,fewan Eofwah p nmilm lilcaxigne]van,ment SfTC1A1,CIRCUIT/h115C.
than he i,liccnaul pmsannu the provnumx of theCmtralars Licnnx law(Chaper9
W1CO (mmmeooingwllh Smtion7000ddPBviaitm Juflhe Hinnnex,aml lTo4<ainna Cntk)vx TIMP Mb-ILR OR POLE INST.
a a e y 'het b,i,ra:mpt Jwrefrmn and the hui,Torr Bi:ana ed caemplinn.Any vii hadim of 'E\t'BLOGIAODITIOh' ❑OEMOLRION
Secular 7031.5 by any applicant fm aPemut subjut,I he aWHeitt To a civil Pewllrof POWER DEVICCS Eal}7NANT ❑FOOD SERVICE
m mare than Eve hooJrgl Jollaa(5.4X)f FIMPROVEMENT
Spa ❑ Lax orwna of Jre prnlrry,rx my cmpLnozx with wags a,thcir,dc conTµnmion. SWIMMINGPOOLELIT:TRIC
y{'F will do lire work,and lir lurvwal wk
crcis nmeneedornRered El (Sec.]014,Bmiaar ❑OTHER
Iy 3 m and Itofeaitm,Cute:The Comraunr'a Lkcme law Gra na apply m an n'aner of OUT'LIHS-SWTfCHHS-FD(TURCS
mc,any war hmlld,-iinpmv,there n,.,it wlin dk ,wch woxk himself can Through
Ir,man cmploym.PnwidN that wch imPmsCoa,n,um rat mtemrkd o,of&ml bur NEW RSIDFXHAL F.I.i R SQ PT,
cake.If.baa'acr,be building R imPmvctrcnt i,mild within oma vrararcmwrlc(om.the SQ.HT FLOOR AREA scsQ.FT.
an rwlll lime Jchuroin of proving that hediJ rot Wilda n,mr,c hwpur- L
oject Papery,oma exdu,ivn l mnft li with li 'he Cconn9ar's i-
Z2 Z 2q
,Wet tic prnjst L4c'.9fY41,Huaitcar anal ItnRtainna CtaJe:)'Hr GtmlmelM%Li-
e se law dans nm apply man ownendpni,anywlb build,tx mpmsa mcrnm.nral QTY. SING PERMIT FEE
whnemtmau for vrh p mjc,1 with reca .lbas)I teemed Purwant m the Carmen nrs p
Liamelaw. PERMIT ISSUANCE
❑tontI Jc
ne �,Hkl'C fm main maven Y
Owr ALTER-DRAIN h VPN('-WATER(IA) VALUATION
wORURS CONIVENSALLC&PECLAIrATION BACK FLOW PROTECT.DEVICE '2, V 6
D fN
�f I thereby nlfirmnndir PcmlyTf perjury.of the folhwine de armiom, V cD
❑Ihuscund will nwintuin aCcniOmm of Comsm mealb-insure fnr Worker,Cwnpm- DRAINS-MCK)R.ROOF.AREA,CO
w0im,an provided fix by Section BHp of me Latin Coxa,for Ihapro f-rawe of the STORIES TYPE CONS]RUCHON
wmk for wrich nrPcrinll i,inwul,
0 I Imvc and will maintain W'Alrs Ciardicnralibm Pnwmnce,ce rec,ned by Secia.
1701.80 Lahr Cixk,Ern Ne Peifimi.enfrhe work ferw Mch Iry permit siaweJ. GAS-EA.. M-1 I. And N. OCC GROU N
Myban, Comp_nru(xn Inwmrce ownerandy NT,:number am: �✓
7S
Carica, Polity Nn.: GAS-IA.S 10 (I 1 6JD '
oxo- icNiE OR E%IiMITION(MOM WORKERS'
COMPENSATION INSURANCE GREASUINI RL WAS IE INTIRCHITOR
(TNv cation nednm heaomPktnt itlhc annul i,f,,me huWrW Jollm,(Ng) RUI )ING DIVISION TENS
9r icx,) GREASIi TR
%ANC
Iccnify mmin tM1c pr(tmawar ul Eaworkrafnr which mia pfnmlis iawal,IdTWI SEWER-SA IT�{'
ma„npWy anyM1 in any manrcrwmmM1aom:wAJca moire Wmkca'GrmPcn- ENIJt TE
Zz salon Lawn of CnB ormir Date WATER I HATER WNPM/IiLF.CIH
O Applicant GRAD[[ 'F:
pj NOTICE'(1)APPLICANT:If.after raking this CroniEcac nE Excmatiar,you shmald WAI IS SYSTIJN/TRErFHNO
C > bee nnc wbjeO to be Wakce,Conyrn.atitm puvisicns of IM Luba C,JK.you muu SUITS IT
aQEmhw'ith eolnply wilh,.hvmvnibrbur thin Permit nha111W Jenmenim,A,d. WATER SERVICE
OZ CONSTRUCTION LENDING AGENCY NEW NP_SIDPMIAL PLhIH. SQ.ITT, PAID
U O IMmhy allirm thaT lhae aatmstmniom lcnJin6 agcmyfnr lh[Perfoxmarac of Date ReceiN0
w — tR,work for which thin Icbmi.ix karin!(Sec,0097,Civ.C.)
O U Lenders Name 12
'1l
LendersAdd—, l'A .
yI anifY that 1 have Teud tenap,licalion and stem that me amve mrunornn ie B L Irl D J/
rA ctxrnn.t agrcc mctnnMy with all city analcwrnly nrJlnerac.and vete lawsrelwingto QTY. MECHANICAL PERMIT FEE
UZ wilding 'armmmn.and lhereby anMn.e rtprocnulivss of this city m enter npon the . I HIE DO
oMrvo-mcmirRemmp clnrnibilyi anpulm,o. PERMIT ISSUANCE
(We)agree m.wee,indemnity and heap harmlan w y nr Ca)wn,l v agalmt f. S RIC D?ii Z� •2 L
inecirser,jwlgmrnte'namimleapena.which may in any may rav,ue agaimtval City gLTGR OR ADD TO MIFH.
mmyuc fth granting of this Pcnnit. PL MBING IIJ?
APPLI ON -.RST .OW 'lah1PLV II ALL NON- NI' AIR HANDLING UN'IT(TO 10.0TOCPhU
SO F EG P FIE. NTCALPLH
I AIR HANDLING UNIT(OVER IB,O)BCFM) CONST CTION'TA%
Sigtmmrc m Aph,. am.m, at U(HAUSPHOOD(WDUCI) HOUSING AIITIGA'rIONIZE
HAZARDOUS hIA'IlJ11A1_ (SCI/(SURE
Will thcapplirunt m future building rumpme 4mcoxnundle hnrallous nwmrlal HEATING UNIT(TO IfN1,f0p H,U)
a,tktimil by the Cuacnino Mi niei'l Cuk.Chapin,9.12 amt the Health mal timmy
C(dc.Salion. 5320)^. ((EATING UNIT(OVER IBB,OW(ITU)
❑Yes Ni,❑
VENIIIATION RAN(SINGLE.RP_SID) PAID
WIN We applicam or Emile building occupant us eyuipmcnl m IRvim,which [)me Receipt k
emit lcmnkaus air ctmumirmnn w,Jefnvl by the Bul y Area Air OnnIny Manageria BOILER-COMP(JIIP OR 1011,00)ETU)
D,inc, f
❑Vice r7Nor BOILER-COMP(OVER 10).000(ITU)
1,4,2red Jhe lnruNoiji, riial,nvluircmcnty arab Cmyrer 695 o1 the Cil i- AIR CONDITIONER ISSUANCE DATE
1 Sa[n)' rima^ 4 ,2 ll ani 531.1 urndnamal0w frhe NHWRI'SIDP7ALMFCH. SQ.IT, P
J RI �n �irit�yWto�mXit}'The
T u - ust r .r//' cof a "`III
1 %1((weermeutnomieeJ agcm` I tic A ISSUEIIBY:
OFFICE
09/02/1599 15:45 4009800714
Page—( cl
•°"�'•"° VENTILATION TEST
~1 Job Name /&-/�,NF— Date
OPENING REQUIRED FINAL
AREA SERt'ED K
NC. I SIZE i FACTQR MIN. MAX. MIN. MAX.
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