S 2367 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-F,LECT'RICAL PIiRMIT NO.
BUILDING DIVISION APPLICATION/PERDIIT PLUMBING.h1ECHANICAL S 2367
y — NP BUILDING PROTECT IDENTIFICATION
BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
O Io I
'. 'R,NN ME PHONE CONTRACTOR'S NAME: 1,C O' O ^
5 ho BA& ' — NIC CONI'ROI.a
C 111'I'EC'I IIN(tlNl!Eki LIC AIIDRES i ED
1
CONTACT PHONE: P[N"TMOR
UILDING PERMIT INFO
❑ CUnsullanl Fees Paid by Applicant(Initial) ELECT PLUMB MECH
� L�_LICENSED CONTRACTOR'S DECLARATION Qry, EI.ECI'RIC PERMIT IEE
Ihereby+Bimtlhi,l ala Meawe order pn,,Wom Of chapter 9(mmlmocmg JOB DESCRIPTIONIMxZ ithSecit.7FXXp Of Di eic:memo Busines.me Nefc..ionn Cndw mdl:lylianwia AL:
4C5 w' PERMIT ISSUANCE
W— to full force sed eBat ❑KITCHIN REMODEL
aV�j Lla'nw Cla.v 'jcCora APPLIANCES-RESIDENTIAL ❑PLUMBING RE PIPIT
PWS
Oalc CnnlOetm A CIIITELTtiDECLARATI N IT ❑STRUCTURAL
PANELSMODIFICATION
ZOrrraqZtun 4mmnJ InY PImry shall M1eu¢d u.puM1llc recmdnOZ—O UI'T0200AMPS [-I CHIMNEY REPAIR
P:4L l Lioemcl Nfti siur:el 301-I0I0AM1IPS IM OVFME?4T 0SWIMMINGPC%OLS
C C Q I thereby affair thalll am escimp fRmml-the Contractor i License law for the CLARAILON OVER 11X111 AMPS ATII RFJSI00E1JRE1'AIR ❑DE1a101,RION
6 U 6,11—to,maw n.I Seelion 7031.5,Il eiiners and i'nmewamm Goes:Any cily or comm, SIGNS ELECTRICAL C]OTHER
LL O'A' which rcyolra a permit to eon muer.alcor,impmac,demdidF,ur rmmir nny Imicmre
prircm it,rvoance.dso rtyuirea tM a,licam me such Tinton to file.aq,rif samsme,m SM:CIALCIRCUITIMISC.
That he i, wrrsullwrwumlI,, ,,00 oto, I M Gmmoor,Liter,Low Ghaper9
A.1 02, emFF ncingxdNSeclim7(1( )m DiviAon3oflhc Borircvand Pnrhusiom CAk)a TIa1P, !RI M)LE INSII COMMERCIALta.tL aWw he Is c.emp Ilerttmm and Bhe Finis for the vlkged nempial.Any viadldon of 0 NEWBLINGIADDITON ❑DEMOLITION
nmN :itliun"TNI Shy nny npplicmt Evupcn... nubpvu Oe Fpallc:un¢:aclvil purlally of K)WBRD El TENANT ❑FOODSERVICE
FZr mss maemN live herdtd dollars($.W), IMPROVEMENT
< Q L aa owrcr of the lmyheny,or my employees wish wages as their vole comPvmdon. SWIMMING R F,CTRIC
willisollbe work,oral the Fvucmrt ismxirferdulaotfcrcd Lrwde See 7(W.Ilmiros ❑OfHIiR
63m IW Vrotesvmn Code:lbe Contractor's License law does not apply to m_rnF of OUTLLTS-SWITCI FT RES q' O
Imrycny wM Fonda or inapnn w Iherenn, W who does .IF work himself er thnwgh
his own empoyea,pmvWed that such impmvcnhems are not intaakd Or uttered fur NEW RPS P AI.BhR SQ IT,
vale.IL tomever,thebuildiny.r impmvenarm iIwtbl within me year Mcortkeon.the SQ,FIL FLOOR AREA SISQ.Er.
rmrbuihkr roll]have Ile buNun of pmv'mg Ihit he did let held or improve for ,pur-
of
Cl 1..—Fe,uI Ih pnrpny,vn essit ivcly corooll,wllh lieett convecma to ^I'
mato,,the Pmjal(sin.71141,florins,Fred Omeo,ionv Qak::)Rte Canrwur'.v IJ-
ncLaw does..,)yInmowre,of progeny who build,m mi,,memo,mad Q'TY. PLUMBING
coFm a by soh Me,r is with a cmnorcems)limnrnl pcom ml Ito me Ccmtracmla
Li,emo Lw. PERMITISSUANCE
0 1 vin enennpl omkr Sec. .B A P C for mi.rearm
ALTER-DRAIN h VENT-WATER(EA) VALUATION
Owner Dwc /)jj00
WORKERS COME'ENSATION DECLARATION BACK IIOW PROTECT.DEVICE /D O
L Wrehy a1Brmbl
aer penalty oCpejury tore of the fulhming dalmminn,.
0 Ihax and will mdesaln aCmifcmc of Cmisrnl mslf-into¢faWe1,e,Compere- DRAINS-FLODR.R00EAREA.COND. SIORLES SYPH CONST RUCTION
\ aria.-previdal for by Section 3110 of tie labor Ede,for the lertommna ek the L
sort for which mi, ora Is k,rsd FIXTURES-PER RN AP
0 I have and will mainwn Workers Coo armatkan In.wmrce,as required by Section
3700otmFfulnrGdc.Tad,ry,Lrnwacetiflie work fmwAlch m:n Tamil iaomcd GAS-HA.SYS'I'I!N-I INC.4 OUILTLS OCC.GROUP APS
Aly Wn Im�oryry'��'�r�r lad I'nlic
CarrierLljL,�._�11�ri Nlkll lY RalicY Nn er r. � GAS-IA.SYSTEM-OVER i(PA)
CI!H'TII9CA'Iti PE l'e%TiONINSURANCE RKI:HS' GREASUINDUSTRL W'AS1.WYERCEPfOR
COMPENSATION INSURANCE is Cr'. BUILDING DIVISION ITES
Clhhsatiun neeJ rulhcmnpwed itme permit islmaa hwdrel dullan(S IIM)1 GREASE TRAP --
ur IcaJ 1%ANCHIiCK ITE
lernifymv intoe perforrwrla n(IMxakfawM1khlW,permit ki.asmcd.Ishdl SEWER-SANITARY-STORM is.31X1 FI'.
Int rn:piny any pc,oc m nny tmmar:a n bjano the Worker,Compere ENERGY FEE
zO Farmlnai i. Sfc -a WAl17R IIEAfER W'NENF/IiLF.CI'R icarc GRADING IHH!
.N., N1ITICE'IL)AIR.ICANL IL n sr n� g II< 'ani Ice c of liacmplun.You should WATER SY,STEAVTREATING
C > become suhjea m the Wml:ds Goings vilm povivas of ILC latex Cud:,yav amu SOILS TTI:
� fumwim comply wiN Bach provisions nr this permit sM1dl be dcenN m'ukN. WATER SERVICI!
aQ
CONSTRUCTION
comarr.FNDINGAG194CY NEW'RESIDIiMIAI.PLMB. SQ.1-7 PAID
UQ IMrebyalli,hi, mere ixmca 41,'.30 kr ding ogcrcYlur the performarcc of Oat RccciplM
IM1e work fa which mix pcmwas nmol lSm.?fgl.Civ.CJ TOTAL:
F Lender's Name
L.I� Lsmlcr'a AFLI. BUILDING IPI!
1 earl(,1haI I have Feld this afplicmiw:uN atom 1haI me,terve infunlwliun is
Fy caned.ivgrte tomrr,lywire all city aaldcounry odirlahea anal sum Uro.tri...I to QTY. MECHANICAL PERMIT' PEE
(� ,Z hlildingmngiaioo,mJ ocobymllrriru mpa'Ynlulivls n(mlr r'ity lu emea.,a theSEISMIC[IT
ahuveme tioad lm,srfyfainsp donfrewas. PERMIT'ISSUANCE 1l
(Wc)egrte to save,malemnify load keep hamJes.me City of C�per itm against :'L—,C":!,
TRIC TTI: L/
IiaMLlics.judgn¢ole,awls uml cap_mses which rely innnyw:ryacmrngainm.raid City ALTER LIR ADDED 1. Ifl O
in mnsapserce M de panting of This pmnit. PLUM1IH W G FF.Ii
APPLICANT'UNDI!RSIANUS AND WILL COMPLY WITH AL1.NON-POINT AIR HANDLING UNI ( 14 )
SOURCE R EGUlAT10NS. MECIIANICAL LTi
AIR HANDLING UNC VER 10.1Xp CFM) C(1Nti'I'RUCI'IUN 3'A%
Sigmmmof Appiam/Conwma Dino I!%1 IAUST IIODD(W YUCF) HOUSING MITIGATIONFT,H
HAPARIbUS NIATERIAIS DISCLOSURE
Will the eEPlicnnl nr future lm1dmgO,culmm.wore or hundk bamrdum freesnal I IEAFING UNIT CFO X n f
as def v by the,C.,em.Merrictpd Cork.CMper 9.12 aal me Hes—amt Salny
G.k,Satitm 35532(11)" HHA'1'ING UNIT(OVER 100.000 BTU)
❑YaKl< O PAID
V
ENTILATION FAN RFSIDj I}m RcaiPIN
Will the applcmd or more bur Wing acupmi use yeipment a dcvl which
emit Warm.ab mmmmilmrda as dcfncd by the Bu,Ara Air Quality Mumgcnem '0"
P OHP OR IBII,(XX1 BTU)
De�i1 L'(OVER oo.lmIITU) W"
t. ❑Yma rJ No
ER
1NiiR
I Mve mad Be Warrith.malaiaH«quhrnherl.mater Chapter b 95 of me Cali ISSUANCE,DATE
foratiu fkWlh&Safely Cdc,Scerirms 25505,25533 aid 25534.I mdrnlvml the it ILCTIAL MECH. SQ.FF. �n qf
Funding does ma correcthave a tenses. I a in my rcN.amihilayto at,,Imosei'm
1rclas ullkh 4 Io lntm,red a Cenitic�e
Oxnv aamhanad again (-J Oa¢ 1 ISSUED BY: 92
OFFICE
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-F,LECT'RICAL PIiRMIT NO.
BUILDING DIVISION APPLICATION/PERDIIT PLUMBING.h1ECHANICAL S 2367
y — NP BUILDING PROTECT IDENTIFICATION
BUILDINGADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
O Io I
'. 'R,NN ME PHONE CONTRACTOR'S NAME: 1,C O' O ^
5 ho BA& ' — NIC CONI'ROI.a
C 111'I'EC'I IIN(tlNl!Eki LIC AIIDRES i ED
1
CONTACT PHONE: P[N"TMOR
UILDING PERMIT INFO
❑ CUnsullanl Fees Paid by Applicant(Initial) ELECT PLUMB MECH
� L�_LICENSED CONTRACTOR'S DECLARATION Qry, EI.ECI'RIC PERMIT IEE
Ihereby+Bimtlhi,l ala Meawe order pn,,Wom Of chapter 9(mmlmocmg JOB DESCRIPTIONIMxZ ithSecit.7FXXp Of Di eic:memo Busines.me Nefc..ionn Cndw mdl:lylianwia AL:
4C5 w' PERMIT ISSUANCE
W— to full force sed eBat ❑KITCHIN REMODEL
aV�j Lla'nw Cla.v 'jcCora APPLIANCES-RESIDENTIAL ❑PLUMBING RE PIPIT
PWS
Oalc CnnlOetm A CIIITELTtiDECLARATI N IT ❑STRUCTURAL
PANELSMODIFICATION
ZOrrraqZtun 4mmnJ InY PImry shall M1eu¢d u.puM1llc recmdnOZ—O UI'T0200AMPS [-I CHIMNEY REPAIR
P:4L l Lioemcl Nfti siur:el 301-I0I0AM1IPS IM OVFME?4T 0SWIMMINGPC%OLS
C C Q I thereby affair thalll am escimp fRmml-the Contractor i License law for the CLARAILON OVER 11X111 AMPS ATII RFJSI00E1JRE1'AIR ❑DE1a101,RION
6 U 6,11—to,maw n.I Seelion 7031.5,Il eiiners and i'nmewamm Goes:Any cily or comm, SIGNS ELECTRICAL C]OTHER
LL O'A' which rcyolra a permit to eon muer.alcor,impmac,demdidF,ur rmmir nny Imicmre
prircm it,rvoance.dso rtyuirea tM a,licam me such Tinton to file.aq,rif samsme,m SM:CIALCIRCUITIMISC.
That he i, wrrsullwrwumlI,, ,,00 oto, I M Gmmoor,Liter,Low Ghaper9
A.1 02, emFF ncingxdNSeclim7(1( )m DiviAon3oflhc Borircvand Pnrhusiom CAk)a TIa1P, !RI M)LE INSII COMMERCIALta.tL aWw he Is c.emp Ilerttmm and Bhe Finis for the vlkged nempial.Any viadldon of 0 NEWBLINGIADDITON ❑DEMOLITION
nmN :itliun"TNI Shy nny npplicmt Evupcn... nubpvu Oe Fpallc:un¢:aclvil purlally of K)WBRD El TENANT ❑FOODSERVICE
FZr mss maemN live herdtd dollars($.W), IMPROVEMENT
< Q L aa owrcr of the lmyheny,or my employees wish wages as their vole comPvmdon. SWIMMING R F,CTRIC
willisollbe work,oral the Fvucmrt ismxirferdulaotfcrcd Lrwde See 7(W.Ilmiros ❑OfHIiR
63m IW Vrotesvmn Code:lbe Contractor's License law does not apply to m_rnF of OUTLLTS-SWITCI FT RES q' O
Imrycny wM Fonda or inapnn w Iherenn, W who does .IF work himself er thnwgh
his own empoyea,pmvWed that such impmvcnhems are not intaakd Or uttered fur NEW RPS P AI.BhR SQ IT,
vale.IL tomever,thebuildiny.r impmvenarm iIwtbl within me year Mcortkeon.the SQ,FIL FLOOR AREA SISQ.Er.
rmrbuihkr roll]have Ile buNun of pmv'mg Ihit he did let held or improve for ,pur-
of
Cl 1..—Fe,uI Ih pnrpny,vn essit ivcly corooll,wllh lieett convecma to ^I'
mato,,the Pmjal(sin.71141,florins,Fred Omeo,ionv Qak::)Rte Canrwur'.v IJ-
ncLaw does..,)yInmowre,of progeny who build,m mi,,memo,mad Q'TY. PLUMBING
coFm a by soh Me,r is with a cmnorcems)limnrnl pcom ml Ito me Ccmtracmla
Li,emo Lw. PERMITISSUANCE
0 1 vin enennpl omkr Sec. .B A P C for mi.rearm
ALTER-DRAIN h VENT-WATER(EA) VALUATION
Owner Dwc /)jj00
WORKERS COME'ENSATION DECLARATION BACK IIOW PROTECT.DEVICE /D O
L Wrehy a1Brmbl
aer penalty oCpejury tore of the fulhming dalmminn,.
0 Ihax and will mdesaln aCmifcmc of Cmisrnl mslf-into¢faWe1,e,Compere- DRAINS-FLODR.R00EAREA.COND. SIORLES SYPH CONST RUCTION
\ aria.-previdal for by Section 3110 of tie labor Ede,for the lertommna ek the L
sort for which mi, ora Is k,rsd FIXTURES-PER RN AP
0 I have and will mainwn Workers Coo armatkan In.wmrce,as required by Section
3700otmFfulnrGdc.Tad,ry,Lrnwacetiflie work fmwAlch m:n Tamil iaomcd GAS-HA.SYS'I'I!N-I INC.4 OUILTLS OCC.GROUP APS
Aly Wn Im�oryry'��'�r�r lad I'nlic
CarrierLljL,�._�11�ri Nlkll lY RalicY Nn er r. � GAS-IA.SYSTEM-OVER i(PA)
CI!H'TII9CA'Iti PE l'e%TiONINSURANCE RKI:HS' GREASUINDUSTRL W'AS1.WYERCEPfOR
COMPENSATION INSURANCE is Cr'. BUILDING DIVISION ITES
Clhhsatiun neeJ rulhcmnpwed itme permit islmaa hwdrel dullan(S IIM)1 GREASE TRAP --
ur IcaJ 1%ANCHIiCK ITE
lernifymv intoe perforrwrla n(IMxakfawM1khlW,permit ki.asmcd.Ishdl SEWER-SANITARY-STORM is.31X1 FI'.
Int rn:piny any pc,oc m nny tmmar:a n bjano the Worker,Compere ENERGY FEE
zO Farmlnai i. Sfc -a WAl17R IIEAfER W'NENF/IiLF.CI'R icarc GRADING IHH!
.N., N1ITICE'IL)AIR.ICANL IL n sr n� g II< 'ani Ice c of liacmplun.You should WATER SY,STEAVTREATING
C > become suhjea m the Wml:ds Goings vilm povivas of ILC latex Cud:,yav amu SOILS TTI:
� fumwim comply wiN Bach provisions nr this permit sM1dl be dcenN m'ukN. WATER SERVICI!
aQ
CONSTRUCTION
comarr.FNDINGAG194CY NEW'RESIDIiMIAI.PLMB. SQ.1-7 PAID
UQ IMrebyalli,hi, mere ixmca 41,'.30 kr ding ogcrcYlur the performarcc of Oat RccciplM
IM1e work fa which mix pcmwas nmol lSm.?fgl.Civ.CJ TOTAL:
F Lender's Name
L.I� Lsmlcr'a AFLI. BUILDING IPI!
1 earl(,1haI I have Feld this afplicmiw:uN atom 1haI me,terve infunlwliun is
Fy caned.ivgrte tomrr,lywire all city aaldcounry odirlahea anal sum Uro.tri...I to QTY. MECHANICAL PERMIT' PEE
(� ,Z hlildingmngiaioo,mJ ocobymllrriru mpa'Ynlulivls n(mlr r'ity lu emea.,a theSEISMIC[IT
ahuveme tioad lm,srfyfainsp donfrewas. PERMIT'ISSUANCE 1l
(Wc)egrte to save,malemnify load keep hamJes.me City of C�per itm against :'L—,C":!,
TRIC TTI: L/
IiaMLlics.judgn¢ole,awls uml cap_mses which rely innnyw:ryacmrngainm.raid City ALTER LIR ADDED 1. Ifl O
in mnsapserce M de panting of This pmnit. PLUM1IH W G FF.Ii
APPLICANT'UNDI!RSIANUS AND WILL COMPLY WITH AL1.NON-POINT AIR HANDLING UNI ( 14 )
SOURCE R EGUlAT10NS. MECIIANICAL LTi
AIR HANDLING UNC VER 10.1Xp CFM) C(1Nti'I'RUCI'IUN 3'A%
Sigmmmof Appiam/Conwma Dino I!%1 IAUST IIODD(W YUCF) HOUSING MITIGATIONFT,H
HAPARIbUS NIATERIAIS DISCLOSURE
Will the eEPlicnnl nr future lm1dmgO,culmm.wore or hundk bamrdum freesnal I IEAFING UNIT CFO X n f
as def v by the,C.,em.Merrictpd Cork.CMper 9.12 aal me Hes—amt Salny
G.k,Satitm 35532(11)" HHA'1'ING UNIT(OVER 100.000 BTU)
❑YaKl< O PAID
V
ENTILATION FAN RFSIDj I}m RcaiPIN
Will the applcmd or more bur Wing acupmi use yeipment a dcvl which
emit Warm.ab mmmmilmrda as dcfncd by the Bu,Ara Air Quality Mumgcnem '0"
P OHP OR IBII,(XX1 BTU)
De�i1 L'(OVER oo.lmIITU) W"
t. ❑Yma rJ No
ER
1NiiR
I Mve mad Be Warrith.malaiaH«quhrnherl.mater Chapter b 95 of me Cali ISSUANCE,DATE
foratiu fkWlh&Safely Cdc,Scerirms 25505,25533 aid 25534.I mdrnlvml the it ILCTIAL MECH. SQ.FF. �n qf
Funding does ma correcthave a tenses. I a in my rcN.amihilayto at,,Imosei'm
1rclas ullkh 4 Io lntm,red a Cenitic�e
Oxnv aamhanad again (-J Oa¢ 1 ISSUED BY: 92
OFFICE