S 1119 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELi ItICA L PERMIT NO.
^BUILDING DIVISION APPLICATION/PERMITI'LLYMBINC.-MECHANICAL S 1119
PUILDING PROJECT IDENTIFICATION
'/ BUILDING ADDRESS SANITARY NU. APPLICATION SUHMITIAL DA;1:
OWNER NAME �� ,t�_PHU _ - ONTRACfOR'SN 1F/'� /'f-�I�� •� �C//N/�O'� Ntt; C'f1NTR(Il.x
�RCIIIIECf/PNGINEER: LIC NII: J�/(r//r G4aro ❑
CGNTACT: r PHONE: SS S BUIL-DING PERMIT INFO
j0h ��S 4W,/Lf a ❑ Consultant Fees Paid by Applicant(Initial) BUXI ELECT PLUMH MECO
IJCPNSED CONTRACTIIR:S DECLARATION
QTY ELECTRIC PERMIT PEE
T Merano nlrmt tet I ant fieaniv
uncle,I'n
.F nwi,'lon,of ChoN,9 aammeneina IOU DPSCRIPPI N
Z witn Section 7g10)of Di,6i fma Husineaad Pnicsomn CuJa.ad my lkcnw u' RFSIDF.NTIAI,
O O p PERMIT ISSUANCE
W in full faa W cRal. �0 ❑$fUWh - ITCIII:N REMODEh
ZZ, IJcenxe Cl Ilex '• APPLIANCES-RI!SIUIiNfIAL ❑ADDffION ❑ UAIHING RE PIPE
ZZ,
Dae Conor
ARCHITECTS DECLARATION ❑MULTE-UNU` ❑STRUCTURAL.
Z O m Z 1 arect,mnd e eell my Planhe e,M as Public ri PANELS MODIFICATION
O ZK!- UP TO 2q1 AMPS I ❑INTERIOR ❑CHIMNEY REPAIR
Iscrnn iPmfcssiwW 20I-1000AMPS IMPROVEMENT ❑SWIMMINGPOO S
tY Q•] OWNER-17i UECIARAfLON OVER HVI)AMPS ❑BATH RP,MODEIIRI?PAIR ❑DEMOLITION
I hemby affirm flet I on cxcmq form the Contractor'.Licenx law'for U,e
x 3 i (Station mH wins rai(Son 7031 5,Buxincu vfcsaium M Pori Any city or coutny SIGNS ELECTRICAL ❑OTHER
Oa which oc mm a Permit m crnoruct,oHcr,imp t ,Jcroul W,.rr tqu ,elore
ir any NnC) print.its inst alu,tequite Box,apt,licnnt trreueM1 Permit to fikvtm
sii acnem SPECIAL.CIRCUITIMISC.
oa.'$G o• that he is licrmudpurvtantm the pmvisioru of the Contract License Law(ChapterY
�a�0� (cmnmortcing with Sadun]Ixllll rt Divmsion3ol helluainc-0 Pmfcseion.C,Ve)or 'll?M1 P.MGTP.R OR 1'OLIi INST. COMMERCIAL:
a ly aoC that he is cxcmq thaerrml acl the Buis for the Wlcg d ex non man.Any violation of ❑NEW BLDGJADDIIION ❑DEMOLEPION
Sec(hn 7031.5 by any applicant for permit wbjals the aMlicam to a civil penuhy of 1OWEA DEVICES ❑TF,NANT ❑FOOD SERVICE
CLQnot nrna than Eve hodradd0lars 49)(p.
❑ SWIM
I.uawrcr ofole ptopcny.ort my cmpt�yeer with waQe+ss their sale compcnwion. MING POOL F,LI:C TRIC IMPROVFMFNf
f=� willdothe work,ad lnesaactumkrax intealcdorrRend forsak(Sm.70TI,Busim, ❑OWER
rind Proficv i.xw Col,The Commuch is Ltecmc Law roc,tva apply ,ua owner of OUTLE.-SW I')CHP_S-FIXTURES
poleny wlai builds or imp.ava tMreon,me!who dac wch work himself or tMagh
his own cmptryas.PrvvidW let rich impr Acroa a art not intended,r olTcrcl to NEW RESIDENTIAL ELECTR SQ FT.
vatic.If,haweveplhc buid'mgor mmpmvctmnl ii—old wiNln ore ycurofaor,1a,,,n,the SQ .PL(F)R AREA S.M1Q.IT',
merier.builder will have the boNcn of Proving tet he dd not bund or imi,ri For fur- � I D
pore ar W e.).
❑ 1,as uwwr of the proi Inn ceclusmvuly contracting with Iwer,cd cortrat
comouct the fri(tis.7D .Rusincev ad Prafecommi Corta)lite Comrator's Ii-
came la,vMe,not apply w an(oi M ProPcny wit,huiuls or im,my,amae.m.end CITY. PLUMBING PER FEE
whnamlraeta Eo-ch nrests with aeomucha )Leered pursuant to m Ccorasmr's a, /�
licauc Low. PERMIT ISSUANCE UI
❑ l am cxcmpt mdcr Sec. ,Il&PC forthis m.
ALTER-DRAIN&VENT-WATER(CAI ll(IN
Owmr
Data
WORKER'S COMPENSATION DECLARATION BACK FLOW PROLECT.DI!VICE
I herchyaffirm radar permlly or Pei or One folhxuin,JcclmNirm:
i] Ihavead wlltaintWnvCrnificat<rf Cowrntm act Timurc fur WurkeYS Comlrcm DRAINS-FLOOR.ROOP.AREA.COND, SPORE EI TYPECONSTRUCION
vA,rtwork E
,as provided for M1y Sun 17g1 of ole labor Code,fort Ire Terfsrmarce of tM
r wrier this perntll issiwti U. FIXTURES-PEH'UAP
❑F have and will maintain Woher'a Campcmation Inwrance.u Naiad by Session
3II ofthe labor Gxk.for the ,rformamea ofthe work for which this Permit is ieaed. GAS-IES.SYSTEM-1 INC.Y OITTLET5 OCC.GROUP APN
My Wader's Cot 'rye ewrier ural Policy n�ur�h
Curicr.oI GAS-LA.SYS I'F,At-0VI!N1(EA)
CERDFlCAII!OF SAHO INSFROM W'ORKI:R.S
COMI'GNSA'IIIIN INSURANCE GkFASI%INDUS'fHL WAS'Ri INTERCEPTOR
BUILDING DIVISION PETS
(This ln ired not a compktcd iftlac permit is fororse erdml ddlaa(SIW) GREASETRAP
or ka..l KPL\NCIIIiCK Fl!I!
I certmty Nut in the perhn„mw'c nl the wsit ro-whkh this Permit is aad.I hall SEWER-SANITARY-STORM EA.2(l)F..
na employ'any pat in my manner to so as me to becowAluct to the worker'Camper- ENERGY T!
ZZ sation law'arf CWmfarm. Date WATER HHATERWNEN'CELECI'R
O AplAicwt , GRADING FEE
(I NOTICE!TO APPLICANT.If.aftn making this Cenifiaoe of H.atim ximn you sbi NATER SYSEEAVTRE VHNG
a M1eeome suhlecl m P,e Worli ComrPenmtion Mawinions of tM labor Cale,your must SOLI S FETE
forthwlN cnnply with each pnrvixions or this pcnnit.hall4 Jcei Jrevoked WATER SERVICE
a �
z
CONSTRUCTION is i.a m
IONLENDINGAGENCY N'1!W RIiS1UF,M LAI,PLMH, SQ.PI'. PAID
'7 Ileraby aro iron them cnnaminn kMiny agency ror Inn peretaate
,ntna rr Daiptx
L7 We work for whichtnma permit is iewN(See.3q)7,Co.C.)
leeer'x Namc TOTAL;
V Lender's Adhei TUTAI-
1 canny man I nava r®d this apfrlicatiml and nate that Be above information is BUILDING IEE
i..t cA corms.iagree m imply with in ciy.nd county onammeas and ams laws mleanpm QTY MECHANICAL PERMIT FEE
V z Fu IIJin¢anstmcftan.ail hereby auWxire mpremnmtivn of this city tocntauprm the SIi1SMIC Fl!E
aMve a =11 pfopcny.fa 77th m pogx,ara. PERMIT ISSUANCE
1 4e)ago¢In ase,iMenmify sed keep hmmlca tM City of CUPtttiro apaiml ELECTRIC LLE
HaMlilics 'Wemem casts end cxpaai wmch nosy in any way acerttcayaiw said City ALTERORADDTOMECI.
cnf gnntine of this permit. PLUMBING FEE
APPLIC U ERSTANDS AND WILL COMPLY WITH ALI.NONMINTAIR HANDLING UNIT(TO IBIMXI CPM)
one Ll TONS. t'k MECHANICAL PIT
1 ALR HANDLING UNff(OVER 10.000CFTA CONSTRUCTION TAX
Signtuum of am/Conlaacur l Orm EXHAUST HOOD OVMUCn
HAZSR MS MATERIALS DISCLOSURE! !LOUSING AIRIGATION FEE
Will mel HEATING UNITHD 100JX9I HTIH I
as oktircd ny Ne ufeninu Muninpal Code,Chapter Y.12,rid the Health ord Surely
Code.Satirn 25532007 HEATING UNIT(OVER 100.000 BTU)
❑Ye, ❑Nn
VENTILATION PAN(SINGIJ!RESID) PAID -
Ume Rai 0
Will the at, onta in forum
ry a bu fined by hie B uric ea Air(Sa a JM ns whim
Mil hosardvr air untamimnm ua Joined by the Bey Area Air lAtnlity Manngcmminl DOTER-COME(3HP OR 100,000❑TU)
TOTAL'
JisWn? BOILER-COMP(OVER 10100ORTU)
❑Yes ❑No
I have Mad Nc haffiJotav mitcrum,ocquimnenta orxk-r Chapter b 95 of the Cd,- AIR CONDITIONER
ISSUANCE DATE
forma Health&S.rety Cure.Soctiau 25505.25533 rind 25531.1 uMaanod that if the NIIV RESIDENTIAL MECII. SQ.IT
buiklin8dae,not currently haw a lemmrt,that it iemyrory si Mlltyanotify IMaagwnt
ofthertgairtmemswhichmunafe melpnnrwiauace Inn Cinifietacofoccuparcy.
Uwncr cr vulMdrW riycnl Dna 'ITITAL: ISSUED BY:
OFFICE
_ 02
Mi a R
asezi n emodel .I
J
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10151 Firewood D
up erti"no,
a
Phone 9734436 W ] -_6504494229
M rn
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DRAWING NUMBER
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