99110144 APPLICAA"r TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY -
CITYOFCUPERTINO BUILDING-ELECTRICAL PRRM NO.
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BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-MECIIANICAL
BUILDING PROJECT IDEPI'IFICATION
ILDINGADDRESS'. SANITARY NO. A . SUBM TALDATE
NER ,' ME. PIIO. CIOR'S 'AMG LIC
1 1 9 ,- NIC CONIIdOLM
RCHITECTRSSGINEER: LIC NO: ADDRESS
Z Aig #-b -ST
PHONE BUILDING PERMIT INFO
S��� 1 y J 3 ❑ Cowl ant Far Paid by Applicant(Initial) BLDG T PLUMB MF:CH
QQ 6-7
In
Vial
LICENSED CONTRACTOR'S DECLARA ION QTY ELECTRIC PERMIT FEE ❑ Elm 2 1 heRhy affirm met I..Ikaned rnxr rrod,ainn,row❑wear 9 knmmeming JOB DESCRIPTION
1— in full
fifnes awith ]aro)or Divi,ntm Jnfine BtrsirevwPmwdnacw,amt my gimme'„
F O nd cR LA PERMrt ISSUANCE RESIDENTIAL
Q U� liccn,e Clan, `� LacCorr WL ❑KITCHEN REMODEL
i—Z' Dmc Cmmctm PI'LIANCFS-RESIDFMIAL ADDMON [I PLUMBING RE-PIPE
(..Dm ARC I'ICCTS UIiCIARAIION ❑MULTI-UNIT ❑STRUCNRAL
Z 1 unferuaal my Plans shall he used as blit records PANELS
Z O W MODIFICATION
O ZtQ UP TO 21N)AMPS E-1 INTERIOR [I CHIMNEY REPAIR
<4F'Itaa�� Licensed!Professional 211-201IMPROVEMENT'
QY j OW'NF,R-BU1I.UCN DIICLARATION ❑SWIMMING POOLS
Q I hemM1y dfirm that I em astow,from me Contactor',License Law for the OVER T)o0 AMPS ❑BATH REMODEIIREPAIR ❑DE?AOLMGX
X C 2 V following ouon.(Soden 7031.5.Badness,and Professions Cuh:Any city creewnY SIGNS ELECTRICAL ❑OTHER
3 LLQ which rcyu'oe,a Pornal m amatruch alcor,improve,domlldn,m«pair any,fracture
pimahritsi.ciiBO
nquim Je gplicw fa such pomid to filcasigoarN stetcrmu SPECTAI,CIRCUITMISC.
f 1yY that he i,licensed pumrrnuothe pmvi6Ln,of the Cnmracor's License Law UTmI +9
W SOC) Booamrencing aim Sm,imn]lgp)of Division 3 wok Be.road Professions Cods)or TCs1 P.M,,,,,EPCU INST
a Loy ohm he v instants therelrmn find the bvi,for the alle0cd cscmpim.Any vinlatinn of NEW BLDG/. MON El DEMOLITION
^m
Section 7031.5 by any applrnnt for a Permit subjects the applicants s to a civil pof POW ER DEVICES TENANT ❑FOODSERVICE
Z} mg mrom man five hundred dollars(5500).
�=0 ❑ Lasnsvnerulthe propcry,of my employees with wagon as freirwlemmpcha ion. SWIMMING POOL ELECTRIC MPROVEMENT
y.F will do the wok,and ilio adrarmc is tot intended or offered for tole(Sce.10W,Banaevs COMER
and Profce,ion,Coe:The Conttacmh 1,1¢n.m law Jots nu,apply m.owner of OUTLETS-SWI'rcill's-FIXTURES
pnyeny who builds m improes vthi ma,goad who does such.M himself m thtno da 4
his own employees,ProviW,rat such imPmvemema are not interded or offend for NEW RESIDENTIAL ELECTS SQ UP - �1 n
sale.If.however,ole handing or imprmehlant i,sold within rose yacrofrntry,leocin.One D TQ Fr FLOOR AREA LSQ.FT
gamer-Wilda will have the burden of proving Jot he did not mild on improve for put-
Pow of olafL 4
El 1.ses owner M'me profach,am eseluuvely cantrsoing with Ranted contractors to TOTAL
nnm
: NOV 2a `� 1999
ruthe p,cn,(Sc-ISc-7194,Hme,s and Prnfassimts P.le.)The Comrrcoo'a U-
x law don,her.Wy to an ow'aa a rocny who holds or lmpm.e,thvcan,and Qw. PLUMBING PERMIT FEE
who mntmctI mattprujec„with nmntraorr,fiemwl punannothe Comme,ar's
Item.law. PERMIT ISSUANCE n
I em esc.N under See. ,B R P Cfia mil meson o1/
ALTIiR-DRAINS VLNT-WATER IEA) l VAI Dane (� U
Wl1RKErr pend M of NSATION DECLARATION BACK FLOW PROTECT DEVICE
1 hereby affordmesh under n.Corral ..p uttyaneofthe imon,f tkclwtuimu:
❑on.as rod willmoi mei Sation 3M of Cot sem toLobar.soda.forcfu Wformnce of tet DRAINS-11OOR.R(RIF.AREA.COND, STORIES TYPE CONSTRUCTION
wi,rk for
provided for by Satin 3]00 of that labor Cole.for the rcrfomutoe of the,
auk fnrwhich this
nitia is brIver. Fl%Il1RE5-PER TRAP
Fl I have and will nuimain WUAefs Compensation Insuwue,as mquiml by Section
My WidrlaMCod or the perfunurre ofthe work forwhim this permit is isucd. GAS-EA.SYSTEhf-I INC.d OUTI,LTS OCC.GROUP
My Wortcr',Cnrypc^;ion lnwyrwwc rnrticroliand y Noy nty�bc�aR��^r1�9 GAS-EA.SYSTEM OVER 4l
Cartier: IS ilWU �Y ER 'JL.fY 1 O
CERTIFICATE PE SATIO RaS FROM WORKERS
COMPENSATION INSURANCE GRUASFJINDUSTRL WASTE INTERCEPTOR
(This rccdinn rad not M compined ifine pum,i,i,fuomchumhcd dJlun($I W) BUILDING DIVISION UT?ES
or Iw) GREASETRAP PIANCIIF.CK Ft
I rectify that inthe perfmrnera'e ofrhe woh fu which this Prmtit is issued,l shall SEWER-SANITARY-STORM EA. FT.
ass employ my M,.n in any nwnner so a,to biome suhjad m the wmkenx'curnperr ENERGY FEE
QZ satin laws M Califomu.Date WATER DEALER WNIM?J,ECIR
Z O Applicom GRADING ME
N NOTICE TO APPLICANT:If,after nuWU this Coif to of Eaerro n,yw shculd WATER SYSILMOREATING
becottr,abut,e me WmLee,campenvrron Provision,otlho la6,n Cn1e.You must SOILS IIiE
f«D,wtm comply wish such roves.u the, amot shall be droned revolved WATER SERVICE
Q
7z CONSTRUCTION iso ION'LENDING AGENCY NEIL'RESIDENTIAL PLA1B. SQ.FT PAID
V p Thor by which
Porromiss issued
lending agrayfm me perfomurceof Dat Rccciptg
ly the wort roan arid,m.,Pima'„i.raed(sa.w97,[i,.c)
O U Lank"Name TOTAL:
V Lemler,AJdrw TOTAL',
F1 1 call thaw I have nal this application and%ate dust Je.buve infmmuien u BUILDING FEE
h c<xaed.I agra ht comrly mon all cloy and runty nWinmm�rnd,,soar lawx miming w QTY. MECHANICAL PERMIT FEE
Z "Idin 'm,har ion,and thereby aumodre mprvtoscovesofthia city mawae,em,l, SEISMIC FEE
abov,menuoneJ Popery fm,nspconan Purposes.
(We)agree to sa ,im4mnil and M1arndea the City of Cir nim PERMIT ISSUANCE
y u p pc ad City ELECTRIC FEC
inoisa,jadi,of heo. minars aMnpis rorich may in my way accrveagainsoa raid City ALTER OR ADD TO MECIL
naymnm nf,nc grunting of thin Pcmtid. PLUMBING FEE
APPLICANT UNDERST S AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT TO 10.OW CFM)
SOURC EGULATIO S MECHANICAL TLE
AIR HANDLING UNIT(OVER 10,Tf0(1 CFM)
CONSTRUCTION TAX
Signwe ofAppllcnlCnnt Doc EXHAUST HOOD(WNUCT) HOUSING MITIGATION FET:
HAIUARDOUS MATERIALS DISCLOSURE
Will the appfirornc more lmildingoccupam,lore or henJlehvallou,mwmrad HEATING UNIT M)10(f”HTU)
z+definM by me Caperti,n Municipal Cad,Cray oar 9.13,and the health and S.fcy
Code.Sm,mm 255320)'7 HEATING UNIT(OVER PAM)BTU)
E]Yes
VENTILATION PAN(SINGLE RESIN) PAID ._
W II tM u licent a tutor huiltlin d u,c Doe Receipt a
pp !by dee egmPrcuafiiy iceswhich
BOILER-COMP(3HP OR 100Jp0 BTU)
mit n.-.ro ecus air mnuminanu a earned!by de Bay Arca Air Quality Mewgcmend TOTAL:
Ui.uricC
0 Yep "1611"' HOLLER-COMP(OVER IOO,gMI BTU)
1 have oaead the haaardou,notmah verneus under C'lupder 6.95 of the Cali- IR CONDITIONER
�u ISSUANCE DATEeadd,
Tania doe'k Scary come CMc.Scaium 2550.5,25531 and 25534.1 a notify th,het if he NEW RGSIOENTIAL MECH. SQ.FT. / /� /l y q
building hca rod cvrmmly have.dewu,dw if it my m,PtnubiHdy to nedfy the ampvg (/ ( C� C_
M Je mquirrn,em,whicM1 mat M1e mrd prior m iau0rre or a Cenilraoac of Ocmpmry.
Owrcr uraumonrN ogent Data r TOTAL: ISSUED BY:
f OFFICE