30709 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. 7 /yam
BUILDING DIS7SI0N APPLICATION/PERMIT PLUMBING-\IFCHANICAI, O I OV
BUILDING PROJECT IDENTIFICATION
LDINGADDRISS: SANITARY NO. NSUBMITTALDATE
BR'S NA YHONI C NIRACIDR'�AMErL LI ZZ� NA] CONTE L0
tR HTTBCI'/Et`GINEEN: 64-1
LIC NO: DRESy f' yyYY�A�a LJ FNML ❑
CONTACT: 1 PHONE: S GlyIlf BUILDING PERMIT INFO
❑ Consultant Fm Paid by AppIkmH(InRIl U BLDG ELECT PLUMB MECH
X
hICFNSIII)n ON laces aACH)R:SDIiConsofcON QTY ELECTRIC PERMIT FEE
Iios7 affum Out1.mliccnscduNa povisiotsofs Coleef9 my licerwis JOB DESCRIPTION
O-Z with Salinn](pflpd Divi.0nn3of rM1e Bnsirea ud Pmfcav'inns C«Ic,acrd myliccnm is RFSIf1FNTIAL
00 in full force eM eBm. PIiRmir ISSUANCE
aF.VZ� License Clav Use.N ❑SFDW'L - O KITCHEN REMODEL
N6� Dare ConnectorAPPLIANCES-RESIIHiNMAI, %xDflHON F1 PLUMBING RE-PIPE
ARCHITECTS DECLARATION PANELS MULTI-UNIT [I STRUCTURAL
ZOYJZ lurderslnrM my plw shell he used.public records MODIFICATION
OZ UPT0205AMPS RIOR ❑CHIMNEY REPAIR
I-�f'[il Iicaucd PmfcssionW 201-I""PS ` I_PMPRDVEMFM
Y OWNER-b c.,t IDF.CIARATION OVER I(XX)AMPS El BATH REMODLL/ AIR El DEMOLITION
y C 1 thereby efbrm Inns exempt nm from the Cannulais License Ww for the
x O 1 U fstlowing ream.(.Section]031.5,Buunns anal Pmfe.siwn Code:Any city or eounty SIGNS EI.ECIRICAL El OTHER
41 a{y ri inn its
i .IKTnh rn cmYNCI,uncq inlprtwc,dRnnrdl.nr Rp9ir nny nlNcmR I n
Fu O
y pn«to iu issuvrce.also lesryirn the vpp)icant fm such prmdt to BlcosigneJ suvtrcns SPECIAL GIRGGTr/MISG.
0.f Butkis licensed pvvud In Ne pmvisrcxu Mthc Conwno/s License Lew(Charc,9
apo (wmmencing wish Salion]II(MI)of DivieionJo[Bn Ouslrm.w ural Prncs,imsr Gdu)nr THMP.MIifER OR POLE Ilsyt ,,.^T
6 oC Bw be,is esemp thexcfmm and Ik basis for Inc stRa l c.ctro oe.Any IioWion of ❑5' I[[D��G/AD r1AN'I� FAIOLTDON
--,y
Section 7031.5 by any eWlicant for a pmnil subjnys the epplicenl to a civil Penalty of POWER DEVICES ❑TF NLF N7 OODSERVICE
FZQnor nrore Nan live hu n dollen 15500), ,, II
, IMPROVEI.I
Elias—of tM lxopoty,«try emas pinywith w.gnas,Btelrsdam
e etoopc:ob , SWIMMING POOLE
�I=.O will rlo lac wort,and thestrunum is not inlcMM oroffned for sale(.Scc.7u..,Bo_., ❑OTHER
i '.'and Mo fnsioru Code:TM ConlrnvuW,license Law does rw apply to an owner of OUTLETS.-SWITCHES
who builds or insit demurs,and who docs such work himself«Bsnwgh
h6 own emp]oym,pmvidal Bol such imprnvemenie are,not in entkd or offned for NEW RF_SIDENTIAL IAP S
We.If.howeva,the Wilding or imprvvcmcni in sold within one yeae ofcnmpklies,the SO.FT.FLOORAREA ESQ.FT.
Dever-lat will have the hurdcn of Pmving Inv k tint nor torM ef impnuse(m pn- Q ,'V11TT1\
pnm of rale.).
❑1,as,owns of the pmpeny,am exclusively contracting with licensed convenors to
cmnvu t Bre pmjecl ISce.'BW.Business mud Pmfaminne Cot The,Contmnor's C-
rueLaw do. ot apply rn un nwncrnf pnpcny wMi buil&,or im,toes thrnvo,and QTY. PLUMBING PERMIT FEE
who crow is fa such prejecn with•cmtmnoTD)Iiceas.-t pasuam In the Cmnatora
License law'
PERMIT ISSUANCE
El Iunr eaen st under See.—,B&P C for this re.
Owner Dolc NT
ALTER-DRAIN&VE -WATER(FA) VALUATION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE
I hereby.R under penally of pcqury ane of IN,following dcclervtims: Q�f'//
❑I hnveald will maimain eCeroficum of Comxm loselFlmum for Warker'.C..,tt- DRAINS-FLOOR.ROOFSAREA,GOND.
Italian,a act for by Satim 3700 of the labor Code,for the perforountce of Its, STORREJ TYPO CONSTRUCTION
wart fm which this prnnit is batted, FIXTURES-PER TRAP
❑ 1 hove unJ will mein.in Worker.Ccon, union I..,at required by Saninn
3700oflle,labnr Cedc.fmthc perfmrmam of the work fm which Nis permit Dia. M GAS-RA.SYSTFM-I INC.i OV11ETS
' ieOCC.GROUP MN
) rY �
Mzley Nie. 2L—) TF
CERTIFICATE OF EXEMPTION FROM WORKHRS
COMPENSATION INSURANCE GREASFANDU.STRI.WASTE INIERCFPTOR
BUILDINGDIVISI NFEFS
(Thu sectionneed mile campkud if the pvmil uf«orc hmdrtd Jdlars Pi Halt) GRFASETRAP D
or he.) PLANCHECK FEE �.
ramifyN in rbc PcH«noss,no s1h.w«k fur whim lhis the Wisl.xuN,IJWI SEWER-SANITARY-STORM FA.200 FT.
ac,;iemploy any personia my manrcrnato hmame svb}a1 to IIm W'«kcri Cnmpen- FYERGY FEE
Z A,I,laws W Calilmmie Dote
WATER IIEATGR WNENT/ELECI'R
Z NOTI ort GRADING P[E
h NOTICE TO APPIJGM:rs Nn making This sisio c of Lvhur W.You stroost WATER SYSTEM/IREATING
bec«rc subject to the Workers"intpee thus
eruvit ha]of rye faborr Conk,Ern muv SOILS IEE
forthwith comply with such prnvislom mlWs pe+mit shall be deemed rtvatM. WATER SERVICE
uZ CONSTRUCfI(IN LI3NDINGAGENCY NEW RESIUFN'IIALYLMP. SO Eq. PAID
U 0 1MebyetFum tbvdcmisacti(See 3M7, is,egercy r«the perr«meatt of to Receipg
IL F the a«kr«wmmh mi:Pamir i.irsaea(sac.JW],c�.e)
p U Lender.NeneTOTAL:
f]J I.codc ,Addnd TOT1
I cenify thatrt
1 Use ml thio application and stone thde
at above infmnution is BUILDING ETE
poi ca oma 1 agree m rnmply w'iN all city and coumy«div um sum hes mW ng In QTY, MECHANICAL PERMIT FEE
U Z baiWingcmvrcedom atal ltertby aurhmiae rtpescmvivn of this city to ever upon the SEISMICFEE .�.�•
above-mentiomW pnpeny for inspection W,oc,
PIiNMIT ISSUANCE,
(Wc).gra to save,irakmnify vd keep Iwrmlea the City of Cupenim againw LECIRIC
p1daD
axwhkh maymmyaY+arucag.imr mid Ciry ANTER OR ADDTO MLCII.rymiiL PLUMNINGI iH WILL COMPLY WITH ALL NON-POINT PIR HANDLING UYIT(TO IO.000CFA1) M1fECHANI .FEE
(
12-1 � LO AIR HANDLING UNIT(OVER jbBb(CFM) CONSTRUCTED K
All of Applicontrmor Date EKIIAUST HOOD(WMUCT) HOUSING MUIGATIO E
I ZARI%IUS MATERIALS DISCLOSURE
Willtk eppl s
en hour,Mtiu,ceso tstor.«h.Mk h.wdous nwcriel HEATING UNIT(TO 100.000 BTU)
M1y the Cul m Municipal Code,C1upr.r 9.12,nod the HeWrh aM Safny
Cade, ton 255311eIYr HEATING UNIT(OVER 100.000 BTU)
Yn Fl N. VENTILATIONI'AN(SINGLERESID) PAID
Will the epplicem«fmure Wilding occopxnt use cquipntem or devices which IBve Raeiq t
Ih.wdous air conwnimmx as dcfnrd by the Bay Area Air Quality Maiagercnt BOILER-COMP CHIP OR I00,Ig10 BTU)
OTA
District f
EJ yet Fl No BOILER-COMP(OVER 1 W.000 BTU)
I have rmd the,haxeNows nutenNs requirs.tracer Clmperb95 nl tbo Cali- AIR CONDITIONER ISSUANCE DATE
forou Health&Safety Code.Sasimw 25505,25533 anti 235X.I uNcmud the if the, NEW RES]DENI'IAL MECH. SQ.FT.
building drams..emrrnlly ham.Irn W r,oleo it is my rapondAllily to rxnify the tacvponl \\�1I 1�/A�•T'
ofthe«quvemems which roan be met poor Io ixvuvwc d'•Confute MOccuWrcy. �I-Y n
(?rrcr«eutboriacd ugrnt Due TOT ISSUED BY:
OFFICE