00020060 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CTTY OF CUPERTINO BUILDING-FLFCT'RICA]. PFRMI'I NO,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 50001
BUILDING PROJFCr IDFNrincAdnoN
BUILDING ADDRESS: / SANITARY NO. APPL IAL DATE
N , l,Jll ✓d Sy9'
E 'S H E,q�u P t C ACIOP.;S 'AME.'1 1 LIC 'O:
LH/lxllo. ,)'0000/l0/.' NIC CONTROL
RCHIIBCIAWGINI t. LIC NO: REIE U,71C Asti ❑
CONfALT: PHONE i E] BUILDING PERMIT INFO
CringBIERH Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
❑ ❑ LV/ ❑
LICENSED CONTRACTOR DECLARATION QTY ELECTRIC PERMIT FEE
1 n uany arrimt that 1 an liccn.kd Iadm prrwidnns of❑aper 9 comnrncie, JOB DESCRIPTION
7. mSsctian]1x01 of Ulvisim lnfde Bueiva.atd Pmfeun m Ida, ify liccoscix RESIDENTIAL:
+100 wit PERMIT ISSUANCE
full Tome vat,Reel. II ❑SITIW'L El KITCHEN RF'_\fUDEh
-ICU Liunx - LiaN ppl'LIANCCS-RGSIDFNI'IAL ❑ADDITION El PLUMBING RE-PIPE
G C�ntrocux
RCUIIECFS DECLARATION ❑MULTI-UNIT ❑STRUCrURA,
Z O I mter,fi d my Planvdull he awELS J ns public recarcLs PANMODIFICATION
OZ-C UP DO 29)AMPS El INTERIOR ❑CHIMNEYREPAM
w Iieen.N Profeui°ael 201-10010AMPS IMPROVLMENT 0SWIMMING POOLS
OYC 1 hereby el hat ii ora OWNER-EexernrA RrnmrlCM1 C°nlrxloYs liccme Iww fa Ilrc RATION UVIiR IIMxI AMPS ❑HATH REMODEI/RI;PAIk DEMOLITION
X 0 a U fdloning reran.(Section]031.5.Busies and Dofccidu Corte:Any city of county SIGNS ELECTRICAL ❑OTHER
LL131[, which quito'a Pcouil e.con tim,alar,impnwc,denwlish,rated,any nmcmrc
pnor,,it,issunere.°IutIryuitcx Ur.Ppliure for xuch pdtni,to file anignulnaaenrnt SPHCIALCIRCURI,11 C.
Eby Out leis larnlM pdssud tobe,",dolonof the Contractors Licence Law(Claimer 9
I�il�J O O COMMERCIAL
(mmm+.mngwim Sndim]p01B al lTod,far the alleged!
R,andfir AnvinnxeNnl m TEMP.MISI'HR OR IY)LE INST.
a a e K the he is 31-1 b IMefrvli amt the prrir forme aticgN cx.,In.If.
Any viuWihn of El NEW BI.DGIAUUITION ❑DEMOI.RION
Savfm)0315ny any applilvufuepdmit whjdu de npplicun toacivil prsWty of POWER DEVICES
m nm lmm Nan rive hondml dullam($500). ❑IMPROV ❑PWDSIiRVICE
1..'&Q 0THERVIiMENI'
_ ❑I.u'mvncruf the the, ,u dyot uncoated
wimwage. rsale( ec,cunµscnsuiml. SWIMMING POOL ELECTRIC
1`1 will do mcwon,aNc The Contract—
o tra fi,t Licausd d.die,eci sale(Sec,1.I1r owed,of ❑OTHER
Y antl Profession,wine na Calc:Tltc—thn,oc'e L nrl w law aces cid apply at if nwwr,h ON1.EI1-SWITCIIFS-SWITCHES
Iii, n rsln had,dl,or imdk,d Ba such i asd ve bn such wnte nedl or nr mrnugh
Iii,wit owava,es,psnvided mat such imprvveol ds ve cid idended c offered for NEW RF_SIDFMIAI.ELECTR Sp FT
sale.if.how'cver.dn nuilJingmimpeuvetrcmis r+Jd wilnin ane year of axnpldinn.the OOR AREA LSQ.IT.
d builder will have the burden M u ing mat be did rax build m impose for pw-
Pca of We.). _
TOTAL:
[31,as owner of the pnN"ny.m esclmivcly cmmnum with Ikcns,d umnoean or
conmmt tie project(Sec.]BNL Braine and Ynsfci i°m Code, ne Conaaaotn LI-
rncLave cm;cidapplyl°en caner Mleoerry win baron,or impmvdlher,an,owl QTY. PLUMBING PERMIT FEE
whit cmlrecls for such pmjectn wilh a eonlmnorl0 llfeosai puauanl tome ContnevM.s
Lcmw Law. PERMIT ISSUANCE
I.m cecmp mdcr 5 . .H A P C fnr this teewn
ACII!R-DRAIN A VENT-WATER(FA) VALUATION
Date
r WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE SU0FI fV1
Illaffimn,,,by aunder Penalty ofprrte jury ofmc fullmving Jcclenols
ti : ((�.// (A_/
I have and will maintain eCenifiuleefOnrnunaelGirwue fat WoAaf,Coon,— DRAINS-FLOOR.RODE AREA.GOND. STORIES TYPECONSTRUCHON
xvtivn,as pmviJW fm by Surior 1]00 or the Lala,CoJc,fu one perfmtwane of Ik
V,
forwhich ill peracidie icslscd. Fl%LURES-PLR TRAP
(7I wee neon or odintain wnskers eomPrn ani w msurvmc,v rtyaitcd by Sectiox,
My of lite lsbsn Codc,far do perfdmamcofthe wuk f�yaywhich mgia pctmilnis.d. CAS-FA.SY.STEht-1 INC.J OUTLf:IS I]CC.CROUP J APN
M � �.yNoPolicy{-f/y�/dfGAS-EA,,SYSTEM-OVER J(FA) gf�p �
�RJIFlCATE OFE ESIP ION FROM WORKERS'
COMPPASATION INSURANCE GRFASMNDUSTRI,WASE IN E-RCP,PHOR
BUILDING DIVISION FEES
Clot action need ml bet sa
rnplcad fare
Admit is Be me hundred dollen(51110) GRPASETRAP
er leaa.l(TiPLANCHECK IEE
Irrmifyden in tMPeffrmancnfmtwoi,done which Nis Penner is iswc41shall SEWER-SANITARY-SIDRM EA.2 )tat'.
her employ any pr,in alamerw
ny nazl°hear.eonda to m,Wodara'Confiner- ENERGY MEOz cation Lew,of Cal;fsnda.Date / WATER IIHATI:R WNEMIIdFCTR z LIT Applicant GRADING F
NCHCE TO APPLICANT:IL add nuking die Cer ifotur of Exemptiml,yw should WATER SYSTF'.N/1'BEATING
F-' brcurc mbject n the Wuker'.Compenxatior povi.siam of the Labor Code.Yea man SOILS IEE
forthwith mmply wilh xuch prnvi.,im.n.Inde .if,h.11 he d„mil ue..ked. WATER SERVICE.
a �
CONSL'RUCTIONLFIIDlNGAagency NEW RFSIDCYfIAI.PLSIB. SO.Fr PAID
r�1 z Uma Rttcip M
V I for
rwhich mnhnt dere i.eamNCB°nkrCry.agency fan me perfmmnceof
^ de work for which lh'la pmvdt is issued(Sec.3lN],Civ.CdNam TOTAL
F-'
V tcrdcrn AddLodE, AM
0 rtx. TOTAL:
F1 1«rtify That 1 have rad mk upplicatim a d stat,Inst the above infnnnotim L. BUILDING ME
rn ,omenlegre,m,omMy wild eliciry and enemy ddimmn oro sate Gus mluingm QTY, MECHANICAL PERMIT FEE
U Y, building em.amnion.and herchy ramorbc read uvn ofthi.s city banner uryn line, SEISMIC FEE
anovCredinOeJ pmpny for ingecliml Parpac, - PERMIT ISSUANCE;
(We)agree to nave,iMnnnify aM k,ep harnor x the City of Cupceim agaimt ELECTRIC ilii:
Inhili r,jo,,melx, .iv,rud cel"w•s'"which nay in any way acerae xg.insl and Cuy MITER OR ADD T,I MECI I.
ir7ronce of Ile grading of min pcmdl PLUMBING FEE
(APPLICANT IDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10,00 CFM)
SOURCE REC ONS. MECHANICAL.FRE
A/_ y /S AIRHANDLING UNIT(OVER 10,000CFN1 CONSTRUCTION TAX
S,,adm ofAr umrtclar (/ Dmc V EXIIAUSI'HOOD(WMUCI') HOUSING ME I'IGAGON FEL?
HA%ARDOUS MAI ERIAI S DISCLOSURE
W 1l do epplicenlmfmmc WiWin6accal'a'n n°rc°rnardkh ydau m.tcrlal HEATING UNIT TO 100.000 BTU)
a,defi,rd by IM:Cupenim Munkipal Cede,Clupmr 9.13,and the Health end Safety
Codd.Section 2553200yt HEATING UNff(OVER 101,000 BTU)
/- VINHIAIION CAN(SINGLE RESIU) PAID Dam RcrcioN
Will the upplicam a nature IvilJing ran'upunt uu aquipmcnl m dsvica whim BOILER-COMP(3DP OR 100.000 RTU)
clnl hvaAws.b a...a,dcfrdl by do Bay Am Air(haliry,Matag,mcnt
Donner TOTAL:
❑Peso BOILER-COMP(OVER 101,0011 HTU)
(haver nvarJsus nwten:J,rcquircmenix utdcr CNNer fi95of do Call- AIR CONDITIONER ISSUANCE DATIi
fomes H,ald A 1 y Code.Sminot nNe5,11!Q3 and 25531.1 unslmlafd flet if are, NEW RESIDENTIAL SUCH. SQ FT.
building rice.oulfcciourry bervers .that if my rey.vwbilny to rani the«eu(wt
ofde aquim i..of a Cmitiadc off
Onea,c�upa
wr or alt. hkh mu.it ((JJ Date TOTAL ISSUED BY:
OFFICE