30163 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CPPV OF CUPERTINO RUD,DING-ELECTRICAL L. PERMIT NO.
30163 BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICA
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: r SANITARYND. APPLICATION SUBMITTAL DA
ioxis l r 007lN/cL /vd. �v erf no CN• 95
0
15Z
OW 'S NAME; PHONE r�/� O,YFRACTOR'S NAME D LIC NO:
/NA NTQ IyUcG1 YO O N L KC ZD NIC CONTROL It
ARCHfFECT/ENGINEF.R: LIC Na. ADDRESS: ❑
CONTACT: PHONE: BUILDING PERMIT INFO
Gc'ear
Z-114'6 ❑ ConsWlant Fees Paid by AppLl a t(Initlal) BLDG ELECT PLUMB MECH
14 ® 50 ❑
LICENSED CONT'RACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 ber<by Or m Ina 1 em liar w untler provi%iom or Cnal.er 9 Bcerctettcit� JOB DESCRIPTION
DMZ thSati.]BOD)of Divisim JufN<Bosite.0 and Rofcaniena Codc,und m lianscu NTIeT,
�OO wt r PERMITISSUANCE L3 SFDW. ....
n lull fora.ml dT
QU Lia Clan I] lic.� r�i- 12C'Ll 7-7 e) ❑SFDWL ❑KUMBINREMODEL
Dac /231 -Q? C.tren�• P1 Oma✓ L.�P APPLIANCES-RCSIOFNfIAL ❑pDDIT10N PLUMBING RE-PIPE'
F- ARCHfTECTS DF,CIARATION PANELS ❑MULTI-UNIT XSTRUCTURAI.
Z O E2 Z I understand my plana.hull be¢a m public Imot MODIFICATION
OZ-, UPTO NIO AMPS RIOR ❑CIJIM1WEY REPAIR
.N. 1+1 I.icrn.cd Pro(aai«ol r)1-IOW AMPS IMPROVEMENT
Y f OWNER-BUILDER DECLARATION OVER 10f1(IAMPS TH REMODF7JREPAIR (]DEMOLITION
C w 6 I hereby eIGmt Lha I em eacmM Tooth the Conlunor'"Lwarw Law for Inc
3 a FU- ourvolne ream.(Safi.]OJ IS,Buninua end PmfeWons Crde:Aoy city m emot, SIGNS ELECIRICAI. Ll �
OT
LL which rtyuira a p[rmil to ronnwm,alter,impnnc,demolish,«rtPoir nny urucwrt
priorta iu issooce, ho tayoirts IN,'pli.for owh prmdt to Rk,sigtedsutcmem
y SPIiCIAL CIRCUIT/MISC -
�. that he it licensed Eurvonl to theEovmon. of the C.ri.cto(a Lie—Law(Chafe,9
-0O (nx.ereing with Saunn]fplOof UivisionJoflheBmiss vu Rofrni.,Cadc7« TEMP METIER OR POLE INST. - COMMERCIAL
L y thou k i,exempt thertfe«n and the bsi,f«the,IIegM uemption.Any violaitm of ❑NEW BLI>G/ADDrT1ON ❑DEMOLITION
LL Schon]1131 S by any applic.m for a permit.object.the applicant to u civil peoaB,of POWER DEVICES
rn ❑TENANT ❑FOOD SIRVICE
H y Ea nu ml gsro)-
c < o.nw.r "Be
de my cm oyc wiln w.gcn as these vile contpevwlun, SWIMMING MX)L ELECTRIC IMPROVEMENT'
2 will do me xvrk,aW roc moBerM f«ole(Sa.]Dil,Btwasa ❑OTHER
ti]3'� vN RuGsainn.a Cole Thc .ani tr re hiw Jxr nM apply to on nwnn of B OUTLETS-SWITCf1ES-IlX'1'URES
L pngertr»110 nlu6i. irtgwves who coca ten wmk ni o'elr or tnrwyh
nin own cmploYan.movilkd m mem"m not imcndul«ulTerd for NEW RESIDEMTAL ELELTR SQ FT.
wle.If.huweve,,he Wiklin impruvemenlissald ximin omycwnf caorfi e ,Ue SQ.FT.FLOOR AREA Ls.Q.ET
w 1,eibler will love me baN of proving tha he did.r build or i.,,,e for r-
page of incl.
❑1,u owucr of Be,prgeny,,m excluaivcty comrmhng with licensed comracmrs to T T V A�
ae.,lmcl ilc reject a4
t(See.]I ,Bu.ioa.aml Prof.,,..Code:)The Coni a,,Li- -Y G
Isw does.I,pplY w.owteraf pm ,wim builk or improves thrrcvn.end QTY. PLUMBING PERMIT FEE
who cro.,for,.h Mth.wim ammoctoo.)I reenxvl ryvauar,lode C.Ilael«'s r/�� ( 1996
License
I sen uder arox unSee ,II K P C for this reamn PERMIT ISSUM'CLr
Gr.
(Nncr lyric ALTER-DRAIN A VENT-WATER(FA) VALUATION
• WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE
I Mchy grit.meter Ee by of perjury ore of the following dalemtlom.
❑Ihev<vtd»ill ttoirnaR `C tore
YZ
to sclNiwu<fm Worker,Cotmeo- DRAINS-FLOOR.ROOEAREA.COND. STORIES TYPE CONSTRUCTION
cation,a povidcd he by Sc n 7] .CMe,fm Ike Pcrfmntorce of mework fm which tatia permit is u W. FIXTURES-PER TRAPI live ad will m,i, rr' n Irta t._TAIOofthe laM Gek.f theP for whkh this Ecmtit u maid. GAS-EA.SYSTEM-I INC.i OUTLETS OCC.GROUP APN
My Weaker,Cc IrsuMiry numner ire:
Carrera Policy No: GAS-EA.SYSTEM-OVER d IEA)
CERTIFICATE OF EX W PITON FROM WORKERS'
COMPF.NSAr1ON INSURANCE GRI:\SFJINDUSTRI,WAST-I!INTERCEPTOR
BUILDING DIVISION FEES
ON,uv.roNna4ampktcd iflle pmnil is fmorc Mmlrtdddl,n l311p) GREASETRAP
«IcuJ PLANCHECK FEE
1 certify met to me peafarmna of Ih work for which Ilii.Permit i.iuued.l abut
Na employ any en;en in any mwoer w iolp)cunt<rh 1m the W«ken:Com SEWIJt-SANITARY-STORM FA.2(M]FT.
Z
saki.Ai fcelif«rtia Dae _�- 9�)a Ecn- FNERGTIEE
Q �' WATER HEATER W/VFM/FIECIR
O
NOTICE
�I-P l s �¢�D GRADING PEE
UJ N corse i by AI'FLICANT:If,Corr disking t Cmifum of lvempCo ytm umatt WATER Sl'STEM/11tEATWG
F fecarte wbjccr m me Worlec{s C«npmr IN, it,hit of the lablr code.y.moat sons FEE
Gmhwim contPly with rush provlei.ntr Nin Eennil.hall he deemed mvokal. WATER SERVICE
Q
5z CONSTRUCTION LENDING AGENCY NEW R251UENTIA1,PCMB. SQ.FT. PAID
U O hereby oR tw 11e,<ia,a.vra0.lendirtg age«yr«UepMamrsna ar Date -ip
W n mew«k rm wxicn lme path lin i..adl$m.JIM].civ.cal
U Lender',N. mTAL:
Lenders Addrtu
I amity ma L h.ve ra this Plirlim orae thm me,bove infavi is BUILDING FEE �.
N mrta.iegreemmmply im .tacm inamcaendvaelaxarelounym 'QTY, MECHANICAL PERMIT FEE
U z Nildinea..Ton.toil col,y ct n tiva of mi.city la enter upm Ute SEISMIC FEE
shave-memioncd proPcny 'm 1mP u xa.
(We)ogtec to wv.indemnify oral keep nwmkss the City NCupeUim Utsira PERMIT ISSUANCE ELECTRIC
Ii,bilinMladLmeets,c .taeM eaPcnx.whim may in,ny w,y accnu,gutwaud Cilr ALTERORADDTOMECL PLUMBING FEE
«ueyu:na of the gaoling er Thin perrok.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT TO I0,000 CFM)
SOURCE REG-UhLNFIONS. 2 MECHANICAL Il'
NR HANDLING UNIT(OVER I0.000CPM) CON.STRUCUO TAX
LLYI
Sigtoture of pplw�' tv7 n Ren« A Dae EXHAUST HOOD(W/DUCD HOUSINGMFI'IGAT10 FEE
HAZARDOUSMA Icu t DI,SCLor NoiL
WI1Ue furcre e.Cha,uortarlM tehaa.lffi"Seriy fIFATING UNITfIO 100.000 BTU)
m de.Se by In[Cupertino Municiryd Cade.CTwper Y.13,uM the Health aril Safety
Code.Snti.]JSJllel' HEATING UNIT LOVER 1 W.g10 BTU)
❑Yea No PAID
VENT'ILATTON I'AN(SINGLE RESID) Dac R 'npY
Will the,Pplicorx«rumrt building by be,Bt y ey Air
ay Mitt.wM1iaM1
cmllnnnrtl.s air ennmmi.nla u.depnW by the Boy Area Air(juahy Mawgetmnt BOILER-COME-GNP Ok 100,000 BTU)
TOTAL.:
Dovcfl
E]ye,' No
BOILER-COMP LOVER Iq, q qPTU)
�
1 have read Ile N iodoo.mwmwln AIR CONDITIONER
mgmmmenbi dUUt.1 nays nr th<coli- ISSUANCE DATE
forokWild Heil.o Eatery Code,e.hce 25305,i, yeru'J31itIlenentaN tow ifine NEW RESIDENTIAL MECH. SQ.FT /
building ata nm elute-h nave a I.vnt,that it in my tcarynai Niity In notify IhC aapaa
or111e r�Y w nrtIY46<r11et o...=
CGfli 17f Pmy
Owttecmo w agent Due TOTAL
ISSUED BY:
OFFICE