S 3388 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES•USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL Pitt]fNG. 3388
BUB,DINIG DIVISION APPLICATIONIPERMIT PLUMBING-MECHANICAL `�
BUILDING PROJECT IDENTIPICAT ION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBM1tIII'AL DATE
in L4 t,• v Fe 0-\. sLiiss, v-4 'Rod.a t —Z 9_q9
0 NEH'S NAMC: �eaa u�' PIIUNI COMRACfIIR'S NAME: LIC NO: NIC CONI
V voN�C4 ��- `��7 �1Fa' S'lcll g tl
ARCHI'MCI AINCINITER'. LIC No ADDRESS:
CONTACT: PHONE. BUILDING PERMIT INFO
❑ Consultant poet Paid by Applicant(Initial) BLDG ELEM PLUMB PATCH
El ZIi� ❑
LICENSED CONTRACTORS DECLARATION QTY ELECTRIC PERMIT FEE
I] Z 1 her ay ammo Ihae I am li<xmcd ulster I.nsisiin.of Chimp 9(commencing JOB DESCRIPTION
P- full foac mill crcm.wivn�nannhe Businanvna Prufc.... 0l.@ mldnlylianwn RFSIDENTIAL:
W00 to PI?RMIT ISSUANCE
aU~ Lcense Clncc C• �� IJe.M $�16 ❑SFOW'I. ❑KITCHEN RFMODFI
6 U APPLIAh'CE!S-ki-SIDp TIAL ❑ADDITION ❑PLUSIIHNGREPIPE
Comrvriw
ponCT'SDFCUARATTQN % ❑MULL-UNIT ❑STRUCIVRAI,
ZONZ Iuldc enhi my Phan* be,rind a public records PANELS MODIFICATION
CZ- UP 11)2(M)AMPS ❑INTFRIOR El CHIMNEY REPAIR
Ilcensell'rmmwjtsmI 201-1000AMPS IMPROVEMENT E]SWINIMING PO015
C a 5 Q I MrthY alf nn JwINlwre cmp[from R )[„e CN mrvemr's Licenw inw for the OVER 1000 AMPS ❑BATH RI'MODI1lRFpAIR El DEMOLITION
pa(3 L U fidlmvinp ratan.(.Se tion 7031.S.Business and Profitex—ts Gia:Any city nt manly SIGNS ELECTRICAL �UTIIfJt
W LL Wa which rtqui e,a Rmtit to crmsnuct,eller.it,ni demolish,or reper any slnKlure
Time to its iavalee,almryulr On,applicant her.mah pend,In flee signet sturcnem SPECIAL CIRCUMNIISC.
}•„ that W in licrnsd purwannnl hepmvi.uens of the Comm,' r's Lien.l-aw Chatter
Kaz (mmmencinewim Section 7000)4 Divici.3nflhe BesircxsvM Permssims Code) TIJsIP MBII:R OR POUT IN,ST. COMMERCIAL:
Ea o EThat k isseo,l teretmtn arW the basis for the am
legel e,epden.Any violation of ElNEW BLDC [3JADDHHON DHMOLITION
M Section 70315 by any applicant firca fertnL sabjec,tM:applicom le it civil corl'yor POWER DEVICES ❑TENANT ❑FOOD SERVICE
�_y tat mw man five Wrdred del4m;(S500)' e IMPROVEMFM
< Q Laowrer of the plapeny.or my cmpb,ym wish wages ns heir sale cempcmation. SWIMMINGPOOLELECIRIC
W F.� rand Pr thewtat,.mddestr^ammismts Lineedr I..ddfswla,dy I,,an Biof TIER
LL�13� and lMexsitms Codc:The CaRrxlofs License Paw dm not appiY to an mvner of OUTLETS-SwITCHfS-FlX'1'URIS
�' .. Hapmty who Wilds or initiates noncom and who chips such sock him eIf w mrvugh
R"own emldnyeee,pnrvitlol IM1c,such impnwc nems am rel inlenikd or offered ter NEW RPSEIEN'DAL P.I.ECIR SQ FI: go
sak.If.howror.toe builJingtrimpmvenirnl iswld within encycmofcompinhm.the SQ.17 FLOOR AREA S Q.Fr.
owner-builder will M1asx the buNcn of proving anew he did nm build or scopes,fir pur-
puc of sale L
E]1,to owner of the progeny,em uclmi,c],'chm ting with IieemeJ mmtmenm m TOTAL
consumer the protect(See.7841.Business and Pmfes.i m,Create)The Contestation,Li-
Law does not apply mwow—dh,tiany who builds or tmpovo lhcrem.and QTY. PLUMBING PERMIT FEE
who cantons fat such pnjecn.with a umwmnr(sl licrn..d pur,ucot m the Clmmnois
Lice.hw. / ITRMI'IISSUANCE
❑ I am eseinp mde Se. ,B&PC f«This n.so
ALTER-DRAIN&VENT-WATER(III VALUATION
owe nate
WORKER'S CO.M of Pe I cr DECLARATION BACK[LOW PROfFCT.DIiVICP.
1 Wrehy affirm utdcr pastry leperjury Iceof theinoumfgWkd 'sum:
❑Prow and will meinuin oCrnif mof Constau mself-imue fat Wm4dsCmmpcm DRAINS-ILODR,ROOF AREA,COND. 9IORIF_5 'fYPIi CONSTRUCTION
smit a.Ih'osi at!1.by Selden 3700 Of the Iah^Code,fw de rermari qnk fir which this petmn is issued. IU -PE
1 has.and will ma stain Wsslefs Contras int Inswena,a req t S37W of the Labor Cade,I,the pMarmmcc M IM1c warAforwhich this tAS- SYS[ L CA OUTLET'S OCC,CROUP APN
My W cher%Cro"nratinn Inwnix:o cvrtim and Polity number mc:
Carron Policy No.t G -`A_. .R d(Isl
CERHI9CATE OI'EXIih11TION FROM WORKERS' D
CONIPBNSAHON INSURANC17 'GR S Sf '1'E INTERCEPTOR
BUILDING DIVISION Fli1S
fDhisttGian ncN nor bo cwnplmW tribe,pencil is foresee hmulrnl d s15h W1 GREASETRAP
w IeuJ 111,ANCIIfCK FlJi
I tinily mm in the prntmtwme ofdw wort for which min Worm is is 1.1,hall SEWP.R-.S - )ItmPA.zpn En
Ilea employ tiny person in any own Seas nlhc K'mlc. C INEHGY Iti -
z ..tion hat: f Celifmmiti.Date Z 'ATER HEATER WN111171,11
q_ M s m
zApplicmn R - _O GRADING FEE
N NOTICET APPI.ICAIdI':Il.tiOermaki.,le,Cuniftmc of 17,emplin r,yo,shood
WATER SYSItiM11/1'KFA'I'ING
becolT sobjecl In tae Wor4cls Camprnsnion provisilms of the hoar Code,Ya most SOILS Fl;I:
ftnhaemn mmlky with.such provuams or Iris perinit shad be lkxned mcolel. WATER SERVICE.
Q
� z CONSTRULTIIIN LENDING AGGNC1" NIiW RISIDI3MIAI.PLNIH, SQ.IT [PAIDV O IretN+yah his 1""i,i, ,,ocd ec.Y1leveling agency iw lr[lerRntmrrx tsl I RecipM
M1c wok fur wriaM1 Ihia IMennit in iewcA(Ssc.AMP,Civ.C.IOr" Letdm',Name 'PUPALW IcecknesAridness
1 error,mal 1 rate mad this ap pester,std Mw thal my uM,te infontwdon ds lie
earn I.'r,em mthly aid'all city mod eMmty nedilmness and state law.relating ht QTY NIECHANICALPERMIT FEEU zImilJdngc wrctirm and hereby audun¢isweenuaisxs of lhi,61you emer spat de I IC PI?
as..c-ncmi,,H p ,,wec for Im,'tiim pugc—,(We)tigree Ia save,indemnity and keep hamdcss the City of Caweem sgainaPI3RMIT ISSUANCE'. ECT' IC FliE
tahilities,judgtrcnu,m+Ls and eaten.,which may i^any way att.agai. m]CityAI.'H:R(1H AlID 10 MECH.msc,.m:c of the 8nnting ul this pmnil. UMB to FIE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UN IT PTO 10,0011 CIM)
S(IUBUT `EGULATI( 'S. AIECIIANI hFL'E
AIR HANDLING UNIT(OVER IBM)CPM) CONS IRUCI'[ON'TAX
SiSnmwc d AWIthemVChanowtor /f Dat, EXHAU,Sf H(UD(W/DUCI) HOUSING MITIGATION FEE
I AYARDOUS MATE AIS DISCLOSURE
Will lhetipplieam or Imm wildogoecupwl Mom:m handle rwmd,m,ordnal HEATING ON[I'TIO 100.100 BT U)
a ticfreJ by the Cupenim Ftunsipa Code.Chapter 9.12,aIle the Health ed Safety
Coce,Section 25532(a)'f HEATING UNIT(OVER 100,001)BTID
[I Y, ❑Nn PAID
VP,NIlLAT10N PAN(SINGLE RI!SID) Dae Recei,
Will IM apMirwl w fmotrt building occupant use Area
Air Qu tx Ik aha which
emir MmrAtmx air cnnwninuar ar Ju0nu1 by ole Isny Arcv Air Quality Management Isr1ILHN-C(1MI'(31111 OR I01.000 BTU)
durici! Bl11LIJ1-C(1MP(OVIR IOU,WU BTU)
L3 Yes ❑No
I rave real the hvmtbas mmelials mitircmrnts male,0,,P,6.95 of me Cali AIR CONDITIONERBTU)
DAT
farnia Seam k Safety CWe,Stttimc 255(15,25533 std 255N.I malerwrd That'd me NEW RFSIDIJYIIAL MECH. SQ.0l'. / 'l i- Z
huilddng kas not cmrendy have a What Pettit mon,Icspsuibihly to notify de lunpan t L
oAthelequirenenu which must he met prierm isuance of a Cenlf ce uffkcuryrcy.
Owner«oumarizN agent Dore TOTAL: ISSUED BY:
OFFICE