S 3376 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING.-EIAK, RICAL PERJ.IIT NO. 76
BUII.DING DIVISION APPLICATIONWERMIT PLUMBING-MECHANICAL. J ,j7"3^J(
BUILDING PROJECT IDENTIFICAnON
BUILDING ADDRESS: SANITARY NO. APPLICATION SUHMUTAL DATE
OWNIi . AME: ECO ,NAMLI- JC NO:
NC CONTROLI9Os` 9 /115
ARC ITCTANGINEER: LIC NO: ADDRESS: ❑
CONTACT; PHONE BUILDING PERMIT INFO
IL �N/ pp ❑ COnsadmf Ems Paid by Applkisnl(Initial) BLDG EH.F.CT PLUMB MECH
�1( 3uD10 ❑ ❑ �❑
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT FEE
1 hereby dorm mal I em fie n asl mole'immisiamF of Clnprer 9(manmerearg JOB DFSCRIPHION
with See...711(IfIm`Nvismn loflnn Bu.incu ab Professions CNB,and my hma,e i. RFSIDENTIAI:
in I'BRMIT1551JANCE
'F W F full force v.l cRcci. ❑SIIIWL ❑KITCHIiN REMODI!h
NQi UvcnW CluW Lie,4
C�nclo APPLIANCES-RESIDENTIAL []ADDITION BTZ}tttBN68E-PIPE
FON ARCHITECTS DEiCIARATION PANELS ❑MULTI-UNIT ❑SIRUCRIRA,
Z0 Z 1 unhvsmml my plans doll M used as plblic ne«ds MODIFICATION
OZ-0 UPT0200AMPS ❑INTERIOR El CHIMNEY REPAIR
(-�2F'W Liccnwvl Prufcuiuml MI-1000AMPS IMPROVFMESJT ❑SWIMMING POOLS
CYC- OWNER BUILDER DECLARATION OVER 10(I(IAMPS ❑HATH RFAIODEIIREPAIR El DEMOLITION
1 K Q I lenby M.mal I em eaemp Toxo Ik CaminnNF Licenxc law for the
�S L U follmving rtaam.IS¢lion 913E 5,Noeincvs and Profoxitms Ctdc:Any city m emm, SIGNS ELECTRICAL ❑DI'IIER
1+13
WE` whichn',Jmoe a Temad m ca,lmcl,clan',improve.dcninl ash,or repair an,svucaua
0 pinrmiu iswrcc atm rryuitca arta applicant far.us,h pertnilmlileaviynnlsWrnem SPECIAL CIRCUMMISC.
Et2} that be es woorseJp«n1enllo the Imsisioreof the C...'s,s Liccme Law(C ,Xrl9
WC) (commencing with Seemen'If Bof DivisiemInflhe Businsesand Professions Codchx 'OiMP,MICIRR OR POLE INST.
es a a Inco he is exempt Ihenefraev and me besis fix the allegwl esmnpion.Any violedon of ❑ ;W BLIXHNl)MON ❑DEMOLITION
LL Section]631.5 by roy spplicam f«v pmnit eubjmts the applicant m a colla penay of POWDEVICES ll ❑TENANT E]FOOD SERVICE
rra mace man Bve props t.or (5560).
F Z Y IMPROVEMENT
❑Lasoe woc arm prWmY•ormY ttnm,nan wimxvgcaaalhci(mk amm.Imsi en. SWIMMING POOL ELECTRIC
CD
will dul moa,.anJmenmemaisner',Us—
LewrJJBnor ally 91111. wnimw OTHER
3 m mnJ my w1mna Cade The Geri mere land all Lew t nse mI apply u+no owrcr of UUfLETS-SWITCflliS-li%TUNE,S
hisyown who Wills or impmvca t mere-,i,aM wha is s men work hintaclf«eri for
his.If. empluyen,haddaal IMI such am,is sow are matord th..f or spored for NEW RESIDGTIAL EI.I:CIIt SQ Ff.
oaks ola J will have Ping mien oovcrrcn la sow ntve yur r rtmtpinfor oIm,r- SQ.FT.Fl.(I(IH AREA SISO IT.
rcr-huillb will have Ane wrdan nr proving Inan he del n«laid«intlxave r«pnr-
p'atof'it
E]1.as trwrar of de property,am exclusively connttice
ting with Inmn «x
d contct10 TOTAL
cnnatruel the( rjeel(Sec.96th,Busircax mailFtufeasioru Code:)Thmlm
eCclor'sLi-
aeLewmcsntappay to an owrer oftwoi wln builds or improvo maun.anal QTY. PLUMBING PERMIT FEE s
whoctmtracts l arxuch pntjcna with.mnlmchms) ecnMl poroma In Els,Cmtmcux'n
Llmn.m law. PERMIT ISSUANCE
❑ lamexemp«der See. ,B&PCBnthixreawn
0., Dae AhTER DRAIN&VENT-WATER Uiy VALUATION
WORKI!R'S COMPIiNSA'IION DECLARATION HACK H-OW PROTECT.DEVICE
Emmy at Firm made[penally ofperjury one of the folW in,Jeclualions:
❑ Ibaseael will maintains CenifrcmcNCo.,to mlf-imve for WlNker's Cearnls,rr DRAINS-F1.00R,ROOF.AREA GOND. STORII-S TYPECONSTRUMION
waA f es provided RN by issued
19(10 M she Ido Code.for Etc perBnttena of tM
w1 1 Lx which this Ti is ie A,, I IX'NRES-I'EH TRAP
❑ 1 efcaandwill a or he Terf'.Compmsme Imumncc, h nyuier by Satiun
3960M Oc lahN Coalf«IM pcdornwcc of 1a,wmtfor wM1eh this prmtit is i.wN. GAS-EA.SYSTFh1-I INC.JOUTLETS OCC.GROUP APN
M1fy W� r CO 1 xati. F arcs oral fbliry R�Gd�
Carrier TL �"� 14Jiry No,: GAS-EA.CYSOMM OVER J(EA)
GHRI'1 ATI!DI E%' ITI(1N PNU WORKERS'
COMPHNSA ION INSURANCE (IREASEINOUSTRLWASTEINTERCEMOR
BUILDING DIVISION FIEFS
(Un,Fmdn raisedml becnmpletei ifthe'amid is foram,mat&u.(Sloo) GREASETRAP
or less.) PLANCI{EEK RS
I certify that in the perforn
ance oflhe work far which anis permit is hwed.I shell SEWER-SANI'T'ARY-SIORM EA.21X1 IT.
Jany pen
Jan cnnploy anaaryn a as to m
ncns,sam bjeo the Workurs'Cnnpcn- ENERGY FEE
Q z .abort Law,M Cmlibxniu UmaareWATER HEATER WNEN AI ECTR
Applie. GRADING FEE
z
y NOTICE TO APPLICASM IL after nuking this Cmificvc of Exemption,you stand WAMR SYS'MMIIREATINQ
(•` re sus vubj,od In ins Workers Cornpensshun provisions of the Lehr Calc.You must SOILS FIT.
Ila ,'may fnnnwith comply wiiM1 such povlsinnr or(hia prnnit shell he deemed revoked. "AMR SERVICE
d 0
= z CONSTRUCTION
mmsm LENDING AGENCY NIiW'RESIDFMIAL PLN B. SQ.FT PAID Dem RaripN
Il eabyammo thisthere isawn.maum k.Cis, agcnry fa the perGmtaatcwtf
C)O
'he work Na wnicM1 lois pcmnil is ivsucd(So'u.31M)9.Gat.C.1
L:rukra Name TOTAL
� U .
LcnJera ntda.< T M�I
7' 1 ccnifl'that 1 have rmJ this ii'lu'etian ma]ave ohm Ila,nhwc inftxmalitn is O
F rn sums'.1 egae m eompY wiih all city and oomay ordirmrmcs and stats Ivwe naming to QTY. MECHANICAL.PERMIT ...
r
U z builJng cnsweilan,anal hereny nmhorize opus the SHISM1 I�
'move-mentiorcd pmpmy fois asedia n parows. PERMIT ISSUANCE
(Wq agac b,xa"'IMrnnify and omIs humlcv ole City.f Capcnir ser again. T
huNiniesjudgmems.eouts and exparncs which may in any way meanie again.said City Ad MR OR ADDY7,SIECIL
nmµucnmofdwgmmingtJ this permit. PLUMIII FBIi
APPLICANT UNDERSTANDS AND WILL COMPLY WI'FFI ALL NON-POINTAIDLI AIL 'ITT) IN
SOURCF,REGULATTONS. MECII LAICAL FliE
AI LING kN IT(OVER 16,gM)CFA CON STR CM ON AX
Signamm afApplicnnVCommatnr
Use I!. UST E(M)U(W/DUC. IU� HOUSING MffIGAU(1N FY.E
HAZARDOUS MATERIALS DISCLOSURE
Will ileeppl.,er fum ,Wiwing ts,cupam wveorM1vradlcM1vnNous material III NG U,N'ITOFO 10(i RT U)
as tkfrcd by the CuJammo Municiryl Cork,Clnppm 9.13,ud Re Ifcellh marl Safety
Fide,Section 255E2(u)'a III UNIT(OVER LLXI(MMI BTU)
pY" El No VENTILATION FAN(SINGLE R IM PAID
Will the applcenl or faro.IuiWin Date Rettig
gby,lb, aume.Air Qnlor Jcviceswhkn f1011.ER-COMP(3HP OR Ig1,000 BTU(
emir neasdws mfr camtemnwta vs tkhnul by the BeY Arca Air Qualiry Mvugcmem
TOTAL:
DTenim^.
Dyes ❑No BOILER-COMP[OVER TI00JXI0 BTU)
I ha.e rd me hvmdus matmmdsAIR CONDMONER
mryirtrrvna urdn Chapin 495 od the Cili- ISSUANCB DATE
forma UWtn&Sufedy Code.Snti 3518 l0"25.5.X.1 unal,sdwl that if He NEW RESIDINI'I Al.MECII, SQ.17.
huikli grk ucu yna L y 'p sih'lly to raalfy the ce-Janl
of ea��, Wim% �ezz=sP cb
�—, � e
cmul efcaC lk� a, Dote TOTAL: ISSUED BY:
OFFICE