The URL can be used to link to this page

28972 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL MRMI'I'N(l. L�lj7w w 972 BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL BUILDING PROJECT MENTIPICATDJN BUILDING ADDRESS: I� 6 1 , SANITARY NO. APPLICA e/-N�SSUUBM ALDAT /1 Q � Lai .� O NER;S Aet�ME; '`�� NE, -ZI� COR'SJI INAMh 1 LIC NO NIC CONTROLX ICHE'ELT/ENGINMR: I LIC NO: I RFSS: Irlrs ❑ CI r CONTACT: PHONE: BUILDING PERMIT INTO ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT P U B MECH ❑ ❑ ❑ LICENSED CONTRACTOR'S DECLARATIONQTY ELECTRIC PERMIT FEE 1 hereby affirm thn 1 em licensed under pmsdaufa of Usurper 9(ew.nerX,ing JOB DESCRIPTION O=Z wiNS tincn]OOOluf Ni ism Juflhe Buairlus old hNeuiom .an lop'licerecis 3rOO PERMIT ISSUANCE R CIFR SIp DFNTIAI� W—F. in full fwtt - aV Dcerus sss l-� Lot.N ❑SFDWL C)KITCHEN REMODEL h.��W Duc�Caurccl APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUMBING REPIPE I„ ARCHITECTS DE TION PANELS ❑MULTI-UNff ❑STRUCTURAL Z O`nf Z I urvkruar.l my Plans shall Ile used n public records MODIFICATION OZ—O UP TO 200 AMPS ❑INTERIOR ❑CHIMNEY REPAIR r,NI: a edRofwi xl 201-I100AMPS IMPROVEMENT F,W' Oa I son exempt fr DECLARATION to OVER 1010 AMPS ❑BATH REMODEUREPAIR ❑DEMOLITION d �6 1 hereby.(firm Jut 1 em exempt from Ne Crmtrutcts .Any c Lew ea m< ��((3yU following rcmn.(Smion]0JI3,Bmim¢and Hofrnimu Calc:Any cityacowryOTHF7t u1 0 whkm emit m camuuch.Iter, SIGNS ELECTRICAL nespn'ves a pe mpmve,Mmali W,err repair any sducwre 1� n priamiu iuuvret dw rtyuira thc.pplicwn for such penml,to fileaugned swemenl SPECIAL CIR C. WF�-1 lvvIaa��> Thar M1<Is licensed punwrn to the proskials of the Conlrutnez Liamc Law(Charmer 9 0 (crus i.g with Section 70im of Diskien J of me Busieces nd Nnreuiom Code)a TIME M=RAkW INST. Q.0. T most he u exempt therefrom and the hems for me alleged exemption.Any viol.tion of ❑NEW BLDG/ADDITION [IDEMOLITION Section 7031.5 by any afflicun,for a permit suhjau the applicant to a civil penalty of POWER DE N ❑TENANT ❑POW SERVICE ore rare Nen five humlml duller,(SN00), �xzxQFlLmnwnernf the pwpcny,ur my cntpinyeu wish wugavthcir role nxnpcn,atian, - SWIMMING POO IMPROVEMENT FO will Mlle w,ak,and the ntructure is not intended or otremd fur wlc(.SccJM4.Husincas ❑OTHER W3 and Prtdcuinns Gro:'I Contractor's License law toes not.pply to an minc of OUTLETS WI H - TUR pfopeny who builds m improver Ihcrcon,ond who d.n.mach work himself,m Ihmugh his own anploy<cr,pmvitkd thin such Intprnvcn ems ort mX in¢ndcd or off<ml fro NEW RESIDE ,EI E SQ sok lf,huwcveq,M1e M1uilding err lmprnvannd i.uold wimin one ycvnl cnmpldion,the SQ.IT.FLOOR AREA VSQ.FT. ere,-bulkier will have the harden of proving IM1m M1a did not hall(r imMove for pur- port of We.). ❑ 1,as owner critic'ipony,em cadusivcly nmtracting with limnved nmland"m TOTAL. cruduc,me In4cul(Se,.9014,Beshara nor Profession,Co,The-...tenants Li- P cense Lew Jots r.9 ,Ay n en owner dfpropeny who laird,or improve.uhermnend QTY, PLUMBING PERMIT FEE wba eumrveu f n such lmsjects with a coni=it)gal licensed p.nuam m the Conwcmra Lia.Vw' PERMIT ISSUANCE 2 C] em lementunic ,BRPCr miamaew 10 n.. ALTER-DRAIN&VENT-WATER(PA) ail/I L* VALUAn pwocr_ Dme t OR �e knit irjIMmPTmAnoNLrcLARALON BACK FLOW PROTECT.DEVICE LU;- t� Ihertbya um enter Pered ty Mperjury ae of Use fol lowing declnow a.: 1'U ❑IM1ave sm1 w01 maintain.Cenif IeorComem to Wf-imare for Workefs Compeer- DRAINS-FLOOR ROOF,AREA,GOND, STORIES TYPE CONSTRUCTION ...as pwsided for by Seerion J]00 of Je liana,Code,fa the performi of me work far whkh this permit is issued. FINTURFS-PER TRAP Fl 1 have and will maintain Worker's Compmation Instvanee,v rtquirM by Section 1](10 ofthe Usti Code.for the perfornunceof the work fa which this peramnlaa.ed. GAS-EA-SYSTEM-I INC.4 OUTLETS OCC.GROUP APN My Wneket4 nope tl tt and Policy spm pp Cartier//,• Palley Nw:l/J.� 'y GAS-EA.SYSTEM-0OVER CERTIFI TEOFEX ITIONFROMWORKERS 1.� GRE15FlINDUSTRL WASTE INIERCEPIOR COMPENSATION INSURANCE VV [Thu section reed ant Ix canpk¢d if me perms,is farone hnmthN idler,($100) BUILDING DIVISION FEES a Imo) GREASETRAP PLANCHECK FEE Toy my perhatson onin ler!..- to ords Ile,fawhacid1.ThmWnisiv tlahall dwemLlonany Efismw may mannerwmlo become suhjat,o nM H'mkm'C SEWER-SANITARY-STORM EA.200 FT. Z suim lswaMCWifomic Dare ontpen- ENERGY HE zApplicant WATER HEV ER W'NENT/ELECfR GRADING HE y NOTICE TO APPLICANT:IL eller making this Cenifintc of ExeryXins,you should WATER SYSfEMO-REATING became mbjer,to the Worker's Com,.ion"clsiam d do IA Code,you mus, SOILS FEE flmhwim comply wimsuch pruskiom or mix anai,shall he deencd rx orad . WATER SERVICE Q UZ CONSTRUCf10N 1SNDINGAGFNCY. NEW RESIDENTIALPLM B. SQ.FL PAID V0 wort whafErm mvthr is issued C,, egcney furtM pMumtancc of Date Rcccip,N Uthewr's No which this Tamil in owed(Scc.JW].Civ.C.) O U L<Mc(s Name TOTAL'. 1<aletAddress TOTAL: y 1 1 aerie o in 1 py with ll his yti aicwinn end awre thin the starve Infarcting is BUILDING FEE y nomifing ngrt<mmnmly maim ullcityend cvwmy(.dtivs or thin city towarelminghe QTY MECHANICAL PERMIT FEE U Wildingationed round hcahy uumomeaptesentutivn err thin city manner uptm the SEISMICME .havammtin propne for fy npurpmex. (We).gruc to meq indcoollfund - kap M1umiksr the Cryof Cysmino nguiw PERMIT ISSUANCE EIJiCTNIC IEE Iidniolo,judgmcros,cone std expeas<s wh'ah may on,way.ecrve ageimt mid City eonsryue rce of the granting of this p,mot. ALTER OR ADD TO MECH. PLUMBING FEE APP. ANTf NDUFAN S AND WILL COMPLY WITH ALL NON-POINT ALR HANDLING UNIT(TO 10,00)CPM7 MECHANICAL FRE So REAnA s. GIA �� J AIR HANDLING UNIT Edify)CPM) CONSTRUCTIONTAX toreTAppliewl/Cnnlera'Im Dater EXHAUST HOOD(W/DUCTI HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSU E Will meappllcam,home huilding decupamiame or hot herniations maocamid HEATING UNIT TC,100,003 BTU) as defined by Inc Cupeniro Municird Calc,CTmper 9.12,and the Hulm and Sefe,y Cads,Section 2M32009 HEATING UNIT(OVER 100,000 BTU) ❑Yea ❑Nn VBNTIIATLON FAN(SINGLE RPSID) PAID Will Oc ayplican orfutuartmidlingoccupolt u.¢equipnern m devices which Dem Raeip,N mat ihesuoua dvlr conlemftt hle ,m MfineJ by by th< ayAm Air Quaiiny Menegcmrn, BOILER-COST(JHPOR 100.100 BTU) PauinP TOTAL ❑Ya [3 No BOILER-COMP(OVER 100,000 HTV) I hese reel the Isaardeuv mm<nts rtmincoenln under b95 of the Cali- AIR CONDITIONER CTw¢* ISSUANCE DATE hada Redoes or Safny Codl a aMm ISNH.255JJ and 25511.1 avdcrswd ttii it the, buildieg does oral currently hesthef 'i n, items raprlsCem mtodf Jnc NEW RESIDENTIAL MECH. SQ.FT. / of me�.qa,........ Y Y aavPent which new k ran prig I.issuuce W•Cenifuve N(kssgmcy Owneravumvrisal spent pas TOTAL ISSUED OFFICE