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S 2803 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BmuBNC-P,LECTRICkL PERM]r NO. BUILDING DIVISION APPLICATIONIPERMIT PLUMBING-NIECIIANIC L L o C n O O BUILDING PBOJEC`f IDEN1 IFICATION J BUILDING ADDRESS: SANI'T'ARY NO. AITLICAI ION SU13MI'17AL DATE 013 ,-EST" AVE C-2-?7 OWNF 'S Mli I'IWN 3 CO, �(TyRS l G �f NIC CONIROLN ,®ARCH11ECTIENGINEER; LIC NO: /7SS O�t/L.YYi�d K i5sN Lfr � ,53 ❑ CONTACT: PHONE: ! BUILDING PERMIT INFO � +_ E 274'CO72 Consultant Fcrs Paid by Appllcanl QBltlaO BLI)G ELECT PLUMB n11iCH ❑ o- ❑ Q LICENSED CONTRACTOR'S DECLARATION 1 hammy aDum tat I am Bemused mrater pre,iticn,of coacher 9(cmtmcrciELECTRIC PERMIT FEE ng QTY JOB DESCRIPTION Z an Seidl-T011ofuiswonJoflh Bisime anu l'mfessionat ad my licelue,, NF_SIDF_NTIAL: FWS in full flaa aml c/!��a [' X� PERMIT ISSUANCE S, A_ 3Q 7' pU ❑SFl)WL ❑KIT-1 REMODEL. QFVU Liacmc Clue" La.N APPLIANCES-RISIDINI'IAI. ❑ADDITION ❑PLUNIBINGRE,-PIPE 1 NQd Date Cnnuac¢u AHCIIITECTS DIiCV.RATION ❑MULTbUNI'T ❑STRUCTURAL F !� I'ANEI S I utWlwJ Cmmy PlunW . WM I ¢.cit amE :WMa r« MODIFICATION pZC-'� UP 11)2(X)AMPS ❑IND➢t10R ❑CHIMNEYREPAIR F^E"tj Lihmvd l'rofe,,iamd 1111-100OAMI'S INIPR(IVEMBN'r C]SWIMMING POOLS UwNEk-BUILUIiit DECLARATION OVER 1000AMPS ❑BATA REN10DIiUIdEPAIR ❑DENIOL[HON y Y Q I hereby alfuIhat I ecahmpt from NC Cnmtuctor'n License Law for the >(� m m 1 V Imlowing rcn it.Lg«tdm 79313,Business and Pmfcauons Cori Any rily u loamy SIGNS ELECTRICAL ❑OTHER Y1 O�- which rnluirn mi a Purl In c,rtvlrud,alter,imrmoBnve.dran ,,r repair may structure F prior m its issuata,alm reyuimna.'PI car,lir men permit to 11lc.'.gain"am a^t SPIiCIAL CIRCUI'1'IMISC. � Ihlt be is lie .cit lwlw:Int to the Prasi .of the Cmmiellds Liaise Lies,(Chalw9 W C�01a,ntnencing wlEt Sccliun]IXIf)lof Division3 uOhcllusitens mW Pmfnnionx Cnlc)m TEMP.n1EfERORPOLEINST. COMMERCIAL' a i o W Nal he is excmgt thererroin mal ole besis for the alleged exemption.Any vi,daion al ❑NEW BLDG/ADDITION ❑DF_MOLH[ON u' Seel 7I13 13 by any yplicum tar sperm,mt aah,me apo.to a evilprnnityeat POWER DEVICES mm ruse than fisc herdreJ.bllow(551)p. C'INIPROV ❑hOOD SERVICE FZQ 0I.aso mrof9 Mp ny,vmyemployen ilhwagesxl -irwticcampenalim, SWIMMINGk)nLELLCIHIC IMPROVFLIFM �M will Jn ❑ thewM.amllhc.Imntuc is mg intclWN or alTcmd h.salc lScc.]UL{,Plwtrss OTHER be W ma 1'm4rovims Cost- The Canraetora License low does nal:,pply m ad-bcr of OVII.ETS-JWI'rCHES-IFI PURLS him—who ogee,or imlaoves]het h n,s who ares sucht mo himself«Innmgh his own employeese provided but such moan wild w sire on intcnlnl,e o9emd for NEW RESIDENTIAL FlEC!R SQ FT. mlelLnmder will her a 11hepar i.ef,or i iaw,ld wi,hlnn,m yld intmomefo¢the SQ,IT.h1WRAREA S6Q.Er. teohnuder will na.x ole lvrden or rratilrg that be,dial mN Ism m imprate r«par. ,,a oreuk.l. L u ebw a of the progeny,am exclusisely commeting with lion.d mntncmn a, tt)fAl.: 4 NtiUnel the pUjest(Sec.7UF1,Business trod pmrwima Colle:)The Cmlmcla's li- salaw,ko,,,nor apply m un owncrofpropmy who huil,, "n"oses lleteOn.and QTY, PLUMBING PERMIT FEE whU cmtracts 4e ouch project.wish a emtrveu,gs)Iittnaa pumm�t n,Na CUntnlnoi n Lice"Law. PERMIT ISSUANCE I am cxum(e ushrr Se, ,It&P C Rr Ili,reran ACI ER-DRAIN&VENT-WAI ER(EA) VALUATION Dw,tcr Date WORKERS COM nipriS ATION DE Ce bat Poling BACK]LOW PkOIECI'.DEVICE c C) l.> Ihereby.braturalcr Icotlly .perjuryore , the fdl mring dablandWorKtr,CA ,,mrad ,It Mraidbforbinntioa 37M nlCmsrhor Cafenvhef«hed-a's CUmpcm DRAINS-FL(R)R,RWEAREA,CO ,'TORIES l'1'I'F,CONS I'HUCI'ION satins,m gnrvilkd f«by Scclim 3](Nl of Inc lobl,r Gdc,Gv tM prf tuna nr tM Ins which llmanwrmilin iSmM FlATURES-PT:R TRAP M1uuc end will imuin Worker's Cmnlxn.uuinn Irtmrvrca as required by Sntion / 3 pnf the laMr CvlalulFe perfUrmarre uflM wm\Lxwnich lois pcm,il isiwtrJ. GAS-I?n.$VSflinl-I INC.JOVIl,E1S (ICC GROUP APN My Wn Inm ec ItHeyit No u Camcr: Policy No. GAS-13A.SYSTEM-OV1?Ra(PA) /� CE FILA T COMPENSATION INS FRO 1 W'ORKFRS, COMNIJSATION INSUNANCE GRIiASI%INUUSTRh WASTE INTERCEPTOR BULLUNC DIVISION FEES fThivIII iom need nee he anngkmA it the pcnnit is for ole hurWr vl dollars(SEMI) - - -- - or gess,) GRESgE TRAP 1'1.ANC1{I:CK FEL; I''oily that in the penirmu,Kx of the work forwhich disgearat ibos¢N,I WWI SEW[k-SM'IITkY-SfORMI'A.11101'1. rot employ any gemxl in any nmnncl laill m Ixmne.mhjcct to the W�Aera C,,.,a- ENERGY FEE: avian las Uf C.1iform..D. WYIT.R I]EATER WNV- IIELECIR z z. avwO A,Isanl GRADING FT;Ii u NOTICE:TO APPLICANC If,atter making lois Cenincale or Exemption.you should WATER SYSI£II,TBE.TNG ed 5: mm becoe bjecm l tl,e Workers Crmtnu petion pmSiCook, slims of the labor you mus, SDI]:blip W fonhwilh eautply with such pmvmiomm this lKmtit shall be Ueeal ren,ked. WATER SERVICE O Uz CONSTRUCTION LENDING AGENCY NEW RESIUIiNIIAh PLMB, SQ.17, PAID L. O work huffmn t Irnan hisaeo¢ctme,h1CAP.Cing agcttry Gr lne pert tow«c of I)ue NeaipN � '�+ to sock f«which this Ixtmit in ialeJ(Sec JOY].Civ.C) O U1-racer,Nmt1e TOTAL: {U Landers AWJrev TOTAL: y I Cenify tat 1 arc notal this applicmion it martinet,ae above imLmmtiun is BUILDING FIFE Z) enro,,1.I agree tocmnply with all aty,ndx,wmy mJirnrce.rad.tate laws mWingto QTY MECHANICAL PERh11'1' FEE UZ building eermmnim.and hereby umnmia rr,eIaiths ofNiscilymeatert,mthe SEISMIC FEE above-menlimed pmpeny for ir,,omim purryecs. PERMIT ISSUANCE (We)signs to save,inlemniry mail kap humde,the Ci,,of C'ugenitm a,mst ELECTRIC FEE 9 IuMl iliex.jolgmenls,costs and expense,i which may 1 n any way accrue agai int xu kl Ciry ALTER OR ADD TO A ECI 1. ry in Cosy endx foaming the guing Uf this Permit. PLUMBING PIT APPLICANT UNDERSTANDS AND WILI,COMPLY WII'It AL1.NON-PULN'I' AIR HANDLING UNIT ITO 10.009 CFM) SOURCE.RF.GUTATIONS. MECl IANICAL ILII go AIR HANDLING UNIT(OVER 10.000 CITU CONSfRUCIION'1'A% Sigmture 4ApplicenVConuaclnr Uma EXHAUST HOOD(WIDUC) HOUSING MITIGATION FIM IIAl RDOUSMXIERIAIS DISCLOSURE Will theapplicum«future Niilding,ccupunistareorhumlkhvuNoutiiwnal HEALING UNITTIO 110.100 BTU) nx defiwl by the Cupenim Ntimicil al Corte,Caper 9.11,rota the Health mtl safety Cod,.Scotian 25532bi HEALING UNIT(OVER IMNIO RTU) F1 yes No ` VFIlIl1AT1(IN IAN(SINGLE NP_\IU) PAID Wall the aWlicam or future building«tulkml use a,luipmcnl or devices what, Uate Heceip N DULL hvardmn air nmumimenls as defrad by the soy Arca Air Quality Manukunent MOILER-COMP(3HP OR IIXI,IXXI Hll1I a District 'toTAh E]Ycs ❑Nu 11011.LR-COVII'[OVER 100,14)1 IT TU) AIR CONDITIONER f� Ihoth &ad ler Ccor.buteabiet lico, rexyZ533 and ZS534.Idocilli h95nfde Ca9- It ISSUANCE;DATE© fstny Healthei rs Suacr Gxk,Smtiatr 25545,2530 and 255JC. mNkNand Tal if Ia NEW RESIDENTIAL MECIi. SQ.IR of meng dr.m curmNly have r IrnanL that it is mY rswrymuMlity m roily the«.sprat i. o,aaerttraNna,<a asrnl Dare ll)rAL:y . ISSUED By. � I-'1A.7.'>A-C.fGf OFFICE