S 2508 APPLICANTTO IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPF _ BUILDING-ELECTRICAL PERMITNO _
ITUII,HING - APPLICATIONIPF,RMIT PLUMBING-MECHANICAL
DEVISE Q n C_f� O
BUILDING.PROJECT IDENTIFICATION SJ L 51 Q O
BUILDING ADDRESS. SANITARY NO. APPLICAIION SUIIMI'ITAL DATE
OWNFR'SNAA i PHONE 1(1M-RACION'SNAME:
r�A1 7 NM. CONTROL'
RCHIILCLiENCINI} LIC NO: ADDRESS: El
CONTACT: PHONE BUILDING PERMIT INFO
❑ Co¢cultaat Fa Paid by APPIRant(Initlal) BLDG HLECT PLUMB MECH
2 U., ram L�r Ff'
LICENSED CONTRACT DR'S D, RATION QTY ELECTRIC PERMIT FEIi
1 to rah'amrm Pal I oe IlanscJ ander ,tanow" r,of Chapser v(rhmtmndng JOB DESCRIPTION
C=, -ar Scclion]glU)of Divi,aso3ofEm Ki anal Pmfnni.Coda.and my ldansc La RFSIDFNTIAL:
C)C'
in PF,RMII'ISSUANCE
full farce rooddr, ❑SFUWL D KITCHEN REMODEL,
aUU heeler Clau Lic.N API'LIANC'LS-RESIDENTIAL ❑ADDITION DI'LUSIRING RE-PIPE.
efQ A. Umc C'mvvcmr �
R'1IITIiCI'S UECIARATIo - PANELS ❑MULTI-UNIT ❑STRUCTURAL
m Z I uMcnurd my Tons sbvll K used ns public MODIFICATION
UP TU 211U AMPS
OZ=O CIIJ77i0 CCHIMNEY RpyXn_
LittnrcJ lTofruinnal 101-1000AMPS I\ OVEAIPM CSWIF1F11NG FQOIS
OWNER-BUILDER DECLARATION OVER IIXXIAMIS AIA REMODEI/RF,PAM 0DEMOLIT[ON
C C Q 1 helm,vllimt hit I an,e.aamp foam Na Cuntmcier's Liconsa Lw for the
K3 i U fel win Seclinn]UJI 5.xuslncs nna Irm.sdmu Coca,An 1 Iv C OTHER
u] C frim 6 Y ci y nr coon, SIGNS ELECTRICAL
LL which rats o v pamsl 10[ las Tic,afar.imprnva.J poroufh,m repair vny umcmrc
F"1='meq Pry 1 1 vl.w rty lM1e y+Pli f M1" ..... fl Lase uverrcm SPECIAL.CIRNRIFIISC.
G r� that roc _ Jp .0 II IM1C pn1 nn f f cmr I fCtrmcr9
�KpO laxramea g 'm Sml ]OWI fD 'si J flhc Hu ircss M f Grk)or TI;MI'.MEII.R OR I'OLIiINST: COMMERCIAL:
s a e 0 ut Ix p tl el d Ibe hat I tlw all 6 J ShariA y vmlanim of C NEW BLDG/ADDITION D DEJADLI TION
X"� 4n T1315h} y ppl If Mem t. hl I.N -' 'onlyof P iR DEVICIS
W—y ' CTFNANT ❑FOOD SERVICE
= trot ntort Nan 1 vc hurxEeJ Jnll LISW).
Q DLartws'net oltkpo'1'e'n wreisycnaplo wIN Age t rrnleemrycnvalinn, SWIMMING POOL ELECTRIC IMI'ROVEMI:YI'
will Jn lbcwmk.mad Nca lino s o rn1 le'scc.](m,Inoincn. ❑OTTER
4�1 .9 anal ITafa'sions Cori Conhrl I.ia Jaex roan apply m en owner of OUTLPfS-SWITCHES-FIXTURES Q J
4' pnpcny w@�builtls 'mpnov Mr w .Axl M1n ams awn wmk him¢II nr Nrvugh
his awn empkyas,pm a.w[ imprn cmr'nls ane not intanticd or offered tier NEW RESIDENUAL IELECTR SQ IT
mla ll:hwasn,no,No gmimpna hl[nl is Add within om yrrofcomplelxrt Na SQ.IT.Il(x)R AREA 55Q.14.
pcwn
crhuiltkr will have t buNCn of P slog tM1w hC JiJ nal FUJd nr intpmve fm par-
F-I Of sok).
❑st a.awncr of ct pr ny.:un crclusivcly cuntrating wiN Iii"i,Ccmtmnors b A
construct at pmjal(4c]nal, cnar at
wd 1'n.frss,ma d,rt,or i Ile Gntmran.,Li-
le<our,ca snm vpplymen ammraf pnrywny wMa milds tr impmvas Hamm,sant QTY. PLUMBING PERMIT PEE
wM10 awtrste Gr.wch prnjau wiN v emrztu(s)I'xcnaJ pm'uwnn Ile Cmvactm's
License Low. PERMIT ISSUANCE
Q lw ecenge uMcr Sae .B&PC for his remnn
Due, ALTER-DRAIN h VENT-WATER(IA) Vi LUATION co
WORKER aS COMPENSATION DECLARATION BACK FLOW PROTECT DEVICE I hertM1y ufEron m nniAbler pctWlY ul perjmy on of ale fnllmving Jccloratims:
L] I have andwill haaimuin a Ce.iGcumofCansennn wlf-inw¢fm Wnrkcrn C....pea- DRAINS-TIMOR,ROUEAREA,COED, SI'ORIIS TYPECON'STNUCTON
amiss,as provided for by Sccdun J]W of the hU r CM,,fm Lha perfurmvmc of Nc
wart tor which it Icnnit"ls counter. FDCURIS-PERTRAP
s ❑I hvvc:md .It mainwin Wicker's Compensallnn Inmmncq ar reyuirrd by Social,
3]Waf�fla,Lfabor❑Curt fornllr,lpp;^M^nym�u�rc�c Mlle work fmw1hi[h this nerrhat is iuuct) GAS-FA.SYSTEM-I INC.i OUTLETS UCC.GROUT' APA N
24.
Cvmc,LF�Jr fa/4d.,rhLLI�Pu�I�cyN -I� GAS-G.SYST;M f1VIiRJ11:A1My We R
f CERTIFICATE OF EXEMMON FROM WORKERS'
COMPENSATION INSURANCE GREASPJINDUS'l RL WASTE INTER❑
BUILDING DIVISION FFiIiS
fDtis ratim rceJ not he cawq'cEvl ifale pcnnit is fmmchundreJ dollars lSIIXU GREASE TRAY �`
or la,,') I'IANCII el?
I,a.,ilwa t in peUomwnun[Nc, ,o forwhich his pbe Wu ""Calahvll $IiWF.R-SANITARY-SfGRFf IA.3X
not emplq unY 1rr'Im in'nY mannan w as m M1euamc utM1Jat m the WmAand Cnmpcn. Y
Z aim lwwr of Coliksria Dan, WATER HEAT ER WIVENT/IJ,I:CIR
zO Applicant GNADN
Z yNOTICE TO APPLICANT:IL after making Nis Calif m of Ilxanpron.You vft uld WAl1iB SYS'IIiM/I'RIiATNG
F` become subject to the Workar'5 Comlrtwtim pmvici�n of aha Lour CNe,you mom S
OILS
fmhwiih emnply with web pnsiono or Nil Pcnnil Jaall he Jemnal revolovd. WATER SERVICEI Ry
Q
z CONS'I'RUM[ON LENDING AGENCY NEW RESIDENTIAL PIJ K. T R rip N
IMn:byemnn Nut dim is J Cnllslmatlma knding agony Tar dmlwrfantwta 11he wmk fr which this parrant.a issuer](Sana.l(19],Civ.C.)
lumler'.s Nunc TOTAL
C launder',Aadm.0 I TAL:I emify IMI1 bavc redThis.'Lea&n mx!q0G Nt Ina eMn¢infarrtufxw i, w ZZZ
conot I agrac to amply with all city mtJ counly orinhnes and swm mwa relating In QTY. MFCHANICALPERMIT FEE slim-rncia tW prgcny fm inspatitn Parini FERMI'I'ISSUANCE 5 V(We)'gic In vasa,inocmally and kap bet the City of Cupanim aipainsr O
mVs andavpenm,wha hntay inn is way JCCrce againv Said City ALTER OR AHED To MECH.n amacqurncx of Na grvmin8 of this pcnnit.
APPLICANTUNDERSTANDS AND WILL COMPLY WTUI ALL NON-POINT' AIR HANDLING UNIT(TO 10,003CFM)
SOURCE REGULATE A11i IANIG\IJEE B
AIR IIANDIINGUNII'(OVER IO.IXIUCIM) CON. UCI'ION TAX
Signamm of IGlarenroc, tam Dmc EXHAUST'HCXDIW1DUCq HOUMNGMRIGATLON FEE
IIA I DOUS MATERIALS DISCLOSURE
Wllthe Jpplirvnt ur Tamm Willing recupanl wommhatdkhacWamv m"erwl HEATING UNIT(To IUI,gXI RTU)
as Jctioad by Nc Culier inu Municipal Cud.Clams 9.12,awl the I loan It nor!Sal ely
CWr Sacti[m 25532nn' \ / MATING UNIT(OVER IW,U(MI HTO)
[D Y" CW'f t PAID
VI?nTIIATION PAN(SINGLE RESIDE py< RcaitHN
Will Ibe appl'tmw or to.building occupant Asa actuiptrcnt n Ja.i which
nit hvnnitwv air awtamitwnls as JnlincJ by the Ray,Arts Air Quality Marwgcmant BOILER-COMP(3111,OR 10)(M O RTU)
I(yfAh:
Dionct't BOILER-COMP(OVER IIXLUIM RTU)
C Y. o'i
I base red tha wrolous rranmvls e harder Clwpta 695 of t he CJI I- AIR CONDI'HUNER ISSUANCE DATE
m.LS5
folia Hmhb a t,ior CoJc.Sstiom 8$15.25513 etd SSJI.I urvkcaaM tivl if the RIiW'RISIDCNTIAI.MliCll. $Q.PI'.
nuilAtngdes naN comm so. tib Nat n is my myxnvinility to narify Ncaacupant �,�/ ��Q
I mluirtfiems w' rat pnam ueeayznf rnifcmc^f�katlu C —
rhwntrir uyent C Dana GT ISSUED BP,
OFFICE
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wowuj Input'PermitNumber: 52508
PERMIT#: NRCHITECT: /ALUATION: 1250
.ICENSE#:
APN: 32653030 ISSDATE: 02 1 D 9
-US STREET: FREEDOM 3UBDATE: 02121 99
' CHKDONE:
SITUS NO# 21085 TYPE: RSI ATE CODE:
/E,CT,STRD DR
n N,S,E,W: ESCRIPTION: BATH RMDL =NGDEPT:
NO#:
^ PLANDEPT:
t r CITY: =LCHKREO: CMA
k r' ZIP: 95D14
95 ;ATEGORY: CTRFIRE:
_OT# 0 )ATEDUE: SANDIST:
ID: immerciel -iLTHDEPT:
OWNER: AEGE MARIAN L CA-sci#ft# iTRCTENG:
i
OWNER 21085 FREEDOM DR CE-sq#ft# TOTAL
INSPHOLD:
ADORES CN-scl#ft#
' Y,STREET,ZIP: CUPERTINO CA asidential h1
'HONE: RN sq#ft#:
ek r N )NTRACTOR JINTERNATIONALKTI RE-sq#ft#:
h LIC#: 398473 US-sq#ft#: 0 Search by
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