2607 APPLICANT TO FILL IN INFORMATION WITHIN RED LIIJES•USE BALL POINT PEN ONLY
IIUILDCITY OF CUPERTINO - FAL Prxmrr NO,
APPLICATION/PERMIT PLUMB OJECrMECHANICALDEN"PIC2 C 0 T a
BUILDING UI\'15100 � BUILDING PROJECT IUENTIFlGTIO\,• � U
BUILDING
/yADDRESS: 1.'I SANU'ARl'NO. AI'ILCA.TIIOON SU/B�MfIT'Al-DAI
IV �l A UNITN LOT, /�
OWNERS NAME: ,PHONE: C LTORS NAME'_ –/LIC NO:
PAT{ UGI Y N C CONTROL Y
CrITTEUMNGINEEK DURESS: pC 44,,7
/
oNTnCT: PHONE: ^'.BUILDING PERMIT INFO.�si',t'c� K
�v/ �81 Q7Y F.4 T Kr: _4 r :t; S,f sti FLOG E1F� 1U Mf {
J PERFIIT ISSUANCE
UCENSED CONTRACTOR'S DECLARATION APMANCFS-RESIDEI.TIAL
mwz Ihcrcby affirm lhulam liamfd uMcrprwiaiomof CTeplm9(rommcncing Mlh /IOFB�DESCRIPDON
WOp Swim'1 itridi fDiviaim3of the Biuucu Pmua �fusiau Code.ud mY lic[ox is in PANELS C 7i–o Y
yJU
fol fa¢eM�f O/ row/ J � �/W
aZy! Uamc V Uc., UP T0100 AMPS
y6c D' Cona-mor AU-1000AMPS
y SQ.FT.FLOOR AREA SISQ.PT jyr II'IECTS DECLARATION OVER 1000AMPSonyx 1
SIGNS CLECIItICAL 22S I 6
yd'< OWNER-BURDa DECLARATION SPECIAL CIRNR/h11SC. �.{.
I bacbv&TIM that 1 m exernpi Iran che Cmtrwors Owns,taw for the 1 I. 111
:+ay fdlcov*reaam(Swim 70313.Busin¢a.M Pr,fosooru Cowk:Any oily er comny TEMP.METER OR POLE INST �[ [ITS
og
.LL O< wTrt rryuires a permit to caulru ti fir.ut for such
demdiah.a rf Wg•nY avunmf
prioraiu uvuae..la rtquim lbc aPplicmtfa such pcmtit no fila ssigned vucmrnn POWER DEVICES
'5<p this he is liwWa,[pursuant to the P rovisimu ofth[Cmtraclm's License Law(Ehmir
gtmmmencing with Swim 7"i,di'Diviaim 3ofthe Busineu ud Rofcaimo Cods) SWIMMING POOL E1E=1C VALUATION
^o, or mn he is eaens Ittvsfmm and lbclatest for the itHegil exemgion Any'violuimi of �1 ^
I–,QSwim 7031.5Is,ser,applicant!a a permit subjnv the applicant to.civil pumty of OUTLETS SWTMES-FU'NRFS
not rtom nh.n Ev[hundred dmllvs(5500).
ad r– ❑ Luowaraftle PoPestY.mmYmnPloYemwilh w.Fcsulhcirwlcampcmauon. NEW RESIDENTIAL ELECTR SQ.FT. STORIES I TYPECONSTRU,77DON
:3— will m the wort vdthe suuatve tam insendalor off«M for We(Sx.704,4.Business
vch Professions Focht:The Contractor's Licme Taw does not.,Iy to n owner of
pmper who buildsawproves tbernm,ud whodessw.h worthim+clratluaugh his
wnempbym,Ewvidrd thstwchimpov«rsuvc n«imvldei«dfertdf«oak.if. OCC.GROUP RFS.UNUS
lo,,or,the hada ingerimpew,.is add within arc ynrof compinitn,lteowsa-
boulder rill have the burden of,mein,that b[did n«build m improve for par,ou,of !E=1
oak} QTY, iraTPLUMBP7G PERMITv. •l 'r FEE FLOOD ZONE APN
❑ I.0 watmof th<panopmy.vmcafluuvelY canpasaning with lisrnacdtmmammho _ _.,i.-," nRsT M jt"!"s _
mrnh'um the po,,w(SM.7064,Bumcas arch Rofessi«u Cade:)The coo.ors
Lic'eveLawtloeswrap,lytoanomcrofropcnywMbuiMs«ianvpovn dertm.aM f PERMIT ISSUANCE
whacmu.cufor ouchpmj«u with amntrachad.)Henna puvnrat aIle Comrraa
Uttme law. ALTER-DRAWAVENT.WATERIFA3 t+r�T'. Sr'a}}'�SIIMMARY.,rt
����n : '..
❑ I.m eamnp ocher Sec ,B h P C f«this recon BACK IStQ1ECT.Ylk-n51
I r1 SANITARY Y N
0,,nm Dae DRAWS-FLOOR.ROOF.AREA-COTID' RECEIPT,
CL
WORKMAN COMPENSATION DEARATION - --_ SC110OLTAX t' N
I tcrtbY�thanlluvf.ccrlif mo(caYCllt no Klf-ianumf.mautedI� RECEIPT'N
FMTURk/e Iorl[a'Cmyertntim In .ncc a.ccniRd catty rhartof(See.3800.Tab C.3 which `�➢`I " _' �`" IIb PARK FEE Y N'
mrnall smploycls uMm dds,emit. GAS-EA.SSTPlA-0VFR INC. RECEI N
FWIovY BUILDING DIV ION FEES
Conlon)' G 1_ r ,� PLAI:CFiECK
❑ Catifudmpyal,cwhyfundshcd.
❑ C rind copy is BlM will,dr[city inspeetim divisimm GREASEANDUSfRL WASTE INTERCEPITIR GRADING
CERTIFICATE OF EXEMPTION FROM WORKERSGREASE TRAP SOBS
COMPENSATION INSURANCE
(Don.Ywim teed ron be canplmed fifth, weii is face hundml Midi(51 W) SEWER-SAMTARY-STORMF 3(X)FI. ENERC FEE `
«les')
I cmlfy lir in the purarmvec of the wok fa wM<h shin a mn is owed.l mall WATER HEATER WIVENTti.EC1R NV
ma wF, any Pwon w anv mvmm w u a h«ate oobject a the Waken; PAID
z Cwnpewtim laws of Glifamie. Due WATER SYSTEM/TREATING Don, RN
A,1i.
z O NOTICE TO APPLICANT:If..ftfr renting this Ccnifcuc of Esunption.you shouldI
NEW RFSIDFNfIAL P1MB. SQ.FT. TOTAL
In hemrme subjeclto the Wkrkcr'o Coorwroam Fovmerumf the labor Gv] ,You mum BUILDING FEE;
> farthwfincomply With.ouch povinco,mthis,enol shed be,demred revokeG
(] CONSTRUCTION LENDING AGENCY sElsmICPF-
IbetelrvaffrmthatNaeu.mtsn.ctim lending agenry,fn,to perfoimuna of TOT,V,: ELECTRIC F
J 0 Jew«t for wM1ich this pmnit is issuM(5ee 3097.Civ.C.)
lartticr's Nva -.r.may.+t c - — ,
Lco1c,s Addom _MECHANICAL PERMIT ^�'t P n 'G P_E
tJ `e, rFEE1<rnify wt 1 hive r%it Nis tPphmnm and nolo nee We.Fuse iws rm.ting issgrec no canPlY with all cilY and county aNiwt¢s ud care laws rtHtingwPERMRISSUANCE ss .996
buiWwg cwnauaian..nd hcrenv.udoris rePrurntativca oflhis ntyamlm upon Ne
JZ moos-trwomcd vcPcny for inyawim Ioarlwi ALTER OR ADD TO MECII. CTI CTI TAX
Me)agree,1..uvc.irdcrrmifY sand tem harmlm ole Cby of cm tiou.g.iml
11.1h] Bid coos sand calrnses which may tan am)wy.ctma.g.imt cid Ciry AIR HANDLING UNIT(TO 10,000 CFM)
roc of the Footing of thin Penni
�,/ AIR HANDLING UNIT(OVER ILLgMI C'FT11
Sign un is LTIIAUSTHOOD(W)DUCT)
n r PAID
HAZARDOUS MATERIALS DISCLOSURE HEATING UNIT(TO 100.(110 BTU) Uam 'ttiplN
Will the npp0oannmfumebuiidinF oavPum atortmhudle basvdwsanrmuri.l HEATINGUNIT(OVERIM.000BTU) TOTAL: L qA+%.�
4,Sda.S i the32(.)1 oMunicipal CMF.CTarycr Y.1_..N tM Health arrd Saffry
CMF.Swim 2S3Ne)"
ye,,
VEN'TIIATION FAN(SINGLE RFSID)
❑ ❑
ISSUANCE DATE
Hill 11hc.ppliranmrfmurt building«apwtu¢ BOILER-COMPI311P OR I(0.OIX1BN1
equip Air Qua[eimwbicbemin .—
9:rnnn s
sur aminwts u dcGnM by Nes Buy Arta Air Quality Mvugmenl BORER-COMP(OVER 100,(X0 BTU)
❑Yea El No NTA'RESIDENTIAL MECII. SQ.FT. JUN
tf
1 Fare rod v
rhe hardous on�, is«quirtmrnu mdm Ch.plm UN 6.95 of the l• `5 10
Califomi.Health S S.fety Cr id,Swims 3505.:5533 W 755.4.1 untkrvvd that
ifth[building does row cutmnnly have ucrvanr,than it is my o,i nsibiln, .notify the 0 , _
acupam of the m9uiremcmr which moa he met prior to nsance of a CeniEam
Occuparey.
(honer or awhnrivsd aFcnn Ove TOTAL: ISSUE
OFFICE