S 2533 APPLICANT-TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
10WNEj(
ITY OF COPRRTINO BUILDING-ELECTRIC I PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUMBROJECTF:CIL\NIFIC 5 3
BUILDISC.PROJECT IIIF.\'fIFIC.\TI<IN� J
UILDING ADDRESS SANITARY NO. APPLICN'ION SUBMITAI.MATE
20661 C`S p GiPT DIP ".
'SNAME: PHONE CONTRACTOR'S NAME LIC NO:
So HIA `(4l1G NIC CONTROL
GINI;Hk: IJCN'O'. ADDRIT: ) ❑
I III E GFt C-5 2 I 4
CONIACI: PHONES: dUILU1NG PIiRMIT INFO
k4zlbj Z Z- Consultant Fees Paid by Appllict(Initial) BL� EJJ�'�M PLUMB h1F�.Cfry
LICENSED CONTRACTOR'S DECLARATION QTY ELECTRIC PERMIT' IEE CJ LJ
I Tal am...I met I inn hem wm rand«pnwimor,nl Clepler 9(�.minwndng JOB DI?SCRII'TION
Qzz with Sn.tlon 711lXp of Divixinn Jnllha B—ma �ondPm@,,ions Ork,uwd my l lcalm xIi
PERMIT'ISSUANCE
1- at Iso full RnceutalcR¢I. WL ❑KITCHEN REMODEL
aUV Lieruc Cla.a Lie.A APPLIANCES-RESIDE AL [I ADDITION ❑I'I.UMBING RE-PIPE
v:
Z uj For Cmrmct«
FOrn ARCHITECTS DECLARATION PANELS ❑MULTI-DSII' ❑STRUCTURAL
Z O rfn Z I urxlcmnd my plan% fall M1e decd m public decmd, MODIFICATION
OZ—� UPT02q)ANN I ❑INTERIOR [I CHIMNEY REPAIR
Licrnscd Emdamorad ?OI-IBOOAM IMPROVEMENT E]SWIMMING Pool's
6 1 he oflinn thatIN9aempEfromEme Cwulnc(Iu'a Licere a Law f«the OVER 1100 AMT'S El BATA REAIODELAEPAUt ❑DEMOLITION
XC)a U fol4owin,reavm.(Station AH 13.Business and m ParessioCods,AnY cill or courmy SIGNS ELECTRICAL ❑OTHER
W LL y which roNarem a parrot to coom is,alter.ietgfmx,demolish,w repair any sauuure
o, primo to it,ivaurece,al.so require,the applicw f« Pail pto file a mjm,1 swemcnt SPECIAL CIRCUFFIMISC. '
Y., mat he is lic<nwd ptrnuanl to Ile provisions of doe Conmal Creme l aw(Oaprer9
a,�QO (eonureu9iny with Section 7(101)of Dlvidon J oflNe Basins atW RnfeWars Cold or TEAR METER OR I INST.
r��Ar�j
tL Z eC IhOt oe is c,emfx m<rtfnxn mrd rhe hums far tk allegd exemptitn,Any viulvitm of ON IA OLITION
atStation 70315 by any opplicw forapenNl svbpds the applicant to o twit penalty of POWER DEVICES ❑h ��RVICE
nnlmare Than Bvc hunred dollar,(ldl0binnoill
� SWIMMING PMOL ELECTRIC f
will do me wink,and IM mmelure k no Imarded orofeel f«sole(Nee.76bt.Hu,mr,s
a� ,.I I'n f—mono Eck:'1Iw Contmcl«'a Liccn.w law iLou not apply m an nwier of OII11,ETS-SWITCHES-FT%'NRES .9
P' pmpcny wlxo huilJa..r improves IMsrm,vol who dw..wch work hmlmlf m IllrtxlSb
his two enlPla'al Iruvitkd thin such imp.ovcnlens are ren'mtnldemtr infarct furNF.W RESIDENTIAL ELECI'R SO PB
mole lf.hnwcvc9tM huiWingmilnpnmmwmwwold within tnc ycanot c«nplaitm,the Z v SQ.FI',FLOOR AREA 5/SQ.1T.
-hulhkr will have the harden of rynving met M did m held or ieprove for pur-
��/Ci wnler of bit propel um exclusively cantlaoing will)IieenrW etmtinal or
eA O-
oem.Incrojec
pt(tics. bat
] .Business and Perfe,sim,Cde:)oTle Clloodsr's Li-
m<Wwdv non apply m annwnc of property who huilds w immodes thenal aul QTY. PLUMBING PERMIT FEE /1 ...k
won conform Tomei projects with a eonlfaeml(,)licemel Parwent to die Contrdateas f _ y O
U.Law. PERS17 ISSUANCE lD U
1 um c,cmpl trNa Sec. .B K P C for IM1i,r<�.on
] _--- 1� LAENT 'TER
AFTER IEA) VALUATION
W( KF,RT HI ATO DEC ATTON % % f / BACK FLOW PROI
TECT.DI
I hcrehY anon urdcr penally of perjury me of fle following dadan waral
_ L] I have oral will maintrioaCeniGataof Cnnsenl msclf-in.more foutilde sCompcn- DRAINS-FLOI Ri AREA,CON SfORlli TYP ECONSTRUCIION
motion,as provident for by Stain—3700 of the,ulna Code,for IM perriona c mf dee
weak for whidl this pcdon is kmr d. FIXTURES-PER TRAP
❑ I have oral will uainmin Wddor'k Compemutim Insurance,ns rtyuimd by Sc loon
3700of e lnhor Code.Name perfiddr coflhc work his which this)moil I,ivied. GAS-PA.SYSCEM-I INC.4UIIG,IfIS OCC,GROUP APN
My Wmker'e Cnmpununhm Immerse comm and Policy number are:
Carrier: Policy Nrl GAS-EA.SYSIIEM-OVIER 4(17A) D
CER'I'IIICATfa OF 1?KENIPION FROM WORKERS' GREASF/INIIU.STRL WASTE IN'I'IiRCIiPIOR "'`
CONPENSAUON INSURANCE UI VINO DIVISION FIES
flnsm Ioored not he damplerd tribe ,rf itk or oro hundred dolma 05110) GREASETRAY
u le".) YIANCH, ETI 5— T
I cmi(y that in the pcn'trrmr¢<ofd,won fwwhichlhis pcmlil is iraced.l shall SEWER-SANffARY-S ORM E�A,21X1 FE.
permitan
net employ vny permit in y manretme
r so as to becrubjttt to m<warlery Corollate. EVER I.E -5 351,
2 O
I O z enion Wars of Cdllrool Dare NATER HEATER W/VPFI9ELECIR GRAAG F.17.Ap Iran
Z y N(MCE:T()APPLICANT:lf, f=wkingl isCmifevcof FaaVitm.)mu W WATER SYSTESI FREATING
I—' hecwle suhjm In the Worker's Cnmpnrcalim pro dsima of the tabu Code,you mum SOUS
ftrMwim comply alto moth proviniom or this permit shall he deemed revakd. WATER SERVICE
7 Z CONSTRUCTION thro.tor LENDING AGENCY NEW RESIDENTIAL PIAtB. SQ.FT. PAID llatc Rccxiry A
U O 1 liar ae ich S dW mere i,a l IS,c,titn Iclxling 9lcncy for de perftmnarccof
the wok for which mi,permit is i.aucd IStt.3!197,Civ,C.7
� F' Icrak+'xName \I.
CUII Lcodcr's Adds, I,: O BUILDINGI
a I renily that I hove decd This application memoir bol the aMwc Information Is !
F fq m.I agea rte comply with all dry aid eownly mdinerwc,end mate law,Mahn,to QTY. MECHANICAL PERMIT' FEE a -
U ,z, building cnnmmclinn,md heathy uulhwi'm relrc.wnlmivcs of thischy to tomo urym tM SEISMICs. i J O
oMrvamuntiund property far Ineryaaion)amain,. PERMIT ISSUANCE
0Wu)agmo to wvo,irvk neify and keep henule.,s the City of Co,amil against ELE IC II',
2—If its
lchinices.judenenu,costs untl expenses which may in anyway aoruc againq said City ALTEIZORADUTOMECH.
' nwgnorceoffic gramm,of this permiv PLUMS C �EE ( O
APPLICANT UNDEKS'I'ANDS AND WILL COMPLY WI TIT ALL NON-POINT
SOURCE REGULATIONS. AIR HANDLING UNIT G(I III,fXXI CI'M1D MECH CAI.Il?E Z
h AIR HANDLING UNIT(OVER 1).(1011 CFM) t D
" CO.N'SCR TON TA%
I 58 tum of ))titan YoVf N-/ EXHAUST HOOD(W DUCq HOUSING NIFFIGATION ITE
ITA%ARUOUS MAIF.RI DISCLOSUKE
� Will m<epplkanl«futude bui Wing ocvpvu m«<«h.ry 4hvardou�matmal HEATING UNR(T(1100.(OO BTUI
u definal by the Cupertino Municipal Corte.Chapter 9.12,and dee Heal atal Safely
Code,Secritn 25533(x)" HEATING UNIT(OVER 100,000 BTU)
Q Ye, ❑No VENTILATION FAN(SINGLE RESID) PAID -
^SII me a licanl or fulmc huildin I ux I«ticvicn which Ihte Httcipl Y
pp l by then Area
Air Qu BOILER-COMP fJHP OR IIXLIXO N'IUI
.int wnNtms air nmltmlinana as defied by me Buy At®,\ir Quality Mawgcncnt d AI
Dimnell BOILER-COMP(OVER 110.000 BTU)
❑Yo No
.rt,ardi n pier AIR CONDITIONER
i Ihnve vial the hvnrdom nmtedal 1,wdcr Cho G.95 tdmc call- ISSUANCE DATE �] p
I form,health&Smfry Coale,Soonn,25505,25533 and 25534. mAdmard Ilial i floe NEW RF_SIDFNTIAI.MECH. SQ.IT.
( Mddingdxmroccorrenlly have umnam,IMlitlenryee,,rani ility lonolify the,Trpml {/!f-
tTIMt pl' nnlx whhlnnml rel prix to hrwlrccnfa Ctmi&arc 0.r, uy.
I.d agent aid TN'' ISSUIiD 11 Y:
OFFICE