27789 J APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
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CITY OF CUPEUII.DINf�-F.LP,CTR PERMIT NO.
APPLICATION/PERMIT PLUMBING-MECHANICAL
BUILDING DIVLSIO NO ION HA_ BUILDING PROJECT IDENTIFICATION
BUILDING
`ADDRESS:
/���� ,./� SANITARY NO. APPLICA'II((IXJ SUBM�f(IT'Ay��L DA'lti
0 7 �J &e/RJld C' UNITt • LOT# I —7 O
O"ERS NAME. e PIIONE: CONTRACTOR S NAME: LIC NO:
NtCCONTROL�
'RCHI'1 .CI'pNGINEIiR: LIC NO: ADDRESS: ❑
CONTACT: PHONE
QTY. ELECTRIC PERMIT FEE BUILDING PERMITINFO
BLDO ELECT PLUMB MECH
PERMIT ISSUANCE ❑ ❑ ❑
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL
OKZ I hereby affirm that l am Been l undo povinomofCM1apn9(mrmr,ve;ng with HOB DESCRIPTION
POO 9sv1Ioo 7")of Dvidon 3 of the Burin%%"l',afnsiotu Cade,and my lkesue is in PANELS
�bB full fora and effect.
<zw Lccnc Clns Lic.at UPTO2 AMPS sca) G
co<y Dmc Comodor 201-1000 AI11P$
Z O,o z ARCHITECTS DECLARATION OVER 1000 AAfPS SQ.EL FLOOR AREA SISQ.FT.
O7_n lmdersuM my plum shell IT,turd as public accords,
SIGNS ELECTRICAL
an L.icemed Founde«ml
E:=2'6< OWNER-BUILDER DFiT.SRATION SPECIAL CIRNIT/MISC.
�O6u I hereby nfllrm Nes 1 and cxeind from the Contractus Liame law for IN,
3li fallowing reason.(Swim 703iS.BuNev and Pmfusiav Code:Any dry orc«elry TEMP.METER OR POLE INST.
C u'Og which acquirer a pernut to construct,.her,Timmons.demolish.«repair any structure
fsD}7 prions its issuance.9lw mquina the applicant for such pennluo file a aigned statement POWER DEVICES
W C O<p Nor he is I;anxJ purawnt m the Poviu«u of Be Cvnurt«'a Ltcrnx I�w(Chap« .
cixo� 9(cammmcingwith S,nim TOIXll of Division lof the Busiesed Rofsowu Code) SWIMMNG POOL EIECIC[C VALUATION
W�so
or mat be in cacmpl Neacfrnn till the Buis for me alleged exemption.Any violation of
CZQ Section 703 l 3 by any apPliwm far psmit.ubjcu the applicant ba civil Pity of OVIIfTS-SWITCHES-FTXTURFS
ra more dun five hundred de W(S50o). NEW RESIDFMIAL ELECITt _SQ.PT.
C ❑ I,asawrcraflM1cpnpcny,nrmycmpinywwilM1 wagnutheir.snleampanariwl, STORIES I YPE CONSTRUCTION
y will doProddismk,eM de suuaweiswsimLi. offered!«u le(Sx.mlf4,Buairl of
old erty w1a;au Code:The ves th con. sod who ocw don tat apply ton r0 former is
propmy who bit ilm or Improve.dammer,sera who sora aaeM1 wall mmxuor naoagn his
employen,prov;ded des suchimpoverrcwvemlinerdedmoRaedf«vle.B, OCC.GROUP RFS.UN
however,the building or impoverrent is sold within ae yearofcmnpled9n.Be ownn-
Iwllder will have die burden of proving that M did not build«improve for W rpose of TOTAL:
e).
❑ I,uowrinofth popeny,am exclusivelymnvacting with lixmaed rontmanm
QTY- PLUMBING PERMIT FEE FLOOD'/ E APN
ansvun,be pmkm lace.9094.Businae aM Peufm4«u Coded Tie Co...'.
Liana L�wdms n«apply menowrcrof popmywho buildaorhnpovn Bvml,ard PERMIT ISSUANCE
IJerncasex I
wu,rte ouch prolccu with amu,nano(s)liamcd pinwnt to Be Conmactas
es. ALTER-DRAIN&VENT-WATER(Ftp FEE SUMMARY
❑ I am manp,miler Ss,. ,B&P C f«this ruvon BACK FLOW PROTECT.DEVICE SANITARY Y N
OwnerDere SCRECEIPT M
ONS-FLP.A,OOR.ROOF.ARCON
WORKMANCcmirt COMPENSATION DECLARATION RAHOOLTAX Y N
Me
❑ Iby allium Narlhasxacenihrue of arxnsmxlf.imwe.oraceruhrem of RF.CEEIPIT'x
Workm Com fIX'11JRFS-PER TRAP
pavation lmuretcea•emiBM ropy thaeallSa.38(gl,l�b C.)which PARK FF:E YN
coven all empbm
yes'•under this ynit. OAS-FA.SYSTEM-T WC OUTLELSN REC-EIPT0
Polity 0 BUILDING DIVISION FEES
Company GAS-EA.SYSIP HR4(HA) PLANCHECK FID
❑ Coifed espy is M1cacbY fundaM1ed.
❑ CmiCW copy isfded wild Ne city l,uprcBorl division. GRFASEJIN WASTE INCERCEPTOR DWG FFR
CERTIFICATE OI'EXEMPTION FROM WORKERS' O ,TRAP SO FEE
COMPENSATION INSURANCE
(Thisawinn aced n«bccinmidaBde permit u fa con hmArcA ddlm(5100) SE R-SANITARY-STORM IA,2001ENERGY FEE
or leu.)
Icrafy But in do perforr®e<af Be work for wtich this permit u seemed.l abHl WA HEATER W/vFN1'/p.ECIR
not employ,my prom in any manner so as to laecone wbjar to the WokmPAI
z Cumprnetian l�wa of CelifmBa. Date WATF SYSTENUTREAW
TG Dare Receipt
A,Plicsm
'z 0 NOTICE.TO APPLICANT:If.after making this Ceradde a Eaernption,you ahould NEWR' AL B. SQ. TEETOTAL
yBemra.wbjectm the,Worker.C«nvpori.i.of Nar e LubCode,you twat
� > forthwith mmply with such pwviaiom en this,peond,That be deemed revakal UIIDINO TEE
1 L CONSTRUCTION LENDING AGENCY MASMICFEE
Z) z IIlenbyaRrm thv thveisacorumucBm leMirg aBe^cY fm the paf«nwec of
V O 15e workfsr which thi.p,rmit is isued(Sec.3097,Civ.C.) TOTAL: EI.ECfRIC IEE
O ..r LsMcr's Name
rV t<mer'a Addrrn QTY MECHANIC PERMIT FEE PLUMBING FEE.
I certify that I have wall this application and.rue wt The above mans mYm is
anted. I ance mcnmply with all city ardcounlymdinarc®and sem Wws mWingto PLRMIT ISSUANCE MECIIANICALFBE 7.
F-' 7 xbo,c gconswnim,ser horby awh«v<rtpnvBativn ofNudtyto enw upon Bx
ahovcmmti«IM f NNSTRUCI'ION TAX
V 7 popaty indemnify
ALTER OR ADD TO MECH.
.7
(We)egac In eeve,inacnm�fy eM keep may ma th City of Cupeniat against
liabilitin,judgn,mgaxuaMcxp:raan whicM1 may many way serve age'uw geld City AIR HANDLING UNIT PTO IO,IXp CFM)
in crosequeree of de grvlBng of th'a Permit. K T
D AIR HANDLING UNIT(OVER I0,000CPM) lql�yall`
SI mfA 4Cmven arc EXHAUST GOOD(W/DUCn PAID
IAZSRDOUS MATERIALS DISCLOSURE IfFATING UNIT(TO 100.000 BTU) Oar, attempt
Will the gsplinm or faun bai",y occupn,t son m hat ha'urdorn muaisl IIFATING UNIT(OVER I(p,1X1p MTU) TG'1AL: A �0
as dchml by the Cupcnino Munic'i pal Core,Chapter 9.12.rando ar
d] Ileelm m Safety
Cob,Sectio 25512(x)7
❑Y15 ❑No VENTILATION FAN(SINOLE RESID) r
Will The appliran«fume building occapwt useequipmcmmdevicawhichemit BOILER-COMP OHP OR 10.0(1(1 BN) ISSUANCE DATE
hand°as ass cmumirenm as refined!by Be Bey Am Air Quality Menagcmcot BOILUE-COMP(OVER IM.Nott MTU) P A 1 D
ds,dd7
❑Yex ❑No NEW RESIDENTIAL JQPCH. SQ.PT.
I have read IM1e bermdoua mueria]s regoinemrnte u,dm Cheper 6.95 of N, MAR 10 1995
California health&Safety Coffee.Seetiou 25NI5,2531 and 25534. I mdemard that
if the building does not cunemly have.tmum,Nor itis my acPoscoblhty to mBfy dor
,
NU
eupem of the odlmocnema which nos,be m,t prig m issuance of a C,nifcire of
(kcupvey. '
Ownermeuthaimd egcm Doc IUTA1.: ISSUED BY!4r a-
Dale & Mary Newcomer
20671 Gardenside Cir. , #3
Cupertino, CA 95014
February 27, 1995
Gardenside Circle Homeowners Association
C/O Gina Gorman, Community Assoc. Mgr.
Professional Association Service
Newark,
BaCA tine9456 Drive, Sta. 150 COPY
Newark, CA 94560
Attn: Board of Directors
Architectural Control Committee
RE: Approval Request for Installation
of Vent Cap
Dear Board of Directors/Architectural Control Committee/Mgr.
I 'm writing to request the Association grant permission for us to
have a vent cap installed above our kitchen window on the
exterior wall . The aluminum ,vent cap has the advantage of
lightness and it 's placement will be some what concealed by the
roof eves. The cap will be. pai4ted to match the finish on the
rest of the house.
There will be careful coordination and planning for it 's visual
appeal while the permit will ensure the integrity of the
S installation. Enclosed is a full and complete application showing
drawings, specifications and location of the aluminum vent cap.
The Association's timely repl eeds-to be in writing, so there
is documentation of I
an for your
consideration.
Yours very truly,Mary ewcomer10�cc: Doug TimewellNicole GuntherMike NielsonEac:Application with DraPolicy for Gardensid
"Architectural Controls Regulations And Procedures"
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