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S 2098 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY 8CITYRBUINGEAI CPE8RNo. LO^ OF CUPERTINO PLUMBING--MECiANICAI UILUINGDIYINHtry AIPIdCATION/PERMIT PUILDING PN BUILDING ADDRESS'. SANITARY NO. APYLICAIION SUBMITTAL LATE Z - 2DPA) VE -�- y OWNERS NAAIE: PHONE: CONT% ORIS NAME: LIC NO: -CLAvD — — NINE CONTROLx ARCHI'I ECi/HNGINEER: LIC No ADI ESS: ❑ CO/NTA�C'. A1 n PIIONI BUILDING PERAIII'INFO Lila /'+ /&-y ❑ Coneullanl Fein Paid by Applicant(afoul) BLDG ELECF .UMB MECH l -S0_0._ `7 % ❑ ❑ ❑ LICENSED CONI'RACIOR'S DECLARATION QTY ELECTRIC PERMIT IEE I rxrchy air that I not Bcen.tm under pr%t%a.id>�of emPler ¢ r 9 mtmmialt JOB DESCRIPTION WoZ O O wiTM1 SCOion]a1J)of Divisknld>r the Ruorec,,ond Prufa%iorod Codc.eadmy liocreaci% RFSIDENTIAL PERMIT ISSUANCIi F-y- in full forceandcRm. ESFDWL C1 KITCHEN Rhl.WDF1 Gg.ZW Liam Cluvx ComLucAPPLIANCES-RIISIDI?NfIAI. []ADDITION ❑PLUMBING RIS PIPE lnQ6 Dau Commerce F.,ON ARCIII'IECI'$UIiCIARATION PANELS ❑MULTI-UNIT' 0M0DRrI ATK; _ v2Z 1 unordand my Plain shall be uta!ex Public rads MOUIFICATI(lN ZOZ-Q UP To 2(9 AMPS El INTERIOR ❑CHIMNEY REPAIR Fr/-+FW Literati FmB,,umuuT 2111-1000AMPS INIPROVENFI.T E3SWIMMING POOLS OWNER BUILDER DECIARATION 0_y!3µl(MO AMPS O BATH RFMODPJJREPAIR [IDENiCIATION y O C Q I hereby at Ind I am exempt fmthe Contractors xe's Licemlaw for The x,LRimm U ❑ nw illingron...(S¢I nn 70315.Ratio.,and Profccddmv Cddc An,,k,orawmly SIGNS ELECTRICAL 0(yfHEk _ LLl Ir, which regain,n pvrmn To eotelarel,alms reprieve,deTmlish,or rduir any .,are hal 1"'4Tn'O Prior To in intererrc.alw,meant v llrepplicam Rrsllch pamil To fknsi'md rim. SPECTALCIRCUITIMISC. - �— 6L f ylT� Phar he is li,cat punsoanTm do,pmvk%idu%of the Connection,license Lao.(ChapmrIT (Commencing with Sectimt 7000)oflHvicidu 3 oftlrc Bu.ircsi and Prnfcumn%Cola or TEMP,LIFTER OR POLI:INS.. fJ COMMERCIAL: a a e C door he o uempt tlw+cfrom image moi,for the till Bred c.elnryim.Any vidam of ❑NEW BLDC✓ADIIITION ❑DEMOLITION �LLy' Scetiou 70115by any T,liann htr.peout xabettl the apPl'Ieanl lU a eivll Penally of TOWER DBVICILi O' ENTANT FOOD SERVICE man Tose than E,hundred dtllun(S.Wn, MPR EMI:Yf G=O ❑La%Newcatf The pmPeny,armYemPk'Y"�m w'nh wago ar Thdrmule,Fl fgumion, SWIMMING P(%)h liLIiC1A1C F. wBl VOlhcwor,ands The numisrce,,oat Licence Low der, not.(.Sec.]641. wneir-of Wcey honx CNc:Thero,theerx Liantsc Lawdorm gapplymIf ,Ther of (11I11J:fC-SWITCIIIS-fLKIlIRIIti hu,ow y who builds Ir imp le IM1da,h a nu who dxv such gunk him.%clfor Through his.wnnophryrex,Ieilmedrin suchiearm I, Id are Irl IntetlkrlroB'cm1 for NEW RI?SIDFNfIAI.ELECTµ SQ FT. ace.If.hdweven the building orimpmvcmnnl is.-Id ,Thin onerimu(contplcoiun.the SQ.FI'.ISL(%IR ARTA SISQ.I%n rcr-balder will hove The huMcn of ponding Not he did nut build m impotc fur Pur- pose N vlc.). Ab IC 0 L x ow.of the Ivrtlroey,am cach,4,cly.1.,with li erecd emtncua.m T r_u.,Be ryoiec,(See.71100,Bmircsx"Prnfi i—Ca l Pre Camm,11r'1 Li- wrlawdkNsn.apply to ml owner of Toi who b.Bds or in.Truvex ThrnrT,med QTY, PLUMBING PERMIT FEE whoaNlT tisfor,tuch Po Ijeel with.comranort-V liwored puna:nnote Conlneurm License law. PERMIT ISSUANCE 1 on rucmmT Mater Sec. .B k P C for This marten ACIER-TRAIN h VISYf-WATER THAT VALUATION (]%vncf Dole WORKER'S COMPENSATION DECIARABON BACK FLOW PRO I.CL DEVICE I herby.Bion under pemany of Perjury ale of the fUh,wlng datlanTiIro: � IhuvewdwillmalnminaCmiliea¢nfCun¢mmulf-Insure Bx Wuher't Cumpen- DRAINS-FLOOK,ROOF,AREA.GOND. STORIES 'fYPECONS7RUC7ROF cation,uPr s ovided for by Section 37W of Th:lahm Code.for the perfmnvec of oe l wad for which dais parniT u banned. FIXTURES-PER TRAP 0 I Irate.rd will maintain Workers CmmPcnertinn Imunrrc,vs trainloadM S«Time 3](9 of the labs Gee,fm the Performance of the work for which Ibis Permit is vowel, GAS-EA.SYSIAI-1 INC,4 OUR,EIS OCC.GROUP APN My Workers Compenwtion Imannee earrucr and Policy numltir ar, Carrier: Pulley No.: GAS-IIA.SYS1'BM-OVER 4(EA) CERTIFICATE OF EXEMPT ION FROM WORKERS' CREASF%INUUSfRI,N'ASTE INTERCEPTERCOMPENSATION INSURANCE BUILDING DIVISION FEES Met it..aced tial ba umplcTM if The Irani,is ftrore Vantin!dollEI 1001 GREASP,TRAF w It,.) YIANCHECK FTai Ice,lfyl eirmonelrerfu area, of ,b,gokfnembhlhie dic Weloriaed,IWn- SEWICR-SANITARY-S'IORM EA.210 FL nm cntpluy any frnuu in any nnnncr m ar In tumor subja'I m thu Wcrkea'Cdwlpen- TNI?RGY FEE (] z ..on Law If Calderon.IAtc WAIIiR HEATER WNEYIEELECfR z g APpfGRADING FEE ^'" N NOTICE TO AI'PLICANI:If.efter rreking Thi%Ccrtificure a ExcmPTicn.You should WATER SYSTEMIRILVDNG (•"' ? laYome xubjeci To the Worker.Cornpentation pmvivwls of 11h,labor Coal yen nucr SOUS FEE forthwith tt 0_d,with o eh nov,kinm,'mi,peal..Jwll redeemer!Invoked. WAIER SERVICE Q Uz CONhere". o.ti'DWGAGBNCY NIiW RESIDGTIAh PLMB. SQ.FT. 11'All) Rtt<i N U � IhenMy vdirm lbs there iaaconflN[Tidm lending al;enYfm lhcpm'amunre of N dr wink for which mit Permit i%io%tml(,Sac.3197,Civ.C.) U. F" 1<tderl Nanta TOTAL � � Lcndmr'%Addn%xs TOTAL: BUILDING FI';1-nlfy mat 1 have rtad dliv aPPheauoll,I.1 alae IMI Phu ur,ve iummu ion is Val comet.F arra to comply with WI city and a%,my ordoancc%m rl mute laws relating to QTy, MECHANICAL PERMIT FEE U Z buidingmillemo ear.ardltrrebyeanhri=e mfor,crmtives d to,cRy nemerapm tti• SEISMIC almve-rrcaiorcd papmY lor ilbpSTion P.rryo%es. PERMIT ISSUANCEO (We).gm to save,irdentnify toad keep hmmlexc The City of Cuper ino agaime ELECTµIC FF. Inthilitias.judgnrnrs,cdxioxnndcxPcnwl which Tay in troy way accmc again,said City AI:HR ORADD'FOM17CH. Imyuelre of Ihic granting of lhix penult. PLUMBING FTI Za APPLICA N'1'UNDERS'T'ANDS AND WII.I.COMPLY WIT IT ALL NON-POINT AIR HANDLING UNI T(TO IWO)UNIT SOURCE:REGULATIONS. MECHANICALl1Ji AIR HANDLWG UNIT(OVER I0,000 CENT) CONSTRUCTION TAX Sigrmmm el AfFlicenrrZoodtrTor Date EXHAUST FOOD(WIOUCI) HOUSING MIT]GAT[ON FEE HAZARDOUS MAF12RIAl S DISCLOSURE Will me,applicant or future holding-Onaan some or h.nlle hararker,material HI:A'PING ON[I'R 0111%00013'1'U) as dcBlyd by doe Cupertino Municipal Cork,Chari 9.12,and TM Health and Safe, Code.Section 25532(0? HEATING UNIT(OVER 100.000 Bill) ye, ON. anti VEbRPLATION PAN SINGLE RF_SIDI I'.\ID Dae Receipt# Willmar d applicam nr famrt Ix,fired by the B u%c Area Airrcm or review whoa, omit M1umulouv air c'onnminnuln.n dcdrcA by do Hay Ara Air(Awlhy Mewgcnrnt IfUILER-COMI'pIIP ON IIMI.q%)BTU) ( DisTrin; E]Yc, ENn BOILER-COME(OVER 100.1100 BTU) myu ocurre Chaper AIRCONDITIONER 1 have and The haauddus rnwrrials Ts Tinder fi95 Mahe Cd] ISSUANCE DATE famia Health At Safe,y CWc.Sectinm 25915,25533 rax!255E I mrtler mnd Ilial if the NLM1V RESIDEN'IIAILMECH. SQ.PL r- Q huildillg d1Kx mM anently lave u lenuni.th.T'll isur,re%,roinlity In notify the IY',founl a of 1)r nyalM1mcmx which Illus Ir Ire,prior m Iti<ttvice era Cenilicdm,of ekcapancy, TT%'rcrmaulM1ud=eJ Vent Dam TOTAL: PSSUEDBY: OFFICE