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S 2040APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING. - FILECTRICAL BUILDING DIVISION APPLICATION/PERMIT PLUMBING. -MECHANICAL. BUILDING PROJECfF IIIEM'IFICATION' PEt"N0 2040 2 0 4 0 J BUILDING ADDRESS ' � R"o G r era Viteu/ 411d-2 SANHARYNO. APPLICATION SUBMITTAL DATE 99 OW I"S NAMI3: PHONECONTRACIOR'5N9ME ( LIC NO: le-ALQQLIG NIC CONIltU1,M -ARpITTELT aCIN� LI ADII 11❑ Pip 0 8 e-r3i n oC CONI'nCl': PHONE , BUILDING PGRMI'T INFO ❑ Consultant Fees Paid by Appllcant (Initial) BL❑IM 2UicT PLU❑MH ME❑CH �Q2x ' f V LICENSED COMRACTORIS DECLARATION 1 tereby arra wr 1 am hren..ed unkr tnviaimte nr chats v (enmrnenems QTY ELECTRIC PERMIT FEE JOB DESCRIPTION PERMIT ISSUANCE. with Scctitn]0ixq of Diviniun9nf Jct Ousincw anA ltrnoxiuro Crdc. and myliccnsc ix in full fora and effect.f:Q RFSIDF_N9'IAL ❑SIIDWL ❑ KITCHEN REMODEL APPLIANCES - RESIDENTIAL Liacnw Clan U'. It DLC Coura..m ❑ADDITION ❑MUMBING RE PUTE MULTI -UNIT ❑ STRUCTURN. MODIFICATION El INTERIOR L1 CHIMNEY REPAIR IMPROVEJI I-] SWIMMING POOLS ARCHITECTS DECLARATION❑ I an lenwnd my plans shill he ural a. pihlic ncoNs PANELS - UPTO300AMFti Llccnvd Pnoe"osal 2)14000AMPS OWNER -BUILDER DECLARATION I hereby affirm mat I em neat from from the Commit License law for the foll,ceing r,awn. (-Section 7031-5, Bueinevs curl (hoes ions Corlq Any city nr anumy [I BATH REMOF.IJIIF.PAIR ❑U&MOLCDON [10 HHER OV17R I00i SIGNS ELECTRICAL which requite a permit to mown, alter, imleovc demolish. or ml any actio e SPECIAL CIRCU1TIMISC.r ANf Fi Timorits i.amince, also the affnicanl forsuch permit In file a,igm'dmmcarm Jute is Itsenv ori lxnsuant ane pavisions of the Crxmanor's License l-aw (Chapter 9 (nanmeneiall.mu Sectio 7WB.fDivrlan Jot me, Business tuN ProfasinnsCWchx TRIP. METER OR POLE INS.. COMMERCIAL_ that k is exempt therefrntn and to huts for the alleged exemption. Any violation of ❑NEW BLDGJADDrnoN ❑ DEMOLITION Scvtian703" by any applkanu for a feadl wbpos to epplioru lovciril lrctulry of POWER DEVICES ❑'D!NANT ❑FOGG SERVICI: man .... I Iban Eva hutalmd dollars (510(b. 9I. a, m'rcrof the fratent myemphrym with wipes as theirsolc compensation, 1 lathe wn4.anitM1e sitiure is urviu,Ndorotfcrcl fasWelSec. 7(b HusioessI IMPROVEMENT EI OTHER SWIMMING POOL ELECTRIC ITl.lel'S -SW ITOIIIS-Il%TVRCS eml Pmfessiune Glc: Tbc Con nsuics Liccnw law k— nut apply au an owns of HE -IDI IAL IO,IiCIR SQ FP. property wTn aids or improves mrcrmn. IW who grew such wish Wmnclf rr treat his awn cmploycc, anwir4d that rich ianpruvcnents um metal metaw obered fur sak.If. hams,,,, the ambling a impnnerrcm is sold within one yearofemapktun,the SQ. FT. FLOOR ARIA s/SO ITT our-luildor, will have the hurdan of p ,,a, Ghat he did to Gild a mob r for pur- prw of saleJ. ❑ I, as owner of use frosten, enY, um exdursely ceurnswung Ivan hcenscd rnn.I— to TOT L: amaum & pn,it, (Sac. 70,14, Ba,incnn aral I'mfcuiuns Gvk:) The Cunmtaor', Li. - xresaapp)ytoanowreroflImstmy wa Gilds car improves beacon. mil cemeWm QTY. PLUMBING PERMIT FF,F. w1b,scontracintursuchpirriNct, with uaontmeouns) Iiccn'dpursuan tothe C'onlmmars PL'RMI'IISSUANCE Lt. law. I on exempt uNe Sm. . B is P C for this ruvn AL'IF,R - DRAIN & V ENT- WATER (LTA) O n LA¢ VALUATION WOR KER S COM I'EN SATION DECIARA TION BACK FLOW PRUTECT. DEVICE I G,clry aR umkrpensay offerjwymm ofib, following deductions: Cl Ihavcad willmainmaneCmificmcofConxem t.,If imurt forwurke,rnContscm cation, ux pn m,sal for by Section 37110 of as Iaar Qvk, he Bettdoxnwnm of to DRAINS- FLOOR, ROOF, AREA. CONE, STORIES TYPE CONSTRUCI ION work for whits this permit is issard FIX'T'URES - PER TRAP ❑ 1 have and will ouiutain Wuder'v Cnngensation Imunuee, ac, required by Section 37M white, Lubar Code, fa the perfumurce of the work for which tM1n permit is isxned. GAS - IA. SYSIIN-1 INC.4 OUTl OCC. GROUT' - APN My Workers Cmtpenwlion Insurance cooler and Policy number are: Came Policy Nn: GAS - IA. SYSTEM -OVER 4 (IA) GRIAMAN IPUS'I RI. WASTE I IA'IOR CERTIFICATE OF ENE1vU7[ON FROM WORKERS' COMPENSATION INSURANCE BUILDING DIVISION (EL'S Cmu.eem. reed M becumpktM Hina lcmtit is faonchuMed dollars(plWl or la wJ GRIiA513 TRAP PLAN81ECK FEE IcmifylMtinta lrrfornmec uftFe work for which lhix permit iniweJ, I,hall ephry any person in anvum y mer n v sees. object 10 the When' Connector SEWER-SANITARY-SIORM 1 F1' umtinn law, of Celifomia. Gott Atq carat WAI'I2R HFA'IPIR WNEN DELE GRADIN ItJi NOTICE TO APPLICANT: If allm making this Cenirtedlc of Exemption, you aMmtd tmxrc wryest lex to Wsekefs Coalrnc+ti.n pmvirioos of the lshrz Cafe, You muga WAIEA SYSTEM/IREATING S forthwith comply with arch pmvisiau or the, permit droll be, ikened revol,nL WATER SFAVICI: B CONSTRUCDON LENDING AGENCY I hereby,(rano that Clem ix a rnmametion leading agency 0v the lvrhxr,ace of NEW RESIDPJPGAL 11L10I1. SQ, FT. PAID D Ree pt the work fur wnicM1 rhea pcmit is iasteJ (Sec. 019]. Civ. C.) Lamle''. Net. OPAL: lardcr,Addre.a TOIAL I ccnify that 1 have rend ani, application as sLre Iter theabove informal ix BUIL L QTY. MSCI IANICAPERMIT FEE Mh 1' /.E lalmingm meet.Ia,,, loeomply.,In all may ard,amay ordinances vol, tamws m aiMlin6r VN[li,m.Wd tier by auJu,riss replcumetircsofthis city mrnrer atm ale MRNIR ISSUANCE ELE IC LLE above -marmoset! frol for in'Inneurm pmonats. IWe)agoseu,se, indemnify anal kef, arnal,,the Cayext Crostor ueguia,, Aplin OR ADD TO MECH, PLU WING LEL' IiaMlitks.jWgmenO.crom.riespe— which may in any way acetic attalmt raid City nwyuence of the gemting of a hie permaL AIR IIANIILING UNIT(TO 11,00D CFM) iCHANICAI. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULKfIONS. . AIR HANDLING UNG (OVER HMXXI CFM) C( STRUCTION Signature of AppllcanVCnnanrcav Data HA%ARDOUS MATEAIAI S DISCI-OSURF- PXIAUS'I' HOED(WIDUCI) ir% HO TING MITIGA'fl04IEP, HE,O ING UNIT TIO 1001X00 BTM WIIme,applicatorhJamhumWingoccupantsoreorhaelchvvheemwenal a, dcfred by the Cupeninn Muninfol Corle, Chanter 9.12, anal de Hcalih and Safety Code. Section L5532OC HEATING UNIT (OVER 100.000 BTU) ❑Ye A. PAID VENTILATION PAN (SINGLE, RISIII) Dam Rump x HOILER- COMP OR 100,IIf10 BLU) Aympnwntordeviaawhich Will 1M: np comeor future Gilding by e mit hvrvdw. eir mrrlaminmts as dcfircJ hY lk HaY Arra Air wiliry Managcnnnl Districts ❑Yes E] No T( kv Q HOLLER -COMP (OVER 100,000 9'N) AIR CONDi'H ONCR I lova roil mm h:vmhvso mcoalx umker Chatter 6.95 of Ines Cali- my255 upter ISSUANCE DATE NEW RESIDEiN'IAI. MI:CII. sQ, FT. Tania Hmllhra Safety Code. Smiwu25505, 2, and hatifane huiklingdirsars.whcurrently has. craft. that it is anyand25511.I.rean Jeoraq. be amicnfiriaity,.ra d of me �uirrnrnu which muu be amt prior o ixwaurr of o CmiOnm of Omupurcy. lJ ISSUED BY "I^ TOTAL Owner or aularinNgen t Duro OFFICE APPLICANTTO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING. - FILECTRICAL BUILDING DIVISION APPLICATION/PERMIT PLUMBING. -MECHANICAL. BUILDING PROJECfF IIIEM'IFICATION' PEt"N0 2040 2 0 4 0 J BUILDING ADDRESS ' � R"o G r era Viteu/ 411d-2 SANHARYNO. APPLICATION SUBMITTAL DATE 99 OW I"S NAMI3: PHONECONTRACIOR'5N9ME ( LIC NO: le-ALQQLIG NIC CONIltU1,M -ARpITTELT aCIN� LI ADII 11❑ Pip 0 8 e-r3i n oC CONI'nCl': PHONE , BUILDING PGRMI'T INFO ❑ Consultant Fees Paid by Appllcant (Initial) BL❑IM 2UicT PLU❑MH ME❑CH �Q2x ' f V LICENSED COMRACTORIS DECLARATION 1 tereby arra wr 1 am hren..ed unkr tnviaimte nr chats v (enmrnenems QTY ELECTRIC PERMIT FEE JOB DESCRIPTION PERMIT ISSUANCE. with Scctitn]0ixq of Diviniun9nf Jct Ousincw anA ltrnoxiuro Crdc. and myliccnsc ix in full fora and effect.f:Q RFSIDF_N9'IAL ❑SIIDWL ❑ KITCHEN REMODEL APPLIANCES - RESIDENTIAL Liacnw Clan U'. It DLC Coura..m ❑ADDITION ❑MUMBING RE PUTE MULTI -UNIT ❑ STRUCTURN. MODIFICATION El INTERIOR L1 CHIMNEY REPAIR IMPROVEJI I-] SWIMMING POOLS ARCHITECTS DECLARATION❑ I an lenwnd my plans shill he ural a. pihlic ncoNs PANELS - UPTO300AMFti Llccnvd Pnoe"osal 2)14000AMPS OWNER -BUILDER DECLARATION I hereby affirm mat I em neat from from the Commit License law for the foll,ceing r,awn. (-Section 7031-5, Bueinevs curl (hoes ions Corlq Any city nr anumy [I BATH REMOF.IJIIF.PAIR ❑U&MOLCDON [10 HHER OV17R I00i SIGNS ELECTRICAL which requite a permit to mown, alter, imleovc demolish. or ml any actio e SPECIAL CIRCU1TIMISC.r ANf Fi Timorits i.amince, also the affnicanl forsuch permit In file a,igm'dmmcarm Jute is Itsenv ori lxnsuant ane pavisions of the Crxmanor's License l-aw (Chapter 9 (nanmeneiall.mu Sectio 7WB.fDivrlan Jot me, Business tuN ProfasinnsCWchx TRIP. METER OR POLE INS.. COMMERCIAL_ that k is exempt therefrntn and to huts for the alleged exemption. Any violation of ❑NEW BLDGJADDrnoN ❑ DEMOLITION Scvtian703" by any applkanu for a feadl wbpos to epplioru lovciril lrctulry of POWER DEVICES ❑'D!NANT ❑FOGG SERVICI: man .... I Iban Eva hutalmd dollars (510(b. 9I. a, m'rcrof the fratent myemphrym with wipes as theirsolc compensation, 1 lathe wn4.anitM1e sitiure is urviu,Ndorotfcrcl fasWelSec. 7(b HusioessI IMPROVEMENT EI OTHER SWIMMING POOL ELECTRIC ITl.lel'S -SW ITOIIIS-Il%TVRCS eml Pmfessiune Glc: Tbc Con nsuics Liccnw law k— nut apply au an owns of HE -IDI IAL IO,IiCIR SQ FP. property wTn aids or improves mrcrmn. IW who grew such wish Wmnclf rr treat his awn cmploycc, anwir4d that rich ianpruvcnents um metal metaw obered fur sak.If. hams,,,, the ambling a impnnerrcm is sold within one yearofemapktun,the SQ. FT. FLOOR ARIA s/SO ITT our-luildor, will have the hurdan of p ,,a, Ghat he did to Gild a mob r for pur- prw of saleJ. ❑ I, as owner of use frosten, enY, um exdursely ceurnswung Ivan hcenscd rnn.I— to TOT L: amaum & pn,it, (Sac. 70,14, Ba,incnn aral I'mfcuiuns Gvk:) The Cunmtaor', Li. - xresaapp)ytoanowreroflImstmy wa Gilds car improves beacon. mil cemeWm QTY. PLUMBING PERMIT FF,F. w1b,scontracintursuchpirriNct, with uaontmeouns) Iiccn'dpursuan tothe C'onlmmars PL'RMI'IISSUANCE Lt. law. I on exempt uNe Sm. . B is P C for this ruvn AL'IF,R - DRAIN & V ENT- WATER (LTA) O n LA¢ VALUATION WOR KER S COM I'EN SATION DECIARA TION BACK FLOW PRUTECT. DEVICE I G,clry aR umkrpensay offerjwymm ofib, following deductions: Cl Ihavcad willmainmaneCmificmcofConxem t.,If imurt forwurke,rnContscm cation, ux pn m,sal for by Section 37110 of as Iaar Qvk, he Bettdoxnwnm of to DRAINS- FLOOR, ROOF, AREA. CONE, STORIES TYPE CONSTRUCI ION work for whits this permit is issard FIX'T'URES - PER TRAP ❑ 1 have and will ouiutain Wuder'v Cnngensation Imunuee, ac, required by Section 37M white, Lubar Code, fa the perfumurce of the work for which tM1n permit is isxned. GAS - IA. SYSIIN-1 INC.4 OUTl OCC. GROUT' - APN My Workers Cmtpenwlion Insurance cooler and Policy number are: Came Policy Nn: GAS - IA. SYSTEM -OVER 4 (IA) GRIAMAN IPUS'I RI. WASTE I IA'IOR CERTIFICATE OF ENE1vU7[ON FROM WORKERS' COMPENSATION INSURANCE BUILDING DIVISION (EL'S Cmu.eem. reed M becumpktM Hina lcmtit is faonchuMed dollars(plWl or la wJ GRIiA513 TRAP PLAN81ECK FEE IcmifylMtinta lrrfornmec uftFe work for which lhix permit iniweJ, I,hall ephry any person in anvum y mer n v sees. object 10 the When' Connector SEWER-SANITARY-SIORM 1 F1' umtinn law, of Celifomia. Gott Atq carat WAI'I2R HFA'IPIR WNEN DELE GRADIN ItJi NOTICE TO APPLICANT: If allm making this Cenirtedlc of Exemption, you aMmtd tmxrc wryest lex to Wsekefs Coalrnc+ti.n pmvirioos of the lshrz Cafe, You muga WAIEA SYSTEM/IREATING S forthwith comply with arch pmvisiau or the, permit droll be, ikened revol,nL WATER SFAVICI: B CONSTRUCDON LENDING AGENCY I hereby,(rano that Clem ix a rnmametion leading agency 0v the lvrhxr,ace of NEW RESIDPJPGAL 11L10I1. SQ, FT. PAID D Ree pt the work fur wnicM1 rhea pcmit is iasteJ (Sec. 019]. Civ. C.) Lamle''. Net. OPAL: lardcr,Addre.a TOIAL I ccnify that 1 have rend ani, application as sLre Iter theabove informal ix BUIL L QTY. MSCI IANICAPERMIT FEE Mh 1' /.E lalmingm meet.Ia,,, loeomply.,In all may ard,amay ordinances vol, tamws m aiMlin6r VN[li,m.Wd tier by auJu,riss replcumetircsofthis city mrnrer atm ale MRNIR ISSUANCE ELE IC LLE above -marmoset! frol for in'Inneurm pmonats. IWe)agoseu,se, indemnify anal kef, arnal,,the Cayext Crostor ueguia,, Aplin OR ADD TO MECH, PLU WING LEL' IiaMlitks.jWgmenO.crom.riespe— which may in any way acetic attalmt raid City nwyuence of the gemting of a hie permaL AIR IIANIILING UNIT(TO 11,00D CFM) iCHANICAI. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULKfIONS. . AIR HANDLING UNG (OVER HMXXI CFM) C( STRUCTION Signature of AppllcanVCnnanrcav Data HA%ARDOUS MATEAIAI S DISCI-OSURF- PXIAUS'I' HOED(WIDUCI) ir% HO TING MITIGA'fl04IEP, HE,O ING UNIT TIO 1001X00 BTM WIIme,applicatorhJamhumWingoccupantsoreorhaelchvvheemwenal a, dcfred by the Cupeninn Muninfol Corle, Chanter 9.12, anal de Hcalih and Safety Code. Section L5532OC HEATING UNIT (OVER 100.000 BTU) ❑Ye A. PAID VENTILATION PAN (SINGLE, RISIII) Dam Rump x HOILER- COMP OR 100,IIf10 BLU) Aympnwntordeviaawhich Will 1M: np comeor future Gilding by e mit hvrvdw. eir mrrlaminmts as dcfircJ hY lk HaY Arra Air wiliry Managcnnnl Districts ❑Yes E] No T( kv Q HOLLER -COMP (OVER 100,000 9'N) AIR CONDi'H ONCR I lova roil mm h:vmhvso mcoalx umker Chatter 6.95 of Ines Cali- my255 upter ISSUANCE DATE NEW RESIDEiN'IAI. MI:CII. sQ, FT. Tania Hmllhra Safety Code. Smiwu25505, 2, and hatifane huiklingdirsars.whcurrently has. craft. that it is anyand25511.I.rean Jeoraq. be amicnfiriaity,.ra d of me �uirrnrnu which muu be amt prior o ixwaurr of o CmiOnm of Omupurcy. lJ ISSUED BY "I^ TOTAL Owner or aularinNgen t Duro OFFICE