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