C 80410 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-U?,E BALL POINT PEN ONLY ICAL �gy�
CITY OF CUPERTINO BDMBING-MECH MECHANICAL
f� t / ITN 0410
RUR.DING DIVISION APPI,ICATION/PERMIT PING PROG-MECHANIFIC SWOT it
' BUILDING PROJECT IUINI'Ih'ICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMU UAL DATE
C S
P
OW SNAMEPAP CONTRACTORS NAME:
VI�a NIC CONTROL II
�ECHUTCT/ENGINEER: LIC NO; ADDRESS: ❑
CON'1'ACL PHONE: BUILDING PERMIT INFO
❑ Consulutru Fees Paid by Appikirral(Initial) BLDG ELECT PLUMB
MEClI
uc/ O- I ❑ El ❑
LICENSED CONTRACIT)R'S DECLARATION QTY ELECTRIC PERMIT FEE
I nerety alrmr ar
ded I am bred tndn porrim.a csa.,mty,er 9( el JOB DESCRIPTION
�zZ with Seeticn R¢N))ofpivi,ion 3M tk Bir,inex.end Pntre,dun,cud.andmy Ecrosa i, RESIDENTIAL
�i)00 I'I!RMITISSUANCI!
in roll tome mel eRcc ❑SFDWI. [_1 KITCHEN REMODEL
.ag.VU Liccu�Lk.I r APPLIANCES-RESIDENTIAL. � ❑ADDITION ❑PLUMBING RE-PIPE
NQ1 Ihn Caurtcr
ARCNmULT1.UNIT ❑STRUCTURAL
y
ARCHITECT S DIiCLA AVON PANELS
Z O�.Z. 1 and trod illy Platte droll be u,,l M With,mord+ MODIFICATION
OZ—O UPTO200AMPS [I INTERIOR [I CHIMNEY REPAIR
F�FW Iicea,ad PmfccaimW - NII-Io00AMPS IMPROVEMENT C1SWIMMING POOLS
; OWNER-BUILDER DECLARATION OYER Igro AMPS ❑BATA REMODFIJREPAI R ❑DEMOLITION
i s m a 1 nemny mrnr Inas 1 cant exempt loom me Contractors Lirenk Law for the I�i f R C g2TF R T-4Eb7E,rl.,
x:a F (^((cavi^¢rtaun(Sxtiw 703I3.Busiateu eM Pofecdms Code:Arry city moral SIGNS EI.ECfRICAI. '7(F A� !OO
tvl LL, which aNuirtx a Peoria rat—born,Utv,iml'mre,demnli,h.'a repot any Iarai K
pric,.n..i.<aaarc.rimnyuiro thr.,lcarl for stenpermi to We aagrcd+Aa'ea.al SPECIALCLRCURIMIS C�LLa �yl�iej
rhaa k,licooed pursuant to theptuvisi.Mthe Cafforetor,License law(CMger 9 OMMER IA
0 (canmrncing xith Sarion]OW)of DividomJof the Busitev enl Pro(eidau Codc)or TEMPM[TEROR )LEINSt
a e tY thv M i,exempt tkrtfrom and rM1e taxi,frrz the aIIc6M cxempticat.Any vir4ation of ❑NEW BLDG/ADDITION ❑DEMOLITION
Scctim 9BJI 5 by ary ap i.,our a pcorit tibi rla npplicrnt la a civil l cark,of LOWER DEV _'S 0 TENANT ❑FOOD SERVICE
I_ZY not more thN Eve hordtN dnllan(S500). IMPROVEMENT
6 Fl l,uowrtnof Nelopwy.mmyemplge %ithwagcmthnrsarecompcnsvion. SWLMM GPOOL ELECTRIC
will do the wo,1,std the strtavurein rat intcMcd aoRc d Fr,ulc Ulao,]IH4.Hasirtes, ❑OTHER
m enol Pmfaxaionn Ccda'I'he Contractur'r Lken.¢Law dres no,apply a,un rwner of O E S-NWI'TGIILS-PX ES
a S— Popery wk W it b ow impovd der,aa and who dun such w.k mmol(ar though
his wm employes Povidcl Blot such impmvemcma ere tad inteMW u offered for EW R[NIDENIIAL ELE
naw
lIf,h 'cen tk Wilding t.ito,,raccment i,wild within one yernfe.niol,ior. he
SQ 17 Fi(R)R AREA LSUIT.
om rcr-buiWcr will have the tooter of proving that k did cat Wild or Imryove lot put-
e m w .). TOTAL:
of the Pupmy,em exdusnely cantrsing with licrnsed cortremms rat
crmwrun Iht Puy.+.t LSca 90fJ,Htni�trd Nnfcuintr CuJc)The Crntrvetor'n LJ- - D
e n,elawclonrva apply tawwrur of prrrymy who huJd+ulmpmv sec000r.erxl QTY, - PLUMBING PERMIT FEE
wCknseLa w. w,uch ryojecu aithaaomnanm(s)lianscd quwaru to de Cmtnanor'a MAY 19.19 9
I,Icenoo law. .�0
I ant exempt order ties'. ,N&P C for Ihir term^ PI!HMC[ISSUANCI!
ALTER-DRAIN&VENT-WATER(EA) J VALUAT10N
laxrtcr Dile R 1
WORKER'S COMPENSATION DECLARATION HACK FLOW PROUiCT DEVICE, 'j1'y
I hereby afEmt under perafty of petitory care of use following declarations:
O 1Moe ami will m.imaina Ccnirtnteof Cone.to,elf-inoal fa Willa aCanpcn- DRAINS-FLOOR.ROOF.AREA.COND. STORIES TYPECONSTRUCT10N
aadort,as provi,icd for by Sectimt J]f10 of Me Leben Cuda,for tk p,rfarwee of RPa
wok fir which Nin penrk t,i,wad PXTURM-PER'TRAP
I have and wid maintain Worker's Cumpcn tion Insurance,a rrywml by Sectio
J]00of the labor Cocle.fa the�¢pe�.�(rt{oy�m��tay^r�(e��e��roftM worky.fqoyr�xTich rho p//emyydyt/1,��ic,w1. GAS-EA.SYSTEM-I INC.i OUILELS OCC.GROUP APS
Cm.ic�� ./��J�p�yryttc(� .mot OAS-[A.SYSIEMOVER 4(EA) Q�
CEROFlCATE OI'EXI1 MI OON FROM WORKERS' GRGSFJINDUSTRL WASTE INTERCEPTOR
COMPENSATION INSURANCE BUIIDLNG DIVISION FEES
(Thi, to.neM nn k^.plow(lfthe permit is frorehurdred dollan,($100) GRGSETRAP -
nor low.) - PANCI IECK FEE
Icomfy Resin Ue perf.eeoflM woh for which tlri,ennit i,issue(,I shall SEWER-SANITARY-STORM EV 200 17.
Par eogtWy any Paoaan in any mentor su as m became whjat ao the Wor4m'Conifer.
LNERGI'fir
Z motion law, Calihmia.Date WATER I[EATER WNENT/EI.EC[R
ZA,licant CA* /•I [- 1 �a GRADING I'EE
rn
NOTICE TO APPLICANT.If,dis,+akin¢du,Certifcare of f cmpdre,you s W WATER SYSTEM/TREATING
F ; bavrr ,ubjcto the Worker',Cosi easarinn pin, of tk labor Code,Tot must SOILS FEE
ven
tunh%ith m.rply wi lh lash provi,xw or thin permi(oball he cleaned revo" WATER SERVICH
Q
7z CONSTRUCTION LENDING AGENCY NEW RISIDFNTIAI.PLMB. SQ,ET. PAID DareReni N
U O Iherebyaffloor tMr there l,acoouruction lrMin¢a¢emy forth perforasora of t"
the work Gr which Ihir permit la ierued(Nor.R)9),Civ.CJ TOTAL:
(•' Lender',N.
U Irrdn',AJJnna TOTAL:
1 certify that I have real this apMicetion and state that risem
above inftiat it BUILDING IPE
s rneof 1 agrw ro coin,ly with all city and county ooLion e.rod all Iawx tulating m QTY. MECHANICAL PERMIT FEE
U z Wilcling cona,teum.and beery awhmve rtpre,enurivc oT lhi.city to corn upon the SEISMIC ITE
above-meru- -'mgeny for irufection pa,o,ea. PERMIT ISSUANCE
(Wo)agree rat rove,irdemmfy arW knp haimlua the City of Cuperrino Wa,,1 ELECTRIC PEE
li,bilitien.judgmenra,cost. d"Peol" which owy in any way accrue egaimwdd City ENTER OR ADD TO MECH.
P.UMBING FEE
nctvvesuereer, the riga +mit.
APPLICANT UI4D .TA A DWIIJ `LY W' ALL NON-POINT AIR HANDLING UNIT(TO 11),tXp CPM) MECHANICAL ELI!
SOURCE ' .0 ID
ALR HANDLING UNIT(OVER 10,"C1'M) CONSTRUCTION TAX
Sigw o! ppltcon tmctur Dare EXHAUST HOOD(WMUCT) HOUSINGM[OGATIONFEE
IWARDOUS MATERIALS DISCLOSURE
Will theappkumrrfurum Wilding raxupenr vrceorbardle heasrdw,materiel UEAMNG UNIT TO 100.000 )
a,Jefiial by the Copcnioo Municipal Code,Chapter 9.12 ad the Health and Safety
Coca.Seboo 255326,)? HEATINGUNIT(OVE W,(g0PTU)
E3Yor EPKR VI'NTILATION (SINGLE RESID) It"PAID --
Will de applicant or future Wm
Wilding or ara use equipma ent dcvic,z which RaetP g
S emit hvard,mn ar nrtwmiaenu m defend by the Bay Arm Air Quality Mar,gemenr BOILER- )MP(3111'OR Hrimm BTU) TOTAL;
Dtnmd^ Ya QNo BOILER-COMP(OVER 100."BTU)
klth trod rkh dour,^morulareyulm 3aro,;p Clapar 695 oftk Cali AIR CONDITIONER ISSUANCE
�
Emda HrnItM1&Sal^ 'ole, 25505.255 J vrd" M.I then,..,t that if de NEW RESIDENTIAL M11ECI1. CQ.ET.
offhe6 hi To I i'tYca ratifythe v{va
of ole ,wM1i' a per Iliwte of Occu
Owner 'zW bare TDTAL ISSUED BY:
OFFICE