S 0744'J APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL I'P Ir NO,
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MEGIfANICAI' 0744
BUILDING PROJECT IO6NTIPICATION
BUILDING ADDRESS: SANITARY NO. APPLICATION SUBMITTAL DATE
ll7i Z/9-9r
OW R'SN ME ONE CO CT RS NA LICNO:
NUC CONIROI,e
ARCHITECfIPNGINEE LIC NO: ADDR'SSlei : ❑
CONTACT; PHONE: BUILDING PERMIT INFO
❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
Z ❑ ❑ ❑
LICENSEDCO )R:SDECLARKHON QTY ELECTRIC PERMIT FEE JOB DESCRIPTION
1 bedeby efErm lhu 1 am Iorder meitican,N Chapter,9(eumrtrnciag
Zwith Section 7")of Uivleion 3ufdte Bmirc.ss and Irmfesim.CNe,W my liana ix RESIDENTIAL:
Iy PI!RMIT ISSUANCE
F�O� in full free�u�vl���yyyc :36 3 ❑Srnwl. ❑KITCHEN REn10uEl.
<ZW Dwc�CIll/-1 Le ) APPLIANCES-RESIDENTIAL ❑ADDRION ❑PLUMBINGNE-PIPE
�n Ga (/ I -J Coal Par ❑MULTI-UNfT ❑STRUCTHRAL
F=tQ ARCHITECTS ma OE I N PANELS
Z O-Z 1 mldcralunJ my 1Sen.Jlell M mad ar public ma�rd CHIMNEY
REP
OZ=� UP T02g1AMP5 [D INTERIOR ❑CHIMNIiY REPAIR
Pot j I.ieemaal Pmfeuiaul 2(U-I"AMPS IMPROVEMENT' C]SWIMMING POOLS
9Y2,� OWNER BUILDER DECLARATIONOVER❑A0AMPS [-I BATH REMODEIIREPNR ❑DEMOLITION
C I hereby afmn that I am exempt from the Contractor's Licerw l aw lin the CUTTER
K 6 V follo ing reams.(.Swoon 70313,Busirca.vW Pmfevswu Code:Any city or Monty SIGNS ELECTRICAL
u]LL Oa� which rela Trout to cn^ums,dtea.improve,dermadolo nr nyur un,wucmre
J prinno nar nare,alwtmpui,,the applicam far,deh .I,to fkangreAsmmment SII! IAL CIRCUITIMISC.
WIh01 he is Ikcnacd punuwt otic ptnviritmr at tHr Callraatar'a Lkenm Isw'(CTGticr9
COMMERCIAL
fc«a^e^cine with S¢fmm]0v0]of Dvisittnlofae Huaircss eM Pmfs.ionr Codc)a TEMP.METER OR POLE(NST. .LAI
:
Q.a c a, that M is exempt thetefres,aa1 the hasis for the alleged exemption.Any vitAmio^of ❑NEW BLDGIADDTHON ❑DEMOLITION
"N Scrtimn 10313 by any appllcnat for a pe,mit-Meets the uPphcnm to a cull ptmalty of IY)WBR DEVICES ❑TENANT ❑FOOD SERVICE
n more Ilan five hualred dollan fS500). I,MPRDVI?MENT
�0 ❑ I,u oamer of the penpmy.or my employee.with wage.as throsaNe compe^.vaon SWIMMING POOL ELECTRIC ❑OT
d, will to the adak.anal deurucumek mintcldN-offered for rdc(See.]nu,Burma.
L 4 and Nofm.imv,Code:The Comment-Liccn¢law 11(e nm apply In no mener of UITTLEIS-SWITCI I ES-RX URIS
6 Ir.ycny who Wi1N m impruv�.thcrtan,unJ wM dc.
ouch ata himrclf ow thnvgh
his own employes,ptoviaes]1hor such imPravemrnts arc rot intetald rc oft fa NEW RESIDENTIAL I:IFCTR SQ FT.
vek.IL Mewever.the tuilJingwimpmvemcnt is ml within arc Yeu of completion.the SQ.lT.Fl. RAREA SISQ.Ff.
cr-builderwill have the buNen of proving thin he did no Lo tonnpmwforpur-
paa of ole.).
❑L as owner N the propertyo am exclusively m^urting with licen i rnnlncton to
r.,the Project(So,IoW.Hr,r,,s and Pmfeuio^s Codc:)'ITe Ctmmutnrs Li-
cena taw ars not apply to am owner of pnrpeny who hours or impnwen llerem,and QTY PLUMBING PERMIT FEE
wtlo mnlra[Yr her such mjmrs with a corms tnr(a)Ikeaed pwsedur to the Contorames
Ixmse Law, PERMIT ISSUANCE
lam eve.N utder See. .B R P C G.Oil rea.mt
AUMR-DRAIN A VIM-WATER EFA) VALUATION
OwMr DLC
• WORKER'S COMPENSATION DECLARATION BACK FLOW PROTI:CP.DEVICE!
1 haeebY allimt nnJcr PruBy of penury uta o(Ihc fulhwing dalarwion,:
❑ (have wxlwillmvinlnkaCcniticvm of Conanuusdf-InmmGeWMcr'r Cumpcm DRAINS-T.00R,ROOF.ARFA,COND. 0 STORIES TYPE CONSTRUCfION
scion,m phi,h ti fa by S,ivar l]lq of ae Labor Cole,fa Itr pe.famurcc of tM Q
work far whirl w,11 proctitis irwcd. IIXTVRIS-PER TRAP L
)I have^id will nwimuin Wtrkcla Cnnmcnwtion Inmmncc,u rrymral M1y tiedMxt
]OUof the ishan Code,for Ne prrfarmrmc of the wish for which thin permit it i�sueJ. GAS-FA.SYSTEM-I INC.i OUTLETS OCC.GROUP APN
My Work,e(( Cgqt^tyy��e tigyJ- e� er and Yoliry
Cortico Laf/ItfJYI 4 Polic Nn.; GAS-FA.$YSIRAI(OVERY(IiA)
.� CIC(?FCI'IIICAI}OIr EXPJr1 PH(ONIrROM WORKIeNS' GHPAS[nNDUSTHI.WASTE INTERCEPTORCOMP
COMPENSATION INSURANCE BUILDING DIVISION FEES
G-hka mheal.bcmmptmW iftleperout isfrcorchundoddell (Sion) GRP.ASETRAP
%ANCHECK ITU:
r less.)
I,evify that In the pcdonwnreofthe wax for which thhlrnna,,i..ed,l shell SEWER-SANITARY-STORM EA.201)FT.
wt employ any perm in any moms,or m to betutne subject to rhe Wohrn'Castpe.^- ENERGY FEE
Z otion laws of Califomia Date WATER HEATER w NEKT/ELECPR
O f GRADINGFLU:
AM leant
NOTICE lU APPLICAN:If,a0cr nwkin,Im,CeniGmte of Exemption,riot�111 WATiR SYSfEM/IRIW INC
SOILS FEE
Mu
<omc abjeed to rhe,Woftrr'r Coo,cnswion Pridemore,of the Labra Code.year must
t
forthwith dompl,with ruck provi.s.orthi,Petr it Dull Is,deemed rooked. WATER SERVICE
Q
Z) z CONSTRUCTION LENDING AGENCY NEWR ID NTIAL PI.MB. SQ.PT. PAIDRale Rreeipt
V C) IheaebY affi^^tha the.it.construction kali^,agency feathe perf.m
the work for which this somil n is.wal(Sec.30R].Civ.C.) TA .
H Isaler'a Name 'TOTAL'
V Lender',AdJfs,
0. 1 cenifY that 1 have read this applkation and state that the above infmmnion it BUILDING FEL!
.F., VI rnoed,I.'reetommMywith all my ud coumy adinmee.amt rtaelawsmIatingo, QTY. MECHANICAL PERMIT FRE SI!ISMIC FlU!
U Z mildin,,arwor]inm,mdMCM1y aulhoo,rtptoemmivcsofmk city to emerulm the
above-nentime'I Property he inspection prupae.. PERMIT ISSUANCE71
(we)agree to"am indemnify aM keep ha C.,
rkss Ilse City of Cunim agrumt F.I 1 hT:E
Iiubilim,.)algmenu,ants and e.pems which may in any way a,eme agai nal raid City AITF.R OR A DD TO MECH. PLUMBING
no ae"ramee M the gramin,of this on, '
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNITITO IOAq)CFM) Ah FEE
�E NECUTATIONSNECUTATIONS. p
����/��T� AIR HANDLING UNIT LOVER III,( CFM) CONSTRUCTION-TA%e
Slgav MAppllraHAZnAR war Uwe EXHAUST II(OO(W/OUCT) r I I ITbUSING F1ITIGATION FEE
HA]ARuture AIATERc,., DISCLOSURE
W II the BeCu,,t or furore hMI Coa occupant-tae or handle lib hvardtmn msenvl IIiATINC UNIT 1'10 11g1,(glfl BTU)
as def tee by e Cupcdim Mun'e'llul CMe,Chapter 4.12,and the HdJth wJ Safely
Cute.Stttirm�SJ2(v)'! HEATING UNI'(OVER IOO.fgp BTU)
0Yet ®No VENTILATION FAN(SINGLE HESID) PAID
D le Re,e"4
Millthe app nardaurfuture hefinaig by 11be Buse ryuipmcnt wJea. mem BOILER-COMP(311P OR 100.1100 BTU(
•coil harnnbu,a'v cmmmimnu aw def nlN by Ile Bay Arm Air QIWIIY M>nagcmenl TOTAL
Muriel, BOILER-COMP(OVER I0BW)BTU)
C)Yet ❑No
I lout m,,,Be hvvdwn rwaula nryu'ucnnlu Roder Chal+cr fi 93 of the CaAIR CONDI IONEH Cali. —
ISSUANCE D
funds Heallh R Safety Gdo,Setim.23505.25533 and 255}1.1 uMnamd that if the N, RESIDENTIAL ME H. SQ.FT. �"/ 7
M1uilding doe.not enmraly have al nam.11wl it i.my nenoiMlity lnl notify llw nordWI
of 0e which rlvul tlmmloiwuw Mo Cerdfiere o Occu
t st Da�e�) a� 'TOTAL: ISSUED B1':
OFFICE