S 3360 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL Pli IT NO
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL 3360
BUILDING PROJEC'IDETTIFII'ATIO\'
BUILDING ADDHE54 � �� J Iia SANITARY NO I. AI'IM.1(�I(I�BMI]TAh LATE
105 61 �e
(IWN NS NAME:_ G��5 1'IIONE'. (j}N�ACfO AME:e]� /' r 16ND f Nc Cf1NBO1.If
ftm
RCHRECTIFNGINEER: LIC NO: 42
AUDRFS':Sm LT 16 ❑
1
CONTALT - )WN ,pgD _ BUILDING PERMIT INFO
5(pyyl ya8-t�sA'iss ❑ CnnsBllanl Fees Paid by Applicant(Initial) If hIK IiLECf PLUMB MECH
LICENSEDCONTRACTORNI)ECLARATION QTY ELECTRIC PERMIT FEE
1 Worry of rin'hal 1:::n home d ander gnd.inm of Capmr 9 Qmnnencmg _ _ _ JOB DESCRIPTION
caZ NSmlirw 9(10111 of Division]of Nc Hasirnm'I aoW lho(cwinns elle,af+l my liccna is RR SID�NIIAI:
WOO W1 3yo I)( PLRAIR ISSUANCE
F
W- n full fmx W ❑SFl1W'L ❑KITGHFN REM1I0DP.1.
gF.zw Uc IJc.g AIfL1ANCIzS-RESIDENTIAL CADDITION El PLUMBING RF,-1'll'li
NQL Uma Cnwm _ZO ❑MULTI-UNIT ❑STRUCTURAL
ARCHITECTS DECLARATION
~ Z. Iurdcraand mypl.ns dull be and u naptic mmdr, PANELS MODIFICATION
it
iZzQ Ill'T02W AMI5' []INTERIOR C Cl IIMNHY RITAIR
�F�FW hianad lYnfcsinnal 2M.IlMUAM11P5 IMPROVEMENT ' OSWIMMINGPOoIS
�yf; OWNER-BUILDER DECLARATION OVER IOg1nM11P5 O BATA RE.MODELTfEPAIR ODEMOL1'I'ION
c
yy 1w�]]Q I herchy efGmr Ines I em r—"from the Cnmrannr.License law fir the
)d O C U VAnwing«amn.(,Snufion]1111.5.IWC,..Anil fYof ssimx Cmic:Any ciy rx c:xuny SIGNS ELECI'NICAI. ❑OTIIiR 4
1lilil 3 4. whidS rosuir� a I'ermil m c.IL ala,imLm^,demolish.or rtlUir any srnuwrt
OryQ ma to ie,iswana.ell rtyuim Oc aP,I i for such Prom,do file esi6lKd sturnmem SM:MALCIRCUITIMISC. - oefO 0 r<
1va��
Ti Inm Ic is Iiccnwi Pnrwnnnn me pmnsinns nr lhccnndmnnr'v Ciccone IAw(conger 9
{y�pC (anon ingwne Sndim]IXClnfllivisianlafthellusimarard Prda'sions Cdve)or TEMP.MLTER OR D)U IRST. COMMERCIAId
a a o U mw W is cxemg fhcrtfrom atd the huffs for rte alleged exemption.Any violation of O NEW BLDGIADDTHON O DF_MOLrrIO,Y'
tiM
Smion]1315 by my ryrplicam for a prom,-hjmsfhc opplicanf In a evil pcmldy of IY)W'ISR DEVICES El TENANT []FOOD SERVICE
H Z Y nm more then five hundred dol l:m(S5)(0). IMPROVEMENT
�SD n1,as mwrcrollhc progmY•rx my empbyns wish waycs a.mein sole conycruwun, SWIMMING POOL ELECTRIC
will dolhcwork,rwdfMsf yore is mrd imcrdul arnitrra fir sole LSre70&I,Bto;icss OQTHIR
t W and Pmteeeirxa Co,L:Tie Corm,ror's License law dies onf apply m an owner of OUILFIS-SWITCHES-FI%9URPS
a 3- srope+r,who hands s mTem,n dll[re m,and who:Joss such word,hinewif to mmugh
his ow n mYYoym mali:Jod Dur such irrrpmscrrmau tee rod irumejord w mfrml for NEW RESIDFI LIAL ELECTR SQ FT
sak.If.Mrxesvx,as Wilding or impoireml if sold willrueyear r:fcnmpininn,the / SQ,FT.11-WR AREA ASQ IT
;�her-Mondeo will null Inc harden of pmvmg Chad he did me build m Lngave for pur-
af�e) �9
C] lvn
I.urrer offk lxoprnY,un ea<lusivcly xnrinxdin8 with liccnrdm
rfnnars to
TOTAL:
nmvlmd the project(See 7(W,B-ir—and Prnfssinns CrJc:)'1 or-men 1 ,,,
Low cotap
s not ply to anowrsr of peni who builds ar imgmand!oves ann. xl QTY. PLUMBING PERMIT FEE
ra hnmmrxts fmsuch lxogsr,lithe lontreloreir licemsd pm.uanrlydee Cmhaclon"
Liana law. PERMIT ISSUANCE
0 I un cacug undo,Sec. ,B&i'C lnrfbin rcmn
ALTER-DRAIN RVIIlT-WATER(EA) VALUATION
Oxncr WORKER'SCOMPHNSATIONDECIARAION HACK FLOW PRORCf.DEVICE 9 0o
1 Worthy affirm ardor seamy of perjury one of mne following decluwiom:
III //////��
O thaws Std willrainfnio aCmif mafCmuru m.al4irrwrtfar WarlersCmpeo- DRAINS-R(K)R.BOOK AREA.CONI. STORIES 'TYPE.CT)NSTRUCIION
wfi k fen provided Gx by,cairn 3]1X1 of mx IaMn Cade,fix fM perGxn>ansc of file
w ksewhiah illnuionim ork 14%'1'UHI?S-11eRTRAP
I hese ted will m.iraa r W'arker.Cnmpasation wool,
for xe,as requirro by Endion
i]00olms laM1x Crde,farfl[pcU«mvsu of the wnoA far xhich rhos pemdr:s issued GAS-PA.SYS'IFAf-1 INC.]OIITLEIS OCC,GROUP AI'N
My WnAd CYna7nfintiypinmr'v�mcamcr and iblic nu 'r A
Carrier GAS-EA.SYSTEM-OVER 4(EA)
CL'RTFlCAOMPE SAT' NI NSUIOM1IW'ORKFA.l' O 7 GREASFANDUSTRL WASTE INTERCEI'IDR
' CUMPFN$AT1oN INSIINANCIi BUILDING I1M51(lN EEL'S
1 .'I Inkcfiani WwN he completed ifdhe lennit is for me hurl Vdollam(S IM) GRHASETRAY
w Icss.) LANCIIECK FEIi
I ecnify dem in aW perforri 0 flW wu A fix which this Permit is iswed.I dull AA
not smpiny myq-m in any nearer m a.m I-c a suhjeud e me Wnderi Cxnpcn- $EWICR-SANRARY-, G.2 4Il NENGY FEE 2 O
Z moon Lawsofcmirearma.Dam WATER HEATER WNL' iCB
O Q A Ai. I ,R FEE
ZNOTCE]U APPLICANT:IL alto making this Ccnif teof Exrnipfi:m,swat should WATER SYS]EM(riki
F ; 4r, JAN hnvnw si hist e the Worker's Campe—ems Pmvlslons of 1110 Lfhrx Cwk.rim unit 'OI I '.li
� ..i faMwitb rnmplY with such pmvixiom ry flus permit Hill he dcer.d revaAal. WATER SERVICE
= z LVNSIRUCI'ION LENDING AGENCY NEW RESIDENTIALI' SQ.FL AI Dae K ei x
UQ Ihertny effine,that minis.csxntmcdon Tenting agency for the Perromwrux ofU. q
rthe wart fa.... This permit
- lenders N1 TfITA
C) U Ix'= Addrs TOTAL:
Fy I'mily mor I hale orad this application ead!mal that W.Wo information ix III,IIING FEE
m crmm.l.Prmwn'mgy with dilly and roomy«diarccs Lord ills laws rtWtiog ro QTY. MECHANICAL PERMIT PEE
U h:ilJ:ng cun.urucfirn,enol hereby numxdic reprrvem:aivc offhis ciy mercer ugmlM EISMIC 191E
.1soc imol o d pmpcny fox iospcmim purgrscx. PERMIT ISSUANCE
(Wil ague millenary soil A
m sale.milenre,heomlccs Hoc City aCialouno egunst ELECTRIC FEE
babiliumiudgeri lose,and cxprnws which may in any vay merue against.Still City ALTER OR ADD TO MECH.
I' UMIfING IEE
may::rrcean) •mmnKIOrmt.APPLICANT ' TRS WILL C(LMPLY WITH ALL NON-HINTpIR HANDLING UNfT(TO 10.(D)CFM)SOUR[] GL TO.S. MECHANICAL FEE
/� AIR HANDLING UNI'I'(OVER EIIXMCI:M) CONS9RUCf10N TAX
Sigature of ApplicaWCo —// Dere F INU.STHOOD(W/DUCT) HOUSIN MUDGATONFEh
HAZARDOUS MATERIAIS DISCLOSURE
Will the epl9icvnl ar I'wumluildingaceupunt Wncrx harxlUIwmmous nmfrnvl FIRM ING UNIT(70 W,Ug)BTU)
as defrcd by mre Carmine,Municaul Coi Charon 9.12,uW The Ilwlth tend Safely
code,Scrim 25532LO? HRATING UNIT(OVER IM.000 BTU)
L3 Yl, tz. PAID VENTILATION FAN(SINGLE RESIT)) Dwr Rnciga
Will Inc W,Aimam-fmurt building..,sm tea egiiipmmr or dcviccs ssxhich
emit hvardnus air cormm:nares as dcOrsd by the Bay Arm Air Quail,Mmagcnnm BOILER-COMP(111POR 100.00013
Meson"? BOILER-COMP(OVER 100.000 BTU)
E3 Yes (gy(ra
I move ha he.:mlmu mmeriole rsrluirenwnw mile,Lager(,05 of the ColAIH CONIAT TONER
ISSUANCE.DATE
I.e.Ilml afely Cad,..Sediorsx 3505.2157 and
255:U.1 undaswotl tha if He NEW RESIDE- AI.MECH. SQ.FE
I:ulldinP mrrtmlY h. LJ:v it is m) 'M1illtymmaify mrercalmon
N rtxnts v v hilayavcnf(kcvry y. /
( 'a aauWaneN vgrnr Dam TOTAL: ISSUED BY:
OFFICE