S 2901 APPLICANT-TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT No.
BUILDING DIVISION APPLICATION)'PERMIT PLUMBING-MECHANICAL.
BUILDING PROJECTIDENTIFICATION 2901
BUILDING ADDRESS, ] (1 SANITARY IN APPLICATION SUBMITTAL DATE
3"� �a�w 12 . '1WD MVhJI�jhVulll J '�_� q
OWNER'S NAMg PHONE: ACI OR'SN E, LIC NO,
I� L-y, _ �` 03S WC CONTROL
• ARCI InPCfIENGINEER`:L- LIC NO: ADDRESS: V(/J ❑ -
CONInCT': �QIQ '��,7 N� PHONE: BUILDING PERMIT INFO
yv� 93�/Ffryy ❑ COD uI 2T[Fees Paid by APPA and(Initial) BLDG SCT PLUMB MCCII
LICENSED CONI RACITR T DECLARATION Qtr ELECTRIC PERMIT FEE
I hereby amen thin 1 and IRcnseJ ter pnrvismm m Chapter 9(,.'n'tettcing JOB DESCRIFFION
axZ wM1n Seaim 2alnwnrrvi.irmTonhc na.ine..end lmrfaritru.cafe ardmyrnmseia RFSIDENTIAL'
X00 PIiRMIT ISSUANCE
ALL_E+ in Pollfnrccairl x010,�. �nO ❑SFDWL ❑KITCHEN RJEMODEL
FGUU [Jcrosc Civ.C- Lic4 [/a-iV - APPLIANCES-RESIDENTIAL MI
IAh AUDITION PLUMBING RP.-PIPIT
Visa Dmc Comrx L11 - ICL
F D N
ARCHI-TECTSDECLARATION ❑MULTI-UNIT ❑STRUCLRAI.ZOrr�? Iurvkrstnml my pNm shell he usalmPublic rmPANELS
MODIFICATION
O Z.Ja UI'TO?fp AMI!S El INTERIOR ❑CHIMNEYREPAIR
W Idemd Pnneviourl 201-1000ASUS IMMOVE\1ENT E]SWIMMINGPDO1S
III SlIQ 5J OWNER-BUILDER DECLARATION
C d Q I M1creby strum that and ocnrpt tram the Contractor,License law for tineOVER TAXI AMPS C1 BATH RFWIDDELPREPAIR ❑DEMOLDION
aa a U Cl6rwing-son.(,Scctiur 7031 5,limine,and Vo.fic-ent Cock Any city or marry SIGNS W-MRICAL ❑OIAF.R
'+WQ which Tailor-a r,nnit to construct,alter. roMove,demolish,or rtmr any vtuclurt
F'u 0..1 1'rnam its i..cwancr,Scs ne, irtxthcappliaanl frrauch permit to filo asigscd slmvl¢nl SPECIAL CIRCUTTIMISC.
�y that b,is lkxn,csl Pre,.-Oo tic pnookmsof1he CtmtruauW-s U,cnw Law(Clwplvr9
1^'p0 feumrcming with Sunion,1100)ofDroveem3.OlSo Batsmen and Professions Cedc)nr 'TI?MI'.METER OR PULE:INST. COMMERCIAL
a a e y that ha is ca mpt Ilrtefmm aha three basis lm the alleged examli im.Any violation of ❑NEW BLDG/ADDR[ON ❑DEMOLITION
X m_p- Scctiun 7031.5 by any applicant for a lco at subjects the VjAicam m e civil penally of POWER DI!VICLS
rn nrrnurmthan live hutdseJ Jnllmc U500). ❑TENANT ❑FIX)D SERVICIi
F Z Y IMII'ROVEM1EYf
QDSWIMMING PX)L ELECTRIC
la: will&lh,worA.vd me.,rmnure knot imcm1c,lo-enal frealc(Ser,7(PT Busircsa ❑OTHER
W
$ and Imrfosinns Cottle The Conlrecmr'x License Law Jus MI apply m w vw'rcf of OUTLETS-SWITCHES-IIKTURES
prt>frny wim bands or impmvo rhemrnt,and wMr dru aceh work himself or through
his own employees,provided tha,such impnrveme.L,am not imendeJ or alfertd its NEW RLS IDGTIAL ELECIR S
rale.IL hawmcr,the building(g improvcncnt is sold within one ycarnfcmnplellos.the S0.14.FLOOR AREA 5/SQ.FT.
Err-huid,r uill have the harden of proving that he did nm or Id-hnpnno Ga pur-
pose o«).
I,v owner or Ilb,pro co,am esdusively..,in,with liamsd contmm..m TOTAL:
ctmawcl Jr Imaject(See ](NJ,Bruns.and Pm@aw.0 Ctdc:)'Unc Ctxtlmcres,1,
l:rwd-rctapplyur:rowsrT m'Ptrppny wbo buiWsur impmvcslhrrnn.std QTY, PLUMBING PERMIT
wMw traalc for ands pmjcaswimrcomin:arm licamarri uuvu beffiscorammr',
License Ino. PERMIT ISSUANCE
1 am exams under Sec. .BRI'C for this mail
ALTER-DRAIN R VENT-WATER(EA)
Ou'trr nsi
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE Q
I hall
and.allium aim.Caralryofperjury orc r theimarwing4clametma
r. �ILavcardwill mdnminiolim¢of Consent or mlf-inw¢fx Worlds Cnmpco- DRAINS-IL(K)N,R(A)F.ARBA.Cl1NO' SIi)RIF_S 'n'PI ( 'IRUCfION
:'alien.¢s pruvitkd I'rx by Section J]IIU of the labs Cr.k,fn the perftxmantt of tk
wort avwhichthislrmtain o"re RKNRF_S-%iRTRAP APR 14 1 9
❑I M1avo rid will sic,loo Wtrdurs Cone F,hion Inilsk for a ar rtW'ved by S,nat
J](IO of the laMm Gac,fnnhuferinnn:urc of rbc wukfur which Ibis permit is iauN. GAS-I'A.SYS'IEM-I INC i OUTLETS OCC.GROUP A'N
y NnJ .f,Apc ay.-yr lys pw.2uryC PoGy Na un I}�'I GAS-CA.SYNEM.OVI?Rd(PA)
er C Sy"fCHRTIFFTCATTE+0.1'l EKFSMfP IONFROM WORKERS'
COMPENSATION INSURANCE GRFASFANDUSTItL N'ASI'E INTiRCEP10R
(Ohm,rection and intbe cumpRletl iftba Pannit is for on,hundmd Jollatn(SUO) .DI ISION IYLS_ ___
or los.) GREASE I'RAP PIARCHECK PFF.
I,,riry fins in rise perF.aofma or,f,whichthis pnmit is isvand,[,hall SEWER-SAN[IARY-STORM EA.200 FT.
mg employ any'-o in any meme,-a .w
In bscomehjecl m he
the NWss'Compem ENERGY PLE
.n N
Z Nim lows of Culimorn Date WATER HINTER WNHNTtYLEC1R
O prE,ant GRADING FTE
cunuG
TICE TO APPLICANT:IL afmr mating this cnithicahe of Cxemp ars.pre should WATER SYST NIG RIATNG
F ; batel sobject ur be Wtalar's C...npcnmunn Ur-kinnv of the Labor Cr.Lr.gra nmsl SOILS FEE
far th comply with such pmvisirms or thin permit shall IN demdTmnled WATER S17RVICE
z
= CONSTRUCTION LENDING AGENCY NEW RLSIDINTIAI,PI.N16. SO,PT PAID
Z Ihc,ehy ell-that mere is. .n�N .lending vgetry for the'ri.caut Ihr Rn<ipt#
4. O the wnrl to,whi,h this gamut is..d(See.JIMIJ,Co.C.)
C) lender's He c '1'OI'AL:
1..) Isndcr's AJJrese TOTAL:
r y I amify that I have read this application um1,brae that the alma,inframrnimt is BUIIDIN'G IFI:
F m cast.l.g :comply with alldry and-rotordi......anti cro,IS.,reledng b, QTY. MECHANICAL PERMIT IEE
U Z bei Wing crnslTunion,std hereby auMtrim Tclrcrrnmtivc:or this city To amcrulmn the SENNIIC FEJT
movenrcmirnd psalm,for iro ectem ryupnsCs. PERMIT ISSUANCE
(We)egsee its smg httkmnify amt lzp ham rt the City of Crp inn apaiml e- i'1JiCl'RIC Fl?P, It
IiYrilitio,jWgmemn,,Maxed eaprnxs ufii,h nay in anyxa,an'me mgeimtanid City AI[ER OR ADD DO MECII.
pu Eta of JlC ZEE
I'LUMIiINGIF,E
nPPLI N UNDLRY WLTH AL[,NON-POINT AIR HANDLING UNIT ITO 1LLD10 CI'M)OMECHANICAL FEE
`1.//'y/� AIR HANDLING UNIT(OVER 10,N)II Cild) CONSTRUCTION %
Sil,m ma ofnppllanl/Co Itacmr 1 Dam EXHAUST HOOD(WNUCI} HOUSING MITICATI N PER
MATERIALS DISCLOSURE
VIII tkaMIrarrmafummbtIding tc'culmnl store ur h:udle havarbtu mamriul / If ENING UNI'I'(TO W.OoO BTU)
m tlafieei by tire Cupenirm Municipal Cole.ChvPler S.12,asd the Real and Safmv
Costa.Section 25532(,)'! // HHATNG UNIT L OVER l00010 BTU)
[3Yen L61.
PAID
VHA,ION FAN(SINGLE RISIII)
EN -
W II Jr eppl'rant tr future hilJing rccuDarr use ryuipmrnl«devices which One RCrcipt N
.. ,mil hvmTJrrus air C-nnoownb as Jelinrd be the Bay Area Nr Quality Manegemam ItO1LHR-COM11P OHP OR Ig1,IMp BTU)
IfOILI:R-COMI'fOVER 110(r(0)Bl'U)
❑Yes I•-/Nn
AIR CONDITIONER
'e:tad Ore Soma::natcr"NPr ti!O3 unMT 1,1 and omit thin Oto- ISSUANCE.DATE
fun' al kSoftly Cale,Se 'ms5f15,255JJ vol 255JJ.Il nosimM tomifon NEW RGNIUFNTIAh MECII. 50 FT �/
hi ung m.Nnenll)'h. y�i,�ma Lt mirtrmlbil'll)'mnn'Ifl the rcCuDmt y q�"Q.9
i--En wbrh Or lm fa,twat eCenif,-sten ar��
U /1 yQ
Uwnrr ra authuveJ ager Ilru—� '10'f L: ISSUED Bl':
OFFICE