S 1946 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELECFRICAL PEST I NO
BIJILDING DIVISION APPLICATION/PERMIT PLUMBING-MECIMNICAL VJ 1946
BUILDING PROJECTIDEN'11F'ICA'I'ION
SANI'I'AItY NO. AI'PhICA'I'ION Sl10Ml"I'fA I.DA'I'I?
BUILDING ADDRESS:
O.
OWNER'S NAME: rj 4q ,,O JI'HON'E: CO�[[HA("}P ' f / _ JLIC I"� SIC CONTROL M
' ARCIII'I'f.C'I'/IiNGINIiIiH: ,l/ LIC NO AC�)RESS __� ` M1e(/ /%) � � ? 3 3
CONTACT: PHONE G BUILDING PERMIT INFO
26—r 33 8 Consullanl Fecs Paid by Applicant(Initial) BLDGtrTTsTTELEc� PhUn�i MfiCH
LICENSIiD CONTRACTOR'S DECLARATION QTY 13LIiCFRIC PERMIT FEE
1 hereby air m mm I am licensed under powenons of chapter 9(commencing JOB DESCRIPTION
CaZ Ih Sccunn](M).fnivision3.flhc Busincsnan Jc. ad B' RESIDENT]� IAL:
Wp0 xl I'IiHAtIT ISSUANCE
CWF m.full formand effect. cy-on � Q ❑bFDWI. TCHIiN REMODEL
WUU LimnecC hic.p C/�/ APPLIANCES-RESIDENTIAh DDI9IQN El PLUMBING RE-PIPfi
F Z W Doc Conwdo
m C. ❑MULT6[1NI'I' ❑STRUCTURAL
>y ARCHITECTS DI' I�Nz. PANEIS MODWICATION
O FO_Z I undersand my plans shall be used uMic record, UP TO 2fMI AMPS
❑INTERIOR ❑CHIMNEY REPAIR
FQ�F� Limnscd l'nn'cssiotal 101-1000AMPS IMPROVEMENT (]SWIMMING POOLS
Ca ; OWNER-NUILDFR OF LARATION OVER IIXq AMPS ❑BATA REMODEL/RF,PAIR ❑DEMOLIIION
a ay a I hemhy nrnm,non I a...exempt Gmn me Comm,......License Low for doe
X a O Eillowing reason.(Section]11.1 L5,Business mW Yn,feminnx Calc:Any mty ,[nu^d SIGNS GLGC'IRACAL
OTHER
W 3 LL y which rtquhn,a permit u,construct,al¢f,improve demolish,or mpmr any amclure
OQ an file tied statement til'IiC1AL CIHCUI!/h11SC
prior to its issuance,also requires the applicant for such Permit
that he s licensedp a the provisions fth Contractor's License La (Chapter9 COMMERCIAL:
W�Q0d o oh,in lie i,Sc,urn.]ioseEvanundreJ'dnlhnn(SSBti,fierh,a ,r ss JI Ainy ,GSnol 'I EMP METER OR I'(ILE 5 .
(cont b with t 71X5)) fD l t the
1.5
ad,rd J ...... A y inbn.nl ❑NEW HL0(VADDITION ❑Dh:MOLI'I'ION
y any app j...slheappliez n.a civil penalty of POWER DEVICES ❑TENANT ❑FOODSERVICE
IMPROVEMENT
F=Qm,1.o nw'acTof the t payees with wa their sole compensation. SWIMMING POOL ELECTRIC
C prnpc Y,or my employees &es ar pcnm OTHIiR
a p.1 will Jothework,and lheswcmre isnot ireendedarndcred for role(Sec.](W.Business
d3 nnJl t :Cal:T1 C t :1 1 J I..plyt owner of 3 OUTLETS SWIICIIES FIX*[OR S L
.......ty hld:I,,I too.,lh 1 osho does InCh workh If thrngh NEW HI:SIDGY'IIAI.I:LECI'N SUI§'.
his ndoycr,,provided thut.uch ........n canons un '111 intended or oftlred for SQ.171 FLOOR AREA SISQ.ET.
sale.If,howevee the building or topmvemem u,old within ane year of compininn,the
ox net builder will have the burden of proving that he did nal Wild or improve for put-
pose
❑ 1,Itas owner of the propenY,um exclusively contracting with Iiccrvsal eammetun In
onsloullabo,ojoO 70,14.13 ,s; IPrufo.,,wo,Codo.)ficConuunnr'sU-
cruseLuwdNs nor apply to rot ownerof properly who holds or improve,thereon.and QTY. PLUMBING PERMIT FEE
who nntau YN for such projects with a a.mmctotp)licensed pursuant III Commetors
License Lw. PERMIT ISSUANCE
O l am exempt under Sec. ,H@PCfofmisremon
ALFER-DRAIN&VENT-WINI ER IEA) VALUATION
Unto
Owner
WORKHR'S COMPFN SAI ION]IF R NI]ON BACK FLOW I'RGI Ec'I DEVICE D Q
I hereby affirm under penally perjury encu(the fiolow2g declarations
�Ihave and will maiCcnificatcoof Consent to uhf-imurt for Wade/s Compcn- DRAINS-FLOOR.µ(A)F.ARBA,COND. STOµIG TYPE CONSTRUCFION
ration,as provided for by Section 3700 of the Labor Cale,for the performance of the
work for which this sono is issued. FIXTURES-PER'1'RAP
E] I bloc turd will n.a onion Worker's Cntnlxn,udun Insurnncu,ox required by Smtion
3AX)ofthe Tamm Calc.In he pcffmnanccot rhe work for which in.permit is Issued GAS-EA.SYS'FCM-1 INC.40ALFTS OCC GROQP AI'N
Aly Waders Compensation Insurance Carrier and Policy number are: GAS-EA.SYSTI;M.OVER J ILII
Carden I'ol icy No.:
CERTIFICATE OF EXFMPI'I(IN FROM WORKERS' C. SUINDUSTRL WASTE INFERCF,PFOR
COMPENSATION INSURANCE. 1 11 ,IN D]VISIONFEES
011issmlionntnd naIWmntplc2dlftlmpermil,,ho iehundreddo115a(S1Bd) GREASETRAP
PLANCHEC I IT
Iterrify thin Ncom in pedimmance nl the work for which this preen Wcsee,'Co.,.-sleillSISN'ER-SANITARY-STORM Ids.200 ITT. �Yl
nal employ any pennn in any mmffiner xn as b.become subject m the Workm'G. pcn- ENERGY Ll
Z s arm Law,of Califamla.Dat. WATER HEATER W/VF,NME-LECUR
Z O Applicant GRADING IIiF
Z' y NOI'ICC'I'O APPLICANT:If,after nwka,this Cendicme of Excallidon,Yon should WATER SYS Ip yzG BEATING SOILS hili
(•` beeonm subject m the Worker's Con,pen,tlo i poo oo,of the Labor Code,You tnv,l
(Yid Iimhoodhcno,1,with such pmmsinnsor lhislxreat ehdI W dccmedmvokcd. WATER SERVICE
a �
7 z CONSTRUCTION LENDING AGENCY NEwRISIDEM'IAL PLMd. SQ.IT. PAID
l hercny affirm thatntele isanomtmcfion lendm forme fomtano.of Dat Hccetpta
U O .agency per
W F the work mr wnmM1 his nenoh it iNNaed(sea 3097.Co.e.) le1
O -cocce,Know IALC
L�ndc`S Address T :
U
W
1 entity that I nave mad his application ad state mat he aWve information is duu.Dl ;1 ; `3 7 L d O
to
Coal l agree to comply wjob all city and county cNimmoul and Inde howl rclnling In QTY. M ECI I AN ICAL PERM IT FEE SEISMk'li Q
U Wilding construction,and hemhy authorize representatives of this city to enter upon the
abovs t2al5ncd pmperty for m,N,tionpur,oN PIiRMIT ISSUANCE a Ij O ELF 'lilt
1 W- ugrec o. ookl oily nod Map hu noes 'hy nl Cupeni no ognlno
hohilif .Ju gtnonal el s. and ewlticbtnur!' .mywu srvcagaimuanIcily ALTEROHADD'IDIMECH. I'1. I 11 RI3
mem yu ceefm ru m.' I °Speraid. us 3 I $ Q
APV ICA I'UN +RS'AN YU W . COMP ITH ALL NON-POINT AIR HANDLING UNIT LTO I0,000 CFM) MECHA ICAL FEE
CI RCGP..V'
' � a AIH HANDLING UNI'1'(OVER III,IXIfI CFM) CONST GC['ION'1'A%
cone of Apphemn/Contrucfor I)am EXHAUST IIOOD I W/DUCT) HOUSING I'NGADONFL'C
HAZARDOUS MATERIALS DISCLOSURE
Willthe applicant or future Wilding occupant sore or handle homtdoos material HEATING UNIT(T0100,000 111 U)
as Jefn'd by In,Cup-moo Municipal Calc,Chapter 9.12,and the Month and Safety I]EATING Got I'(OVER 100,00()13 ILI
CnJe,Section 25532(x)? O
[:I Ye, ❑No PAID
VI?NTILSHON IAN(SINGLE RCSID) Date Itmeiprp
Will the applicxnl or future building occupant use equipment or devices which BOILER (3HP OR 100.000 It
emit Wradous air conmminams as defined by the Bay Area Air Quality Management T \L:
District'! BOILER-COMP(OVER IIX.000 BTU)
0Ycn MN.
o I have rend he h sAc.Sc n...15 5.2ecim5533 a 2553 Cltupler loo 0l tnc C.I.-
AIR CON I)fl'ION ER ISSUANCE DATI7
fomia Moots,@ Safety QS.,Sanaa,2St.hat i 25533 and 25534.I i ndcnmth IWI if the NEW RB.SIDENI'IAL MSCI L SQ,PR 2
of the
requirements
w hicp lure a,met prior
rio Io i,uace of a edicanotifythepancy.m
nfthe my5imrnenl.which nmFlWmel pdonoissuance nlaCenifieate of Occupancy.
Owmrmnuthanoed r"a IJote T( ISSUCOHY:
OFFICE