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28617 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPER'rINO RUILDING-F LLCI'RICAI, i'ENMITNU. ,w BUILDING DIVISION APPLICATIONIPERNUT PLINIOING-ME CHAN[CAI" 'LJ l8 {V� BUILDING PROJECTIDENTIFICATION BUILDING ADDRESS: SAN]I'ARY NO. APPLICAI'I(1N SIlNMIIT .DATE 6 2 �' 6�n O NER'S NAME: PHONE: CONIRA ftl 'S NAME: LIC 0 •��`�/' NIC CONTROL ItCH7 ITECT❑iNGINI!lik; LIC NO: AUD iSY: ❑ • CONTACT: PHONE: BUILDING PERMIT INFO _ / El Consultant FCU'PBIJ by Applicant(Initial) BLDG ELECT PLU MECH C W) e C3 ElElLICENSED COM'k ACTON'S DECLARATIONQTYELECTRIC PERMIT FEE 1 facially aHinth Wnt I.,it b«moa under prnri.ions of chapter 9 a,nnmendnr JOB DESCRIPTION WZ WSmiw]INxllof Division Ld Weliminc»ad Pmfessinm Cdc.mW myliceumin R SIF DENTIAI: OO wr PERMIT ISSUANCE ❑SITWI. . ❑KITCHEN REMODEL W full forte unJ0 N<}1 Limnac Clu». (,—Lie.x —Tr/ APPLIANCES-RESIDENl'IAL ❑ADDITION ❑PLUMBINGRGPIPE to Z a Daln Cumrwmr FOy ARCHO ECUS DECLARATION YANELS ❑MULTI-UNIT ❑STRUCTURAL Z02K IankruanJ my pWO,loll beoudaa public rcanrds HPTO 21O AMY5 MODIFICATION O2-.q ❑INTERIOR ❑CHIMNEY REPAIR F�t " [.learned Pmfessi..nal 201.100NIAMFS IMPROVEMENT OWNER-BUILDER DECLARATION OVER IIXM1nMl'S ❑BAI'II REMODEIIREPAIR ❑DEMOLITION yy lY 1 henchy affirm That I ant a.cnhpt hunt the Gan.,.."a Liccnw law IW the )d�1W fullosing«a.m.I Spniun 7031 S.Du.ineaanl Plotdainn,Cada:Anyalyor foully SIGNS CLECI'RICAL (-]OTHER YELL BO}�' h h y P u I n o - p de TI repair Y infinite .aJ pr.l n y IM,applicantl inch tl fl g J rt ret SPECIAL CINCIII'I'/MISC ��, t.lhu be 11 ' u t 1 III C t' . I 1 ICIquer9 p ->, loom mg wish 1. TXxll Iti r) IB II JI I ( opo I I:Mr M III FR uR 1411.1!INS'1'. CO M RCIAL: {1. Wu he.s eaahge Ihcml nr n and rhe sn s for tee al.,.d....upson.Any violid rel ❑NEW BLUG/ADDITION ❑UHMOLII'ION Xm� Section 7031.5 by any aPPlicun.for L•nnila -ecu lLe oppliomJyu eiv'd"Oollynf POWER DEVIC1'S ❑TIiNANT ❑FOODSERVICE Y1 inn num loon live hundred Julian(5 Xmll.fncr IMPROVEMENT .F�.CO []I,c,ownerof the oopi.y.of fly to wages. esnnhpenaotion, SWIMMING Ill ELLCfRIC wJI Jn Ne wn,A.mol iLe,nncmre anal in IunJlumJfur k eJ1114,Valine,. ❑Ol'IIER W•�$ sod Dofc»inns Cole: -Be C.... , m V J a u ly to inn owner of UBTIf;IS-SWIICHI'.S-FI%TURES R' pmpeny won M1uilJa ur imp.. c. J who W,d 'h work himself pr lhmogh hishis own owevere �-11 it /I, rir not intended or pled...for NEW kISIDEN'I'IAI.IiLECfR SQ FT. bowvtm.lhe Ida hmpror a ..withinonentendecompkered toe SQ.FL FLOOR AREA ESQ.IT. wnenbuilJcr wi h: buNcn 01 Wr g IV,e did mK buil)or in,pnnx for Per- pus.of sale.). Nor❑1.mow. the pm n culmivcly elffl.61a,with lacread controewnah TO'T'AL: orrsaam dic pnrjam(Seo.7(A4.Business and Pndassio Coda:)The Commcon',Li- nselawdoes not apply to an Owner ofpropcny who builds or inhproves there'll.and QT'Y. PLUMBING PERMIT FEE wbunrmncs Lm,u.h Vmjsa,with a aommemrbl IicpnscJ punuum ro the Cnumnu/a I.Icenac law. PERMIT ISSUANCE ❑Ian nen iol ankr "n ,H&PC ti,r III,..,an / - ALTER-DRAIN&VENT-WATER(VA) VALUATIOt;L Owner Date V((!YER'S COMPHNSAI ION DECLARATION HACK FLOW PROTECT.DEVICEDO Q r Ihe.byathnm under Penalty of perjury One of the following deflaraliom: I have and will riuimuin o Cenllicue of Consent.scB-iron.for Workees Compen- DRAINS-FldIOR.ROOF.AREA,COND. STORIES ET Minn,as provided fu by Senium 3700 of the talar Cole,for the serf amwme of the ..I fpr which this permit is issued. FIXTURES-PER TRAP ❑1 have unit will nwlnlain Worker'.Cumpenaullon Insurance,as recluired by Section 3]1X1 of We Lad Oude.for Wepedmaraffe refill pA for whmilflas permit..issued, GAS-EA.SYSTEM-I INCA OUTLGIS OCC.GROUP M1ourse, a Iron su licy oar ae: Carrier: No GAS-EA.GAS-IiA.SYSI'EMOVER 41UA) CERTIF ATE;OFE%EMPGONFkOM WORKERS' �'G-/ GREASE/INDUSTRL WASTE INFERCEPIOR C(OMPENSAI ION INSURANCE .}BUIIDINO DIVISION FEES , vadt•, 1'I his mni..nned nu.1.eumpkmd it W,ponnot is fo ane hundred dollar,IS 11X11 GREASE'I'RAI' LANCH- u, law) YLANCIIF.CK PEE 1«nily lout ionic perfull-oeutlheworkba whichlhia permit.,issued.I sho11 SEWER-SANI'I'AHY-STORM EA.21O FT. nm vnnpL9 unY lasso..man,manner u,m et Leanne subject.0 life W...ken'Compen. ENERGY fEl! rZ shlimn Iowa of Calilonla.D:nc WAI'Hit IIHAI'1!H WYVI!M'll!I.ECIR ZO Applw,ad GRADING FEE NOUCE'IO APPIJCAN'1':II,alter maAing thin Cenilk.l.of Laemplion.You thrift; WAII7R SYST EiM/TRI;APING [-^ prone 0hjmt u,IM W,ekar'a Com,va,aOnn pruvisiuns of the labor Code.Pu root SOUS FEE {aJJ forthwith....reply wallsf,b pookientorlus,onail.hdl hc,kennd tattooed. WATER SERVICE Q p' CONSTRUCTION LENDING AGENCY NEW NESIUEN'HAL PLMB. - SQ.PT. IAID Date Rmciptg I U Q l hereby anion that them is aConstruction lending agency for the perfomtance'l1 D. E" We work for whist,tbia permit i,issued(See.3197.Civ.CI �' JI OU Leder'IName K ) AL {IJ Lender's Adlms. TOTAL: 0. 1 certify that I have mad this applieatipn and slate Thal the above information is BUILDING FEE i.. 0 comms.l aDcem fnstply,with al)lily ulW mum,indentures..fit laws relaingm QTY MECHANICAL PERMIT - FEE r SEISMIC FEE 1 U� building foo Lmoti,m,mWbe,ab,ual....4ampmannaive,0fthi,eily,,crier upon the lip 1, above-men iuneJ property Int rmpeaion tuallaa,. FERMI T ISSUANCE ELECTRIC FEE IWe)agree to leve,indemnily unit lot humloa the City of Cupertino against inhilhia.luJgmenb.coau and ar,lales whiotunny in nay way ucfmo uguimlan!d City ALTER OR ADD'I'0 MECH. PLUMBING MY - in onoegneme of One graining of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT AIR HANDLING upfrao l0.(O cm) MECHANICAL FEE SOURCE REGI . 'hONS. .� 7 � � AIR HANDLING UNITIOVER RAN CFMI CONSTRUCTION TAX Signora ofA cealcoamoemr Du¢ EXHAUST GOOD(WIIIUCI) HOUSING MI'I'IGATIDN FET! I IALARI%)US MAI EKIALS DISCLOSURE Will theapplie.ato,lumm budiir,00,upoa,m.ur boot[hn.oloonil HEATING UNIT UO IUhLXO BTU) in Joined byline Cppenlnu Municipal Code,Chopmr 9.12,and the Health and Safety Code,Section 23532(ol'r HEATING UNIT(OVER IDLOlO B'10) ❑Vola 0N VEN'I'HAI'IONFAN(SINGLE RESIDE PAID Dale Reeeipl g Will lh<applicant of(alumluiLbng'lccurym.....iryneintor devicaa which BOILER-COMPDIIPGN IW,IXO RTU) h ] uuManu u,defined by the Buy Arca Air Quul ly Mmagemenl Disaii BOILER-COMP(OVER 100,000131-U) ❑Ye. ON. I hove mOa,lbs mood,u,matenal,fcrsunder Chapter 695nf the Cali AIR CON DI"I'iONER ISSUANCE.DATE yn.mdn fxnia IInIW&Sufny 6W:..ka+inns 255113.:3533 od 23334.1 urukmm�l that if We NEW RESIDLNTInE.MECH. SQ.FT. builJing Jrca not eau<n0y Love a.aunt.Nm I.is my mai,.nnililiiy ret notily the rOcnpam of We,ey n fwnwrh uu G Incl Inl{a/y'n of a Candles.,id cu Y. - I Wil'—` / r— TOTAL: ISSUED B . Owner a Wo o eJ agrnl if