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CITY OF CUPERTINOG-ELHC71 RICAL 'CHMII NO.
BUILDING DIVISION APPLICATION/1"ERMIT PLUMBING•MECHANICAL n �I
BUILDING O BCSI PICA L L}ON
Il UILDING ADDRESS: SANI'T'ARY NO. AIILICA'IIONSI111M1`I')'IAyI.UAIIi
UNII'0 LOT JO �"• I �f
NAME: PIIONH: CONT
NAE: (ONROl,A
IOF:CITiNOINCFR: LIC NO: ADURCSS: ❑
4' •d `' 99 BUILDING PERMIT INFO
a �]�j` nQ¢f��j' pp �I.eC�'RIC PE� IT.t.
—P VV), � �.7� PERMIT ISSUANCE `• RF-1 ELEC9' PLUMB AtEC11
LICiiNSffI CONTRACTOR'S DCCLARAI'ION APPLIANCES-RCSIDF:NTIAI. N
Deez
yPJVOW❑UO A700inoofffDroivnmisimonlAlsnoflifle, eurprovisiunsolChapmr94tmtmlcicense kkin
n PANF.S
fillarmC
Ity<�.ZQ4a) cff«r
Lleer,m Clasv
IIPT'O Hb AMPS
a Conte 201-RICK)AMPS
SQ.PI'.19,OOR ARnA SISV.I'
Z8yZK ARCI RTECIS DI:CIARATION OVER 1000 AMPS
OZ—❑ I understand my E na, '.
.wall he roof u lninlic records.
r!n t Y SIGNS ELIiCTRICAL T
Li . Pmlecsinnol
OWNCII-BUILDER DECLARATION SPECIAL CIRCUITIMISC.
yo,.0 I hunch,error,that I am smut ram, he Camara r•s 1 Iran+e Law for me
W3 W~ billowing reason,Bello.Rpl.5,Business and ProfeWons Coca:Any city or county TEMP.MFT ER OR POLE INST,
tfS 0O which requiter a permit to construct eller,improve,demolish,at repair any structure � 1
I Y� joint to its issuance,Alin requires thearpli«m Gr,such Permit o file salaried woement POWER UCVICIS
<O that beis li«nved pursue nun the provisions of be Contrecem'a Li«n«law(Chapter O
SWIMMING POOL F.LECIRTC t 1 I N
d6x 9e am.,rcina with Swi.n1000).1 Divi.Jon)of the Buaineasmnd Prafinens Cde) S �l
WR "'Jmt he h isempt dmrelrsn endthe basis fome.11aged enemptinn.Any violation of \
Y Section 7011.5h any Applicant for Emit sun t the 1 too a civil h f OU)LUIS-SWITCHES-FIXTURIS
Cza r r EE re hen ppi="" Penalty
m orae man Five nmmmJ moon(3SnB).
,L,L❑ NFW R1151UIiN)'IAL.ELLCIA _SQ.FT. •� IRKS T'V I'F CO 51RIIOTION
C$ ❑ I,es work.oOhepmpmry,utmymntendeeswim wage s.. dmirsol.compensation,
windrf—in.,Ard the rocureinnmmLimioc rwdosnot apIlly
it,an ow4. ner
<a •Jl.
And Paden .Cutr:'Fb.Cnmm�cmk<And
Ink dre.<nl hinio m an nknpr.f
pralerty why huilJarclminnventhnuw,mA whdrc<nuch work himadfur mnugh bis �, 0(C.UROUP RLLONEIS
cmptlay«a,pr.videdrolasaenimprovemenmin are imendMurofferedfsrc.ule.If.
hands, ,me have In,pmimpn.vemm�tis Our
withinoreuild.1 rprowe on.meowncr TOTAL:
sale.)r will hive ter hnnirn of Proving that he did rot build m Improve far pugnee of
nmap Cj . �� f1. 1.(1 {�INtl PBI�MIT`v F:; , :non ZONE APN
❑ Ida ownet
ject(Sw.70,Amesclreivdyconnfctlrnawill,or:)Tha Coalition, .iti'A rqt .yr,+„• `i•s �r:
License
the ores nor apply Ran,owner of
a pe Professywhobirma Ode:J the Contrectm'A PERMIT
Slav
.ianse Lew does nor apply mvnawnerofpmpeny who huildnabnprovesthereon,end PERMIT ISSUANCB
whocontmcm for such projecn with a co"vecmgs)licensed purmem rode Conuacmi s
License Law ALTER-DRAIN,9 VGMWAT'C0.(BAT N: IEE SUMMARY
❑ 1 am mrnp,"rob Sm. .B A P C for this mason BACK FLOW PROTFCF.DFVICH �
SANITARY Y N_
Owner DmeftCCFI1Tx
WORKMAN C(/MPENSA'I'ION UECLARAl10N DRAINS.FLUOR,ROOF,AREn,CONU' SCIIfJOI.'IAX Y N
❑ Ihereny nl'frm mm lhtiveecertifcee ofamum sial Gimuu,oracertifipee of FIXTURES-PPR TRAP 0.1iGEl1Tx
Warkets Compenmdmi lnsrrnmecoratertifteJrnpymer«f(S«.Jag).fah C.)which PARK ITU Y N
coven all em do ee'n under this tpgpiFFx
i Y a^"' GAS-EA.SYS'HiMi INC.INC40UT1,IT5
I'nfcy x BUILDING DIVISION fTGS
Company GAS-F.A.SYSTEM OVER 4(RA) PLANCIMCK FEB
❑ CenifnlmpyisherehyfumishJ.
❑ Certified copy is fled with thecity lnspeditm Division. ORF.ASF/INUITS”IRL WASTE,INTFRCBP`rOR GRADING ITE
CHR'I IITCATE 01'P.XEMITION FROM WORKIiRS' G 'RAP SOILS ITi:
COMPENSATION INSURANCE
(Thins«tinnnttAnohmmpleudilthe permit isfoone humncsld^Il...($IM) SFWEB NI LARY-STORM BA.21pFr. ENERGY FEC
or less.)
I certify that in the perbomanceof the work or which thispemtit is iswed,l shall WATER IIMTFR W/VENr/E1.F.CIA
not employ Any person in any manner it)as to hom
h=one subject the Wmkern' PAID
Campen<minn Lnwn of Cnlifnmia, Dan WATFRSYS'IEMORP.ATINO Date Racoipt0
O z Applicant
z 2 NOT'ICE'r0 APPLICAN'F:ILaftea making this Cenifcare or Fsempi......shmdd NLW RISIDFN'I IAL.PLMB. SQ.M. 'TOTAL:
I-. y become suhjee to the Wnflcr'.<Coalwomitiro pmvisiom^r the LaMar Code,you moot
BUILDING FHB
lt-'a .' forthwith.imply wim<uch pmvininnsmmis permit ahnllhAnmeA revntM.
pl Q SHISMIC FIili
CflNSTRUCFION LENDING AGENCY
I herehy alfun Ind there Is A ennamction lending agency fill Roo performance of
U z IiLIiCINIC IRiIi
O mA walk bar wbivlt thi.v pemtit i.n isaeA(Sec.11N1,Civ.CI
L2. u Indere Name 1 PLIIMBINC FIiF
O Lenders Adntr.<a QFY. ..t ,�BCHANICAL FI:RMIT .fie`,.
B.1 1 certify that I hove read thin applia0nn..J lane thnt the"have Inf^rmmia^in MECIIANICAL FT:F
A. «t, lagr«mcmnply with ell city aM musty oJino«ooenJ lame laws rtlningm PERMIT ISSUANCE
building construction,and betray euthmira eprelcnmdvesnf thin City turnter upon the
CONSTRUCTIONTAX
U z above-nemati
ioned property for inelon pugm<n. ALTER OR ADD TO MECIL
IWeI agree m.ave,indemnify mJ keep hrmnan the City Cupertino against
IinNlitim,' gmnu,cnvm endespcn.es wMabm yw yr, meageimtneiJCity AIR DANDLING UNIT(TO 10,IX00 CFM)
in calm of the gran) nit. /
AIR HANDLING UNIT(OVER IB.IXp CPM)
ig�mmrtmnprr«n Ctmmr,m l,m E%nnusTlOOD(Wnlucn
PAID
I IA].ARDOUS MATURIAL.S DISCOSIR, HEAT IND UNI F(TO 100,000 ItI U) Data Receipt IT
Will the applicant or future building necupam store or handle Lmardous materialIIIiATIN(1 IINI I'IOVIiR 100,000 B 1111 'I OFAI.:
es dit by the Cupenlro Municipal Code,Chapter 9.12,end Ile I ICxhh nod Sorely
Olde,Section 255720? - Vr.NIH.A'I'[ON FAN(SINGLE;RESI DI
ElYes ❑No
ISSl1ANCF:UA"I E
Will theaprlicnnt or future building aceupent uuequipnumar deviecswhich emit HOILIB-COMP(711POR 100,010 BTU) A
tmmdnu+air amtanninmh A,defiard by the Bay Area Air Quality ManAlleml BOILER-COMPaOVFR 100,(x)0 Blll) P' A D
Dinbirl?
❑Yes ❑No NEW RRSIDIzN'rlAL MECIL. SQ.M. Q 1 '1(J[]
I have rend the hnQ ard^us materials requirements under Chapter 6.95 of the OCT + 1994
California Health R Safety Code,SeA.ns 255115,25577"till 255.14, 1 Understand that
if to buddi"Xdoesnot calamity have.coma.that it iv na c,vinibility m mtifrthe
m of a ranfi me of V!�
cul•ant of the trgnironems whirh must h mil prim m isxuenI Y 1,)Y 1 sl Jr La111 IIVIf
Occupancy.
Owner or mmunlvcd Agent D:ne TOTAL: ISSUED BY:
OFFICE