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S 2909 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 PROJECT IDENO IFICXTI N BUILDING ADIUNIiSS: aSANIjNO. A'I'hICAI'ION SIIIIMI'I'IAI.UAI'li ,�Da 7 U2� r SQ s" 2, OWNF :S NA A1 YNONG: CO TRACTOR:SN fE LIC NO: C1� yy COM ROLA RCHU ECI'IIiNGINIIR: CONTACT: PHONE:. BUILDING PERMIT INFO X31 _�jq, S ?sem ❑ Consuhant Pees Paid by Applicant O ELO PLUMB LJ L-i LICENSED CONI'RACIOk;S DTECLARAION QTY ELFC9'I41C PERMIT FEE 1 nerehy ahem that I ace docused under provisions o'Chader 9 Oimmmea ing JOB DESCRIPTION DMZ with Section h0unf Division3 afthe Business and l'mfesion%Cadi and my license I% RESIDENTIAL: LL]pp in PERMIT ISSUANCE Fyl full farce and cRea. ❑SPDWL El KITCHEN RIiMODFa. aUV License Class— —Lich APPLIANCES-RESIDENTIAL. ❑AUDITION El PLUMBING RETWE F Z W Doe Conuumor mQly ❑MULTI-UNIT ❑STRUCTURAL AI CIII'II'(-I':I DECLARATION PANELS F h Z I undcmm�d m i s l II he usd ns Pane,records MODIFICATION ZpN ypan svI UP TO 200 AMPS ❑IN]ERIOR C1CIIIMN17Y REPAIR pZ—o F.Fa{ Licensed lkn@ssinnal 201-1000 AMPS IMPROVEMENT C]SWIMMING P(HUfS ZCQ Iherchy nfEnn OWNER-BUILDEaim R DECLARATIONm the r's License Law far the OVER 1000AMP5 ❑BATH REMODE,IlR1E'AIR ❑DEMOLITION 0.p W Uif,] ❑OTHER K3L IILw b m a pflal S B1 :C J e Y al wry SIGNS I'1 I?CI'NICAL _ which Pr 1, t It P J I'.h Ya 'tun //Y� E'�-p� prion I 'I: 4 napplicantI II n flsigned.i sent SPECIAL CIRCUIT/MISC. A Q^.n_ -GQ• 5 nnN that he is fivervedpursuant tthe P lfhcC I I lacellove W (Chpna9 i �{Y<o" (commencing x ah Section TrulufDre aon3 f,he Business..]lkf 'on.Cnle)tie TISMP bICITR OR POLE INST. COMMERCIAL: 1 C.e y that he iemaciationntpl therefrom and the hasis for the alleged emaciation Any violation of [INI:W BLDG/ADDITION [I DEMOLITION ,il'I Section]OJld hyany applicmp for a proud ounces the applicant us a civil penaltynf POWER DEVICES ❑TENANT E]FOOD S17RVICE not Isom 1111.1 Eve hundtul Aullid(Soon LMPROVEME.N'I' ­1I.....wnat,of IM1e Propery.......yen"laycu will wages an llcirml.a.... mvafcn SWIMM ING POOL ELECIS'R IC EFD will do the work.and lheelrvaum is am intended.....Beaeetn d facil (S .71......iens. ❑ HER L3 w and Prnfavaons Code:TEs Condrac nr's License law does sad uPPly m W mono..f OUTLITI S-SWITCHES-FIXTURES Property who builds or improves thereon,and who does such work himself or through his . ntployen...... cJ Ili,,such improvements um urn intended a offered It,, NEW RESIDILNTIAL ELEC'R SU IT7 sele�IL hnwman the building or improvement is sold within one Year of completion,the SQ.I9'.ILOORAREA $/SQ.IT. cr-handar will have the banlen of pawing that ho dW am hnild ser improve ill,Pur- paseofsale.). 'IOIAL: ❑1,as nw or, If the Imof ,ata exchei,el,collating with Licensed emndatoO I, wnma the Pmjm(Sec.AHd.Business and Professions Cade:)'I ne Contmao/s- came law does sol apply loam owncr.Epr..Perty is no builds or improves daemon.and QTY. PLUMBING PERMIT FF,E D who contrast for such pmjetx will,a conloicdorls)I acnsed i uestiand m the Condretodl Lieaavc Law. .❑&I'C iia this reason PERMIT ISSUANCE Y 121999 ❑I um exempt under See. ALTER-DRAIN&VENT-WATER(EA) VALUATION .Owoer Dom W'ORKER'S COMPENSATION DECLARATION PACK FLOW PROTECT.DEVICE 1 Merely al inanition under penalty ofperjurynaeof Inc following ingW.kmtions. � Inuvcundwill mmnutinu CcniecuaofConsunn..sclf-Insvclia WnrkuNCnmlen- IURAINS-FLOOR.ROOP,AREA.COND. VPE CON\1'RUCr111N so, 1,as pnweled fur by Seem....3700 0l the Labor Cade,Lx nor Iertorm.1oce of the work fee whirl,Ibis .at is issued. PIXTORES-PER'rRAI' O I have and will maintain Worker's Compensation Insurance,m required by Section 37M office Whir Cade hndhe performance of the work far wM1ichun,Paran,is I...ed, GAS-IiA.SYSTEM-1 INC.J OUTLETS (XC.GROUP APN My Work yr n( Insure cAma rand Policy b(J-•��'�/�(/ �[� Cenier!'NVNIef n[•fJ YleM.f/ Policy Na.:f'itil {V_/� i'� GAS-CA.SYSTEM-OVER J(EA) CE911FICAIII OF EXEM PITON IItGM WORKERS' GRI3ASIJINIOUSTItL WAS 117 IN'reRCEI'Tf IR COMPIE'SAUON INSURANCE BUILDING DIVISION FEES _ ('Ibis sction ncM nm McnmplecJ if the Pcm,it is fur ane hundred dullan Slell GREASIi TRAP or lc,,,) PLANCIIECK FEE I verify that in the performanceofthe work for which this permit is issued,i shall EWER-SANITARY-STORM EA.SIR IT. not employ any pemon in ony mmrner so us to W"ar,subject m IM1e Workers Compen- ENERGY FEE %alio..Lawsof California.Duro WATER IIEAllik W/VEN'IAN.ECTR GRADING IgiE z O Applicant NO]CH 10 APPLICANT':If,a0cnmakia,this CCrilicme of Eac..yaiam yshould ould WAIIiR SYSTEMnREAPING N SOILS Itil; became subject ar Inc Waders Comms or this povisi hal of the talo Cade., mu.a � forthwith comply with wen provisions or this pencil shallMdeemeJ rcsokcd. WATER SERVICE CONSRl1CTiON LENDING AGENCY NEW RESIDENTIAL I'Lh11L SQ.19PAID 1 Dade Receipt a I M1cmny ulErm than lune In II rnnumainn I,adenJin6 ugcncy Lor the Vcdomaancc nl I U 0 the work for which this Permit is i%sued(S«.3097.Civ.C,) TOTAL: F' lamdds Name U Letakes Address TOTAL: } W 1 verily that 1 have mad this application and allow,that the awe infumation i. BUILDING FEE y comet,.I agrecmcamply withall city and countyoNimmces and woe laws mining ill QTY. MECHANICAL PERMIT FEF: SEISMIC FEE Is U banding Canstmetinn.and hereby aa0,od..e repfeemadves aft his city tamer upon lha ahrvo-mcmit ed Pmperdy I'nr inspmIll nm,mws. PERMIT ISSUANCE ELECTRIC ITE (We)agree u,save,indemnify and keep harmless the City of Cupernam against Iiabi0lies,juJgmcros.cams and coNevex which may in any way accrue again..said City ALTER OR A DD TO MECH. PLUMBING FEE in nsegaence of the graining of this Permit. APPLICANT'UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINTAIR HANDLING UNI"1'(TO Io.IYJOCFM) MIiCf1ANICAL EE SOURCE?RIFULNnON.S', AIR HANDLING UNI'I'(OVER L00)CVM) CONS'I'ItUC1ION TAX Signature ofnp,icunl/ mimeo Date EXHAUST GOOD(W/DUCT) HOUSING MITIGATION PIT. HAZARDOUS MATERIALS DISCLOSURE Wun¢upplicam m rule.WiLJing«cupa.1lnloa nr handle M1aemJom material HEAT ING ON IT(TO 1011010 HT U) as defined by the Cuperino Municipal Civil,Chai ar 9.12,and the Peals and Safety Code,Soaiat1255J2(ml' HEALING UNI'.(OVER Initial)BTU) ❑Yc% ❑NuPAID VENTILA'T'ION FAN(SINGLE RESIDE Date N.ou,,# Will the applicant or future building oecupant use equipment or devices which emi,hamm suBOILIiH-COMP fJHI'OR I W.0011 RTU) nlor contaminants as defined by the Bay Arca Air Qualityplan rgemem TOTAL: Districtp BOII.ER-CDMP(OVEk 100.003 BTUI ❑Yex [-1 No I have read the haanh umwmiulsre Ls ainderChuterh.95 of We Cali- ALR CONUI'TIONBK ISSUANCE DKI1i yuirenren P ^ ,S fomia Rea CNe.. 'tions25505.25577ata1255M.1 nn.esmndthinif[liealard NEW RESIDENTIAL MECH. SQ.17. / 2 Y' 7 building] vn Icon yhuve imlant.that it isnry asrymsihiliry amaxill IM1e nova lard !� of ane ro t"n t net Prior In iesuabee of a Cttmicme of(treasury. Owner sera Ikon 'J ugna UWcA. 'GOAL: ISSUED fly OFFICE 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 PROJECT IDENO IFICXTI N BUILDING ADIUNIiSS: aSANIjNO. A'I'hICAI'ION SIIIIMI'I'IAI.UAI'li ,�Da 7 U2� r SQ s" 2, OWNF :S NA A1 YNONG: CO TRACTOR:SN fE LIC NO: C1� yy COM ROLA RCHU ECI'IIiNGINIIR: CONTACT: PHONE:. BUILDING PERMIT INFO X31 _�jq, S ?sem ❑ Consuhant Pees Paid by Applicant O ELO PLUMB LJ L-i LICENSED CONI'RACIOk;S DTECLARAION QTY ELFC9'I41C PERMIT FEE 1 nerehy ahem that I ace docused under provisions o'Chader 9 Oimmmea ing JOB DESCRIPTION DMZ with Section h0unf Division3 afthe Business and l'mfesion%Cadi and my license I% RESIDENTIAL: LL]pp in PERMIT ISSUANCE Fyl full farce and cRea. ❑SPDWL El KITCHEN RIiMODFa. aUV License Class— —Lich APPLIANCES-RESIDENTIAL. ❑AUDITION El PLUMBING RETWE F Z W Doe Conuumor mQly ❑MULTI-UNIT ❑STRUCTURAL AI CIII'II'(-I':I DECLARATION PANELS F h Z I undcmm�d m i s l II he usd ns Pane,records MODIFICATION ZpN ypan svI UP TO 200 AMPS ❑IN]ERIOR C1CIIIMN17Y REPAIR pZ—o F.Fa{ Licensed lkn@ssinnal 201-1000 AMPS IMPROVEMENT C]SWIMMING P(HUfS ZCQ Iherchy nfEnn OWNER-BUILDEaim R DECLARATIONm the r's License Law far the OVER 1000AMP5 ❑BATH REMODE,IlR1E'AIR ❑DEMOLITION 0.p W Uif,] ❑OTHER K3L IILw b m a pflal S B1 :C J e Y al wry SIGNS I'1 I?CI'NICAL _ which Pr 1, t It P J I'.h Ya 'tun //Y� E'�-p� prion I 'I: 4 napplicantI II n flsigned.i sent SPECIAL CIRCUIT/MISC. A Q^.n_ -GQ• 5 nnN that he is fivervedpursuant tthe P lfhcC I I lacellove W (Chpna9 i �{Y<o" (commencing x ah Section TrulufDre aon3 f,he Business..]lkf 'on.Cnle)tie TISMP bICITR OR POLE INST. COMMERCIAL: 1 C.e y that he iemaciationntpl therefrom and the hasis for the alleged emaciation Any violation of [INI:W BLDG/ADDITION [I DEMOLITION ,il'I Section]OJld hyany applicmp for a proud ounces the applicant us a civil penaltynf POWER DEVICES ❑TENANT E]FOOD S17RVICE not Isom 1111.1 Eve hundtul Aullid(Soon LMPROVEME.N'I' ­1I.....wnat,of IM1e Propery.......yen"laycu will wages an llcirml.a.... mvafcn SWIMM ING POOL ELECIS'R IC EFD will do the work.and lheelrvaum is am intended.....Beaeetn d facil (S .71......iens. ❑ HER L3 w and Prnfavaons Code:TEs Condrac nr's License law does sad uPPly m W mono..f OUTLITI S-SWITCHES-FIXTURES Property who builds or improves thereon,and who does such work himself or through his . ntployen...... cJ Ili,,such improvements um urn intended a offered It,, NEW RESIDILNTIAL ELEC'R SU IT7 sele�IL hnwman the building or improvement is sold within one Year of completion,the SQ.I9'.ILOORAREA $/SQ.IT. cr-handar will have the banlen of pawing that ho dW am hnild ser improve ill,Pur- paseofsale.). 'IOIAL: ❑1,as nw or, If the Imof ,ata exchei,el,collating with Licensed emndatoO I, wnma the Pmjm(Sec.AHd.Business and Professions Cade:)'I ne Contmao/s- came law does sol apply loam owncr.Epr..Perty is no builds or improves daemon.and QTY. PLUMBING PERMIT FF,E D who contrast for such pmjetx will,a conloicdorls)I acnsed i uestiand m the Condretodl Lieaavc Law. .❑&I'C iia this reason PERMIT ISSUANCE Y 121999 ❑I um exempt under See. ALTER-DRAIN&VENT-WATER(EA) VALUATION .Owoer Dom W'ORKER'S COMPENSATION DECLARATION PACK FLOW PROTECT.DEVICE 1 Merely al inanition under penalty ofperjurynaeof Inc following ingW.kmtions. � Inuvcundwill mmnutinu CcniecuaofConsunn..sclf-Insvclia WnrkuNCnmlen- IURAINS-FLOOR.ROOP,AREA.COND. VPE CON\1'RUCr111N so, 1,as pnweled fur by Seem....3700 0l the Labor Cade,Lx nor Iertorm.1oce of the work fee whirl,Ibis .at is issued. PIXTORES-PER'rRAI' O I have and will maintain Worker's Compensation Insurance,m required by Section 37M office Whir Cade hndhe performance of the work far wM1ichun,Paran,is I...ed, GAS-IiA.SYSTEM-1 INC.J OUTLETS (XC.GROUP APN My Work yr n( Insure cAma rand Policy b(J-•��'�/�(/ �[� Cenier!'NVNIef n[•fJ YleM.f/ Policy Na.:f'itil {V_/� i'� GAS-CA.SYSTEM-OVER J(EA) CE911FICAIII OF EXEM PITON IItGM WORKERS' GRI3ASIJINIOUSTItL WAS 117 IN'reRCEI'Tf IR COMPIE'SAUON INSURANCE BUILDING DIVISION FEES _ ('Ibis sction ncM nm McnmplecJ if the Pcm,it is fur ane hundred dullan Slell GREASIi TRAP or lc,,,) PLANCIIECK FEE I verify that in the performanceofthe work for which this permit is issued,i shall EWER-SANITARY-STORM EA.SIR IT. not employ any pemon in ony mmrner so us to W"ar,subject m IM1e Workers Compen- ENERGY FEE %alio..Lawsof California.Duro WATER IIEAllik W/VEN'IAN.ECTR GRADING IgiE z O Applicant NO]CH 10 APPLICANT':If,a0cnmakia,this CCrilicme of Eac..yaiam yshould ould WAIIiR SYSTEMnREAPING N SOILS Itil; became subject ar Inc Waders Comms or this povisi hal of the talo Cade., mu.a � forthwith comply with wen provisions or this pencil shallMdeemeJ rcsokcd. WATER SERVICE CONSRl1CTiON LENDING AGENCY NEW RESIDENTIAL I'Lh11L SQ.19PAID 1 Dade Receipt a I M1cmny ulErm than lune In II rnnumainn I,adenJin6 ugcncy Lor the Vcdomaancc nl I U 0 the work for which this Permit is i%sued(S«.3097.Civ.C,) TOTAL: F' lamdds Name U Letakes Address TOTAL: } W 1 verily that 1 have mad this application and allow,that the awe infumation i. BUILDING FEE y comet,.I agrecmcamply withall city and countyoNimmces and woe laws mining ill QTY. MECHANICAL PERMIT FEF: SEISMIC FEE Is U banding Canstmetinn.and hereby aa0,od..e repfeemadves aft his city tamer upon lha ahrvo-mcmit ed Pmperdy I'nr inspmIll nm,mws. PERMIT ISSUANCE ELECTRIC ITE (We)agree u,save,indemnify and keep harmless the City of Cupernam against Iiabi0lies,juJgmcros.cams and coNevex which may in any way accrue again..said City ALTER OR A DD TO MECH. PLUMBING FEE in nsegaence of the graining of this Permit. APPLICANT'UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINTAIR HANDLING UNI"1'(TO Io.IYJOCFM) MIiCf1ANICAL EE SOURCE?RIFULNnON.S', AIR HANDLING UNI'I'(OVER L00)CVM) CONS'I'ItUC1ION TAX Signature ofnp,icunl/ mimeo Date EXHAUST GOOD(W/DUCT) HOUSING MITIGATION PIT. HAZARDOUS MATERIALS DISCLOSURE Wun¢upplicam m rule.WiLJing«cupa.1lnloa nr handle M1aemJom material HEAT ING ON IT(TO 1011010 HT U) as defined by the Cuperino Municipal Civil,Chai ar 9.12,and the Peals and Safety Code,Soaiat1255J2(ml' HEALING UNI'.(OVER Initial)BTU) ❑Yc% ❑NuPAID VENTILA'T'ION FAN(SINGLE RESIDE Date N.ou,,# Will the applicant or future building oecupant use equipment or devices which emi,hamm suBOILIiH-COMP fJHI'OR I W.0011 RTU) nlor contaminants as defined by the Bay Arca Air Qualityplan rgemem TOTAL: Districtp BOII.ER-CDMP(OVEk 100.003 BTUI ❑Yex [-1 No I have read the haanh umwmiulsre Ls ainderChuterh.95 of We Cali- ALR CONUI'TIONBK ISSUANCE DKI1i yuirenren P ^ ,S fomia Rea CNe.. 'tions25505.25577ata1255M.1 nn.esmndthinif[liealard NEW RESIDENTIAL MECH. SQ.17. / 2 Y' 7 building] vn Icon yhuve imlant.that it isnry asrymsihiliry amaxill IM1e nova lard !� of ane ro t"n t net Prior In iesuabee of a Cttmicme of(treasury. Owner sera Ikon 'J ugna UWcA. 'GOAL: ISSUED fly OFFICE