24906 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE SALL POINT PEN ONLY
CITY OF CUPERTINO 1 ,)N•• :LCE I]A. I'liNMil'N024906
. ^0
BUILDING DIVISION APPLICATION/PERMIT rl.umnwr..MEcunNlcnl' L �9 g6.e
BUILDING ROJEI,T DEN'TIFlQATION
R GILDING ADDRESS:
'��.�( ,' an SANITARY NO. AI'i'LICA'IIGN SUI)MII'TAh DAIT
U �'`C I L Ylw` UNIT# LOTx 3 — ���
OV�JI'tS NAME', �) PHOW. L CO CIOR'S NA ° LIC ND
JJ 11 N/C CONlR01.X
CIII'liiCf iNGINIiIiR: LIC NO: AUDRPS
ONTACI: NONE BLFCfRIC PERMIT PER I3UILDINO PERMIT III
BLDG ELECT PLUMB MliCll
PERMIT ISSUANCE 0
LICHNSIiUCON1RACTOR'S DECLARATION APPLIANCES.RESIDENTIAL JOB DI:SCR1FIION
gcz Ih[rchynffnnm.,lnm licensedunderprovisiomefCharler9(cannnencingwilh
{ 0PANELS
F0 Scaion]I%X10 of Uivisinn Sof the Business'mA Prof/essi�n GWj,anA my license lc in
FFFZW L¢Ieom Clvae! t _ 4 Li 1.x 6 L4 i7 C, UPT02(X)AMPS
F=y Dae Conlmnor 201.IIXI(IAMPS SQ, ''.FLOOR AREA V IS Q.19.
Z OHZ ARCUTTECCS DECLARATION OVER RXX)AMPS
OZ— I understand my plana shell lie used as Public records.
P uI SIGNS ELECTRICAL
Licensed Pndeainnel OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. D I e.1
x0.EOE. I hereby efrom mel I ole es[mrl from the Conhactor'a License Law for the 'V
'W 31x,1" following reason, Seedon7031.5.Onsirear amt Prokssinns Code:Any city memory TEMP.hi OR ROLE INS'['.
t whichmyniresnMmilmconsimci.altar,improve,deennlish,mrepairanyslrvnure RY7, priuno im issuance,alsoscrnires the applicant fm such permit In Neo signed statement POWER DIiVICES � l•LO ma he is licensed lmrsunm to the provisions of the Condinois License law(C'hapmrq,3
o�' 9(cmmencing with Section 7000)of Division J of the Business and Professions Cole) SWIMMING PULL ElfEIRIC VALUA'II N
_m or dun heI,exempt mcedon,and the hnis for th[ullcged exemption.Any viol.,ion of OU1LIi 1'S-SWIT CIIC5.19%l'LIRfS�
< Seddon 9011.5 byvny.f,11vmn for.permit objects lheapFlifanl or civil penullynf --
z nm tame that live I olu d doll...($50m.
C� ❑ hnanwneniOheprnpeny,ora In cev wills wv vmdmolecom mrsnton, NEW RESIDEN'IIALlil.f:C'fR _SQ.Fr. SIORI S '1'1'1'I!CONSTRl1C110N
3 yemu Y gess p
s will JnlLf walk,unJmc souchreeCont Contact
ireanse La dot,. sal[ISm I..... .win4. ,r if
amI nywlilons Gslc:'llsc Gmbvrmn.License Law does nal apply bi nn owner nr
Fmpfny whnhuilAanimpravcs lhcrrnganA who Aire inch work bothmlLnlhnnrglt his DCC.GRI) P RES,UNI IS
ever'.dia building
nUha improvement
imemenmm[nnl Year
completion,
edie ow.Ir,
howevo,me have
the
bur den of[mem is sold within one year of.,prove fn,dmawnn' 'TOTAL:
builder will have the M1urJ[n of proving that he did Trot builA m Improve for poorry¢e of
sale L00 PLUMBING PERMIT hE8 It
ZONIi APN
[:] I.n owner oflhe pml'eny.am exclusively commctingwilh learned comramms InT
o 4r't: .
mn.lmct the project ISO.704,Business and professions Code)Th[Comunum. PIiRA11T ISSUANCE / L•
License law does not ooemov
apply to wrofFpenywho builds or theean,anJ
whocommI be.such Prnjecu with a contractions)licensed Pursuant ome Comments,
Licari[law. ALTER-DRAIN A VIiNT.WATER DIA) FEE SUMMARY
❑ 1 nm exanp under Sec. ,R k P C far mix reason BACK FLOW PROJECT'.DEVICE ) T!o-
SANITARY Y N
Owner Dula DRAINS.I9.00R,ROOF,ARIiA,COND. RECEIPT'#
WORKMAN COMPENSATION DECLARATION DRAINS SCIIOOLTA% Y__N
❑ IhereM1y ell irm.hatI veaanifcme nffinercm mmlbinmre,nracenificnm of Tv RECEIPT#
ukrri Cnmprnamion lnm...wemvc[rlifedeopy th[rmrySee.3800 OCL)which IRXTURI'S-PIiR T'RAI' PARK IRA: Y_N
coverall crpioyods under thispermit. GAS.PA.SYSTEM-I INC.401)1 LUIS RECfSx
Policy X BUILDING DIVISION PEES
Company GAS-PA.SYS'IEM-OVER 4(EA) PLANCOECK 19iE
❑ C[ninedanpynher[hyfnni.dved.
❑ Crnifinl MpY is pint with me oily inspection division GREASPIINDUSTRL WAST INTERCEPTOR GRADING Mit:
CE I'IFICATE OF EXEMPTION FROM WORKERS' GREASETRAP TOILS FEE
COMPENSATION INSURANCE
IOn,section need Ml becmmpleted iOha parrot is for.handled dollen(S IM) SEWER-SANITARY-STORM EA.200". ENERGY TLE
m Ira.) -� PAID
Ifmify din in me Ffrfnrma ce al w fol which thin
m on au n A A :..
not
ernpiny.�<non in so as s hec a ei h
Cmnpensa�inp�wl Cn if ice. me _ WATER SYS❑iM/IRPA'IINO Dom Rttnp x
O 7. ApFlicnnt A A6 61
-
q NOTICE TO APPLICAN'1:If.aB6making ildelCarlific.le ill Hrempli you should NEW RESIDENT IAT.PLMn. SQ.M. TOTAL:
NI�! L-t become subject tame Worker's Cnmlcnnmionpruvisionx of m[Luton Code,younmst BUILDING[;[:.I.[;[:.I.W
inch.hit ro
eom,A,wit,such pvisimnormit sl
is permit bodcenmd revoked,
Q CONSTRUCTION LENDING A0ENCY SEISMIC FEF.
z
1 hereby alms that there is a construction lending igenpa
cy for the rfmmance of
TOTAL: �'.O f FLECTRIC dolt
1..) O the work hr whifh this permit is iasunl(Set.)119],Civ.C.7
ttr�� Larder's Address
0 V Lead,Irn Aify the QTY. - . �rIRCYIAIVICAI.PeRi.41T ;";;5. PLF rl.umxlNG Felt a
D.1 I c[nify that 1 have read itIbix application u y sum that he etas[information trelmis MECBANICALITE
LSA caned.degree wemnrlI with ell ty end<mumy ordinance and nam lawn rclotingm PERMIT ISSUANCE:
•s' y building comeracliim.and hereby thorissmNese mlves ofthiscily m enter uronme CONSTRUCTION TAX
UZ ahma man0onnl pmpcny r ction urgnc, ALTLRORADDTOMECIL
1 agree m save nde t n'y and h lea the Ch of CVp[nino:$
notal
1' otitis judg enu,as none pencesw ' mywvync.to geinaIx $City A IR I IANDLINO UN IT'(TO 10,1X10 CFM)
n rye., of the anti of this Fe 1
AIR DANDLING UNI I'(GYIiR 140(X)CFM)
Signa., u Aypl¢. acne ma EXTAUST110,01)(WIDUCO
P AZARDOUS MATERIALS DISCLOSURE IIT:ATING UNIT I10 1110,1X10 Ol U) Dore RccciM N
Will he applicant on future building occupant sore at hnnAle hasurdous material TOl'Al,:p
as defned by the Culwtinm itipal Code,Chapmr 9.12,and tile ltruth and Surety HEA'IINC,PINI1(01 U91,000 III'U)
C'o 1,SeGlon 255)2(0)1 VENT ILAI ION 1'AN(SINGLE RUSID)
❑Yes Nn
ISSUANCE.DATE
Will meapplicmnor fumrebuildingmeumnlucenryipm[nlardevic[swhichemil BOILER"COMPIJIIPGR Ira). )DR17 �k ryry
h:vardmn or comiminams derned by the Bay Atha Air Quality Manogrm st ROILER.COMP(OVER 100,011ORTU) r 1S''gg A
ITarirrt
O Peer tln n NEW RESIDENT IAL MEC1l. SQ.FT.
I have read the larerdnus materiels r[yaireni under Chxp er Sits or the MAR ear 9
9 1993
California I IenitM1 A Sofny Cmle.Seclirex 23505.2350 and 253N. I nnAammud Thal rs
it the building dic.anot currently have amonm,that it is my rexpomsibilily m notify the `ill Y UI• (,i Uf'tr1111VV
umcupvnl of the mpuremenu which must he mel Frim to issuance of a Cenifcae of
Gfrnpmfy. ,
Dwne nr and itedagent Gum TOTAL: ISSUE 110VY
OFFICE