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30995 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OFrCUPERTINO BUILDING-ELECTRICAL. PERMIT NO, B ELI. ' DIVLSION APPLICATIONIPERMIT PLUMBING-MECHANICAL. 30995 ' BUILDING PROJECT IDENTIICAI'ION DRESS: - SANITARY NO. APPLICATION SUBMITTAL DATE NER'S NAME PHONE: 1C DR'S AME: EJC NO'. / NPC CONTROL ARCIIITIiCI' OINELK LIC NO: �G� _ �• ❑ CONTACT: PHONE: BUILDING�PEEPMIT INFO �N S(LVA t44�O,Ia-raw ❑ Consultant Face,Paid by Applicant(InI1iW) e�DG ELF. PT ME LICENSED CONTRACTORS DECLARATION 17`x/ QTY ELECTRIC PERMIT FEE 1 hereby affirm than I am liaoxcd umcr(uv4sm,of Cha(nu 9 o: monowing JOB DESCRIPTION WOO with Se-Pm71XX)mID'vision3oflbe Hu ircsautd Pmfeaslav Cwe,"toyliameis RESIDENTIAL F1_ in full Tera oral c_ffwt PERMIT ISSUANCE FaUr Licemc Clues U,0 �� ❑SFDWL [I KITCHEN RF-PIPE NzW Dom Cwtmclw APPLIANCES-RESIDENTIAL ❑AOUITION [I PLUMBING RF:-PIPE Z�7tn (- IT--S Df' PANELS -1 MULTI ❑STRUCIV RAL to Z tstd 4n +IwL publictmwdr MODIFICATION O Z IIP TO 2W AMPS a� Pmfeashmnl -1000 AMTS ❑IMP ❑CHIMNEY REPAIR 201 IMPROVEMENT OWNER-exemptRDEtheCon IO. OVER 1000 AMPS �BATH REMODELIREPAIR 0DEMOLITION �C Q 1 hrtby aR Jw I am exempt from the Cmnaanttr'a Liame Lev fm se k 3 U fdlnwing lemon.(S yion M313.Husurms and PM¢rirns Code:Any city a co mly SIGNS ELECTRICAL - ❑OTHER u] w1ucM1 mquirts a permit to cotwruct,alter,impoom demobs.a repair any sMucm e O prior to itsisawu'c.alw neyuion thett'licara for rsclbpemmo file,ugrcd Raf.ta SPECIAL CIRCUIT7MISC. f�} That he is licensed patsrwtm me Provi0om oath Contrands Ui.Law.(Chapter 9 WR�p (commencing with Smtion70g)uf Dlvinion 3 oftbe Busin¢s and!Pofea'imna Cole)or TEMP METER OR POLE INET. COMMERCIAL 0.p,o a' Ihm he is exempt IM1ereWm vrd the W...far the dleg 1 exempinn.Any violation of (_1 NEW BLDG/ADDITION ElDEMOL ION iC 4. kshitn 70313 by any epPlicont foc.,ouit uhjmu lM epplicw to.civill Al,ofPOWER'DEVICES r _, Z y fax,00m Them flue hundred dollvm ISMO) M) -NAM' ❑FOOD SERVICE ��O ❑ L,mowter of the pmpeny,ormyemPlnyceswith wugmmtMirsoknimpen utitxt, SWIMMING POOL ELECTRIC IMPROVEMENT will Bothe work,uvllbxstmmtue uaximeMvl«oRertdf«cile(Sev.TOf4,Nuritws - ❑OTHER and Pmfi.iwa Code:The ConvaOnt'.Liceme Lw does.apply In an owrcr of O US-SWITCHES-FIXTURES prapcny who builds or impmraa t ereon,and who dm steh work himself a through his trwn employees,provided Jut such improsmenr me tet intcnivl mr mfanxi for NEW RESIDENTIAL ELECfR SQ ET. sale.IL bowever,the building or improvement is sod wisin are yterofcumpfemm to SQ.FT.FLOOR AREA FT. rcnbuilt will have the buNenMFrolm,til he dM nwt build amill for Pon- 1134 poor mf sde.). 1_Jle III��� ,,,JJJ ❑1,as uxner mf Ire prgeny,ant exclusively etmtnvcting wilt IiannW ennlrYlnn to cin4mel the pmje<I(Sx.7000,9unittun orad Rofesaiarc Cade:)'Ilte Cuntrutuh V- P D crn.m law dace rot applymanawrcndpnryeny wlw budtL.err impmvcn svrwm.and QTY, PLUMBING PERMIT FEE wMp cummmn l«stnmh pmjcmlx with a Cnntrn9ut(q lkeo,ed ptueum i ,,the Commetor'e - Lianmaw.' APR 1'7 �, • Li Tum Low. tuMUSec. ,tl&PC fa Nis tenon PERMIT ISSUANCE � 71 Owrcr Date ALTER-DRAING VENT-WATER(EAI VA WORKERS COMPENSATION DECLARATION BACK FLOW PROTECC DEVICE I hereby orf.user perally of pesjury este of th followingdeeliratians: ❑Ihaa mdwill maintvnaCeni(icvte ofCw.err to sAf-imurc f«M'ohe/s Contpcn- DRAINS-FLOOR,ROOF.AREA.CON . union,as provided for by SeOion 37q)athe Labse Code,fm the pMtumorx c of me STORIES TYPE CONSTRUCTION work fm which this ptsmil.s jawed. FIXTURES-PER TRAP ❑1 have and will maintvn Wol cen Ctmtpcnsatimn Inurma-ex rt Lirxd by Sacrum 37Wofthe labmr Code,fa the perf.nce.fthe work for which lfix pcwdt ix ixwW GAS-EA.SYSTEM-]INC.4 OUTLETS OCC GROUP AI's My Workcr'n Cm n,sm mhm lnmmrcc comer end Policy omnher ire: - - Cvrrier, Policy No GAS-EA.SYSTEM-0VER 4(EA) CERTIPICAIE OF RXEMIMON FROM WORKERS' COMMINSATION INSURANCE GREASEANDUSTRL WASTE INTERCEPTOR BUILDING DIVISION MMES (This secOon rtW ad be mnplcicd jade permitufa one butxlmlddlan(310f1) CREASETRAP ^r Iona) PLANCHECK Flt lordly that io in pcdt.oastwank fa whichthis thepermitWorkers' stall m employ any Person in any twver w m to bcearc subjct m the Wa4m'Compen- SEWER-SANITARY-STORM EA 200 FT. ENERGY FEE - O Z u0on La.of Califmmia.Dix - WATER NESTER WVVENTIELECIR ' Z O Applicant GRADING ME y NOTICE TO APPLICANT:If,after making this Certificate of Exemprirn,you Nwld WATER SYSTENITREATING aIcutrc suM1jal to the Workers Com,nini mn m io.of th Iatinr OxIc,you most SOILS IEE f37 form ith<omply with.00h pto ,6mxnr phi,p mmitshall he damW revoAed. WATER SERVICE Q Z) CONSTRUCT IDN LENDING AGENCY FEW RFSII11N1'IAI.ELMS. SQ.f"1'. PAID U O Ihrtby nf!Jit that is acatstmctioo kMingmgrncy for the perfm.,,.f Dot Ree ' N Ne w«k f«which Nis pemut is fatted(Sec.3097.Civ.C.) O U larder,Name lrndels Addhe,s Is 'IT)TA1.: S 1 certify than 1 ba,read Nu application and store Ow the abua irfmmmimn is BUI h uorteel.l agree.mcanPb'xis.n chy error campy ordirurtcea and sate lawn rtlating m. QTY. MECHANICAL PERMIT FEE (.1 Z buidinganstructimo.etd hemby.wMxize represmuures mfsiscitym ever upon the SE .Invomc eirnN popave roe indemnity lion purptrs ba. (Wel,gra m save,itvYmnily aM 4ap harmlcu the City of CuFenitto against PERMIT ISSUANCE FJ.E imbllitiea,judgmcros.conte mml expemes which may in any way aarut agoinr said City ALTER OR ADD T(1 MF.CH. PLUM NCF'C 2 income uc«c oflh gmnI'm of lhla permit. - API' INDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 101100 CFM) MECHANI AL FEE S( RCE RE JLATIONS.--T 4 AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRU TAX Sig. IAMicettt/C..mc Dote EXIIAUST HOOD(W7DUCn H RDDUS MATERIALS DISCLOSURE HOUSING MITIGATE FEE Will the applicant mfttme boolding acupmt mtx a handle hamx1ou,mmerW HEADING UNIT(TO 100,000 BTU) as lefircd by the Cupmorso Municipal Code,Chapter 9.12,vd th Heads ami Safety Code.Smmn 25532(,)^ HEATING UNIT(OVER 100,000 BTU) Y. No .. yENTILATION FAN(SINGLE RESID) PAID Dmc R ipr M Will tM:applicant«fulmrt Mlilding by the BtyA.At,cmmr Mkv which mit LaeaJuux vii conutnittmts en ACliaJ by the play Aire Air Quality Mmwgemenl BOILER-COME'(3fIP OR I(n.g10 BTU) IDl4rica' TAE: .(]Yat 0N POILER-COMPIOVHR Ig1,pA7 BLU) I hove red she hemrtkxu tr,emltpier AIR CONDITIONER ISSUANCE DATE tryttitrnrna miles 6.v5 d th Cili- ftmin Hcelth A,Saaely Code.SecJaa 25503.M533 aN 25534.1 tmderm rd Nat if tle NEW RESIDENT]AL MECH. SQ,PT. building does rta eomem)lave a tetanl.sat u u my nesPrmstlnlity to on iry Je natpmtt a me rtsgtitrntms which must be ran prier on itstrnta of a Ceruftene MOccuEmtcy. , Oyer m offlnmaed agent Date ISSUED BY: OFFICE { APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OFrCUPERTINO BUILDING-ELECTRICAL. PERMIT NO, B ELI. ' DIVLSION APPLICATIONIPERMIT PLUMBING-MECHANICAL. 30995 ' BUILDING PROJECT IDENTIICAI'ION DRESS: - SANITARY NO. APPLICATION SUBMITTAL DATE NER'S NAME PHONE: 1C DR'S AME: EJC NO'. / NPC CONTROL ARCIIITIiCI' OINELK LIC NO: �G� _ �• ❑ CONTACT: PHONE: BUILDING�PEEPMIT INFO �N S(LVA t44�O,Ia-raw ❑ Consultant Face,Paid by Applicant(InI1iW) e�DG ELF. PT ME LICENSED CONTRACTORS DECLARATION 17`x/ QTY ELECTRIC PERMIT FEE 1 hereby affirm than I am liaoxcd umcr(uv4sm,of Cha(nu 9 o: monowing JOB DESCRIPTION WOO with Se-Pm71XX)mID'vision3oflbe Hu ircsautd Pmfeaslav Cwe,"toyliameis RESIDENTIAL F1_ in full Tera oral c_ffwt PERMIT ISSUANCE FaUr Licemc Clues U,0 �� ❑SFDWL [I KITCHEN RF-PIPE NzW Dom Cwtmclw APPLIANCES-RESIDENTIAL ❑AOUITION [I PLUMBING RF:-PIPE Z�7tn (- IT--S Df' PANELS -1 MULTI ❑STRUCIV RAL to Z tstd 4n +IwL publictmwdr MODIFICATION O Z IIP TO 2W AMPS a� Pmfeashmnl -1000 AMTS ❑IMP ❑CHIMNEY REPAIR 201 IMPROVEMENT OWNER-exemptRDEtheCon IO. OVER 1000 AMPS �BATH REMODELIREPAIR 0DEMOLITION �C Q 1 hrtby aR Jw I am exempt from the Cmnaanttr'a Liame Lev fm se k 3 U fdlnwing lemon.(S yion M313.Husurms and PM¢rirns Code:Any city a co mly SIGNS ELECTRICAL - ❑OTHER u] w1ucM1 mquirts a permit to cotwruct,alter,impoom demobs.a repair any sMucm e O prior to itsisawu'c.alw neyuion thett'licara for rsclbpemmo file,ugrcd Raf.ta SPECIAL CIRCUIT7MISC. f�} That he is licensed patsrwtm me Provi0om oath Contrands Ui.Law.(Chapter 9 WR�p (commencing with Smtion70g)uf Dlvinion 3 oftbe Busin¢s and!Pofea'imna Cole)or TEMP METER OR POLE INET. COMMERCIAL 0.p,o a' Ihm he is exempt IM1ereWm vrd the W...far the dleg 1 exempinn.Any violation of (_1 NEW BLDG/ADDITION ElDEMOL ION iC 4. kshitn 70313 by any epPlicont foc.,ouit uhjmu lM epplicw to.civill Al,ofPOWER'DEVICES r _, Z y fax,00m Them flue hundred dollvm ISMO) M) -NAM' ❑FOOD SERVICE ��O ❑ L,mowter of the pmpeny,ormyemPlnyceswith wugmmtMirsoknimpen utitxt, SWIMMING POOL ELECTRIC IMPROVEMENT will Bothe work,uvllbxstmmtue uaximeMvl«oRertdf«cile(Sev.TOf4,Nuritws - ❑OTHER and Pmfi.iwa Code:The ConvaOnt'.Liceme Lw does.apply In an owrcr of O US-SWITCHES-FIXTURES prapcny who builds or impmraa t ereon,and who dm steh work himself a through his trwn employees,provided Jut such improsmenr me tet intcnivl mr mfanxi for NEW RESIDENTIAL ELECfR SQ ET. sale.IL bowever,the building or improvement is sod wisin are yterofcumpfemm to SQ.FT.FLOOR AREA FT. rcnbuilt will have the buNenMFrolm,til he dM nwt build amill for Pon- 1134 poor mf sde.). 1_Jle III��� ,,,JJJ ❑1,as uxner mf Ire prgeny,ant exclusively etmtnvcting wilt IiannW ennlrYlnn to cin4mel the pmje<I(Sx.7000,9unittun orad Rofesaiarc Cade:)'Ilte Cuntrutuh V- P D crn.m law dace rot applymanawrcndpnryeny wlw budtL.err impmvcn svrwm.and QTY, PLUMBING PERMIT FEE wMp cummmn l«stnmh pmjcmlx with a Cnntrn9ut(q lkeo,ed ptueum i ,,the Commetor'e - Lianmaw.' APR 1'7 �, • Li Tum Low. tuMUSec. ,tl&PC fa Nis tenon PERMIT ISSUANCE � 71 Owrcr Date ALTER-DRAING VENT-WATER(EAI VA WORKERS COMPENSATION DECLARATION BACK FLOW PROTECC DEVICE I hereby orf.user perally of pesjury este of th followingdeeliratians: ❑Ihaa mdwill maintvnaCeni(icvte ofCw.err to sAf-imurc f«M'ohe/s Contpcn- DRAINS-FLOOR,ROOF.AREA.CON . union,as provided for by SeOion 37q)athe Labse Code,fm the pMtumorx c of me STORIES TYPE CONSTRUCTION work fm which this ptsmil.s jawed. FIXTURES-PER TRAP ❑1 have and will maintvn Wol cen Ctmtpcnsatimn Inurma-ex rt Lirxd by Sacrum 37Wofthe labmr Code,fa the perf.nce.fthe work for which lfix pcwdt ix ixwW GAS-EA.SYSTEM-]INC.4 OUTLETS OCC GROUP AI's My Workcr'n Cm n,sm mhm lnmmrcc comer end Policy omnher ire: - - Cvrrier, Policy No GAS-EA.SYSTEM-0VER 4(EA) CERTIPICAIE OF RXEMIMON FROM WORKERS' COMMINSATION INSURANCE GREASEANDUSTRL WASTE INTERCEPTOR BUILDING DIVISION MMES (This secOon rtW ad be mnplcicd jade permitufa one butxlmlddlan(310f1) CREASETRAP ^r Iona) PLANCHECK Flt lordly that io in pcdt.oastwank fa whichthis thepermitWorkers' stall m employ any Person in any twver w m to bcearc subjct m the Wa4m'Compen- SEWER-SANITARY-STORM EA 200 FT. ENERGY FEE - O Z u0on La.of Califmmia.Dix - WATER NESTER WVVENTIELECIR ' Z O Applicant GRADING ME y NOTICE TO APPLICANT:If,after making this Certificate of Exemprirn,you Nwld WATER SYSTENITREATING aIcutrc suM1jal to the Workers Com,nini mn m io.of th Iatinr OxIc,you most SOILS IEE f37 form ith<omply with.00h pto ,6mxnr phi,p mmitshall he damW revoAed. WATER SERVICE Q Z) CONSTRUCT IDN LENDING AGENCY FEW RFSII11N1'IAI.ELMS. SQ.f"1'. PAID U O Ihrtby nf!Jit that is acatstmctioo kMingmgrncy for the perfm.,,.f Dot Ree ' N Ne w«k f«which Nis pemut is fatted(Sec.3097.Civ.C.) O U larder,Name lrndels Addhe,s Is 'IT)TA1.: S 1 certify than 1 ba,read Nu application and store Ow the abua irfmmmimn is BUI h uorteel.l agree.mcanPb'xis.n chy error campy ordirurtcea and sate lawn rtlating m. QTY. MECHANICAL PERMIT FEE (.1 Z buidinganstructimo.etd hemby.wMxize represmuures mfsiscitym ever upon the SE .Invomc eirnN popave roe indemnity lion purptrs ba. (Wel,gra m save,itvYmnily aM 4ap harmlcu the City of CuFenitto against PERMIT ISSUANCE FJ.E imbllitiea,judgmcros.conte mml expemes which may in any way aarut agoinr said City ALTER OR ADD T(1 MF.CH. PLUM NCF'C 2 income uc«c oflh gmnI'm of lhla permit. - API' INDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 101100 CFM) MECHANI AL FEE S( RCE RE JLATIONS.--T 4 AIR HANDLING UNIT(OVER 10,000 CFM) CONSTRU TAX Sig. IAMicettt/C..mc Dote EXIIAUST HOOD(W7DUCn H RDDUS MATERIALS DISCLOSURE HOUSING MITIGATE FEE Will the applicant mfttme boolding acupmt mtx a handle hamx1ou,mmerW HEADING UNIT(TO 100,000 BTU) as lefircd by the Cupmorso Municipal Code,Chapter 9.12,vd th Heads ami Safety Code.Smmn 25532(,)^ HEATING UNIT(OVER 100,000 BTU) Y. No .. yENTILATION FAN(SINGLE RESID) PAID Dmc R ipr M Will tM:applicant«fulmrt Mlilding by the BtyA.At,cmmr Mkv which mit LaeaJuux vii conutnittmts en ACliaJ by the play Aire Air Quality Mmwgemenl BOILER-COME'(3fIP OR I(n.g10 BTU) IDl4rica' TAE: .(]Yat 0N POILER-COMPIOVHR Ig1,pA7 BLU) I hove red she hemrtkxu tr,emltpier AIR CONDITIONER ISSUANCE DATE tryttitrnrna miles 6.v5 d th Cili- ftmin Hcelth A,Saaely Code.SecJaa 25503.M533 aN 25534.1 tmderm rd Nat if tle NEW RESIDENT]AL MECH. SQ,PT. building does rta eomem)lave a tetanl.sat u u my nesPrmstlnlity to on iry Je natpmtt a me rtsgtitrntms which must be ran prier on itstrnta of a Ceruftene MOccuEmtcy. , Oyer m offlnmaed agent Date ISSUED BY: OFFICE {